| Objective:Through the control of the embolization agent dosage combined with intraoperative splenic artery blood flow velocity and the spleen at all levels of the arterial branches and assess the volume of splenic embolization and by postoperative CT calculated actual splenic embolization volume, thus confirming reliability improved visual method in the assessment of the extents of splenic embolization.Materials and methods:l.Clinical data:from March 2014 to August 2015, a total of 64 patients with cirrhosis due to liver cirrhosis were treated with partial splenic embolization in the First Affiliated Hospital of Kunming Medical University. There are 40 patients met the entry criteria were included in this study,26 males,14 cases of female, with an average age of 45.3±10.7 years; 12 cases of liver cirrhosis of hepatitis B, hepatitis C cirrhosis (28 cases), including 7 cases of child Pugh class A, B level 33 cases.2. Materials and methods:(1) In this study, the preparation of 700um-900um three propylene (Embosphere) microspheres and iodine sea alcohol (300mgI/ml) were used to prepare the microspheres and the contrast agent according to 1:1.16.(2) A method using Seldinger technique, with 5F catheter in peritoneal stem multispiral. The catheter along the splenic artery in the door to the spleen angiography confirmed to avoid other organs branch vessels, the preparation of a good contrast microspheres mixed suspension, using low pressure flow control technology were embolized. According to the degree of embolization, the amount of injection embolization agent was controlled and the changes of arterial blood flow were observed, and the degree of embolization was evaluated by DSA angiography.(3) A ccording to the degree of embolization, It were divided into 3 groups: Group A:it was 6 cases in this group 30%～49%, Group B, it was 6 cases in this group 50%-60%, Group C it was 28 cases in this group 50%～60%. All patients with postoperative 7-9 Tianxing abdominal enhanced CT images, the use of processing workstation volume software, calculate each actual volume of splenic embolization and modified "visual" embolization assessment of volume were compared.(4) Laboratory data to collect all the patients before and after 3 days,1 week,1 month,3 months,6 months,12 months, peripheral blood leukocyte and platelet examination results; was observed in the peripheral white blood cells, platelets change trend; recorded postoperative adverse reactions and serious complications occurred.(5) all the observed data using SPSS 17.0 software package to do statistical analysis.Results:1. Embolic agent dosage:three propylene embosphere 700um-900um embolism microspheres and iodine sea alcohol (300mgi/ml) by 1:1.16 preparation, more uniform and stable suspension of ml with an average of 129.3±10.46,2ml average 263.5±15.47,4ml average 519.1+20.31,5 ml of average 651±19.48. Group A: the amount of embolization agent was 5ml-8ml. Group B:the amount of embolization agent was 9ml-11 ml. Group C:the amount of embolization agent was 12ml-16ml;2. Improved visual assessment method of splenic embolization volumeGroup A:6 cases, the contrast agent using 5-8ml, V assessment of the volume range of embolization 35%-49%, with an average of (43.33+6.06)%.Group B:6 cases, the contrast agent using 9-11 ml, V assessment of the volume range of embolization 50%-60%, with an average of (55.83+3.76)%.Group C:28 cases, the contrast agent using 12-16ml, V assessment of the volume range of embolization 61%-80%, with an average of (67.14±6.59)%.3.Assessment of volume and the actual relevance of volumeGroup A:V assess thrombotic ratio for 35%-59%, average for (43.33±6.06)%, V actual embolization ratio for 36.7%-47.2%, average for (43.15±4.42% and by paired t test showed that t=0.139, P=0.895 (>0.05), indicating no significant difference between the two. The results of correlation analysis between V evaluation and V were r=0.855, P=0.03 (<0.05), which showed a positive correlation between the two.Group B:V assessment of embolism proportion is 50%-60%, with an average of (55.83±3.76)%, the actual v embolism proportion for 53.6%-58.6%, average for (56.5±1.73%), the paired t test showed that:T=0.693. P=0.519 (>0.05), indicating no significant difference between the two. V evaluation and V actual correlation analysis results for r=0.892, P=0.017 (<0.05), the two are positively correlated.Group C:V assessment embolization ratio for 61%-80%, average for (67.14± 6.59)%, the actual v embolism proportion for 61.1%-79.3%, average for (69.05± 5.37%), the paired t-test display:t=1.665, P=0.108 (>0.05) showed no significant difference between the two. V evaluation and V actual correlation analysis results for r=0.663, P=0 (<0.05), the two are positively correlated. 4.Platelets and white blood cell changesGroup A:(1) PSE preoperative and postoperative 3 days,1 week,1 month,3 months,6 months and 12 months of peripheral blood WBC count were 3.89±1.12 ×109/L,4.72±1.12×109/L,4.87±1.01×109/L L,3.66±1.56×109/L,3.41±1.34× 109/L,3.44±1.32×109/L,3.55±1.07×109/L. (2), PSE preoperative and postoperative 3 days,1 week,1 month,3 months,6 months and 12 months of peripheral blood platelet count (PLT) are:48.43±13.64×109/L and 87.84±13.66 ×109/L,107.34±1488×109/L,1.14±12.21×109/L,81.45±13.49×109/L,59.89 ±16.33×109/L,55.76±10.76×109/L.White blood cell level increased to normal level 3 days after operation. After 1 weeks, the blood platelet was gradually decreased to normal level. After 1 weeks, the blood platelet rose to normal level, and the 1 month began to fall below normal level.Group B:(1) PSE preoperative and postoperative 3 days,1 week,1 month,3 months,6 months and 12 months of peripheral blood WBC counts are:3.52±1.66× 109/L,6.73±1.08×109/L,8.73±1.44×109/L,5.34±1.22×109/L,4.13±1.49× 109/L,3.88±1.53×109/L,3.76±1.23×109/L. (2) PSE preoperative and postoperative 3 days,1 week,1 month,3 months,6 months and 12 months in peripheral blood platelet count (PLT) are:46.67±15.61×109/L,109.22±11.62× 109/L,116.67±17.63×109/L,129.54±23.68×109/L,114.31±18.69×109/L,106.86 ±16.69×109/L,77.32±1.066×109/L.After 1 weeks, the white blood cells rose rapidly to the highest and then decreased gradually, and the blood platelet decreased to normal level within 3 months. After 6 months of operation, the patients gradually decreased to the normal level at 3 months.Group C:(1) PSE preoperative and postoperative 3 days,1 week,1 month,3 months,6 months and 12 months of peripheral blood WBC count, respectively is: 3.21±1.07×109/L,7.42±1.39×109/L,9.75±1.07×109/L,6.32±0.74×109/L,5.87 ±0.66×109/L,5.21±0.59×109/L,4.56±1.87×109/L. (2) PSE preoperative and postoperative 3 days,1 week,1 month,3 months,6 months and 12 months in peripheral blood platelet count (PLT),are:42.92±14.53×109/L、111.76±13.88× 109/L,156.27±33.65×109/L,221.67±66.21×109/L,179.65±44.98×109/L,156.73± 33.98×109/L,136.57±37.49×109/L.White blood cell and platelet count were significantly increased and maintained at 1 year after operation.5.Postoperative adverse reactions and the occurrence of serious complications In group A, group B and group C patients all patients showed embolism syndrome and were given symptomatic support, antipyretic and analgesic therapy after remission. Postoperative adverse reaction evaluation index sign:C group postoperative adverse reaction was heavier than the B group (P<0.05), B group postoperative adverse reaction was heavier than the A group (P<0.05). No serious complication occurred in all patients.Conclusions:1.with three propylene Embosphere (700um-900um) embolization microsphere and iodine (300mgI/ml) according to 1:1.16 preparation, can form a more uniform and stable suspension, can better control the dosage of embolism agent.2.PSE in accordance with the selection of embolization agent dosage to achieve accurate embolization volume, splenic artery blood flow velocity changes, embolism after the development of the splenic artery, can be more accurate assessment of the volume of embolism. The degree of embolization in 60%-80% is an ideal embolization range.3.Using improved visual method of PSE is a simple, safe and feasible and can accurately assess the volume of splenic embolization method. |
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