BACKGROUND Hypersplenism and esophageal varices bleeding are the major complications of portal hypertension(PHT).In recent years,increasing attention has been given to spleen preservation operations.The mode and long-...BACKGROUND Hypersplenism and esophageal varices bleeding are the major complications of portal hypertension(PHT).In recent years,increasing attention has been given to spleen preservation operations.The mode and long-term effects of subtotal splenectomy and selective pericardial devascularization for PHT remain controversial.AIM To investigate the clinical efficacy and safety of subtotal splenectomy combined with selective pericardial devascularization for the treatment of PHT.METHODS This was a retrospective study of 15 patients with PHT who underwent subtotal splenectomy not preserving the splenic artery or vein combined with selective pericardial devascularization in the Department of Hepatobiliary Surgery,Qilu Hospital of Shandong University from February 2011 to April 2022.Fifteen propensity score-matched patients with PHT who underwent total splenectomy at the same time served as the control group.The patients were followed for up to 11 years after surgery.We compared the postoperative platelet levels,perioperative splenic vein thrombosis,and serum immunoglobulin levels between the two groups.Abdominal enhanced computed tomography was used to evaluate the blood supply and function of the residual spleen.The operation time,intraoperative blood loss,evacuation time,and hospital stay were compared between the two groups.RESULTS The postoperative platelet level of patients in the subtotal splenectomy group was significantly lower than that in the total splenectomy group(P<0.05),and the postoperative portal system thrombosis rate in the subtotal splenectomy group was also much lower than that in the total splenectomy group.The levels of serum immunoglobulins(IgG,IgA,and IgM)showed no significant differences after surgery compared with before surgery in the subtotal splenectomy group(P>0.05),but serum immunoglobulin IgG and IgM levels decreased dramatically after total splenectomy(P<0.05).The operation time in the subtotal splenectomy group was longer than that in the total splenectomy group(P<0.05),but there were no significant differences in the amount of intraoperative blood loss,evacuation time,or hospital stay between the two groups.CONCLUSION Subtotal splenectomy not preserving the splenic artery or vein combined with selective pericardial devascularization is a safe and effective surgical treatment for patients with PHT,not only correcting hypersplenism but also preserving splenic function,especially immunological function.展开更多
目的探讨腹腔镜脾切除联合选择性贲门周围血管断流术前后肝功能及肝脏体积(liver volume,LV)的变化。方法选择2015年1月~2019年8月我院腹腔镜脾切除联合选择性贲门周围血管断流术治疗肝硬化门静脉高压症31例,观察患者术前后LV、丙氨酸...目的探讨腹腔镜脾切除联合选择性贲门周围血管断流术前后肝功能及肝脏体积(liver volume,LV)的变化。方法选择2015年1月~2019年8月我院腹腔镜脾切除联合选择性贲门周围血管断流术治疗肝硬化门静脉高压症31例,观察患者术前后LV、丙氨酸转氨酶(alanine transaminase,ALT)、总胆红素、凝血酶原时间、白蛋白、肝动脉血流、门静脉血流、吲哚菁绿15 min滞留率(indocyanine green retention rate at 15 min,ICGR15)和吲哚菁绿最大清除率(indocyanine green maximum removal rate,ICGRmax)的变化情况。结果术前和术后第3、6个月LV分别为(844.47±80.25)、(1010.07±92.08)、(1050.91±98.79)cm^(3),差异有统计学意义(F=47.695,P=0.000),其中术后第3、6个月LV明显大于术前(均P=0.000),术后第6个月LV显著大于术后第3个月(P=0.016)。术前和术后第3、6个月ALT中位数分别为80(13~235)、29(11~71)、26(11~73)U/L,差异有统计学意义(χ^(2)=28.894,P=0.000),其中术后第3、6个月ALT明显低于术前(均P=0.000)。术前和术后第3、6个月ICGR15分别为(24.12±7.37)%、(18.31±4.59)%、(17.50±4.11)%,术前后差异有统计学意义(F=14.642,P=0.000),其中术后第3、6个月ICGR15明显低于术前(均P=0.000)。术前和术后第3、6个月ICGRmax分别为(1.48±0.18)、(1.60±0.14)、(1.62±0.15)mg·kg^(-1)·min^(-1),差异有统计学意义(F=14.353,P=0.000),其中术后第3、6个月ICGRmax明显高于术前(均P=0.000)。术前和术后第3、6个月肝动脉血流分别为(186.76±21.59)、(352.66±18.58)、(357.27±25.72)ml/min,术前后差异有统计学意义(F=609.171,P=0.000),术后第3、6个月明显高于术前(均P=0.000)。术前和术后第3、6个月门静脉血流分别为(1870.80±244.21)、(1205.37±212.68)、(1183.05±225.80)ml/min,术前后差异有统计学意义(F=110.020,P=0.000),其中术后第3、6个月明显低于术前(均P=0.000)。术前后总胆红素、凝血酶原时间、白蛋白差异无统计学意义(P>0.05)。结论腹腔镜脾切除联合选择性贲门周围血管断流术可改善肝脏供血,促进肝脏再生,改善患者肝脏功能。展开更多
基金Supported by Chinese Postdoctoral Science Foundation,No. 2022M711911
文摘BACKGROUND Hypersplenism and esophageal varices bleeding are the major complications of portal hypertension(PHT).In recent years,increasing attention has been given to spleen preservation operations.The mode and long-term effects of subtotal splenectomy and selective pericardial devascularization for PHT remain controversial.AIM To investigate the clinical efficacy and safety of subtotal splenectomy combined with selective pericardial devascularization for the treatment of PHT.METHODS This was a retrospective study of 15 patients with PHT who underwent subtotal splenectomy not preserving the splenic artery or vein combined with selective pericardial devascularization in the Department of Hepatobiliary Surgery,Qilu Hospital of Shandong University from February 2011 to April 2022.Fifteen propensity score-matched patients with PHT who underwent total splenectomy at the same time served as the control group.The patients were followed for up to 11 years after surgery.We compared the postoperative platelet levels,perioperative splenic vein thrombosis,and serum immunoglobulin levels between the two groups.Abdominal enhanced computed tomography was used to evaluate the blood supply and function of the residual spleen.The operation time,intraoperative blood loss,evacuation time,and hospital stay were compared between the two groups.RESULTS The postoperative platelet level of patients in the subtotal splenectomy group was significantly lower than that in the total splenectomy group(P<0.05),and the postoperative portal system thrombosis rate in the subtotal splenectomy group was also much lower than that in the total splenectomy group.The levels of serum immunoglobulins(IgG,IgA,and IgM)showed no significant differences after surgery compared with before surgery in the subtotal splenectomy group(P>0.05),but serum immunoglobulin IgG and IgM levels decreased dramatically after total splenectomy(P<0.05).The operation time in the subtotal splenectomy group was longer than that in the total splenectomy group(P<0.05),but there were no significant differences in the amount of intraoperative blood loss,evacuation time,or hospital stay between the two groups.CONCLUSION Subtotal splenectomy not preserving the splenic artery or vein combined with selective pericardial devascularization is a safe and effective surgical treatment for patients with PHT,not only correcting hypersplenism but also preserving splenic function,especially immunological function.
文摘目的探讨腹腔镜脾切除联合选择性贲门周围血管断流术前后肝功能及肝脏体积(liver volume,LV)的变化。方法选择2015年1月~2019年8月我院腹腔镜脾切除联合选择性贲门周围血管断流术治疗肝硬化门静脉高压症31例,观察患者术前后LV、丙氨酸转氨酶(alanine transaminase,ALT)、总胆红素、凝血酶原时间、白蛋白、肝动脉血流、门静脉血流、吲哚菁绿15 min滞留率(indocyanine green retention rate at 15 min,ICGR15)和吲哚菁绿最大清除率(indocyanine green maximum removal rate,ICGRmax)的变化情况。结果术前和术后第3、6个月LV分别为(844.47±80.25)、(1010.07±92.08)、(1050.91±98.79)cm^(3),差异有统计学意义(F=47.695,P=0.000),其中术后第3、6个月LV明显大于术前(均P=0.000),术后第6个月LV显著大于术后第3个月(P=0.016)。术前和术后第3、6个月ALT中位数分别为80(13~235)、29(11~71)、26(11~73)U/L,差异有统计学意义(χ^(2)=28.894,P=0.000),其中术后第3、6个月ALT明显低于术前(均P=0.000)。术前和术后第3、6个月ICGR15分别为(24.12±7.37)%、(18.31±4.59)%、(17.50±4.11)%,术前后差异有统计学意义(F=14.642,P=0.000),其中术后第3、6个月ICGR15明显低于术前(均P=0.000)。术前和术后第3、6个月ICGRmax分别为(1.48±0.18)、(1.60±0.14)、(1.62±0.15)mg·kg^(-1)·min^(-1),差异有统计学意义(F=14.353,P=0.000),其中术后第3、6个月ICGRmax明显高于术前(均P=0.000)。术前和术后第3、6个月肝动脉血流分别为(186.76±21.59)、(352.66±18.58)、(357.27±25.72)ml/min,术前后差异有统计学意义(F=609.171,P=0.000),术后第3、6个月明显高于术前(均P=0.000)。术前和术后第3、6个月门静脉血流分别为(1870.80±244.21)、(1205.37±212.68)、(1183.05±225.80)ml/min,术前后差异有统计学意义(F=110.020,P=0.000),其中术后第3、6个月明显低于术前(均P=0.000)。术前后总胆红素、凝血酶原时间、白蛋白差异无统计学意义(P>0.05)。结论腹腔镜脾切除联合选择性贲门周围血管断流术可改善肝脏供血,促进肝脏再生,改善患者肝脏功能。
