Splenectomy plus periesophagogastric devascularization in the treatment of cirrhotic patients with portal hypertention and splentic artery steal syndrome
10.3760/cma.j.issn.1007-8118.2018.05.005
- VernacularTitle:脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压合并脾动脉盗血综合征
- Author:
Long HUANG
1
;
Qingsheng YU
;
Jiajia WANG
Author Information
1. 安徽中医药大学第一附属医院普外科
- Keywords:
Cirrhosis;
Portal hypertension;
Hypersplenism;
Hemodynamics;
Devascularization
- From:
Chinese Journal of Hepatobiliary Surgery
2018;24(5):304-308
- CountryChina
- Language:Chinese
-
Abstract:
Objective To study the hemodynamic changes before and after splenectomy plus periesophagogastric devascularization in patients with splenic artery steal syndrome (SASS) so as to provide a theoretical basis for the treatment of portal hypertension concomitant with hypersplenism.Methods The database of 30 patients who underwent splenectomy plus devascularization from January 2015 to January 2017 was studied retrospectively.Color Doppler ultrasound was performed to detect hemodynamic changes in the hepatic artery,splenic artery,splenic vein and portal vein in patients with portal hypertension and in healthy controls.The outcomes between preoperative and postoperative biochemical indicators were compared.Results The hemodynamic indexes of splenic artery,splenic vein and portal vein in the study group were significantly higher than those in the control group (P ＜ 0.05).The peak systolic velocity [(35.3 ± 5.1) cm/s vs.(53.1 ±7.0) cm/s] and blood flow [(175.9 ±30.5) ml/min vs.(297.0 ±48.3) ml/min)] of the hepatic artery were significantly lower than those of the control group (P ＜ 0.05).The peak systolic velocity [(60.7 ± 11.9) cm/s vs.(35.3 ±5.1) cm/s] and blood flow [(388.8 ±79.6) ml/min vs.(175.86 ±30.46) ml/min] of the hepatic artery increased significantly after operation (P ＜ 0.05).After splenectomy,the levels of the leucocyte [(7.9 ± 3.8) × 109/L vs.(2.8 ± 1.4) × 109/L)],thrombocyte [(491.3±194.9) × 109/L vs.(47.4 ± 16.0) × 109/L)],bilirubin [(15.0 ± 10.6) μmol/L vs.(24.4±13.8) μmol/L)] and transaminase [(32.94±8.57) U/L vs.(43.37 ±16.59) U/L)] recovered when compared with the preoperative data (P ＜ 0.05).Conclusions SASS was detected in cirrhotic patients who had portal hypertension concomitant with hypersplenism.Splenectomy plus periesophagogastric devascularization were effective and safe for cirrhotic patients with hypersplenism and concomitant esophageal and gastric variceal bleeding.
