| Hypersplenism is a syndrome, the clinical manifestations of which is Splenomegaly, one or more types of blood cells decrease and bone marrow hematopoietic cells in a corresponding proliferation. Hypersplenism is divided into two kinds of primary and secondary. Portal hypertension caused by decompensated liver cirrhosis is the most common cause as a secondary hypersplenism, which easily leads to infection and bleeding, and also affected the antiviral drugs (such as interferon) applications. Medical drug treatment had little effect. Splenectomy as the traditional surgical treatment can make the peripheral blood cells increase, but the big trauma, postoperative complications, and high perioperative mortality rate triggered search for the new therapeutic approaches.Partial splenic embolization (PSE) can achieve similar therapeutic effect compared with splenectomy, adverse reactions after PSE is light and few, and the spleen immune function is retained. Partial splenic artery embolization which has been referred to as "functional splenectomy" is widely used in clinic. Objective:To evaluate the efficacy and complications of partial splenic embolization (PSE) used in hypersplenism with liver cirrhosis.Methods:To randomly select 47 patients of hypersplenism with liver cirrhosis which PSE was used in, and splenectomy was used in 41 patients in the Sino-Japanese Friendship Hospital of Jilin University from July 2007 to December 2009.To evaluate the efficacy and complications of partial splenic embolization (PSE)in liver cirrhosis by the observation of peripheral blood WBC, RBC, Hb, PLT count, the portal vein width, splenic vein width, spleen thickness, spleen long trial under abdominal color Doppler ultrasound, and adverse reactions after PSE or splenectomy.Results:To compare the periphery hemogram before and after partial splenic embolization. The white blood cells begin to increase at 3 days past PSE,and reach to normal level. The difference was statistically significant. platelets begin to increase at 3 days past PSE, and statistically significant was shown at 5 days past PSE,then reach to normal level at 7 days past PSE. But the peripheral red blood cells and hemoglobin had no significant increase compared with the preoperative . While the difference of the white blood cells and platelets before and after PSE was significantly less than splenectomy. Splenic vein diameter was lower than that before PSE, and there was statistically significant, while the portal vein diameter, spleen thickness, spleen long trial had no significant change .The results had no statistically significant between two groups.The most commonly postoperative adverse events were abdominal pain, fever, and 2 cases of surrounding spleen effusion, 1 case of hepatic encephalopathy.The incide- nce rate of abdominal pain and fever between the two groups had no statistically significant, but the visual analogue scale of the abdominal pain after splenectomy was higher than the PSE group, and the heating time and heat levels were significantly higher than PSE. In addition, the incidence rate of postoperative surrounding spleen effusion and pleural effusion in splenectomy group was significantly higher than the PSE group.Discussion:Partial splenic artery embolization (PSE) can cause partial splenic tissue embolism, necrosis, liquefaction, absorption, shrinkage, and eventually replaced by fibrous tissue, so that can reduce spleen size, weaken the ability of the spleen engulffing and destroying blood cells, and can reduce the splenic vascular bed, retention of blood cells, thereby can increase the peripheral blood cells count. The comparison of peripheral blood cells count preoperative and postoperative can directly evaluate the efficacy. Many studies have shown that white blood cells and platelets in patients after PSE compared with preoperative increased, but red blood cells and hemoglobin had no significant difference. In addition, the partial splenic artery embolization can improve hemodynamics, can reduce spleen size, splenic vein, portal vein and spleen blood flow ,and lower portal pressure. This study showed that the white blood cells begin to increase at 3 days past PSE,and reach to normal level. The difference was statistically significant. platelets begin to increase at 3 days past PSE, and statistically significant was shown at 5 days past PSE,then reach to normal level at 7 days past PSE. But the peripheral red blood cells and hemoglobin had no significant increase compared with the preoperative . Consistent with other studies, this study suggestted that partial splenic artery embolization is effective. This study cann't implement peripheral blood cells level change by the time because of limited follow-up. The results of statistical analysis of peripheral blood cells after splenectomy was in line with the PSE group. This study also analysised the difference of the white cell and platelet before and after surgery ,and found that the change in splenectomy group was statistically significant. But other studies have shown that white blood cell count increased significantly after partial splenic artery embolization compared to splenectomy.The authors analyzed this result may be related to the defense mechanisms of body for the embolizated spleen.while the white blood cells after splenectomy in this study increased significantly , no consistent with other studies, and we consider this may be related to postoperative infection. With regard to hemodynamics study, the postop- erative splenic vein in PSE groups reduced compared with that preoperative, and there was statistically significant.While the portal vein diameter, spleen thickness, spleen length had no significant change. The splenic vein diameter changement before and after operation between the two groups had no statistical difference.That the portal vein diameter in this study was inconsistent with other studies may be related to a small number of cases and short follow-up time. Failure to observe the dynamic changes and long-term effects because of defects of follow-up. In this study, the most commonly adverse reactions after partial splenic artery embolization were abdominal pain, fever, also spleen surrounding fluid in 2 cases, hepatic encephalopathy in 1 case.In this study, abdominal pain which mostly occured in the first postoperative day can last for 1 day to 1 month, most tolerable, severe pain can alleviate after anagesic treatment, and very rarely needed to use pain pump. The fever mostly appeared in 2 to 3 days after PSE, generally no more than 2 weeks, and may be related to the absorption of tissue, while a few may be accompanyed by infection because of the proportion of neutrophils increased after operation. Nausea and vomiting were mild, and can alleviate by symptomatic treatment. Many studies have shown that adverse reactions after partial splenic artery embolization can also be pneumonia, atelectasis, pleural effusion, peritonitis, liver damage, pancreatitis, renal failure, splenic vein thrombosis and gastrointestinal bleeding, and some may need surgical treatment . while pancreatic branch embolization of splenic artery was potentially life-Threatening, so we required to master the vascular anatomy in order to try to avoid. In this study, no such complications. Studies have shown that adverse reactions after partial splenic artery embolization was related to the area of embolization and liver function classification. In this study ,area of embol- ization approximately the same as 30-50%. Therefore, we consider a variety of adverse reactions may be related to liver function classification. Abdominal pain and fever had statistically significant among the liver function in child-pugh classification A, B, C grade. Surrounding spleen effusion and hepatic encephalopathy had no statistically analysis due to low number of cases. Surrounding spleen effusion occurred in liver function in child-pugh classification A, B grade each one, and hepatic encephalopathy occurred in grade B one case. In the splenectomy group, abdominal pain and fever was also common, and their incidence rate had no statistical difference compared with the PSE group.However, fever lastting time was significantly longer in splenectomy group compared with the PSE group ,also body temperature higher, and there were ststistical significant. This result may be ralated to the following two factors: 1. Splenectomy trauma was relatively large,and easy-secondary postoperative infection; 2.PSE Group retained splenic immune function, so can prevent serious infections. Moreover, abdominal pain in the splenectomy group lastted for a few days shorter than the PSE Group.This finding may because that post-splenectomy abdomina pain come from incision, and the incision most healed well no more than 1 week,then the abdominal pain relieved.While and abdomina pain after partial splenic artery embolization come from splenic infarction and splenic costed tension, so it lasted longer. Another obvious difference between the two groups was that the incidence tate of surrounding spleen effusion, ascites and pleural effusion in splenectomy group was significantly higher than the PSE group.We consider this may because of the bigger trauma. The pleural effusion which can alleviate by symptomatic treatment was commonly reactive, mostly on the left, and may be related to restricted breathing movement.Conclusion:The peripheral leukocyte and platelet was significantly higher than that before partial splenic artery embolization ,and the white blood cells begin to increase at 3 days past PSE,and reach to normal level. The difference was statistically significant. platelets begin to increase at 3 days past PSE, and statistically significant was shown at 5 days past PSE,then reach to normal level at 7 days past PSE.But the peripheral red blood cell and hemoglobin had no significant change compared with that before PSE. While the difference of the white blood cells and platelets before and after PSE was significantly less than splenectomy. Partial splenic artery embolization can improve the blood flow dynamics, can make splenic vein diameter decreased, while the portal vein diameter, spleen thickness, spleen long trial had no significant change , consistent with the splenectomy group.The most commonly postoperative adverse events were abdominal pain, fever, and surrounding spleen effusion ,hepatic encephalopathy were rare, no other serious adverse reactions. The incidence rate of abdominal pain and fever between the two groups had no statistically significant, but the visual analogue scale of the abdominal pain after splenectomy was higher than the PSE group, and the heating time and heat levels were significantly higher than PSE. In addition, the incidence rate of surrounding spleen effusion and pleural effusion in splenectomy group was significantly higher than the PSE group.Moreover,the expenditure of partial splenic artery embolization is higher than splenectomy.
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