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目的分析部分脾动脉栓塞术(PSE)作为门脉高压症合并脾功能亢进患者术前提升血小板的可行性,探讨PSE术后进行脾切除联合门奇断流术的最佳手术时机。方法本组15例患者行PSE术后,观察PSE对血小板上升时间的影响,并明确血小板上升到适宜手术的时间。PSE术后2周内行脾切除联合门奇断流术,术中观察脾脏与周围组织的粘连情况,并明确PSE后进行手术的最佳时机。结果 PSE术后血小板开始升高,1周时达峰值;脾脏与大网膜及周围组织发生粘连,粘连程度与PSE术后手术时间呈正相关。结论 PSE纠正脾功能亢进,改善凝血功能障碍作用明显,可作为门脉高压而脾亢明显的患者行脾切除、门奇断流术的一种术前准备措施。PSE术后2周内是进行脾切除的最佳时机。
Objective To analyze the feasibility of partial splenic arterial embolization (PSE) as a prophylactic platelet in patients with portal hypertension complicated with hypersplenism and to explore the optimal timing of splenectomy and portal denervation after PSE. Methods 15 patients in this group underwent PSE after surgery to observe the impact of PSE on platelet rise time, and to determine the appropriate platelet rise time. Two weeks after PSE, splenectomy combined with door-gate disconnection was performed. The adhesion between the spleen and surrounding tissues was observed intraoperatively, and the best timing for PSE was determined. Results After PSE, platelets began to increase and peaked at 1 week. The adhesion of the spleen to the omentum and surrounding tissues was found. The degree of adhesion was positively correlated with the operation time after PSE. Conclusions PSE can correct spleen hyperactivity and improve coagulation dysfunction. It can be used as a preoperative preparation for splenectomy and portal dementia in patients with obvious hypersplenism due to portal hypertension. Within 2 weeks after PSE is the best time for splenectomy.