| 特集名 | 門脈圧亢進症の治療update | |
|---|---|---|
| 題名 | 門脈圧亢進症に対する外科治療とIVR (4) 部分的脾動脈塞栓術 | |
| 発刊年月 | 2012年 02月 | |
| 著者 | 吉田 寛 | 日本医科大学多摩永山病院外科 |
| 著者 | 真々田 裕宏 | 日本医科大学外科 |
| 著者 | 谷合 信彦 | 日本医科大学外科 |
| 著者 | 吉岡 正人 | 日本医科大学外科 |
| 著者 | 平方 敦史 | 日本医科大学多摩永山病院外科 |
| 著者 | 内田 英二 | 日本医科大学外科 |
| 【 要旨 】 | 部分的脾動脈塞栓術（PSE）について解説する．血管造影剤過敏症とChild-Pugh 13点以上を原則適応外としている．手技は脾動脈脾門部で造影し，脾動静脈の走行を確認する．抗生物質とステロイドを注入後，2mm角のゼルフォーム®またはジェルパート®2mm粒にて選択的に塞栓する．塞栓範囲は40〜80％とし，脾静脈が描出される程度とする．塞栓後に抗生物質とステロイドを2日間，全身投与する．合併症は左側腹部痛，発熱で，まれに腹水・左胸水貯留，脾膿瘍，門脈血栓を認める．汎血球減少症，食道胃静脈瘤，肝性脳症に対し有効である．PSEは安全性も確立され，とくに脾の一部を温存しながら，門脈圧亢進症に伴うさまざまな合併症に対して効果がある． | |
| Theme | Treatment for Portal Hypertension : Update | |
|---|---|---|
| Title | Partial Splenic Embolization | |
| Author | Hiroshi Yoshida | Department of Surgery, Nippon Medical School Tamanagayama Hospital |
| Author | Yasuhiro Mamada | Department of Surgery, Nippon Medical School |
| Author | Nobuhiko Taniai | Department of Surgery, Nippon Medical School |
| Author | Masato Yoshioka | Department of Surgery, Nippon Medical School |
| Author | Atsushi Hirakata | Department of Surgery, Nippon Medical School Tamanagayama Hospital |
| Author | Eiji Uchida | Department of Surgery, Nippon Medical School |
| [ Summary ] | Partial splenic embolization (PSE) is a non-surgical procedure developed to treat hypersplenism due to hepatic disease and thus avoid the disadvantages of splenectomy. Contraindications for PSE include secondary splenomegaly and hypersplenism in patients with terminal-stage underlying diseases.；Pyrexia or severe infections may be associated with a high risk of splenic abscess after PSE. A femoral artery approach is used for selective catheterization of the splenic artery. Generally, the catheter tip is placed as distally as possible in an intrasplenic artery. After injection of antibiotics and steroids, embolization is achieved by injecting 2-mm gelatin sponge cubes suspended in a saline solution containing antibiotics. Complications from PSE include daily intermittent fever, abdominal pain, nausea and vomiting, abdominal fullness, appetite loss, and postembolization syndrome. Decreased portal-vein flow and a rapid increase in platelet counts after excessive embolization may cause portal-vein or splenic-vein thrombosis. PSE is beneficial for patients with portal hypertension. |
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