ABSTRACT
Objective:To investigate the efficacy of endoscopic histoacryl injection in cirrhotic patients with newly-developed esophagogastric varices (EGV) who have previously undergone splenectomy combined with pericardial devascularization.Methods:From January 2015 to January 2020, 125 cirrhotic patients with EGV treated with endoscopic histoacryl injection at the Department of Gastroenterology, Jinling Hospital, Medical School of Nanjing University, were included in the retrospective analysis. There were 45 patients in the group of splenectomy combined with pericardial devascularization (splenectomy group for short) and 80 patients in the non-splenectomy group. The efficacy of endoscopic treatment, postoperative variceal improvement, rebleeding rate, and complications were analyzed between the two groups.Results:Endoscopic histoacryl injection was successfully completed in all 125 patients, and the median volume of histoacryl was 4.5 mL. The overall effective rate in splenectomy and non-splenectomy group was 80.0% (36/45) and 57.5% (46/80), respectively. The difference in the number of significantly effective, effective, and ineffective cases between the two groups was statistically significant (16, 20, 9 cases, and 20, 26, 34 cases, respectively, χ 2=6.469, P=0.039). Two and 14 patients developed rebleeding in the splenectomy group and non-splenectomy group, respectively; and the difference in the rebleeding rate between the two groups was statistically significant (4.4% VS 17.5%, Log-rank P=0.039). No patient died within 1 year in either group, and no serious complications such as ectopic embolism occurred. Conclusion:After splenectomy combined with pericardial devascularization in cirrhotic patients with EGV and hypersplenism, the application of histoacryl has better short-term efficacy and can significantly reduce the rebleeding rate compared with the non-splenectomy group.
ABSTRACT
Objective:To investigate the clinical value of totally laparoscopic exclusion of splenic artery aneurysm combined with pericardial devascularization for portal hypertension com-plicated with splenic aneurysm.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 17 patients with portal hypertension complicated with splenic aneurysm who were admitted to 2 medical centers (15 cases in Shenzhen University General Hospital and 2 cases in Wuhan First Hospital) from January 2013 to May 2020 were collected. There were 7 males and 10 females, aged (59±14)years. All patients underwent totally laparoscopic exoclusion of splenic artery aneurysm combined with pericardial devascularization. Observation indicators : (1) surgical and postoperative conditions; (2) complications; (3) follow-up. Follow-up was conducted by out-patient examiantion and telephone interview to detect the effect of exclusion of arterial tumor, and blood re-flow, portal vein thrombosis and survival of patients 3 months after operation. The follow-up was up to December 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Results:(1) Surgical and postoperative conditions. All 17 patients successfully completed the operation, without perioperative death. The operation time, volume of intraoperative blood loss of 17 patients were (181±30)minutes, 187(range, 90?420)mL. The white blood cell count, red blood cell count, hemoglobin, serum albumin were (9±4)×10 9/L, (3.5±0.9)×10 12/L, (86±17)g/L, (36±7)g/L on the postoperative day 3. Time to postoperative abdominal drainage tube removal and duration of post-operative hospital stay were (7±4)days and (11±4)days. (2) Complications. All 17 patients had ascites after surgery, which were improved after oral treatment with diuretics. There was no complication such as intra-abdominal hemorrhage, gastrointestinal fistula, pleural effusion, infection, abscess formation, fever and vascular embolism. (3) Follow-up. All the 17 patients were followed up for 28.6(range, 7.0?84.0)months. During the follow-up, the splenic aneurysm cavity of all patients was completely isolated, no blood re-flow and no portal vein thrombosis was observed, and no patient died. Conclusion:Totally laparoscopic exclusion of splenic artery aneurysm combined with pericardial devascularization is safe and feasible in the treatment of portal hypertension complicated with splenic aneurysm.
ABSTRACT
Objective:To evaluate trans-artery pressure perfusion autologous transfusion for laparoscopic splenectomy and pericardial devascularization (LSPD).Methods:The clinical data of patients with laparoscopic splenectomy in Zhejiang Provincial People′s Hospital in recent 3 years were reviewed. The therapeutic effects of 30 LSPD cases with trans-artery pressure perfusion (observation group) and 30 radical LSPD cases (control group) were compared and analyzed.Results:There was no significant difference in age, sex, preoperative liver function grade and spleen volume between the two groups ( P>0.05). All 60 patients completed laparoscopic splenectomy without conversion to laparotomy or death. There was no significant difference in liver function, operation time and intraoperative bleeding between the observation group and the control group ( P>0.05), and there was also no significant difference in blood transfusion, postoperative complications and hospital stay ( P>0.05). The hemoglobin level in the observation group was significantly higher than that in the control group ( P<0.05). Conclusions:Laparoscopic splenectomy and pericardial devascularization with trans-artery pressure perfusion autologous transfusion can increase post-operative hemoglobin value effectively.
ABSTRACT
ObjectiveTo investigate the clinical effect of laparoscopic splenectomy and pericardial devascularization (LSPD) in patients with portal hypertension and the long-term effect of LSPD. MethodsA total of 40 portal hypertension patients with Child-Pugh A/B liver function who received LSPD in The First Hospital of Jilin University from August to December 2017 were enrolled as surgical group, and 44 portal hypertension patients with Child-Pugh A/B liver function who received conservative treatment during the same period of time was enrolled as internal medicine group. The patients were followed up to June 30, 2019, and liver function parameters, upper gastrointestinal bleeding, and portal vein thrombosis were recorded for all patients at each time point. The t-test was used for comparison of normally distributed continuous data between two groups; an analysis of variance was used for comparison between multiple groups, and the Bonferroni test was used for further comparison between two groups. The Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution; between multiple groups, and the Mann-Whitney U test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. ResultsAt 6, 12, and 24 months after discharge, compared with the internal medicine group, the surgical group had a significantly higher level of cholinesterase (t=3.527, 3.849, and 5.555, all P＜0.05) and a significantly lower Child-Pugh score (t=2.498, 2.138, and 2.081, all P＜0.05). Compared with the internal medicine group at 12 and 24 months after discharge, the surgical group had a significantly higher level of albumin (t=3.120 and 2.587, both P＜0.05) and a significantly lower incidence rate of upper gastrointestinal bleeding (χ2=4.947 and 5.155, both P＜0.05). At 24 months after discharge, the surgical group had a significantly lower number of patients who had a significant increase in alpha-fetoprotein level than the internal medicine group (χ2=4.648, P=0.031). At 12 months after discharge, the surgical group had a significantly higher incidence rate of portal vein thrombosis than the internal medicine group (χ2=4.395, P=0.036). The surgical group had significant improvements in albumin (F=2.959, P=0.013), cholinesterase (F=11.022, P＜0001), prothrombin time (H=94.100, P＜0.001), and Child-Pugh score (F=3.742, P=0.003) from admission to 12 and 24 months after surgery. ConclusionIn portal hypertension patients with Child-Pugh A/B liver function, LSPD can improve liver function and reduce the incidence rate of upper gastrointestinal bleeding, and the high incidence rate of portal vein thrombosis can be effectively reduced by oral aspirin and rivaroxaban.
ABSTRACT
Objective:To study the impact of anticoagulant therapy starting at different platelet levels on the incidences of portal vein thrombosis (PVT) after splenectomy and devascularization.Methods:From January 2014 to January 2017, 125 patients with liver cirrhosis and portal hypertension underwent splenectomy and pericardial devascularization in Beijing Ditan Hospital, Capital Medical University. All patients routinely received anticoagulant therapy. There were 85 patients who had a platelet count greater than >100×10 9/L (the study group) and 40 patients who had a platelet count greater than >300×10 9/L (the control group). The incidence of PVT was compared between the two groups. Results:A total of 125 patients were included in the study, including 91 males and 34 females, aged 20-59 years. Age, gender, preoperative platelet level, preoperative splenic vein and portal vein width, preoperative coagulation function, preoperative liver function (Child classification), preoperative esophageal and gastric varices, operation time, preoperative bleeding time, preoperative venous blood flow velocity, coagulation function 1 week and 2 weeks after operation between the two groups were not significantly different (all P>0.05). Of 125 patients undergoing splenectomy and pericardial devascularization, PVT was not found in all patients before operation. The incidence of PVT was 39.2% (49/125) within one month after operation. Among the 85 patients in the study group, 28 patients developed PVT, and the incidence of thrombosis was 32.9% (28/85). In the control group, 21 patients developed PVT, and the thrombosis rate was 52.5% (21/40). The difference was significant (χ 2=4.366, P=0.037). After anticoagulant therapy, the incidence of bleeding in the study group was 4.7% (4/85), and that in the control group was 5.0% (2/40), the difference was no significant ( P>0.05). Conclusion:Early anticoagulation (platelet >100×10 9/L) does not increase the risk of postoperative bleeding, but can reduce the incidence of PVT.
ABSTRACT
Objective@#To investigate the clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization in the treatment of cirrhotic patients with cirrhotic portal hypertension.@*Methods@#The retrospective and descriptive study was conducted. The clinicopathological data of 425 patients with cirrhotic portal hypertension who were admitted to Northern Jiangsu People′s Hospital Affiliated to Yangzhou University were collected. There were 289 males and 136 females, aged (53±11)years, with a range from 21 to 79 years. All the patients were allocated into 3 periods according to the operation time, including 100 patients of early period from February 2012 to March 2014, 156 patients of mature technology period from April 2014 to August 2016, and 169 patients of technology innovation period from september 2016 to December 2018. The patients of early period and mature technology period underwent laparoscopic splenectomy combined with pericardial devascularization, and the patients of technology innovation period underwent vagus nerve-preserving laparoscopic splenectomy combined with pericardial devascularization. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Patients were followed up by outpatient examination to detect the upper digestive rebleeding, gastric retention, and diarrhea up to March 2019. Sequential therapy of endoscopic variceal ligation (EVL) was slectively performed on patients based on results of gastroscopy. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using ANOVA, and paired comparison was analyzed using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was anlyzed using the Kruskal-Wallis rank sum test, and paired comparison was analyzed using the rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test and Fisher exact probability.@*Results@#(1) Surgical situations: the operation time, volume of intraoperative blood loss, cases with intraoperative blood transfusion, cases with conversion to open surgery, and cases with emergency operation for bleeding were (187±46)minutes, 150 mL (range, 50-1 300 mL), 2, 2 , 1 for patients of early period, (164±22)minutes, 50 mL (range, 30-100 mL), 1, 1, 1 for patients of mature technology period, and (150±18)minutes, 50 mL (range, 10-300 mL), 0 , 0 , 0 for patients of technology innovation period, respectively. There were significant differences in the operation time and volume of intraoperative blood loss between the three groups (F=55.482, χ2=94.620, P<0.05). There was no significant difference in the cases with intraoperative blood transfusion, cases with conversion to open surgery, or cases with emergency operation between the three groups (P>0.05). (2) Postoperative situations: 425 patients had oral aspirin enteric-coated tablets for prevention of thrombus, with no perioperative death. Duration of postoperative hospital stay, cases with portal vein thrombosis at postoperative 7 days, cases with pancreatic fistula, cases with pulmonary infection, and cases with abdominal infection were (11.0±2.9)days, 46, 2, 1, 0 for patients of early period, (9.9±1.7)days, 81, 3, 0, 0 for patients of mature technology period, and (8.8±1.3)days, 83, 2, 1, 1 for patients of technology innovation period, respectively. There was a significant difference in the duration of postoperative hospital stay between the three groups (F=39.836, P<0.05), between patients of mature technology and patients of early period (t=3.329, P<0.05), between patients of mature technology period and patients of technology innovation (t=6.502, P<0.05). There was no significant difference in the cases with portal vein thrombosis at postoperative 7 days between the three groups (χ2=0.865, P>0.05) and no significant difference in the cases with pancreatic fistula, cases with pulmonary infection, or cases with abdominal infection between the three groups (P>0.05). Patients with portal vein thrombosis at postoperative 7 days had oral aspirin enteric-coated tablets or warfarin for treatment. Patients with pancreatic fistula, pulmonary infection, and abdominal infection were cured and discharged after conservative treatment. (3) Follow-up: all the 425 patients were followed up for 1-72 months, with a median follow-up of 36 months. Of the 425 patients, 261 underwent postoperative sequential therapy of EVL, including 133 patients of mature technology period and 128 patients of technology innovation period. The incidence rate of upper digestive rebleeding was 3.83%(10/261) of the 261 patients undergoing postoperative sequential therapy of EVL and 17.68%(29/164) of 164 patients without postoperative sequential therapy of EVL, showing a significant difference between them (χ2=23.185, P<0.05). The incidence rates of gastric retention and diarrhea were 96.24%(128/133) and 61.65%(82/133) for 133 patients undergoing sequential therapy of EVL in mature technology period, and 1.56%(2/128) and 3.91%(5/128) for 128 patients undergoing sequential therapy of EVL in technology innovation period, showing significant differences between them (χ2=233.876, 97.883, P<0.05).@*Conclusions@#It is safe and feasible of laparoscopic splenectomy combined with pericardial devascularization for patients with cirrhotic portal hypertension, and intraoperative vagus nerve-preserving can reduce volume of intraoperative blood loss and incidence of postoperative complications.
ABSTRACT
Objective To investigate the efficacy and safety of preventive anticoagulant therapy at different time windows on formation of portal vein thrombosis after laparoscopic splenectomy and pericardial devascularization.Methods The study was performed as a randomized,prospective trial.83 patients with portal hypertension who underwent laparoscopic splenectomy and pericardial devascularization were divided into four groups:the non preventive anticoagulant group (n =21),the prophylactic anticoagulant group (n =23),the 24 hours of preventive anticoagulant group (n =19) and the 48 hours of preventive anticoagulant group (n =20).The incidences of postoperative portal vein thrombosis,the Yerdel grading,platelet count,APTT,and bleeding complications were studied.Results The incidences of portal vein thrombosis in the four groups were 100％,39.1％,47.3％,55％,respectively,and the difference among the 4 groups was significantly different (P ＜ 0.05).The incidences of portal vein thrombosis between the prophylactic anticoagulant group and the 24 hours of preventive anticoagulant group showed no significant difference (P ＞0.05),but the incidences of portal vein thrombosis after 48 hours of preventive anticoagulant group was significantly higher than the prophylactic anticoagulant group and the 24 hours of preventive anticoagulant group,respectively (P ＜ 0.05).Postoperative bleeding complications,platelet count and APTT after the operations showed no significant differences (P ＞ 0.05).However,the plasma level of D-dimer in the non preventive anticoagulant group was significantly higher than the preventive anticoagulant group (P ＜ 0.05).Conclusion Preventive anticoagulant therapy effectively reduced the incidence of portal vein thrombosis after laparoscopic splenectomy and pericardial devascularization,but it did not significantly increase the risk of postoperative bleeding complications.
ABSTRACT
Objective To investigate the clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization in the treatment of cirrhotic patients with cirrhotic portal hypertension.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 425 patients with cirrhotic portal hypertension who were admitted to Northern Jiangsu People's Hospital Affiliated to Yangzhou University were collected.There were 289 males and 136 females,aged (53±11)years,with a range from 21 to 79 years.All the patients were allocated into 3 periods according to the operation time,including 100 patients of early period from February 2012 to March 2014,156 patients of mature technology period from April 2014 to August 2016,and 169 patients of technology innovation period from september 2016 to December 2018.The patients of early period and mature technology period underwent laparoscopic splenectomy combined with pericardial devascularization,and the patients of technology innovation period underwent vagus nerve-preserving laparoscopic splenectomy combined with pericardial devascularization.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) follow-up.Patients were followed up by outpatient examination to detect the upper digestive rebleeding,gastric retention,and diarrhea up to March 2019.Sequential therapy of endoscopic variceal ligation (EVL) was slectively performed on patients based on results of gastroscopy.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using ANOVA,and paired comparison was analyzed using the t test.Measurement data with skewed distribution were represented as M (range),and comparison between groups was anlyzed using the Kruskal-Wallis rank sum test,and paired comparison was analyzed using the rank sum test.Count data were described as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test and Fisher exact probability.Results (1) Surgical situations:the operation time,volume of intraoperative blood loss,cases with intraoperative blood transfusion,cases with conversion to open surgery,and cases with emergency operation for bleeding were (187±46) minutes,150 mL (range,50-1 300 mL),2,2,1 for patients of early period,(164±22)minutes,50 mL (range,30-100 mL),1,1,1 for patients of mature technology period,and (150± 18)minutes,50 mL (range,10-300 mL),0,0,0 for patients of technology innovation period,respectively.There were significant differences in the operation time and volume of intraoperative blood loss between the three groups (F=55.482,x2 =94.620,P＜0.05).There was no significant difference in the cases with intraoperative blood transfusion,cases with conversion to open surgery,or cases with emergency operation between the three groups (P＞0.05).(2) Postoperative situations:425 patients had oral aspirin enteric-coated tablets for prevention of thrombus,with no perioperative death.Duration of postoperative hospital stay,cases with portal vein thrombosis at postoperative 7 days,cases with pancreatic fistula,cases with pulmonary infection,and cases with abdominal infection were (11.0±2.9) days,46,2,1,0 for patients of early period,(9.9±.1.7)days,81,3,0,0 for patients of mature technology period,and (8.8±1.3)days,83,2,1,1 for patients of technology innovation period,respectively.There was a significant difference in the duration of postoperative hospital stay between the three groups (F =39.836,P ＜ 0.05),between patients of mature technology and patients of early period (t =3.329,P＜0.05),between patients of mature technology period and patients of technology innovation (t =6.502,P＜0.05).There was no significant difference in the cases with portal vein thrombosis at postoperative 7 days between the three groups (x2 =0.865,P ＞ 0.05) and no significant difference in the cases with pancreatic fistula,cases with pulmonary infection,or cases with abdominal infection between the three groups (P＞0.05).Patients with portal vein thrombosis at postoperative 7 days had oral aspirin enteric-coated tablets or warfarin for treatment.Patients with pancreatic fistula,pulmonary infection,and abdominal infection were cured and discharged after conservative treatment.(3) Follow-up:all the 425 patients were followed up for 1-72 months,with a median follow-up of 36 months.Of the 425 patients,261 underwent postoperative sequential therapy of EVL,including 133 patients of mature technology period and 128 patients of technology innovation period.The incidence rate of upper digestive rebleeding was 3.83％ (10/261) of the 261 patients undergoing postoperative sequential therapy of EVL and 17.68％ (29/164) of 164 patients without postoperative sequential therapy of EVL,showing a significant difference between them (x2 =23.185,P＜0.05).The incidence rates of gastric retention and diarrhea were 96.24％ (128/133) and 61.65％ (82/133) for 133 patients undergoing sequential therapy of EVL in mature technology period,and 1.56％ (2/128) and 3.91％(5/128) for 128 patients undergoing sequential therapy of EVL in technology innovation period,showing significant differences between them (x2 =233.876,97.883,P＜0.05).Conclusions It is safe and feasible of laparoscopic splenectomy combined with pericardial devascularization for patients with cirrhotic portal hypertension,and intraoperative vagus nerve-preserving can reduce volume of intraoperative blood loss and incidence of postoperative complications.
ABSTRACT
Objective To summarize the efficacy and feasibility of laparoscopic splenectomy combined with selective pericardial devascularization for cirrhotic portal hypertension.Methods From January 2015 to January 2017,the clinical data of 29 cases of cirrhotic portal hypertension treated by laparoscopic splenectomy combined with selective pericardial devascularization were analyzed retrospectively.Results Laparoscopic surgery was successful in all but one cases,who was converted to open surgery.Theoperation time was (235 ± 54) min,intraoperative blood loss was (384 ± 262) ml.The spleen fever syndrome and splenic vein thrombosis were found in 1,2 patients respectively after operation.No serious complications of abdominal hemorrhage,pancreatic fistula and intra-abdominal infection were found.The postoperative hospital stay was (9.6 ± 1.9) d,patients were followed up for 3-6 months,and 3 cases had portal vein thrombosis.The liver function was well maintained.Conclusion Laparoscopic splenectomy combined with selective pericardial devascularization for treatment of portal hypertension is with high success rate and lower incidence of postoperative complications.
ABSTRACT
Objective To evaluate the feasibility and safety of laparoscopic splenectomy and esophagogastric devascularization (LSPD) via spleen bed using endoscopic linear stapler (Echelon Flex 60 Endopath) versus open splenectomy and esophagogastric devascularization (OSPD) for cirrhotic portal hypertension.Methods A total of 390 patients suffering from liver cirrhosis and portal hypertension operated in our department from Jun 2012 to Jul 2016 were divided into two groups:145 for LSPD and 245 for OSPD.Characteristics,clinical data and postoperative complications were compared.Results There were no significant differences in estimated intraoperative blood loss between LSPD and OSPD groups.The operation time of LSPD group was longer than OSPD group.However,the time of hospital stay and time of oral intake were shorter in the LSPD group than the OSPD group (P ＜ 0.05).No significant differences were detected for liver function such as ALT,AST,T-BIL and ALB after operation,nor in the rate of postoperative complications between the 2 groups such as portal vein thrombosis,pancreatic leakage,pleural effusion and PLT ＞800 x 109/L.But amount of ascites and fever (＞38.0 ℃,＞3 d) in OSPD group was higher than LSPD group (P ＜ 0.05).Conclusions LSPD via spleen bed combined with endoscopic linear stapler for liver cirrhosis and portal hypertension is a safe and feasible procedure.
ABSTRACT
Objective To evaluate the feasibility of splenectomy and pericardial devascularization in patients with Child-Pugh grade C cirrhosis,portal hypertension,and severe hypersplenism or after the first gastroesophageal variceal hemorrhage (GEV bleeding).Methods From January 2010 to January 2017,the clinical data from patients with Child-Pugh grade C cirrhosis,portal hypertension with a high risk of GEV bleeding were retrospectively analyzed.These patients underwent splenectomy and pericardial devascularization at the Huashan Hospital Affiliated to the Fudan University.The safety and effectiveness of surgery,postoperative complications and mortality were further explored.Results Liver protection treatment was given before surgery to improve the liver function.Of the 32 patients who underwent splenectomy and pericardial devascularization,the operation time was (2.2±0.3) hours.The blood loss was (208.0± 102.0) ml and the hospital stay after surgery was (11.8±2.8) d.Postoperative complications included fever,wound infection and ascites.One patient died of hypovolemic shock and acute renal failure.The incidence of postoperative PVT was 12.5％ (4/32).The rates of GEV rebleeding at 1 year,3 years,and 5 years after surgery were 6.3％ (2/32),6.3％ (2/32),and 9.4％ (3/32).The 5-year overall mortality rate was 12.5％ (4/32).Conclusions In the absence of obvious surgical contraindications and with a lack of donor livers for liver transplantation,aggressive perioperative management,splenectomy and pericardial devascularization are a feasible option for patients with Child-Pugh grade C cirrhosis,portal hypertension with a high risk of GEV bleeding.
ABSTRACT
Objective To evaluate the clinical efficiency of Tunnel-building laparoscopic splenectomy and pericardial devascularization (TLSPD) in the treatment of portal hypertension.Methods The clinical data of patients who underwent TLSPD from 2014 Jan to 2017 Jun were retrospectively studied.The operative time,intraoperative blood loss,conversion rate,postoperative complication rate,and the follow-up data analyzed.Result 466 patients underwent surgery successfully.The operative time was (145.0±55.0) min,and the intraoperative blood loss was (60.0±29.0)ml.There were 6 conversions to open surgery.The complication rate was 4.3％.No deaths occurred during the perioperative period.Variceal rebleeding occurred in 9 patients and portal vein thrombosis occurred in 214 patients.Conclusions TLSPD was safe and efficious with a low operative risk.The treatment resulted in a low rate of variceal rebleeding.
ABSTRACT
Objective:To discuss the clinical reference value of multimodal analgesia in laparoscopic splenectomy and pericardial devascularization around perioperative period (LS+PDA) based on FTS (fast track surgery) concept.Methods:Previously from September 2015 and March 2017,69 patients with portal hypertension were given LS+PDA,37 patients were given traditional perioperative analgesia program (named traditional group),other 32 patients were given multimodal analgesia around perioperative period (named FTS group).The degree of postoperative pain,ambulation time,eating time,anal exhaust time,gastric tube decompression,indwelling time,postoperative 72 hours sleep time,postoperative hospital stay,postoperative adverse reactions were compared between two groups.Results:When operation finished,1,4,8,12,24,48 and 72 hours,pain digital assessment scale of FTS group was significantly lower than traditional group (P＜0.05).FTS group's ambulation,feeding,anal exhaust,gastric tube indwelling and postoperative hospital time all were significantly shorter than traditional group (P＜0.01),its sleeping time after 72 hours was obviously longer than traditional group (P＜0.01).Nausea and vomiting,regurgitation and gastrointestinal reactions,breathing difficulties,splenopyretic incidence of FTS group was significantly lower than traditional group (P＜0.05),and other adverse reactions were no statistical significance between two groups.The all approval rate of postoperative analgesia in FTS group was significantly higher than that in traditional group (P＜0.05).Conclusion:Multimodal analgesia in LS+PDA based on FTS concept has been safe and effective,which nearly can achieve painless surgery.
ABSTRACT
Objective To investigate the clinical efficacy of pericardial devascularization (PCDV) combined with splenectomy and partial gsstric fundus resection (PGFR) in the treatment of portal hypertension-induced severe gastric varices complicated with gastrorenal shunt (GRS).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 18 patients with portal hypertension-induced severe gastric varices complicated with GRS who were admitted to the Fujian Provincial Hospital from January 2010 to December 2015 were collected.According to the stage of technical development,open surgery or laparoscopic surgery was selected based on patients' and their family's wishes.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival.The follow-up using outpatient examination and telephone interview was performed once every 3 months within 1 year postoperatively and once every 6 months after 1 year to detect long-term complications and survival up to June 2017.The reexaminations of gastroscopy,enhanced scan of X-ray computed tomography (CT) on the epigastric region or magnetic resonance imaging (MRI) were done at 1 month postoperatively for detecting resection of fundus ventriculi varicosity.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).The survival rate was calculated by the Kaplan-Meier method.Results (1) Surgical and postoperative recovery situations:18 patients underwent successful PCDV combined with splenectomy and PGFR,including 12 with open surgery and 6 with laparoscopic surgery (1 with conversion to open surgery due to intraoperatively uncontrollable bleeding).There was no perioperative death.The operation time,volume of intraoperative blood loss,recovery time of gastrointestinal function,time of postoperative drainagetube removal and duration of hospital stay were (192± 20) minutes,(280± 30) mL,(33 ±6) hours,8 days (range,5-9 days),8 days (range,5-12 days) in 12 patients with open surgery and (208±40)minutes,(210±10)mL,(28±5)hours,7 days (range,5-26 days),7 days (range,5-10 days) in 6 patients with laparoscopic surgery,respectively.One patient with laparoscopic surgery had intraoperative condensed erythrocyte infusion with 2 U.Seven,1,0 patients with open surgery and 4,1,1 patients with laparoscopic surgery were respectively complicated with pleural effusion,delayed gastric emptying and pancreatic leakage in level A,and they were cured by conservative treatment.(2) Postoperative pathological examination:results of postoperative pathological examination in 18 patients showed that a large number of varicose veins in the mucous and seresal layers of gastric fundus and moderate or severe hepatic cinr hosis.(3) Follow-up and survival:18 patients were followed up for 8-78 months with a median time of 39 months.The gastroscopy and enhanced scan of X-ray CT at 1 month postoperatively showed that no varicose veins in the gastric fundus.During the follow-up,there was no recurrence of gastric varices with GRS and esophageal stenosis.Of 4 patients with portal vein thrombosis,1 died of portal hypertensive gastropathy-induced upper gastrointestinal bleeding due to stop taking warfarin,and other 3 patients had portal vein patency by warfarin therapy.One patient was complicated with liver cancer at 32 months postoperatively and received radiofrequency ablation therapy.Two patients died,including 1 dying of hepatic failure at 35 months postoperatively and 1 dying of advanced liver cancer at 54 months postoperatively.The 1-,3-and 5-year overall survival rates of 18 patients were respectively 93.8％,84.4％ and 70.3％.Conclusion The PCDV combined with splenectomy and PGFR is safe and effective in the treatment of portal hypertension-induced severe gastric varices with GRS,with a dissemination value for appropriate patients.
ABSTRACT
Objective To investigate the clinical effect of laparoscopic splenectomy combined with pericardial devascularization for the treatment of portal hypertension.Methods The retrospective cross-sectional study was conducted.The clinical data of 310 patients with portal hypertension who underwent laparoscopic splenectomy combined with pericardial devascularization in the Tangdu Hospital of Fourth Military Medical University between January 2012 and June 2016 were collected.All the patients underwent laparoscopic splenectomy combined with pericardial devascularization.Observation indicators:(1) surgical and postoperative situations;(2) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the gastrointestinal rebleeding and postoperative survival of patients up to January 2017.Measurement data with normal distribution and skewed distribution were respectively represented as average number (range) and M (range).Results (1) Surgical and postoperative situations:all patients underwent successful operation.Twelve patients converted to open surgery due to intractable bleeding and 298 underwent totally laparoscopic splenectomy combined with pericardial devascularization.Average operation time,average volume of intraoperative blood loss,average time of gastrointestinal function recovery and average time of postoperative abdominal drainage-tube removal of 310 patients were 192.5 minutes (range,120.0-300.0 minutes),402.3 mL (range,150.0-1 200.0 mL),2.4 days (range,1.0-4.0 days) and 4.2 days (range,2.0-8.0 days),respectively.Among 11 of 310 patients with postoperative complications,1 died of acute severe hemorrhage of upper digestive tract,5 with intra-abdominal bleeding received successful hemostasis (3 undergoing reoperation and 2 undergoing conservative treatment),2 with pleural effusion were improved by thoracentesis and drainage,2 with pancreatic leakage and 1 with pulmonary infection were cured by conservative treatment.Other 299 patients didn't have postoperative complications.Duration of postoperative hospital stay of 310 patients was 6.4 days (range,5.0-9.0 days).(2) Follow-up situations:260 of 309 patients were followed up for 6-60 months,with a median time of 26 months.During the follow-up,1 patient died of acute portal vein thrombosis at 1 month postoperatively;15 with gastrointestinal rebleeding and melena were cured by conservative treatment;other patients had survival.Conclusion Laparoscopic splenectomy combined with pericardial devascularization for the treatment of portal hypertension is safe and effective.
ABSTRACT
Objective To evaluate the impact of obesity and spleen length on laparoscopic splenectomy combined with pericardial devascularization.Methods We retrospectively analyzed 121 patients with portal hypertension who underwent laparoscopic splenectomy combined with pericardial devascularization in our hospital.Using BMI,these patients were classified as the obesity and the non-obesity groups.Using length of the spleen,the patients were divided into two subgroups:spleen AC diameter ＞ 20 cm and spleen AC diameter ≤20 cm.Results (1) For the Obesity group,the operation time,the rate of conversion to open operation and the complication rate after operation were higher than the non-obesity group [(184.0 ± 49.0) min vs (142.0 ±39.0) min,26.1％ vs 8.0％,26.1％ vs 6.7％,respectively,P＜0.05].However,the differences were not significant for mean blood loss,intraperitoneal drainage and complication rate after operation.For patients with massive splenomegaly,the obesity group had higher rates of conversion into open operation and complication (42.9％ vs 11.7％,33.3％ vs 8.8％,respectively,P ＜0.05).For patients with non-massive splenomegaly,the differences were not significant between the obesity and non-obesity groups (P ＞ 0.05).(2) For obesity patients,the spleen AC diameter ＞ 20 cm group had a longer operation time and a higher rate of conversion to open operation [(224.0 ± 42.0) min vs (152.0 ± 44.0) min,42.9％ vs 12.0％,respectively,P ＜ 0.05].The length of spleen had no effect on the operation and its complication (P ＞ 0.05).Conclusions Obesity extended the operation time and increased the rates of conversion to open operation and complication after operation.The spleen length had a major impact on the rates of conversion to open operation and complication after operation for the groups of obesity patients.
ABSTRACT
Objective To explor the operative method of modified pericardial devascularization and compare the effects of modified pericardial devascularization and traditional pericardial devascularization on esophageal gastric varices of liver cirrhosis with portal hypertension. Methods The clinical data of 35 patients receiving modified pericardial devascularization (MED group) and 35 patients receiving traditional pericardial devascularization (ED group) were retrospectively analyzed . Results The operating time in MED group was significantly lower than that in ED group:(182 ± 30)min vs.(220 ± 30) min, P0.05). Conclusions The operating time, blood loss and early complication rate in modified pericardial devascularization is better than traditional pericardial devascularization. There is no significant difference in long-term efficacy between two methods.
ABSTRACT
Objective To discuss the effect of pericardial devascularization plus gastric fundus transaction in advance schis?tosomiasis patients with portal hypertension. Methods Thirty?six advanced schistosomiasis patients with portal hypertension treated with devascularization plus gastric fundus transaction(a portal hypertension group),as well as 10 patients treated with modified Sugiura operation(a modified Sugiura operation group)in the Third People’s Hospital of Yangxin County since 2006 were chosen as the observation objects,and the clinical effects of the two groups were observed and compared. Results The op?eration time,indwelling time of stomach tube,time to taking food after operation,drainage tube removal time of the portal hy?pertension group were all shorten than those of the modified Sugiura operation group(all P0.05). In addition,1 case with delayed gastric emptying and 1 case with stomal leak of esopha?gus happened in the modified Sugiura operation group,while no corresponding complications happened in the portal hyperten?sion group. Conclusions Pericardial devascularization plus gastric fundus is a relatively easy procedure which has a good short?term clinical effect,and therefore it is suitable for application in primary hospitals. However,its long?term effect still needs fur?ther observation.
ABSTRACT
Objective To evaluate orthotopic splenectomy and pericardial devascularization for the treatment of portal hypertension.Methods The modified anterior approach splenectomy includes dissection of the peri-splenic vessels and ligments before division of short gastric vessels.During pericardial devascularization,the dessection panel was close to the esophagus and the stomach,leaving intact both the anterior and posterior vagus trunks.Results 63 patients underwent this modified operation.The free portal pressure decreased from (38 ±4) cmH2O to(28 ±4)cmH2O.The average blood loss was (530 ± 37)ml.There was no mortality,nor perioperative gastric paralysis and portal venous thrombosis.By 12-36 months follow-up,there was no pancreatic leakage,hepatic coma and recurrence of bleeding.Intrahepatic portal venous thromboses were detected in 4 cases at the sixth postoperative months.Conclusions This modified splenectomy plus selective pericardial devascularization carries less bleeding and is safe and effective for the treatment of portal hypertension.
ABSTRACT
Objective To investigate the short-term therapeutic effect of warfarin in preventing portal vein thrombosis (PVT) after modified laparoscopic splenectomy combined with pericardial devascularization.Methods The retrospective cohort study was used to analyze the clinical data of 32 patients with cirrhotic portal hypertension who were admitted to the Clinical Medical College of Yangzhou University between January 2014 and August 2014.The characteristics of warfarin and aspirin regimens were introduced to the patients before operation for choosing postoperative therapeutic regimen.Based on the decisions, 17 and 15 patients receiving warfarin regimen and aspirin regimen were divided into the warfarin group and the aspirin group, respectively.All the patients underwent successful modified laparoscopic splenectomy and pericardial devascularization with intraoperative autologous blood salvage.The treatments were as follows : from postoperative day 3, patients in the warfarin group received 2.5 mg of oral warfarin once daily with titration of the dose to maintain a target international normalized ratio (INR) of 2.0-3.0 for 1 year;patients in the aspirin group received 100 mg aspirin enteric coated tablets for 1 year;and both groups received 50 mg of oral dipyridamole three times daily for 3 months and subcutaneous injection of 4 100 U of low-molecular-weight heparin (LMWH) once daily for 5 days.Blood cell analysis, liver function, coagulation function and Doppler ultrasound screening for the occurrence of PVT were performed at the first and third months.Postoperative electronic gastroscopy was performed at 3 months postoperatively for observing the change of the esophageal and gastric-fundus varices.The patients were followed up till February 2015.The incidences of PVT and the level of INR at the first week, the first month and the third month after operation were observed.Measurement data with normal distribution were presented as (x) ± s and analyzed by t test, and measurement data with skewed distribution were presented as M(range) and analyzed by the rank-sum test.Comparison of the mean INR at different time points between the 2 groups was analyzed by the repeated measures ANOVA.Comparison of count data was analyzed by the Fisher's Exact Probility.Results There were no gastrointestinal hemorrhage or perioperative death in the 2 groups.(1) The overall incidences of PVT at postoperative week 1 were 9/17 and 6/15 in the warfarin and the aspirin groups, respectively, with no significant difference (P ＞ 0.05).However, the overall incidences of PVT at postoperative month 1 and 3 were 7/17 and 3/17 in the warfarin group, which was significantly different from 12/15 and 12/15 in the aspirin group (P ＜ 0.05).(2)The incidences of main portal vein thrombosis (MPVT) at postoperative week 1 and postoperative month 1 were 5/17 and 6/17 in the warfarin group, 4/15 and 5/15 in the aspirin group, showing no significant difference (P ＞ 0.05).The incidence of MPVT at postoperative month 3 was 3/17 in the warfarin group, which was significantly different from 9/15 in the aspirin group (P ＜ 0.05).(3) The INR was changed from 1.30 ± 0.17 before operation to 1.55 ± 0.38 at postoperative month 3 in the warfarin group, and from 1.33 ±0.14 before operation to 1.21 ±0.11 at postoperative month 3 in the aspirin group, showing significant difference in the changing trend between the 2 groups (F =713.908, P ＜ 0.05).(4) All the 32 patients were followed up for a median time of 7 months (range, 3-11 months).The results of electronic gastroscopy at postoperative month 3 showed that the esophageal and gastric-fundus varices were obviously improved or disappeared.Conclusion Warfarin in preventing PVT after modified laparoscopic splenectomy combined with pericardial devascularization is safe and feasible, with a good short-term outcome.