肝硬化脾功能亢進治療之臨床角色

The Clinical Role of the Treatment for Hypersplenism in Patients with Cirrhosis

鄭興(Shing Chang) ； 陳炯瑜(Chiung-Yu Chen) ； 林錫璋(Xi-Zhang Lin)

《內科學誌》 20卷5期 (2009/10) Pp. 403-408

https://doi.org/10.6314/JIMT.2009.20(5).03

摘要

脾臟有免疫及過濾功能，而脾臟腫大常繼發於感染，血液或肝臟等疾病。臨床上我們用超音波或電腦斷層來評估脾腫大。在肝硬化的病人，由於門靜脈高壓之故，脾腫大約占三分之二人數。脾腫大是血小板低下的一項主因，這使我們對於肝硬化病人行侵入性治療如肝切片、肝癌治療、腹水或胸水引流或是藥物治療C型肝炎病人有所顧慮。因此對肝疾患者而言，脾腫大的處理主要是針對血小板低下症及降低門脈高壓而作治療。目前對於脾腫大的治療有脾臟切除、部份脾栓塞術、以及放射治療和燒灼術等。治療的成果，包括長期的血小板數穩定，降低靜脈瘤出血機率及肝功能改善。對於肝硬化病人的生活品質及提高存活機會，治療脾臟腫大提供了一個治療選擇。

關鍵字

脾功能亢進 ； 脾腫大 ； 肝硬化 ； 脾臟切除 ； 部份脾栓塞術

並列摘要

The spleen has major roles in immunity and blood filtration. Splenomegaly is usually secondary to infection, hematological diseases, or cirrhosis. We can make diagnosis accurately by using ultrasound or computed tomography. Two third of cirrhotic patients have splenomegaly due to portal hypertension; and they often have thrombocytopenia. The cirrhotic patients may need invasive therapy for their diseases, such as dental extractions, percutaneous local ablation for hepatoma, paracentesis for ascites and hydrothorax. These procedures may be hampered by the presence of bleeding tendency. The indication of treatment of splenomegaly in cirrhotic patients is presence of thrombocytopenia or complications from portal hypertension. Current treatment modalities include splenectomy, partial splenic embolization, irradiation, and radiofrequency ablation. The benefits are increased platelet counts, reduced episodes of variceal bleeding and improved liver function. Therefore, treatment for hypersplenism may offer improved life quality and improved survival for these cirrhotic patients.

並列關鍵字

Hypersplenism ； Splenomegaly ； Cirrhosis ； Splenectomy ； Partial splenic embolization