Changing rules of free portal pressure and influencing factors after splenectomy combined with pericardial devascularization

Abstract

Objective To summarize the changing rules of free portal pressure (FPP) after splenectomy combined with pericardial devascularization and investigate its influencing factors. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 55 patients with portal hypertension who were admitted to the People′s Hospital of Ningxia Hui Autonomous Region from January 2016 to September 2018 were collected. There were 39 males and 16 females, aged from 17 to 67 years, with a median age of 46 years. FPP was measured using CT portal vein angiography before splenectomy and intraoperative manometry after cantheterization to the right gastroepiploic veins. Observation indicators: (1) comparison between intraoperative and postoperative FPP; (2) dynamic changes of FPP at the seventh postoperative day; (3) comparison of FPP before and after Valsalva manoeuvre; (4) relationship of FPP with mean arterial pressure and heart rate. Measurement data with normal distribution were represented as Mean±SD. Repeated measurement data were analyzed using repeated ANOVA. Paired data were analyzed by the paired t test. The linear correlation analysis was done for relevance. Results (1) Comparison between intraoperative and postoperative FPP: 55 patients underwent open splenectomy combined with pericardial devascularization. The FPP before splenectomy, after splenectomy combined with pericardial devascularization intraoperatively, at the first and the seventh day postoperatively was (34±6)cmH2O (1 cmH2O=0.098 kPa), (28±6)cmH2O, (34±5)cmH2O and (30±5)cmH2O, respectively, showing a statistically significant difference (F=43.23, P<0.05). The FPP before splenectomy was statistically significant different from the FPP after splenectomy combined with pericardial devascularization intraoperatively, at the first and the seventh day postoperatively, respectively (P<0.05). The FPP after splenectomy combined with pericardial devascularization intraoperatively was statistically significant different from the FPP at the first and the seventh day postoperatively, respectively (P<0.05). There was a statistically significant difference between FPP at the first and the seventh day postoperatively (P<0.05). (2) Dynamic changes of FPP at the seventh postoperative day: the FPP was (30±5)cmH2O, (29±5)cmH2O, (29±5)cmH2O, (29±5)cmH2O, (28±5)cmH2O, (28±5)cmH2O, (28±5)cmH2O, (29±5)cmH2O, (29±5)cmH2O, (30±5)cmH2O, (30±5)cmH2O, (30±5)cmH2O, (31±5)cmH2O, (31±5)cmH2O, (31±5)cmH2O, (31±5)cmH2O, (31±5)cmH2O, (32±5)cmH2O, (31±5)cmH2O, (31±5)cmH2O, (31±5)cmH2O, (31±5)cmH2O, (30±5)cmH2O, (30±5)cmH2O from 00∶00 to 24∶00 at the seventh day postoperatively. Level of FPP was higher from 12∶00 to 21∶00 and lower from 01∶00 to 08∶00, with a peak value at 17∶00 and valley value from 04∶00 to 06∶00. (3) Comparison of FPP before and after Valsalva maneuvre: the FPP was (30±5)cmH2O and (32±5)cmH2O before and after Valsalva manoeuvre, respectively, showing a statistically significant difference (t=82.72, P<0.05). (4) Relationship of FPP with mean arterial pressure and heart rate. Linear correlation analysis showed positive correlations of FPP with mean arterial pressure and heart rate respectively, but the correlation was not significant (r=0.10, 0.16, P<0.05). Conclusions FPP can be reduced significantly after splenectomy combined with pericardial devascularization intraoperatively and it rises briefly again after operation. FPP has regularly circadian fluctuations and is significantly increased by Valsalva Manoeuvre. There is a positive correlation of FPP with mean arterial pressure and heart rate respectively, but the correlation is not significant. Key words: Portal hypertension; Splenectomy; Devascularization; Free portal pressure change; Influencing factors; Valsalva Manoeuvre