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中华肝脏外科手术学电子杂志 ›› 2023, Vol. 12 ›› Issue (04) : 454 -456. doi: 10.3877/cma.j.issn.2095-3232.2023.04.018

所属专题: 综述

病例报告

脾动脉栓塞术后远期腹腔镜巨脾切除术一例
陈亚峰, 李江斌, 王栋, 鲁建国, 董瑞()   
  1. 710038 西安,空军军医大学第二附属医院普通外科
  • 收稿日期:2023-03-01 出版日期:2023-08-10
  • 通信作者: 董瑞
  • 基金资助:
    国家自然科学基金青年项目(81700533); 陕西省重点研发计划项目(2020SF-067)

Long term laparoscopic splenectomy for splenomegaly after splenic artery embolization

Yafeng Chen, Jiangbin Li, Dong Wang   

  • Received:2023-03-01 Published:2023-08-10
引用本文:

陈亚峰, 李江斌, 王栋, 鲁建国, 董瑞. 脾动脉栓塞术后远期腹腔镜巨脾切除术一例[J/OL]. 中华肝脏外科手术学电子杂志, 2023, 12(04): 454-456.

Yafeng Chen, Jiangbin Li, Dong Wang. Long term laparoscopic splenectomy for splenomegaly after splenic artery embolization[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(04): 454-456.

患者男,41岁,因"脾动脉栓塞术后3年余,腹胀、腹痛不适6月"于2021年9月23日入院。既往史:有乙型病毒性肝炎(乙肝)肝硬化病史20年,无消化道出血史。2018年5月胃镜检查示:胆汁反流性胃炎。CT检查示:肝硬化,门静脉高压症,脾大(25.9 cm×14.5 cm×8.8 cm),左肾受压。血常规示:WBC 0.64×109/L,Plt 21×109/L,Hb 75 g/L。诊断为巨脾伴脾功能亢进症(脾亢),给予升白细胞、升血小板、输血治疗后效果不佳。患者因全身营养差、体能状况差、胸腹腔顽固性积液等一般情况欠佳而未行手术切除脾脏,于2018年6月行脾动脉栓塞术(splenic artery embolization,SAE),采用聚乙烯醇颗粒(350 μm×560 μm)与浓造影剂混匀栓塞。SAE治疗后三系细胞短期有所改善,远期仍明显减低,且存在腹胀、腹痛、间断发热等栓塞后综合征表现,进而加重全身消耗,导致患者体力功能状态更差。

图1 一例巨脾伴脾亢患者SAE术后远期腹腔镜巨脾切除术前CT及术中情况注:a为SAE术后3年脾切除术前CT示巨脾;b为"五孔法"腹腔镜脾切除Trocar位置;c为术中可吸收生物夹夹闭脾动脉;d为离断脾下极血管;e为分离脾上极与肝左外叶、膈肌粘连;f为Endo-GIA离断脾蒂;SAE为脾动脉栓塞术,脾亢为脾功能亢进症
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