| Objiective:To explore the short-term effects of partial splenic embolization(PSE)on liver blood perfusion in patients with liver cirrhosis and hypersplenism,and to explore the relationship between liver blood perfusion changes and liver function,aiming to explore the law of changes in liver perfusion after PSE,with a view to clinical practice for reference.Methods:This study is a single-center prospective study.A total of 27 patients with hypersplenism diagnosed with liver cirrhosis and PSE at Kunming Medical University from June 2019 to December 2020 were collected.Peripheral blood was collected to analyze the changes in blood routine,liver and kidney function,and coagulation function before and after the operation.CT "one-stop" whole liver perfusion imaging was used to detect the hepatic artery perfusion(HAP)and portal vein perfusion before and after PSE(PVP),total hepatic perfusion(TLP),blood volume(BV),blood flow(BF),hepatic artery perfusion fraction(HAF),the changes in the inner diameter of the common hepatic artery and the main splenic artery were measured on the original axial image.Simultaneously detect blood routine(WBC,PLT),liver and kidney function indexes(TBiL,ALB and Cr),coagulation indexes(PT and INR),analyze and compare the preoperative and postoperative CT perfusion parameters,common hepatic artery,splenic artery and splenic artery/Common hepatic artery diameter ratio,to analyze the correlation between CT perfusion parameters and liver function.Results:1.Changes of liver CT perfusionPreoperative HAF value was 0.18±0.17,HAP value was 16.51±14.6 ml·min-1·(100ml)-1,PVP value was 93.86±52.22 ml·min-1·(100ml)-1,TLP value was 110.72±49.73 ml·min-1·(100ml)-1,BV value is 18.99±3.86 ml·min-1·100g;HAF value is 0.40±0.25,HAP value is 21.93±12.38 ml·min-1·(100ml)-1,PVP value is 36.89±21.22 ml·min-1·(100ml)-1,TLP value is 58.51±15.14 ml·min-1·(100ml)-1,BV value is 18.77±4.25 ml·min-1·100g;HAF value 0.28±0.18,HAP value 25.30±23.15 ml·min-1·(100ml)-1,PVP value 63.86±29.38 ml·min-1·(100ml)-1 month after operation,TLP value is 89.17±7.96 ml·min-1·(100ml)-1,BV value is 18.93±4.60 ml·min-1·100g.Compared with preoperatively,HAF increased significantly after PSE,and then decreased slowly after PSE.There was a statistically significant difference between 7 days and 1 month after operation and before operation;HAP showed an upward trend after operation.There was a statistically significant difference between postoperative and preoperative,but there was no statistically significant difference between 1 month after surgery and 7 days after surgery;HAP and TLP decreased significantly after surgery,showing significant After the decrease,it slowly increased.The difference was statistically significant between 7 days and 1 month after operation and before operation,and there was no significant difference between BV after operation and before operation.2.Changes of the inner diameter of common hepatic artery and splenic arteryThe internal diameter of common hepatic artery before operation was 3.71±0.34mm,the internal diameter of splenic artery was 6.20±0.30mm,and the ratio of spleen/common hepatic artery diameter was 1.69±0.25;the internal diameter of common hepatic artery was 4.13±0.15mm and the internal diameter of splenic artery 7 days after operation The diameter of the spleen/common hepatic artery was 1.44±0.08;the diameter of the common hepatic artery was 4.08±0.15mm,the diameter of the splenic artery was 5.49±0.20mm,and the ratio of spleen/common hepatic artery diameter was 1.35.±0.06.The diameter of the common hepatic artery after PSE was significantly larger than that before the operation,and it was reduced in 1 month after the operation compared with 7 days after the operation,but it was still larger than that before the operation.The diameter of the splenic artery and the ratio of the diameter of the spleen/common hepatic artery decreased significantly after surgery,and the difference was statistically significant between 7 days and 1 month after the operation and before the operation.3.Changes in liver functionPeripheral blood TBiL and PT on the 3rd and 7th day after PSE were higher than those before the operation,the difference was statistically significant,and the TBiL dropped to the preoperative level in 1 month after the operation,and there was no difference compared with that before It was statistically significant.PT decreased slightly in 1 month after operation compared with that before operation,and the difference was statistically significant.The preoperative MELD score was 9.15±2.51,the MELD score at 7 days after the operation was 11.18±3.06,and the MELD score in the first month after the operation was 7.32±1.80.The MELD score showed a trend of first rising and then falling,and it dropped to a little lower in the first month after surgery.Before surgery.4.Correlation analysis of CT perfusion parameters and MELD score after PSEThere was no correlation between MELD score and HAP at 7 days after operation.MELD score was negatively correlated with PVP and TLP.(HAP:r=0.058,P>0.05;PVP:r=-0.751,P<0.05;TLP:r=-0.685,P<0.05).5.Changes in peripheral bloodPeripheral WBC before PSE was 2.41±0.87×109/L,which rose rapidly to a maximum of 6.47±4.00×109/L 7 days after surgery,and dropped to 3.45±1.03×109/L in January after surgery,showing a rapid increase and decrease;Peripheral PLT before operation was 43.75±17.98×109/L,it rose to 108.81±52.69×109/L in 7 days after operation,and remained at 100.81±26.06×109/L in January after operation,but showed a slow downward trend.Conclusions:1.There is SASS in patients with liver cirrhosis and hypersplenism.PSE can relieve SASS and improve liver circulation.2.The short-term changes in liver CT perfusion parameters after PSE indicate that the hepatic artery perfusion after PSE increases,and the portal vein and total liver perfusion decrease.The decrease in PVP caused by PSE is mainly not the decrease in nutritional and functional liver perfusion,but the decrease in regulatory PVP.It is helpful to improve the liver circulatory disturbance of portal hypertension.3.The transient decrease of PVP and TLP after PSE may be one of the factors that cause liver function damage in the short term. |
PDF Full Text Request