Long-term efficacy of subtotal splenectomy due to portal hypertension in cirrhotic patients

BMC Surgery

Research Article

Jianhua Zhao¹  Haibo Chu¹  Wei Han¹  Yongbo Xu¹  Fengguo Jian²  Weihua Zhang³  Tao Wang⁴  Lei Wang⁵ 

[1] Center of General Surgery, The 89th Hospital of People’s Liberation Army, West Beigong Road 256, 261021, Weifang, China;Department of General Surgery, Changyi People’s Hospital, 261300, Changyi, China;Department of General Surgery, Weifang Traditional Chinese Medicine Hospital, 261041, Weifang, China;Department of Pathology, The 89th Hospital of People’s Liberation Army, 261021, Weifang, China;Department of Postgraduate, Weifang Medical University, 261042, Weifang, China;

关键词: Portal hypertension;    Splenomegaly;    Subtotal splenectomy;    Shunt;   

DOI  :  10.1186/s12893-015-0077-2

 received in 2015-02-16, accepted in 2015-07-20,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundPortal hypertension (PHT) requires invasive measures to prevent rupture and bleeding of esophagogastric varices; however, the long-term results of subtotal splenectomy plus fixation of the retrosternal omentum majus (SSFROM) have not been reported. Specifically, the advantages and disadvantages of surgery that preserves the spleen and the long-term hematologic effects have not been described.Study designOur studies relating to SSFROM commenced in February 1999. As of April 2014 we have performed 256 subtotal splenectomies The records of 65 patients with PHT who underwent SSFROM were reviewed retrospectively.ResultsFour patients died within 4 years of surgery, with a 4-year survival rate of 94 %; the 11-year survival rate was 60 %. Eleven patients (17 %) had re-bleeding from esophagogastric varices. The white blood cell and platelet counts were higher 6 and 11 years post-operatively compared with pre-operative values (P < 0.01). Portal venous diameter, portal venous flow volume, splenic artery flow volume, as well as splenic length, thickness, and average cross-sectional areas were shown to be significantly constricted or decreased (P < 0.01). The proportion of serum CD3+ T cells, CD4+ T cells, and CD8+ T cells was increased (P < 0.01), while the serum levels of macrophage colony-stimulating factor and granulocyte-macrophage colony-stimulating factor were significantly decreased (P < 0.01). There was no significant change in the serum levels of IgA, IgM, IgG, and Tuftsin (P > 0.05). DSA demonstrated that 15 cases formed collateral circulations between the portal vein and superior vena cava.ConclusionSSFROM provide long-term hemostasis for esophagogastric variceal bleeding in PHT and corrected hypersplenism. SSFROM is an effective treatment for patients with PHT in whom long-term survival is expected.

【 授权许可】

Unknown   
© Chu et al. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.