Analysis Of Risk Factors And Management Of Severe Hemorrhage After Splenectomy

Background and purposeSplenectomy is one of the most common operations in general surgery,and is widely used in spleen-related-diseases,such as:spleen trauma,spleen tumors(including benign tumors such as hemangiomas,spleen cysts,etc,and malignant tumors such as lymphoma,sarcoma,etc),local infection of the spleen,and congestive splenomegaly due to intrahepatic portal hypertension with hypersplenism,or extrahepatic portal hypertension(such as splenic aneurysms,splenic arteriovenous fistula,and splenic vein thrombosis,etc),as well as hypersplenism caused by blood system diseases.The current splenectomy methods include traditional open splenectomy,laparoscopic splenectomy,and robotic splenectomy.The scope of resection includes total splenectomy and partial splenectomy.Common complications after splenectomy include abdominal complications(such as postoperative abdominal hemorrhage,sub-diarrheal abscess,postoperative acute pancreatitis,etc),pulmonary complications(such as atelectasis,pulmonary infection,etc),and other complications(splenic phlebitis,thromboembolism complications,and overwhelming post splenectomy infection(OPSI)).Postoperative abdominal hemorrhage after splenectomy is a complication with a relatively low incidence but a high mortality,and most of the events occur within 24 hours after surgery.Slightly bleeding can generally be improved by conservative methods including coagulation factors supplyment,blood transfusion,application of hemostatic drugs and symptomatic treatment.However,severe hemorrhage in a short period of time after surgery can cause hemodynamic disorders,hemorrhagic shock,and even life-threatening complications.At this time,secondary surgery is often required to treat the hemorrhage.This study investigated the risk factors and treatment measures of hemorrhage after splenectomy by observing the basic information and case characteristics of splenectomy cases.Methods:A retrospective analysis of 387 cases of splenectomy performed in The First Affiliated Hospital of Zhengzhou University from 2013 to 2019,including general information,preoperative examination data,postoperative bleeding and treatment measures.The purpose is to summarize the major risk factors related to postoperative hemorrhage in splenectomy.Results:All 387 patients underwent splenectomy successfully,of which 25 patients(6.4%)experienced postoperative hemorrhage,and no case ended in death.Among the postoperative hemorrhage cases,17 cases occured within 24 hours after operation(including 4 cases within 6 hours,2 cases in 6-12 hours,and 11 cases in 12-24 hours),4 cases occured in 24 hours to 3 days after the operation,and 4 cases occured after 3 days.All hemorrhage cases were successfully subjected to a second laparotomy.Intraoperative exploration revealed 8 cases of the bleeding occured in the spleen stump,8 cases occured in the spleen fossa and wounds,3 cases occured in diaphragm,1 case occured in omental vessels,and 3 cases occured in the abdominal wall(1 case occured in the muscle,2 cases occured in the laparoscopic conus),and 2 cases were negative in the exploration.All cases were treated successfully by compression and suture during the operation.The two cases with negative detection were sutured at suspicious place.The univariate analysis showed that the patient's gender,spleen volume,preoperative platelets,preoperative plasma prothrombin time,history of hypertension,history of diabetes,history of coronary heart disease,type of primary disease,and liver function were probable risk factors related to postoperative hemorrhage(p<0.05),and the multivariate analysis showed that the degree of abnormal liver function and spleen volume were independent risk factors.The estimated OR values were 1.001,0.096(slightly impaired liver function compared with normal liver function),9.515(moderately impaired liver function compared with normal liver function),the 95%confidence intervals of OR were(1.049-1.655),(0.008-1.132),and(1.270-71.312).Conclusion:The postoperative hemorrhage in splenectomy might relate to the patient's gender,spleen volume,preoperative platelet,preoperative plasma prothrombin time,history of hypertension,history of diabetes,history of coronary heart disease,type of primary disease and liver function.The degree of impaired liver function and spleen volume are independent risk factors of postoperative hemorrhage.