Splenectomy plus periesophagogastric devascularization in the treatment of cirrhotic patients with portal hypertention and splentic artery steal syndrome

Abstract

Objective To study the hemodynamic changes before and after splenectomy plus periesophagogastric devascularization in patients with splenic artery steal syndrome (SASS) so as to provide a theoretical basis for the treatment of portal hypertension concomitant with hypersplenism. Methods The database of 30 patients who underwent splenectomy plus devascularization from January 2015 to January 2017 was studied retrospectively. Color Doppler ultrasound was performed to detect hemodynamic changes in the hepatic artery, splenic artery, splenic vein and portal vein in patients with portal hypertension and in healthy controls. The outcomes between preoperative and postoperative biochemical indicators were compared. Results The hemodynamic indexes of splenic artery, splenic vein and portal vein in the study group were significantly higher than those in the control group (P<0.05). The peak systolic velocity [(35.3±5.1) cm/s vs. (53.1±7.0) cm/s] and blood flow [(175.9±30.5) ml/min vs. (297.0±48.3) ml/min)] of the hepatic artery were significantly lower than those of the control group (P<0.05). The peak systolic velocity [(60.7±11.9) cm/s vs. (35.3±5.1) cm/s] and blood flow [(388.8±79.6) ml/min vs. (175.86±30.46) ml/min] of the hepatic artery increased significantly after operation (P<0.05). After splenectomy, the levels of the leucocyte [(7.9±3.8)×109/L vs. (2.8±1.4)×109/L)], thrombocyte [(491.3±194.9)×109/L vs. (47.4±16.0)×109/L)], bilirubin [(15.0±10.6) μmol/L vs. (24.4±13.8) μmol/L)] and transaminase [(32.94±8.57) U/L vs. (43.37±16.59) U/L)] reco-vered when compared with the preoperative data (P<0.05). Conclusions SASS was detected in cirrhotic patients who had portal hypertension concomitant with hypersplenism. Splenectomy plus periesophagogastric devascularization were effective and safe for cirrhotic patients with hypersplenism and concomitant esophageal and gastric variceal bleeding. Key words: Cirrhosis; Portal hypertension; Hypersplenism; Hemodynamics; Devascula-rization