ObjectiveTo investigate impact of splenectomy plus pericardial devascularization on liver hemodynamics and liver function for liver cirrhosis patients with portal hypertension. MethodsThe internal diameter, maximum velocity, minimum velocity, mean velocity, and flow volume of portal vein and hepatic artery of 42 cases of liver cirrhosis with portal hypertension were measured by Doppler ultrasonic instrument on day 1 before operation and on day 7 after operation. The free portal pressures at different phases (after open abdomen, after splenic artery ligation, after splenectomy, and after devasculanrization) were read from the disposable pressure sensor. Twenty-four healthy people through physical examination were selected as control. Results① The free portal pressure of liver cirrhosis patients with portal hypertension was decreased from (29.12±1.40) mm Hg after open abdomen to (22.71±1.21) mm Hg after splenic artery ligation, and further decreased to (21.32±1.12) mm Hg after splenectomy, but increased to (22.42±1.15) mm Hg after devasculanrization, the difference was statisticly different (all P < 0.01). ② Compared with the healthy people, for the liver cirrhosis patients with portal hypertension, the internal diameter, maximum velocity, minimum velocity, and flow volume of portal vein were significantly enlarged (all P < 0.01), which of hepatic artery were significantly reduced (all P < 0.01) on day 1 before operation; On day 7 after operation, the internal diameter of portal vein was significantly reduced (P < 0.01), the maximum velocity, minimum velocity, and mean velocity of portal vein were significantly enlarged (all P < 0.01), but the internal diameter of hepatic artery was significantly reduced (P < 0.01), the maximum velocity, minimum velocity, mean velocity, and flow volume of hepatic artery were significantly enlarged (all P < 0.01). For the liver cirrhosis patients with portal hypertension, compared with the values on day 1 before operation, the internal diameter and the flow volume of portal vein were significantly reduced (all P < 0.01) on day 7 after operation; the internal diameter, maximum velocity, minimum velocity, mean velocity, and flow volume of hepatic artery were significantly enlarged (all P < 0.01) on day 7 after operation. ③ The Child-Pugh classification of liver function between before and after surgery had no significant difference (χ2=1.050, P > 0.05). ④ No death and no hepatic encephalopathy occurred, no thrombosis of splenic vein or portal vein was observed on day 7 after surgery. Conclusionsplenectomy plus pericardial devascularization could decrease portal vein pressure and reduce blood flow of portal vein, while increase blood flow of hepatic artery, it doesn't affect liver function.
Objective To defect the level of platelet antibody-IgG (PA-IgG) in patients with congestive splenomegaly and hypersplenism and the change of PA-IgG level after splenectomy and subtotal splenectomy. Methods Twenty four cases of congestive splenomegaly and hypersplenism were investigated. Results The level of PA-IgG in 24 cases were higher than normal range (Ｐ＜0.01), while the platelet count were lower than normal range and there was a significant negative correlation between the level of PA-IgG and platelet count (r＝-0.4747, Ｐ＜0.05). After subtotal splenectomy or splenectomy, the level of PA-IgG descended, the platelet count raised and the negative correlation between the level of PA-IgG and platelet count disappeared. Conclusion The results suggest that there is a immunoregulation between PA-IgG and platelet. Perhaps spleen has some relation with the immunoregulation.
Objective To explore the methods， clinical effects， and application value of laparoscopic splenectomy combined with pericardial devascularization. Methods The clinical data of 23 patients with liver cirrhosis and portal hypertension who performed laparoscopic splenectomy combined with pericardial devascularization between july 2009 and july 2012 in our hospital were analyzed retrospectivly. Results In 23 cases， 2 cases were converted laparotomy due to bleeding， 21 cases were successfully performed laparoscopic splenectomy combined with pericardial devascularization. The operative time was 230-380 minutes （average 290 minutes）. The intraoperative blood loss was 300-1 500 mL （average 620 mL）. The postoperative fasting time was 1-3 days （average 2 days）. The postoperative hospital stay was 8-14 days （average 10 days）. Conclusion Laparoscopic splenectomy combined with pericardial devascularization is a feasible， effective， and safe procedure as well as minimally invasive hence is applicable for patients with portal hypertension and hypersplenism．
Objective To discuss the therapeutic effectiveness of surgical approach to complex intrahepatolithiasis with biliary liver cirrhosis.Methods A case of complex intrahepatolithiasis with biliary liver cirrohosis, portal hypertension was treated with splenectomy and pericardial devascularization plus left hepatectomy and portal cholangio plasty with T tube drainage. Results Follow up one year and a half after operation, no symptom of cholangitis was found, and there is no relapse up to date. Conclusion Combined operation of hepatectomy with splenectomy is an ideal and effective treatment for complex intrahepatolithiasis with biliary liver cirrhosis.
Objective To study the effect of splenectomy on the anti-tumor immunity in rats with induced hepatocellular carcinoma (HCC). Methods At the second and fourth month of the induced HCC, the NK cell activity, TNF-α level and total lymphcyte in blood were measured in the group of splenectomy and the control group. Results There were no different in the total lymphcyte and TNF-α in the blood in two groups, but there were significant difference in the NK cell activity between the group of splenectomy and the control group (Ｐ＜0.05). Conclusion There are some change in the anti-tumor immunity after splenectomy in rats, in which NK cell activity is at low level continuously. TNF-α isn′t affected after the second month after splenectomy.
Objective To approach the prognosis after liver transplantation （LT） of liver function for Child grade A in patients with portal hypertension， and to compare with periesophagogastric devascularization with splenectomy （PDS）. Methods The data of 195 portal hypertension cases with Child A caused by hepatitis B cirrhosis who received surgical treatment of PDS （152 cases） or LT （43 cases） in division of liver transplantation center of West China Hospital of Sichuan University from 1999 to 2011 were retrospectively analyzed. The pre-， intra-， and postoperative variables in two groups that including patients’ age， score of Child， score of model for end-stage liver disease （MELD）， total bilirubin （TB），creatinine （Cr）， international normalized ratio （INR）， albumin （Alb）， complications of portal hypertension， amount of intraoperative bleeding and blood transfusion， operative time， and in the ICU and hospital stay time were compared. The postoperative outcomes were statistically analyzed including severe postoperative complications， short-term and long-term survival rates. Results Compared with PDS group， the amount of intraoperative bleeding and blood transfusion of LT group were morer （P＜0.05）， the operative time， in the ICU and hospital stay time of LT group were longer （P＜0.05）. The rate of severe postoperative complications in LT group was higher than that in PDS group 〔18.60% （8/43） vs. 1.97% （3/152），P＜0.05〕. The levels of TB and Cr during the postoperative period in LT group were higher than that in PDS group （P＜0.05）. Although the INR on day 1 after operation in LT group was higher than that in PDS group （P＜0.01）， but the difference disappeared soon on day 7 after operation in two groups （P＞0.05）.The 1-， 3-， and 5-year survival rates of the LT and PDS groups were 90.3%， 86.5%， 86.5%， and 100%， 100%， 100%， respectively， significant difference were observed in both short-term and long-term survival rates between the two groups （P＜0.05）. Conclusion LT offered no significant survival benefit to patients with portal hypertension and Child A due to hepatitis B cirrhosis， whereas PDS could be an effective treatment.
ObjectiveTo explore the clinical efficacy and experience of laparoscopic partial splenectomy. MethodsThe clinical data of 11 cases of splenic space occupying lesions in the author's hospital from January 2011 to May 2014 were retrospectively analyzed. Laparoscopic partial splenectomy were carried out in 11 patients. ResultsEleven patients were successfully completed the laparoscopic partial resection of spleen. Operative timewas 2.0-3.5 h, the average operative time was (2.5±0.3) h. Intraoperative blood loss was 155-320 mL, the average blood loss was (200.3±55.1) mL. Eleven patients who ride smoothly, there was no case of pancreatic injury, gastrointestinal injury, major bleeding and other complications. Postoperative patients recovered well, 24 h after operation gastrointestinal function recovery, and can get out of bed activities. Silicone drainage tube placement time was 3-5 d, the average for placing time was (4.0±1.3) d. about 60-100 mL, the average (70.3±15.8) mL. The average length in hospital was 5-8 d, patients with an average of (6.3±1.5) d, all of the patients without postoperative complications such as infection, splenic infarction. Postoperative pathologic results suggested 6 cases were spleen hemangioma, 3 cases were pseudocyst of spleen, and 2 cases were true epithelial cyst. Conciusions Laparoscopic partial spleen resection should fully grasp the operative indication, fully understand the pathological changes and the structure of door of the spleen, in earnest and patient, under the operation of laparoscopic spleen resection is safe, feasible, and the clinical curative effect is satisfied, worthy of clinical popularization and application.
Objective To explore the cause, diagnosis, and treatment methods of portal vein thrombosis （PVT） after splenectomy. Methods The clinical data of 29 patients who were got splenectomy because of portal hypertension or traumatic splenic rupture from August 2002 to August 2008 in our hospital were analyzed retrospectively. Results Tweenty-seven patients with PVT were treated successfully, whose thrombi were absorbed completely or partially. One case died of peritonitis，septic shock，and multiple organ failure. One case died of hematemesis, hepatic coma，and multiple organ failure. Tweenty-four patients were followed up, the follow-up time was 0.5 to 3 years, the average was 2 years. Two cases died of massive hemorrhage, 1 case died of hepatic encephalopathy，and 1 case died of liver failure. Two cases occurred deep venous thrombosis in one year after treatment, and the remaining patients had no recurrence of venous thrombosis. Conclusions PVT have some connection with the raise of blood platelet and the hemodynamic changes of the portal vein system after splenectomy. Standardization of operation, early diagnosis, early line anticoagulant，and antiplatelet adhesion therapy are effective way to prevent and treat PVT.
ObjectiveTo investigate clinical application value of totally laparoscopic splenectomy via anterior approach. MethodsThe clinical data of 26 consecutive patients underwent totally laparoscopic splenectomy via anterior approach from March 2012 to June 2015 in this hospital were analyzed retrospectively. There were 11 males and 15 females. These patients included 2 cases of traumatic spleen ruptures, 4 cases of idiopathic thrombocytopenic purpuras, 1 case of hereditary spherocytosis, 3 cases of splenic cysts, 5 cases of autoimmunity hemolytic anemias, 2 cases of splenic hemangioma, 1 case of hematolymphangioma, 8 cases of cirrhosis portal hypertensions. The operative time, intraoperative bleeding, postoperative time to out-of-bed activity, the first flatus/bowel motion time, complications, and hospital stay were analyzed retrospectively. ResultsTwenty-six patients were successfully carried out totally laparoscopic splenectomy via anterior approach. The average operation time was 93 min (72-120 min). The average blood loss was 60 mL (10-80 mL). The postoperative time to out-of-bed activity was 24 h. The first flatus/bowel motion time was 2-3 d. The average hospital stay was 7 d (6-9 d). The postoperative pancreatic fistula (Grade A) occurred in 1 patient, who recovered well on day 6 by postoperative drainage management. After 5-32 months of following-up, all patients recovered smoothly without any long-term complications. ConclusionThe preliminary results of limited cases in this study show that totally laparoscopic splenectomy via anterior approach is feasible, safe, and minimally invasive.
ObjectiveTo explore perioperative management model of ABO-incompatible liver transplantation. MethodsThe clinical data of ABO-incompatible caderveric liver transplantions without urgency performed in our center from July 2006 to May 2010 were analyzed retrospectively. Four patients had received an ABO-incompatible graft: AB to O in three, AB to A in one. All the cases were diagnosed as end-stage liver disese, one of them was primary hepatocellular carcinoma. ResultsFour survived to now （11 to 19 months） without severe infections and acute rejections. Two experienced coagulative disturbance and one of them had a second exploration. One developed acute renal failure and recovered with help under continuous veno-venous hemofiltration. All the cases were given 20 mg basiliximab two hours before revascularization and on day 4 after operation respectively. Splenectomy was performed in three, intravenous immunoglobulin was given in all more than seven days. Isohemagglutinin titers were basically stable and not relevant to the clinical manifestations. Antibiotic prophylaxis and immunosuppression protocol was same as the ABO compatible transplants except a 3-month-delay for steroid withdrawal. ConclusionABO-incompatible liver transplantation could be performed with appropriate perioperative management, such as basiliximab induction, splenectomy, intravenous immunoglobulin administration, and routine immunosuppression.