A Retrospective Clinical Study On Spleen Preserving Selective Devascularization Combined With Proximal Spleno-renal Shunt Bridge

Research background:Portal hypertension(PHT),one of common and frequently-occurring diseases,often results in massive hemorrhage of gastrointestinal tract,thus posing a serious threat to the lives and health of patients.With a broad range of pathogens of post-hepatitis B liver cirrhosis,the incidence of PHT remains high in China.At present,outpatient surgical procedures are important methods in treating PHT.Common surgical methods include portasystemic shunt(PSS),gastroesophageal devascularization(GD)and PSG+GD.In general,clinical operations require splenectomy.Although the spleen is not a necessary organ to sustain human life,it still plays an important role in anti-infection immunity.Whether spleen preserving selective devascularization combined with proximal spleno-renal shunt has better efficacy for patients is worth exploring.Objective:To explore the efficacy of spleen preserving selective devascularization combined with proximal spleno-renal shunt and its effect on immune system by comparative analysis of the intraoperative and postoperative conditions of patients undergoing spleen preserving selective devascularization combined with proximal spleno-renal shunt bridge(spleen preserving combined surgery)and spleen removing selective devascularization combined with proximal spleno-renal shunt(spleen removing combined surgery)respectively in our hospital.Methods:The clinical data on 68 patients undergoing surgical procedures for the treatment of PHT at the department of hepatobiliary surgery in our hospital from October 2010 to May 2015.These patients were divided into two groups: spleen preserving combined surgery group(group A,31 cases)and spleen removing combined surgery group(group B,37 cases).Data on relevant cases were collected to compare thesetwo groups in terms of duration of operation,intraoperative blood loss,intraoperative free portal pressure(FPP),post-operative complications,etc.Rehaemorrhagia,death,hepatic encephalopathy and portal vein thrombosis of both groups were assessed by one-year follow-up.Differences in liver function,white blood cells and platelet of both groups after operation were detected.Furthermore,the levels of immune Ig A,Ig M and Ig G,C3 and C4,T cell subgroups(CD3~+,CD4~+,CD8~+ and CD4~+/CD8~+)were determined.Experimental data were analyzed by SPSS22.0 statistical software.The level of statistical significance was set at p<0.05.The intragroup difference of measurement data was detected with T-test,with two-tailed ?=0.05 as the test level;measurement data was detected with chi-square test,with ?=0.05 as the test level.Results:General conditions: both groups showed no statistically significant differences in gender,age distribution,etiologic classification,history of upper gastrointestinal hemorrhage and Child-Pugh classification.Intraoperative conditions: the average duration of operation of group B was longer than that of group A(P<0.05),and the average blood loss of group B was higher than that of group A(P<0.05),showing statistically significant differences.Postoperative conditions: these two groups showed no statistically significant difference in free portal vein pressure.Various liver function indexes after two weeks were decreased than those before operation and these returned to normal level six months later,showing statistically significant differences(P<0.05).Group B showed a more significant decline in TBIL level after operation than group A(P<0.05).There were no statistically significant differences in incidences of postoperative complications,but the incidence of postoperative portal vein thrombosis in group B was higher than group A(P<0.05).The levels of white blood cell and platelet were obviously increased in both groups after operation,but they returned to normal 4weeks later.After 1 years of follow-up,the number of white blood cells and platelets were normal in the two groups.The levels of CD8~+ in both groups after operation were higher than those before operation(P<0.05),while that in group B was higher than that in group A(P<0.01).The levels of CD3~+,CD4~+,CD8+ and CD4~+/CD8~+ ingroup A after operation had no great changes,showing no statistically significant differences(P>0.05).The levels of CD3~+ and CD4~+/CD8~+ in group B after operation were decreased than those before operation,showing statistically significant differences(P<0.05).The levels of Ig M and C3 after operation in group A were increased than those before operation(P<0.05),while the level of Ig M in group B was decreased than that before operation(P<0.01).The levels of Ig M and C3 after operation in group A were higher than those in group B,showing statistically significant differences(P<0.01).Conclusion:Spleen preserving selective devascularization combined with proximal spleno-renal shunt bridge has good short-term in treating PHT and maintains good immune function of the body.Long term efficacy needs to be further observed and followed up.Thus,such surgical method is safe and feasible in clinic.