Modified splenic arterial embolization plus laparoscopic splenectomy in the management of patients with splenomegaly and hypersplenism secondary to portal hypertension

Abstract

Objective To investigate the safety and effectiveness of modified splenic arterial embolization (SAE) plus laparoscopic splenectomy (LS) in patients with splenomegaly and hypersplenism se-condary to portal hypertension. Methods The clinical data of 54 patients with splenomegaly and hypersplenism secondary to portal hypertension admitted to the Xinqiao Hospital of the Third Military Medical University from April 2012 to December 2015 were collected and retrospectively analyzed. 24 patients underwent modified splenic arterial embolization plus LS (the SAE+ LS group), and 30 patients underwent LS alone (the LS group). The postoperative surgical outcomes between the two groups were compared. Continuous data were analyzed using the t test, and categorical data were analyzed using the Chi-square test. Results The modified splenic arterial embolization plus LS was performed successfully in all the patients in the SAE+ LS group, and no patient required open surgery. Six patients in the LS group were converted to laparotomy. A shorter operative time [(150±29) min vs. (210±40) min, t=-6.098, P<0.05], less intrao-perative blood loss [(168 ± 58) ml vs. (314 ± 87) ml, t=-6.981, P<0.05], and shorter postoperative hospitalization stay [(5.5 ± 0.6) d vs. (7.6 ± 1.3) d, t=-6.797, P<0.05] in the SAE+ LS group were observed when compared with the LS group. There were no significant differences in postoperative complication rates, postoperative gastrointestinal function recovery, oral intake and off-bed activity times between the two groups. Conclusion The modified splenic arterial embolization plus LS was safer and more effective in treating splenomegaly and hypersplenism secondary to portal hypertension than LS alone. Key words: Splenic artery embolization; Laparoscopic splenectomy; Splenomegaly; Hypersplenism; Portal hypertension