脾切除术治疗肝硬化门静脉高压症继发脾功能亢进合并门静脉血栓的效果及安全性OA

Objective To investigate the efficacy and safety of splenectomy in the treatment of hypersplenism secondary to liver cirrhosis and portal hypertension complicated with portal vein thrombosis(PVT).Methods A retrospective analysis was conducted on 85 patients with hypersplenism secondary to liver cirrhosis and portal hypertension who underwent either splenectomy or splenectomy combined with periesophagogastric devascularization at Shanghai General Hospital from Dec.2016 to Nov.2020.Among the 85 patients,14 patients were diagnosed with PVT prior to surgery(PVT group),and the other 71 patients were classified into the non-PVT group.Changes in hypersplenism-related indices,liver function,along with safety-related surgical indicators and postoperative complication rates were compared between the two groups.Results Following splenectomy,both groups showed significant increase in hemoglobin concentrations,white blood cell counts,and platelet counts(all P<0.05).In the non-PVT group,serum albumin levels increased,while AST,prothrombin time and ALBI score decreased,all showed statistically significant difference(P<0.05).However,in the PVT group,these changes were all not statistically significant(P>0.05),which indicated better improvement in the non-PVT group.There was no statistically significant difference between the two groups regarding to the intraoperative blood loss,the operation time,the blood transfusion rate,the postoperative extubation time,the postoperative hospitalization time and the postoperative complication incidence rate(all P>0.05).Conclusion For patients with hypersplenism secondary to liver cirrhosis and portal hypertension complicated with PVT,splenectomy may improve the symptom of hypersplenism;however,the improvements in liver function is not as effective as those with non-PVT,while the surgical safety remains comparable between the PVT group and the non-PVT group.