The Meta- Analysis Of The Subtotal Splenectomy To Treat Portal Hypertension

PURPOSE:To discuss and analyze the effectiveness of the subtotal splenectomy verse total splenectomy with gastroesophageal devascularization to treat these patients with portal hypertension and cirrhosis.METHODS:We retrieved the related literature from Embase,medline,Cochrane Library,CNKI,Pubmed,Chia Info,VIP as for 1 January,2016 and collected the randomized controlled trials of the comparison of the effectiveness of the subtotal splenectomy with the total splenectomy for the patients suffering from the hepatic cirrhosis and portal hypertension. And then,we used the meta-analysis software Rev.Man5.3 to analyze the dates.RESULTS:Ten randomized controlled trials involving 491 patients were identified(The subtotal splenectomy 260 patients,The total splenectomy 231 patients). The results of the comparison for the subtotal splenectomy with the total splenectomy indicated that the subtotal splenectomy were superior to total splenectomy for the serum Tuftsin of post operation(WMD=233.00ng/ml; 95%CI, 123.75~342.25; P <0.0001),the serum Ig M of post operation(WMD=0.49ng/ml;95%CI,0.36~0.63;P < 0.00001),the postoperative platelet(WMD=-47.52×109/l; 95%CI,-59.98~-35.07; P < 0.00001),the postoperative fever( OR=0.08;95%CI,0.01~0.45; P=0.004) and the portal vein thrombosis of post operation(OR=0.29;95%CI,0.10~0.84;P=0.02),while the comparison of the subtotal splenectomy with the total splenectomy for the serum Ig A of post operation(WMD=0.03ng/ml;95%CI,-0.02~0.09;P=0.23), the serum Ig G of post operation(WMD=0.52ng/ml;95%CI,-0.10~1.13;P=0.10),the FPP(WMD=0.07Kpa;95%CI,-0.02~0.16;P=0.11),the postoperative bleeding(OR=0.23;95%CI,0.05~1.10;P=0.07),the postoperative abdominal infection(OR=0.48;95%CI,0.22~1.08;P=0.08)and the Postoperative mortality(OR=0.32;95%CI,0.05~2.08;P=0.23)had no statistical significance.But,the results of the comparison for the subtotal splenectomy with the total splenectomy indicated that the subtotal splenectomy were less than total splenectomy for the leukocyte(WMD=-0.94×109/l; 95%CI,-1.35~-0.54;P<0.0001) and t the values are within the normal range.CONCLUSION:The comparison of the subtotal splenectomy with the total splenectomy manifested that the serum Tuftsin and Ig M of post operation of the former was higher and the postoperative platelet and portal vein thrombosis of post operationand of the former was lower.The subtotal splenectomy contributed to helping patients to hold immune function and reducing the incidence of complications and mortality.