探讨术前预防性脾动脉栓塞术（PSAE）在左侧门静脉高压症脾切除治疗中应用价值。

回顾性分析2025年3月安徽医科大学第一附属医院肝胆胰外科收治的1例左侧门静脉高压患者临床资料。患者男，47岁，因“反复发作上腹痛10余年”入院。体检：腹部膨隆；上腹部明显压痛，伴肌紧张及反跳痛；移动性浊音（+）；肠鸣音减弱。实验室检查：WBC 2.1×10⁹/L，RBC 5.78×10¹²/L，Hb 169 g/L，Plt 42×10⁹/L，ALT 12.0 U/L，AST 18.4 U/L，TB 15.57 μmol/L，DB 3.88 μmol/L，ALB 45.8 g/L。CT检查示脾脏增大，脾静脉栓塞或狭窄；胃镜检查发现孤立性胃底静脉曲张，迂曲呈蚯蚓状。初步诊断为左侧门静脉高压症。经积极术前准备，于2025年3月25日行PSAE。以Seldinger技术穿刺右侧股动脉，采用微导管超选至脾动脉主干，分步栓塞以限制血流，再以1∶2比例混合组织胶与碘化油栓塞脾动脉主干至完全闭塞。于2025年3月26日行脾切除术。

术后3 d行CT复查示胃底静脉曲张显著改善，原迂曲增粗的静脉团消失，证实脾切除术有效解除了区域性门静脉高压。随访DSA复查可见脾动脉主干完全闭塞，未见明显侧枝循环建立。术后病理检查显示，切除的脾脏明显肿大，重量达850 g，包膜增厚且张力增高。切面呈暗红色，质地韧，可见广泛纤维化改变。患者术后Plt由术前42×10⁹/L升至210×10⁹/L，WBC由2.1×10⁹/L恢复至6.5×10⁹/L，脾功能亢进得到彻底纠正。术后未发生出血、感染等并发症，患者恢复良好，术后7 d顺利出院。

PSAE通过术前介入方法阻断脾动脉血流，降低脾切除术中出血风险，缩小脾脏体积以改善手术视野暴露，同时调节门静脉系统血流动力学稳定，尤其适用于胰源性或脾静脉阻塞性门静脉高压症患者。

To evaluate the application of preoperative preventive splenic artery embolization (PSAE) in splenectomy for left portal hypertension.

Clinical data of 1 patient with left portal hypertension admitted to the Department of Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Anhui Medical University in March 2025 were analyzed retrospectively. The 47-year-old male patient was hospitalized due to "recurrent epigastric pain for more than 10 years". Physical examination showed abdominal distension, evident tender in the upper abdomen, accompanied with muscle tension and rebound pain, shifting dullness (+) and weak bowel sounds. Laboratory examination revealed WBC was 2.1×10⁹/L, RBC 5.78×10¹²/L, Hb 169 g/L, Plt 42×10⁹/L, ALT 12.0 U/L, AST 18.4 U/L, TB 15.57 μmol/L, DB 3.88 μmol/L and ALB 45.8 g/L, respectively. CT scan showed enlargement of the spleen, embolism or stenosis of splenic vein. Endoscopic examination revealed isolated varices of the gastric fundus in tortuosity and earthworm shape. The initial diagnosis was left portal hypertension. After active preoperative preparations, PSAE was performed on March 25, 2025. The right femoral artery puncture was performed using Seldinger technique. Superselective catheterization of the main splenic artery was conducted using the microcatheter. The left portal hypertension patients were subject to staged embolization to limit blood flow, followed by complete embolization of the main splenic artery by using tissue glue and iodized oil in a ratio of 1∶2. Splenectomy was performed on March 26, 2025.

At postoperative 3 d, CT scan showed that isolated varices of the gastric fundus were significantly alleviated and original tortuous and thickened venous masses were absent, confirming that splenectomy effectively relieved regional portal hypertension. DSA during follow-up showed that the splenic artery trunk was completely occluded and no evident collateral circulation was established. Postoperative pathological examination showed that the resected spleen was significantly enlarged, weighing 850 g, and the capsule was thickened and the tension was increased. The section was dark red with tough texture, presenting with extensive fibrotic changes. Postoperative Plt was increased from 42×10⁹/L before operation to 210×10⁹/L, WBC was increased from 2.1×10⁹/L to 6.5×10⁹/L, and hypersplenism was completely treated. No postoperative complications, such as bleeding and infection, were reported. The patient was recovered well and discharged at postoperative 7 d.

PSAE can block the blood flow of splenic artery by preoperative intervention, reduce the risk of bleeding during splenectomy, decrease the size of spleen and improve the exposure of surgical field. PSAE can also adjust the hemodynamic stability of portal vein system, especially suitable for patients with pancreatic or splenic vein obstruction-induced portal hypertension.