Clinical Study Of Preoperative Splenic Artery Embolization Assistant With Laparoscopic Splenectomy In The Management Of Patients With Splenomegaly And Hypersplenism Secondary To Portal Hypertension

Objective:Recently,Laparoscopic splenectomy(LS)has been become the gold standard of the normal size or slightly enlarged spleen related disease treatment,however,owning its pathophysiological characteristics,the splenomegaly and hypersplenism secondary to portal hypertension was considered as a relative contraindication of LS.In this study,we compared the clinical data of preoperative splenic artery embolization(SAE)assistant with LS treatment and LS treatment alone on the patients with the splenomegaly and hypersplenism secondary to portal hypertension,to investigate the safety and effectiveness of preoperative SAE assistant with LS treatment.Methods: we collected and analyzed the clinical data of 54 patients with splenomegaly and hypersplenism secondary to portal hypertension admitted to the second affiliated hospital of the third military medical university from April 2012 to December 2015.Among them,24 patients underwent preoperative SAE assistant with LS(the SAE+LS group)and 30 patients underwent LS alone(the LS group).The relevant clinical data of two groups including preoperative data,such as gender,age,length of the spleen and liver function Child-Pugh grade;intraoperative data,such as conversion rate,operative time,intraoperative blood loss,blood transfusion rate and intraoperative blood transfusion volume;postoperative data,such as postoperative gastrointestinal function recovery,oral intake,off-bed ambulate time,postoperative LOS(length of stay),total LOS,postoperative complication rate,postoperative routine blood test and liver function,etc.Based on the analyzation of the above indicators,we systematic evaluated the clinical advantage of the preoperative SAE assistant with LS treatment on the patients with the splenomegaly and hypersplenism secondary to portal hypertension.Results: 1.Intraoperative indicators: The operations of SAE+ LS group were performed successfully on all patients,and no patient required open surgery,while six patients were converted to laparotomy in LS group,the conversion rate was 20%(6/30).Compared with LS group,the operative time of SAE+LS group was shorter(150 ± 29 min vs.210± 40 min,P<0.05),the intraoperative blood loss volume was less(168 ± 58 ml vs.314 ± 87 ml,P<0.05),the blood transfusion rates was lower(8.3% vs.33.3%,P<0.05)and the intraoperative blood transfusion volume was less(200 ± 0 ml vs.410 ± 110 ml,P<0.05),the differences were statistically significant.2.Postoperative indicators: Compared with LS group,the postoperation LOS(5.5 ± 0.6 d vs.7.6 ± 1.3 d,P<0.05)and total LOS(8.0 ± 1.0 d vs.10.1 ± 1.4 d,P<0.05)of SAE+LS group were significantly shortened.However,there were no significant difference in postoperative gastrointestinal function recovery,oral intake,off-bed ambulate time and postoperative complication rate between two groups(P>0.05).3.Routine blood test: Compared with preoperation,the postoperative WBC,PLT were significantly increased in both groups(P<0.05);the postoperative HB were slightly decreased in both groups,but the difference was not statistically significant(P>0.05).Meanwhile,there were no significant difference in postoperative WBC,HB and PLT between two groups(P>0.05).4.Liver function: ALT of the first day and the third day postoperation were significantly higher than that of preoperation in SAE+LS group(P<0.05),ALT of the first day postoperation was significantly higher than that of preoperation in LS group(P<0.05).AST of the first day and the third day postoperation were significantly higher than that of preoperation in both groups(P<0.05).The postoperative ALB were significantly decreased in both groups(P<0.05).The postoperative TBIL and DBIL were slightly increased in both groups,but the differences were not statistically significant(P>0.05).Meanwhile,there were no significant differences in ALT,AST,ALB,TBIL and DBIL between two groups(P>0.05).5.The splenic volume of SAE+LS group after SAE were significantly reduced(1000 ± 434 cm3 vs.664± 323 cm3,P<0.05),the patients' splenic volume was reduced about 33±9 %.Conclusions: 1.Comparing the preoperative SAE assistant with LS treatment and LS treatment alone on splenomegaly and hypersplenism secondary to portal hypertension,preoperative SAE assistant with LS treatment has some advantages,such as lower surgical laparotomy rate,shorter operative time,less bleeding,less intraoperative blood transfusion and shorter LOS,etc.2.Preoperative SAE treatment can reduce the volume of the spleen effectively,increase the visual field of laparoscopic operation,and facilitate the operation of laparoscopic surgery,thereby improve the surgical safety.3.Preoperative SAE assistant with LS was safer and more effective in treating the splenomegaly and hypersplenism secondary to portal hypertension than LS alone.