The clinical application of partial splenectomy in advanced schistosomiasis cirrhosis megalosplenia

Abstract

Objective To evaluate the efficacy of partial splenectomy in the treatment of advanced schistosomiasis cirrhosis megalosplenia.Methods 22 patients with advanced schistomiasis megalosplenia were equally divided into two groups at random.11 patients in experimental group were performed partial splenectomy,and another 11 patients in control group were performed splenetcomy,we obeserved splenic nest oozing blood volume of two groups in postoperative 24 hours and detected immunologic quota including tuftsin and IgM of two groups in preoperative and postoperative 50 days respectively.The portal vein flow of two groups' patients were measured in preoperative one week and postoperative one year.Biochemical changes including WBC,Platelet,Liver function were examined in preoperative one week and one month respectively.Patients were revisited for the rate of recurrence of hemorrhage in 5 years and the quality of life.Results The splenic nest oozing blood volume in the control group (600 ± 50) ml is higher than the experimental group (100±25) ml obviously (P ＜0.05).The tuftsin and IgM of the control group in preoperative and postoperative 50 days are detected respectively (278.6 ± 13.80),(2.93 ± 1.42) μg/L and 107.4 ±9.09),(1.45 ±0.41) μg/L,both of the immunologic quota declined evidently.But the detection of experimental group in preoperative 50 days (280.7 ± 14.50),(2.41 ± 1.07) μg/L and postoperative 50 days (277.5 ±7.03),(2.70 ±0.91) μg/L have no decline.Differences between the two groups was significant (P ＜ 0.05).The portal vein flow of the experimental group before operation and in postoperative one year is (1.23 ±0.11) cm2 and (0.85 ±0.15) cm2,and the flow of the contol group before operation and in postoperative one year is (1.19 ±0.18) cm2 and (1.03 ±0.19) cm2.Both of the flow of the two group decreased,and the flow in experimental group is less than in control group.There is no statistical differences in WBC,Platelet,liver function,the rate of recurrence of hemorrhage in 5 years and the quality of life between two groups.Conclusion Partial splenectomy is feasible in the treatment of advanced schistosomiasis cirrhosis megalospleni.It can reduce the oozing bleeding and the risk of operation,retain the immunologic function of spleen and prevent overwhelming poste-splenectomy infection (OPSI).The operation can play a role of spontaneous shunts. Key words: Partial splenectomy ; Advanced schistosomiasis cirrhosis ; Megalosplenia ; Clinical application