关键词: 肝豆状核变性, 脾功能亢进症, 脾切除术, 脾栓塞术, 治疗

Abstract: Objective This study was conducted to compare the clinical efficacy of splenic embolization (SPE) and splenectomy in the treatment of patients with hepatolenticular degeneration (HD) complicated with hypersplenism. Methods 105 HD patients with complicated moderate-to-severe hypersplenism were admitted in our hospital between May 2020 and June 2023, and out of them, the SPE was carried out in 61 patients and splenectomy in 40 patients. The mean arterial pressure (MAP), heart rate(HR) and blood oxygen saturation (SPO₂) were monitored during the operation, and serum cortisol (COR), C reactive protein (CRP) and interleukin-6 (IL-6) levels were assayed by ELISA. Results The intraoperative blood loss in patients receiving SPE was (4.2±0.6)ml, much less than [(162.3±54.2)ml, P＜0.05], while the MAP and HR were (84.6±11.8)mmHg and(79.8±7.3)beats/min. both significantly lower than [(89.6±8.5)mmHg and (84.2±8.5)beats/min, respectively, P＜0.05] in patients receiving splenectomy; after operation, serum COR and CRP levels in patients receiving splenectomy (487.8±50.2)nmol/L and (82.4±12.5)mg/L, much higher than [(370.8±47.3)nmol/L and (48.5±9.2)mg/L, respectively, P＜0.05] in patients receiving SPE; the white blood cell and platelet counts in patients receiving splenectomy (6.9±1.2)×10⁹/L and (164.5±27.3)×10⁹/L, significantly higher than [(4.9±1.3)×10⁹/L and (92.6±26.4)×10⁹/L, respectively, P＜0.05] in patients receiving SPE; there was no significant difference respect to post-operational complications between the two groups(P>0.05), although abdominal pain after SPE, and portal thrombosis after splenectomy was common. Conclusion We believe that the splenectomy could ameliorate hypersplenism radically, but it might induce portal thrombosis, which should be carefully managed perioperatively.

Key words: Hepatolenticular degeneration, Hypersplenism, Splenic embolization, Splenectomy, Therapy