In situ subtotal spleen resection combined with selective pericardial devascularization for the treatment of portal hypertension  

作　　者：Hai-Lin Li Shang-Lei Ning Yan-Jing Gao Tao Zhou Yu-Xin Chen 

机构地区：[1]Department of Hepatobiliary Surgery,General Surgery,Qilu Hospital of Shandong University,Jinan 250012,Shandong Province,China [2]Department of Gastroenterology,Qilu Hospital of Shandong University,Jinan 250012,Shandong Province,China

出　　处：《World Journal of Gastrointestinal Surgery》2023年第4期634-642,共9页世界胃肠外科杂志（英文版）（电子版）

基　　金：Supported by Chinese Postdoctoral Science Foundation,No. 2022M711911

摘　　要：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 wer

关 键 词：Subtotal splenectomy Portal hypertension Surgical treatment Splenic function Selective pericardial devascularization 

分 类 号：R657.6[医药卫生—外科学]