Analysis on splanchnic vessel diameter changes following splenectomy in cirrhotic portal hypertension
10.3760/cma.j.cn115610-20240610-00287
- VernacularTitle:肝硬化门静脉高压症患者脾切除术后腹腔内脏血管直径变化分析
- Author:
Mingqi LIU
1
;
Mingguo TIAN
Author Information
1. 宁夏回族自治区人民医院肝胆外科，银川 750002刘明奇现在海军军医大学附属东方肝胆外科医院，上海 200438
- Keywords:
Cirrhosis;
Hypertension;
Splanchnic vessel diameter;
Splenectomy;
Change
- From:
Chinese Journal of Digestive Surgery
2024;23(7):961-968
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the splanchnic vessel diameter changes following splenectomy in cirrhotic portal hypertension.Methods:The retrospective cohort study was con-ducted. The clinical data of 149 patients with cirrhotic portal hypertension who underwent splenec-tomy in the People′s Hospital of Ningxia Hui Autonomous Region from January 2012 to June 2022 were collected. There were 115 males and 34 females, aged 46(range, 17-68)years. The patients underwent abdominal computed tomography (CT) before surgery and at 1 week, 2 weeks, 1 month, 3 months, 6 months, 1 year, 3 years, 5 years after surgery. The blood vessel diameters in the portal vein system and abdominal visceral artery system were measured after three-dimensional image reconstruction. Measurement data with skewed distribution were represented as M(range). The repeated measured data were analyzed using the generalized linear mixed model, and the marginal mean of the estimated target was expressed as Mean± SE. Simple effects were used to analyze the differences in vascular diameter between pre-surgery and different time points after surgery, and sequential Bonferroni adjusted significance was used for multiple comparisons of marginal means. Results:(1) Changes in diameters of common hepatic artery (CHA), proper hepatic artery (PHA), gastroduodenal artery (GDA) before and after splenectomy. There were significant differences in the diameter change of CHA, PHA and GDA before and after splenectomy ( F=28.66, 29.46, 8.12, P<0.05). The diameter of CHA was thicker at 1 week, 2 weeks, 1 month, 3 months, 6 months, 1 year, 3 years, and 5 years after splenectomy than pre-surgery ( P<0.05). It reached a peak at 1 week after surgery, and then declined slowly and fluctuated. The diameters of PHA and GDA were thicker at 1 week, 2 weeks, 1 month, 3 months, 6 months, 1 year, 3 years, and 5 years after splenectomy ( P<0.05). They reached a peak at 1 month after surgery, and then declined slowly and fluctuated. (2) Changes in diameters of splenic artery (SA), celiac artery (CA), and left gastric artery (LGA) before and after splenectomy. There were significant differences in the diameter change of SA and CA before and after splenectomy ( F=155.33, 66.40, P<0.05). The diameters of SA and CA at 1 week, 2 weeks, 1 month, 3 months, 6 months, 1 year, 3 years, and 5 years after splenectomy were thinner than those before operation ( P<0.05), the changes of which were obvious within 3 months after splenectomy, and then tended to be stable. There was no significant difference in the diameter of the LGA before and after splenectomy ( F=1.07, P>0.05). (3) Changes in diameters of superior mesenteric artery (SMA), right renal artery (RRA), left renal artery (LRA) before and after splenectomy. There were significant differences in the diameter change of SMA, RRA and LRA before and after splenectomy ( F=8.22, 13.21, 10.27, P<0.05). The diameter of SMA at 1 month, 3 months, 6 months, 1 year, and 3 years after splenectomy was thicker than those before operation ( P<0.05). The diameters of both RRA and LRA were thicker at 1 week, 2 weeks, 1 month, 3 months, 6 months, 1 year, 3 years, and 5 years after splenectomy than those before operation ( P<0.05). (4) Changes in diameters of portal vein (PV) and superior mesenteric vein (SMV) before and after splenectomy. There were significant differences in the diameter change of PV and SMV before and after splenectomy ( F=31.74, 2.01, P<0.05). The diameter of PV at 1 week, 2 weeks, 1 month, 3 months, 6 months, 1 year, 3 years, and 5 years after splenectomy was thinner than that before operation ( P<0.05), and there was no significant difference in the diameter of SMV at above time points compared with that before operation ( P>0.05). Conclusions:After splenectomy in patients with cirrhotic portal hypertension, the diameters of PV, SA and CA were reduced, and the diameters of CHA, PHA, GDA and renal artery, superior mesenteric artery were enlarged. These postoperative vessel diameter changes maintain as long as five years.
