Spleen embolization

1. Hypersplenism caused by portal hypertension and rupture of esophageal varices. 2. Idiopathic thrombocytopenic purpura. 3. Thalassemia, hereditary spherical or oval red blood cells increase. 4. Splenic aneurysm. 5. Traumatic spleen rupture. 6. Spleen tumor, Hodgkin's disease. 7. Leukopenia after renal transplantation or interventional treatment of liver cancer. 8. Splenic veins, portal vein thrombosis or sponge-like changes and hypersplenism. Treatment of diseases: splenic aneurysm spleen hyperfunction Indication 1. Hypersplenism caused by portal hypertension and rupture of esophageal varices. 2. Idiopathic thrombocytopenic purpura. 3. Thalassemia, hereditary spherical or oval red blood cells increase. 4. Splenic aneurysm. 5. Traumatic spleen rupture. 6. Spleen tumor, Hodgkin's disease. 7. Leukopenia after renal transplantation or interventional treatment of liver cancer. 8. Splenic veins, portal vein thrombosis or sponge-like changes and hypersplenism. Contraindications 1. Sepsis, severe constitutional failure and iodine allergy are absolute and contraindicated. 2. Liver dysfunction, coagulopathy is relatively contraindicated. Preoperative preparation 1. Equipment preparation Digital subtraction angiography (DSA) machine, high pressure syringe, splenic artery catheter catheter guide wire, puncture needle, contrast agent, gelatin sponge or stainless steel spiral ring embolization materials. 2. Conventional preoperative examination to determine liver function, renal function, prothrombin time, blood and spleen enlargement. 3. Prophylactic application of broad-spectrum antibiotics 2 days before surgery. 4. Selection of embolization methods (1) embolism of hypersplenism: various types of spleen hyperfunction and blood diseases with spleen indications use partial spleen embolism, embolization of spleen artery with gelatin sponge strip is good, embolization range is controlled at 40% ~60%. Partial splenic embolization not only achieves partial "spleen resection" to relieve clinical symptoms, but also preserves the immune function of the spleen. When the patient's constitution is weak or the clinical symptoms are not satisfied, it can be repeated many times, which is currently recognized as a safe and effective method. (2) embolization of spleen tumors: preoperative embolization and advanced tumor palliative embolism. Preoperative embolization can cause tumor necrosis, reduce intraoperative bleeding, and prevent tumor cell dissemination. Preoperative embolization can be performed with gelatin sponge fine particles for total spleen embolization, and can be surgically removed 3 days after suppository. The palliative embolization of advanced tumors also uses total spleen embolism. In addition to gelatin sponge particles or absolute ethanol for peripheral embolization, the proximal end of the splenic artery is also embolized, which can lead to total spleen infarction. Severe complications and mortality after total spleen embolization are limited to spleen tumor embolization. (3) spleen trauma and splenic aneurysm embolization: only the proximal splenic artery embolization. Most of the embolic materials are stainless steel spirals, and large gelatin sponge strips or detachable balloons can also be used. After embolization of the spleen artery, the spleen can obtain sufficient blood supply through the collateral circulation formed by the short gastric artery, the left gastric artery and the gastric retinal artery, and generally does not produce infarction, so it is only used for embolization of splenic trauma and splenic aneurysm. . Surgical procedure 1. Seldinger technique was used to perform abdominal angiography through the femoral artery or radial artery puncture intubation. The contrast agent was injected at a concentration of 15 ml per second and the total amount was 15-20 ml. The splenic artery was observed. 2. Supervise the catheter to the spleen angiography with a guide wire, inject 5 to 8 ml per second, a total amount of 15 ~ 30ml into the contrast agent, observe the size of the spleen and lesions in the spleen, spleen rupture visible contrast agent extravasation, blood vessel separation Wait for the image to change. 3. Select embolization materials according to spleen lesions and different embolization methods. Part of splenic artery embolization is usually made of gelatin sponge granules, about 2mm3, immersed in physiological saline containing penicillin and gentamicin; it is also recommended to use a gelatin sponge strip, about 2mm × 8mm size, inserted into a 2ml syringe nipple, usually 6 to 8 articles. When the embolization is performed, the catheter should be over-selected to a deep depth. It is best to cross the dorsal pancreatic artery to prevent iatrogenic pancreatitis caused by mis-plugging. In the operation, the degree of spleen embolism is usually judged according to the blood flow of the splenic artery. The author's experience is that the blood flow of the splenic artery is slightly slowed down by 30% to 40%, and the slowing is 50% to 60%. The creeping advance is 70% to 80%. Gelatin sponge powder or absolute ethanol is often used in the whole spleen embolization. The superselection of the catheter should be more accurate and deep. If necessary, a liquid embolic agent such as absolute ethanol can be injected through the 3F microcatheter or balloon catheter to avoid reflux. When the spleen artery is embolized, stainless steel spiral is used. The diameter of the embolus should be slightly larger than the diameter of the splenic artery. The catheter is placed at the proximal end of the splenic artery, but it should still pass over the opening of the dorsal artery of the pancreas. 4. Splenic angiography again, to determine the degree of splenic embolism. If the feeling is insufficient, add a plug until it is satisfactory. The catheter was withdrawn, the puncture site was pressed and hemostasis, and the pressure was bandaged, lying flat for 24 hours. complication Post-embolic syndrome Almost all patients after partial splenic embolization had a transient fever, pain in the left upper abdomen and loss of appetite. The fever is generally around 38 °C, a few can reach above 39 °C, lasting 1 to 3 weeks, moderate abdominal pain, symptomatic treatment can be. 2. Bronchial pneumonia and pleural effusion More common on the left side, associated with pain limitation after left spleen embolism, left respiratory movement and reactive pleurisy. It can be recovered by antibiotics and symptomatic treatment. 3. Spleen abscess Caused by bacterial infection. After the spleen embolization, the spleen venous blood flow slowed down, the intestinal bacteria reversed into the spleen tissue and the aseptic operation was not strict. Controlling the extent of embolization, strict aseptic procedures, and perioperative prophylactic antibiotics can effectively reduce the incidence of splenic abscesses. Once a spleen abscess occurs, it should be active anti-inflammatory, as soon as possible to puncture drainage, or surgical treatment. Spleen rupture After embolization, the spleen is congested and edema. When a cyst or abscess is formed, spleen rupture may occur. Once discovered, immediate surgical treatment is required. 5. Accidental embolism Often due to over-intubation, excessive injection pressure and excessive application of embolic agents. In-depth superselective intubation and fluoroscopy with slow injection of embolic agents are key measures to avoid accidental embolization.