Splenectomy For Portal Hypertension Research Articles

Early mobilization and delayed arterial ligation (EMDAL) as a surgical technique for splenectomy and shunt surgery in portal hypertension.

Splenectomy is the most frequently performed procedure as definitive management or as part of shunt surgery or devascularization in portal hypertension. Splenectomy is technically challenging because of the frequent coexistence of multiple collateral varices, splenomegaly, poor liver function, and thrombocytopenia. Early arterial ligation and late mobilization (EALDEM) is the traditional method for splenectomy in portal hypertension. Early spleen mobilization offers good control of the hilum. We aim to compare the effect of the early mobilization and delayed arterial ligation (EMDAL) technique with that of the conventional splenectomy technique in patients with portal hypertension. During the study period from September 2011 to September 2022, 173 patients underwent surgical intervention for portal hypertension at our institution. Among these patients, 114 underwent the conventional method of splenectomy (early arterial ligation and late splenic mobilization) while 59 underwent splenectomy with the EMDAL technique. Demographics were compared between the two groups. Intraoperative and postoperative outcomes were analyzed using the Mann-Whitney test in each group. A minimum follow-up of 12 months was performed in each group. Demographics and type of surgical procedure were comparable in the two surgical method groups. Median blood loss was higher in the conventional group than in the EMDAL method. The median duration of surgery was comparable in the two surgical procedures. Clavien-Dindo grade III/IV complications were reported more frequently in the conventional group. The splenic hilum can be controlled well and bleeding can be minimised with early mobilization and delayed arterial ligation.

Clinical efficacy of total laparoscopic splenectomy for portal hypertension and its influence on hepatic hemodynamics and liver function.

The liver hemodynamic changes caused by portal hypertension (PH) are closely related to various complications such as gastroesophageal varices and portosys-temic shunts, which may lead to adverse clinical outcomes in these patients, so it is of great clinical significance to find treatment strategies with favorable clinical efficacy and low risk of complications. To study the clinical efficacy of total laparoscopic splenectomy (TLS) for PH and its influence on hepatic hemodynamics and liver function. Among the 199 PH patients selected from October 2016 to October 2020, 100 patients [observation group (OG)] were treated with TLS, while the remaining 99 [reference group (RG)] were treated with open splenectomy (OS). We observed and compared the clinical efficacy, operation indexes [operative time (OT) and intraoperative bleeding volume], safety (intraperitoneal hemorrhage, ascitic fluid infection, eating disorders, liver insufficiency, and perioperative death), hepatic hemodynamics (diameter, velocity, and flow volume of the portal vein system), and liver function [serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), and serum total bilirubin (TBil)] of the two groups. The OT was significantly longer and intraoperative bleeding volume was significantly lesser in the OG than in the RG. Additionally, the overall response rate, postoperative complications rate, and liver function indexes (ALT, AST, and TBil) did not differ significantly between the OG and RG. The hepatic hemodynamics statistics showed that the pre- and postoperative blood vessel diameters in the two cohorts did not differ statistically. Although the postoperative blood velocity and flow volume reduced significantly when compared with the preoperative values, there were no significant inter-group differences. TLS contributes to comparable clinical efficacy, safety, hepatic hemodynamics, and liver function as those of OS in treating PH, with a longer OT but lesser intraoperative blood loss.

Postoperative Outcomes Following a Modified Method of Surgical Division of the Splenic Pedicle in 719 Patients During Splenectomy for Portal Hypertension: A 12-Year, Retrospective, Single-Center Study.

BackgroundPortal hypertension associated with liver cirrhosis can be treated by splenectomy. During splenectomy, the gastrosplenic and the splenorenal ligaments that form the hilar splenic pedicle can be surgically divided by several approaches, with the aim to reduce portal vein thrombosis (PVT) and postoperative pancreatic fistula (PPF). This 12-year retrospective study from a single center aimed to evaluate postoperative outcomes following use of a modified method of surgical division of the splenic pedicle (MSDSP) in 719 patients who underwent splenectomy for portal hypertension (PH).Material/MethodsFrom January 2010 to December 2021, 719 consecutive cirrhotic patients with PH and splenomegaly underwent splenectomy in our department. According to different methods of surgical division of the splenic pedicle, patients were divided into a Control Group (n=349) and a Study Group (n=370). The characteristics of the patients, perioperative indicators, postoperative complications (PVT, PPF and abdominal hemorrhage) and follow-up data were compared between the 2 groups. Propensity score matching was conducted to adjust for differences in preoperative characteristics at a 1: 1 ratio, resulting in 260 patients in each group.ResultsAfter PSM was conducted, intraoperative blood loss, PVT, PPF, and hospital stay were decreased significantly in the matched Study Group (all P<0.01). Both groups showed similar results concerning recurrent esophagogastric variceal bleeding and overall survival during the follow-up period.ConclusionsOur MSDSP help to reduce postoperative complications and shorten hospital stay.

Risk Factors for Hepatocellular Carcinoma After Splenectomy in Liver Cirrhotic Patients.

Splenectomy is sometimes indicated for portal hypertension caused by cirrhosis, which is a risk for hepatic carcinogenesis. This study aimed to identify risk factors for hepatocellular carcinoma (HCC) development after splenectomy. This retrospective study included 65 patients who underwent splenectomy for portal hypertension between 2009 and 2017. Cox regression analyses were performed to identify factors related to HCC development after splenectomy. The predictive index for HCC development was constructed from the results of multivariate analysis, and 3 risk-dependent groups were defined. Discrimination among the groups was estimated using Kaplan-Meier curves and the log-rank test. Post-splenectomy, 36.9% of patients developed HCC. In the univariate analysis, the etiology of cirrhosis (hepatitis C virus antibody, P = .005, and hepatitis B surface antigen, P = .008, referring to non-B and non-C patients, respectively), presence of HCC history (P < .001), and preoperative hemoglobin level (P = .007) were related to HCC development, and the presence of HCC history (P = .002) and preoperative hemoglobin level (P = .022) were independent risk factors. The predictive index classified three groups at risk; the hazards in each group were significantly different (low vs middle risk, P = .035, and middle vs high risk, P = .011). The etiology of cirrhosis, presence of HCC history, and hemoglobin level were associated with HCC development after splenectomy. The predictive model may aid in HCC surveillance after splenectomy for patients with portal hypertension.

Dextranum in Combination with Low-Molecular-Weight Heparin Prevents the Portal Vein Thrombosis after Splenectomy for Portal Hypertension

This study aimed to explore the effect of dextranum in combination with low-molecular-weight heparin on the prevention of portal vein thrombosis after splenectomy for portal hypertension. Between February 2015 and February 2019, we enrolled 128 liver cirrhosis patients with portal hypertension as the subjects which were later divided randomly into the observation group and the control group, with 64 patients in each group. All patients received the splenectomy in combination with the esophagogastric devascularization. Following the surgery, dextranum was given to the patients in two groups for prevention of portal vein thrombosis, while those in the observation would additionally took low-molecular-weight heparin for prophylaxis of portal vein thrombosis. After medication, incidence of portal vein thrombosis after surgery was recorded, and at 1 d and 14 d after surgery, the platelet count in peripheral blood was also detected; furthermore, we recorded the condition of patients in preventive anti-coagulation treatment, oral administration of enteric-coated aspirin, postoperative hospitalization days and the incidence of complications, including gastrointestinal bleeding and liver failure, within 3 mo after operation. In the observation group, the incidence rate of postoperative portal vein thrombosis was 9.37 %, significantly lower than 31.25 % in the control group (p<0.05), while the difference in the platelet count test at 1 d after operation showed no statistical significance (p>0.05), and the platelet count test showed an increasing trend at 14 d after operation (p<0.05); however, the intergroup comparison showed no significant difference (p>0.05). Between two groups, the duration of preventive anti-coagulation treatment and oral administration of aspirin showed no significant difference (p>0.05), while the patients had a shorter hospitalization duration in the observation group than their counterparts in the control group (p<0.05). Within 3 mo after operation, the incidence rate of complications, including gastrointestinal bleeding and liver failure, in the observation group was 6.25 %, significantly lower than 26.56 % in the control group (p<0.05). After splenectomy for portal hypertension, dextranum in combination with the low-molecularweight heparin can prevent the portal vein thrombosis by inhibiting the platelet aggregation, thereby promoting the patients’ recovery and decreasing the incidence of postoperative complications.

Prediction of the Factors Influencing the Shengjing Classification of Portal Vein Thrombosis after Splenectomy for Portal Hypertension in Cirrhosis: A Single-Center Retrospective Case-Control Study.

Objective To compare the survival time of patients with portal vein thrombosis after splenectomy for portal hypertension in cirrhosis and explore the influencing factors of the Shengjing classification. Methods Clinical data of 108 patients with portal vein thrombosis after splenectomy in the department of general surgery of our hospital from November 2011 to December 2018 were selected, and a retrospective analysis was performed. Results Among 108 patients with postoperative PVST formation, 9 had type Ia, 32 type Ib, 39 type IIa, 20 type IIb, 5 type IIIa, 3 type IIIb, and 0 type IV. Survival analysis showed that the difference in survival time distribution among the Shengjing typing groups was statistically significant (P < 0.05). The higher the classification level, the shorter the survival time and the higher the risk of death. The results of a single-factor analysis showed that there were statistically significant differences in the PVST Shengjing typing groups between the preoperative group with or without hepatitis, preoperative d-dimer level, and postoperative day 14 fibrinogen (FIB) level (P < 0.05). Multivariate logistic regression analysis showed that the OR value of higher PVST Shengjing typing in patients with hepatitis was 4.634 times higher than that in patients without hepatitis (95% CI: 1.593-13.478, χ2 = 7.922, P = 0.005 < 0.05). Preoperative d-dimer volume increased by 1 μg/L; the OR value of higher grade PVST Shengjing typing was 1.001 times higher (95% CI: 1.000-1.002) than that of lower grade PVST Shengjing typing (χ2 = 8.369, P = 0.004 < 0.05). Conclusions The survival time of patients with portal vein system thrombosis after splenectomy was significantly different among Shengjing typing groups, and the higher the classification level, the shorter the survival time and the higher the risk of death. In patients with portal hypertension in cirrhosis and PVST formation after splenectomy, if the preoperative d-dimer level is high or accompanied by hepatitis virus, the formation of PVST will involve a wide range, the disease is more serious, and the prognosis is also poor, so corresponding preventive measures should be taken to avoid the aggravation of PVST.

Effective Prevention for Portal Venous System Thrombosis After Splenectomy: A Meta-Analysis.

Portal venous system thrombosis (PVST) is a common and potentially life-threatening complication of splenectomy for portal hypertension due to cirrhosis. A meta-analysis was conducted to study the necessity of pharmacologic prophylaxis of PVST after splenectomy and how to select the feasible treatment method. Articles were searched through the PubMed, EMBASE, Cochrane Library databases, and CNKI. Overall, 404 articles were initially identified, and 11 of them were eligible. Among these selected articles, 7 articles were associated with the necessity of anticoagulation for prevention of PVST, while 5 were about the drug selection. We first demonstrated that the incidence of PVST after splenectomy was significantly lower in patients who received the preventive measures than in those who did not (odds ratio [OR]: 0.22, 95% confidence interval [CI]: 0.13-0.39, P < .00001). Then, we compared the new-style treatment with the conventional treatment and found that patients with new therapy method had lower incidence of PVST than those who received conventional treatment (OR: 0.37, 95% CI: 0.27-0.51, P < .00001). Also, some studies (n = 4) reported that early and combination use of anticoagulation drugs can lead to better outcome for patients with splenectomy and devascularization. Preventative use of anticoagulant drugs might decrease the incidence of PVST after splenectomy in patients with portal hypertension, new anticoagulant drugs such as low-molecular-weight heparin should be used, and early or combination use of anticoagulation drugs might lead to lower PVST incidence for patients.

Laparoscopic azygoportal disconnection with and without splenectomy for portal hypertension

IntroductionLaparoscopic splenectomy and azygoportal disconnection (LSD) has been reported to be safe, feasible, and minimally invasive for cirrhotic patients with portal hypertension. There is still controversy as to whether it is necessary to perform synchronous splenectomy for patients with moderate hypersplenism who undergo azygoportal disconnection for esophagogastric variceal hemorrhage (EGVB). MethodsWe retrospectively evaluated the outcomes in 51 cirrhotic patients with EGVB and moderate hypersplenism (PLT ≥50 × 109/L) who underwent LSD (n = 28) or laparoscopic azygoportal disconnection (LD) (n = 23) between January 2014 and October 2015. Their demographic, intraoperative, and postoperative variables were compared. ResultsLSD and LD were successful in all the patients. When compared with LSD, LD had a significantly shorter operation time, less intraoperative blood loss, shorter postoperative hospital stay, fewer days of postoperative body temperature >38.0 °C, lower rate of fever postoperatively, and lower C-reactive protein concentration and procalcitonin concentration on postoperative day (POD) 7 (all P < 0.05). The incidences of portal vein system thrombosis in the LD group on PODs 7, 30, and 90 were significantly lower than those in the LSD group at all the time points (all P < 0.05). According to the postoperative serum proportions of CD4+ and CD8+ and the CD4+/CD8+ ratio (all P < 0.05), the LSD group had significantly lower immune function than the LD group on POD 90. ConclusionsLD is safe and effective for EGVB with moderate hypersplenism secondary to portal hypertension in selected patients.

General Gastroenterological Surgery: Spleen.

General Gastroenterological Surgery: Spleen.

Esophagogastric devascularization without splenectomy in portal hypertension: safe and effective?

Esophagogastric variceal hemorrhage is a life-threatening complication of portal hypertension. In this study, we compared the therapeutic effect of a novel surgical procedure, esophagogastric devascularization without splenectomy (EDWS), with the widely used modified esophagogastric devascularization (MED) with splenectomy for the treatment of portal hypertension. Fifty-five patients with portal hypertension were included in this retrospective study. Among them, 27 patients underwent EDWS, and the other 28 patients underwent MED. Patients' characteristics, perioperative parameters and long-term follow-up were analyzed. The portal venous pressure was decreased by 20% postoperatively in both groups. The morbidity rate of portal venous system thrombosis in the EDWS group was significantly lower than that in the MED group (P=0.032). The 1- and 3-year recurrence rates of esophagogastric variceal hemorrhage were 0% and 4.5% in the EDWS group, and 0% and 8.7% in the MED group, respectively (P=0.631). EDWS is a safe and effective treatment for esophagogastric varices secondary to portal hypertension in selected patients. Patients treated with EDWS had a lower complication rate of portal venous system thrombosis compared with those treated with conventional MED.

Laparoscopic Versus Open Splenectomy for Portal Hypertension

Laparoscopic splenectomy has become the gold-standard procedure for normal to moderately enlarged spleens. However, the safety of laparoscopic splenectomy for patients with portal hypertension remains controversial. We carried out this systematic review to identify the feasibility and safety of laparoscopic splenectomy in treating portal hypertension. A systematic search for comparative studies that compared laparoscopic splenectomy with open splenectomy for portal hypertension was carried out. Studies were independently reviewed for quality, inclusion and exclusion criteria, demographic characteristics, and perioperative outcomes. Although laparoscopic splenectomy is associated with longer operating time, it offers advantages over the open procedure in terms of less blood loss, lower operative complications, earlier resumption of oral intake, and shorter posthospital stay. Therefore, laparoscopic splenectomy is a safe and feasible intervention for portal hypertension.

Characteristics of splenic CD8+ T cell exhaustion in patients with hepatitis C

There is increasing interest in the role of T cell exhaustion and it is well known that the natural history of chronic hepatitis C virus infection (HCV) is modulated by CD8(+) T cell immunobiology. There are many pathways that alter the presence of exhaustive T cells and, in particular, they are functionally impaired by inhibitory receptors, such as programmed death-1 (PD-1) and T cell immunoglobulin and mucin domain-containing protein 3 (Tim-3). We obtained spleen, liver and peripheral blood (before and after splenectomy) lymphoid cells from 25 patients with HCV-related cirrhosis undergoing liver transplantation for end-stage disease or splenectomy for portal hypertension. In all samples we performed an extensive phenotypic study of exhaustion markers [PD-1, Tim-3, interferon (IFN)-γ) and their ligands (PD-L1, PD-L2, galectin-9] in CD8(+) T cell subpopulations (both total and HCV-specific) and in antigen-presenting cells (APC; monocytes and dendritic cells). In the spleen, total and HCV-specific CD8(+) T cells demonstrated enhanced markers of exhaustion, predominantly in the effector memory subpopulation. Similarly, splenic APC over-expressed inhibitory receptor ligands when compared to peripheral blood. Finally, when peripheral blood CD8(+) T cells were compared before and after splenectomy, markers of exhaustion were reduced in splenic CD8(+) T cells and APC. Our data in HCV-related cirrhosis suggest that CD8(+) T cells in the spleen manifest a significantly higher exhaustion compared to peripheral blood and may thus contribute to the failure to control HCV. Counteracting this process may contribute to inducing an effective immune response to HCV.

Portal hypertension: Effect of early splenic artery ligation on platelets count during splenectomy

Background/Aim:Hypersplenism due to splenic congestion is observed in portal hypertensive patients. This study was done to know the change in platelets count following early ligation of splenic artery during splenectomy in patients with thrombocytopenia due to portal hypertension with a hypothesis that splenic decongestion results in increased platelets count; thereby platelet transfusion can be avoided.Materials and Methods:Patients with platelets count <100,000 per mm3 due to portal hypertension were involved and we followed a protocol of ligating splenic artery first, followed by 30 minutes waiting period for splenic decongestion. Blood sample was collected at 5 and 30 minutes for the estimation of platelets count.Results:Significant rise in platelets was observed after 5 and 30 minutes of early ligation of splenic artery with mean rise being 23735 ± 15417 and 35085 ± 20458 per mm3, respectively. The rise in platelets at 30 minutes was significant when compared with 5 minutes rise with mean platelets count being 91661 and 103070 per mm3 at 5 and 30 minutes, respectively. The platelets rise was equal to 4 and 6 units of platelets concentrates, respectively.Conclusion:Early ligation of splenic artery during splenectomy for portal hypertension results in significant rise in platelets after 5 and 30 minutes. This method conserves platelets and avoids platelets transfusion and its complications.

Relevant factors of portal vein thrombosis in patients after splenectomy for portal hypertension due to cirrhosis resulting from hepatitis

Objective To analyze the relevant factors of portal vein thrombosis in patients after splenectomy for portal hypertension due to cirrhosis resulting from hepatitis. Methods The clinical data of 226 patients with hypertension due to cirrhosis resulting from hepatitis receiving simple splenectomy or splenectomy and portal-azygous devascularization in our hospital from August 2000 to June 2007 were retrospectively analyzed. Effective results were found in 154 of the patients. The 154 cases were divided into the thrombosis group and non-thrombosis group. The relation of portal vein thrombosis to the descendent level of portal vein pressure after operation,the prothrombin ratio (PTR) and fibrinogen(FIB) before operation, platelet count before and 1, 7, 14 days after operation, diameter of main portal vein and bilirubin level before operation and blood loss in operation were determined by logistic regression analysis. Results Portal vein thrombosis occurred in 31 patients. Regression univariate analysis showed that portal vein thrombosis was related to the descendent level of portal vein pressure after operation but not to the PTR and FIB, platelet count, diameter of main portal vein, bilirubin level and blood loss. Multivariate analysis demonstrated the same results. Conclusion The descended level of portal vein pressure is an important factor in portal vein thrombosis in patients after splenectomy for portal hypertension due to cirrhosis resulting from hepatitis. Key words: Hypertension portal; Portal vein thrombosis; Portal vein pressure; Splenectomy

Laparoscopic splenectomy in portal hypertension: a single-surgeon 13-year experience

Although laparoscopic splenectomy (LS) has become the standard approach for most splenectomy cases, some areas still remain controversial. To date, the indications that preclude LS are not clearly defined. Portal hypertension from liver cirrhosis still is a contraindication to LS in the clinical practice guidelines of the European Association for Endoscopic Surgery published in 2008. This study aimed to evaluate the feasibility of LS for hypersplenism secondary to liver cirrhosis and portal hypertension. The study retrospectively analyzed 206 laparoscopic splenectomies performed for a variety of indications over 13 years. According to diagnosis, the patients were divided into group A (hypersplenism secondary to liver cirrhosis and portal hypertension, n = 96) and group B (hematologic and other disorders, n = 110). A detailed review of medical records was conducted. The perioperative data for the two groups were compared including patient characteristics, diagnosis, operative details, complication rates, and postoperative hospital stay. Laparoscopic splenectomy was completed for 201 patients. Conversion from laparoscopic to open surgery was necessary for 5 patients (2.4%) because of hemorrhage, and 26 patients (12.6%) had complications. There were significant differences between groups A and B in terms of mean operation time (2.8 vs. 2.1 h), complication rates (17.7% vs. 8.2%), and postoperative stay (7.1 vs. 4.7 days). However, the two groups showed no significant differences with respect to intraoperative blood loss, blood transfusion, and conversion rate. Laparoscopic splenectomy is a feasible, effective, and safe surgical procedure for patients who require splenectomy. Hypersplenism secondary to cirrhosis and portal hypertension should not be considered contraindications for LS.

Analysis of perioperative multiple factors affecting postoperative complications in splenectomy for portal hypertension

Objective To investigate the postoperative complications of splenectomy for protal hypertension by analyzing the perioperative affecting factors to explore the countermeasures for their prevention. Methods The clinical data of 115 patients with portal hypertension receiving splenectomy in our hospital were analyzed, and the priorities were put on perioperative management and postopera-tive complications. Results Eighty-five of the 115 cases (73.9%) had postoperative complications and 7 of them (6.09%) died. The Child-Pugh grades, portal pressure level before and after operations, the mean blood glucose level after operations, central venous pressure level duing or after operations were closely associated with the postoperative complications. Conclusion The patients with portal hy-pertension had more complications after splenectomy and we should be cautious about the cases with poorer liver functions, and control the mean blood glucose, portal pressure levels and central venous pressure levels within suiter ranges during peroperative period. Consequently, the rate of the postop-erative complications could be reduced. Key words: Splenectomy; Portal hypertension; Complication; Perioperative period; Affecting factor

Partial splenectomy for portal hypertension in cystic fibrosis related liver disease

To review the middle- and long-term effects of partial splenectomy (PS) on portal hypertension (PHT) and its complications in patients with cystic fibrosis (CF) related liver disease risky PHT. Over a 20 years period, 19 patients aged 7-23 years underwent partial PS for massive splenomegaly, hypersplenism, and/ or severe PHT. In all but three cases, PHT and hypersplenism have improved for long periods. Noticeable improvement of hepatic tests occurred simultaneously. In all patients PS resolved abdominal discomfort. Fifteen patients are alive and a stabilization of the liver disease occurred with a follow-up of 1-20 years (mean 7.9). One patient died following respiratory insufficiency 10 years after PS although PHT was stable. Manifestations recurred in 2 patients 5 and 6 years after PS. In two patients, the course of the disease evolved to hepatic insufficiency without recurrence of PHT 3 and 8 years after PS. PS did not give the expected results in three cases only, in which PHT was not modified or reoccurred during the following year. No severe complication was observed. Early (three patients) or late (one patient) eventration required surgical procedure. Our results show that PS is a reliable and well-tolerated technique. Therefore, it is a therapeutic option for the management of PHT in CF patients with a preserved liver function. It can prevent and significantly delay a liver transplantation and its constraints.

On splenectomy for portal hypertension ? some viewpoints after reading relevant literature

感谢刘永雄主编交给我有关门静脉高压症(PHT)切脾问题的文章数篇,使我有机会阅读学习.诸位作者皆为著名专家,既有丰富的实践经验,又有深厚的理论功底,观点鲜明,立论精辟,旁征博引,言之有据,读后见识倍增,收益良多,不揣冒昧,也思用片语支言,道出点滴感悟,供同道指正。

Matters of right and wrong in splenectomy for portal hypertension

门静脉高压症是一个综合征或症候群，在我国主要源于肝脏的病毒（乙、丙）性或寄生虫（血吸虫）性损害，是一个慢性渐进性过程。它的诊疗主要依赖于非手术处理，核心在于灭毒、杀虫、保肝。脾肿大、食管静脉曲张破裂与胃黏膜病变所致的上消化道出血及腹水是肝实质损害和肝纤维化不断加重的结果。外科治疗已往主要针对急性大出血，现在亦有了非手术处理的有效手段。断流术和分流术并不是对因的措施，效果并不很理想，还带来某些被动的结果，甚至进一步加重肝损害。 脾脏在门静脉高压症发生、发展中是个什么因素？应如何看待？对门静脉高压症脾的外科处理的出发点和落脚点又有些什么思考和认识？百余年的探索，切脾对缓解肝损害的实际效果和价值仍没有确实的结论，但各种形式和份量的特别是说不清理由的单纯脾切除仍很常用。需要深思的是门静脉高压症切脾的适应证是什么？门脉高压症病人什么状态和时机应施行脾切除。意即切脾能给门静脉高压症病带来什么好处和带来什么害处。 我们就这一老问题约请了几位专家，从各个角度来进行讨论，希望能理顺一些思路，如何把门静脉高压症的脾外科问题处理好，帮病人所需而不使病情复杂化!

Relevant factors and prevention of portal vein thrombosis in patients after splenectomy for portal hypertension due to cirrhosis resulting from hepatitis

目的 析肝炎肝硬化门静脉高压症脾切除术后门静脉系统形成血栓的相关因素,寻找预防门静脉高压症脾切除术后门静脉系统形成血栓的方法.方法 回顾性分析我院1999年3月至2005年6月收治的肝炎肝硬化门静脉高压症行单纯脾切除、脾切除加EVL或脾切除加贲门周围血管断流术的病人132人,用Logistic回归分析分析术前肝功能Child-Pugh分级、门静脉和脾静脉直径、脾脏的大小以及术后血小板的数量与门静脉系统血栓形成的关系;将其中符合要求的112人分为三组,A组56人:术后未用抗凝、祛凝药;B组33人:术后在血小板＞300×109/L时用抗凝、祛凝药;C组23人:术后早期应用抗凝、祛凝药.比较三组门静脉系统血栓的发生率.结果 Logistic单因素分析提示门静脉系统的血栓形成与门静脉直径、脾脏的大小、脾脏的厚度、血清总胆红素以及术后血小板的数量有关;多因素回归分析发现门静脉系统的血栓形成与门静脉和脾静脉直径、脾脏的大小和是否行抗凝祛凝治疗有关;A组、B组和C组门静脉系统发生血栓的人数分别为19人、9人和1人,发生率分别为33.9%、27.3%和4.3%,门静脉血栓发生率的比较A组和B组的差异无显著性(χ2=0.427,P=0.514),A组和C组的差异有显著性(χ2=7.545.082,P=0.006),B组和C组的差异有显著性(χ2=4.856,P=0.028).结论 肝炎肝硬化门静脉高压症脾切除术后门静脉系统血栓的形成与门静脉和脾静脉直径、脾脏的大小和是否行抗凝祛凝治疗有关;早期、全身应用抗凝、祛凝药能有效的预防肝炎肝硬化门静脉高压症脾切除术后门静脉系统血栓的形成。