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HCV-related decompensated cirrhos,hypersplenism,thrombocytopenia,which not only affect the standard antiviral therapy,fail to achieve the sustained virological response(SVR),but also increase the risk of infection and bleeding.The only successful option is liver transplantation (LT),but the recurrence of HCV after LT remains to be resolved.The patients of HCV genotype 2 are suitable for splenectomy and antiviral therapy following splenectomy,which can achieved a higher SVR and reversed cirrhosis.As an effective alternative to splenectomy,the partial splenic embolization (PSE) can improve the changes of portal hemodynamics and reduce the sequelae of portal hypertension.The appearance of direct antiviral drugs (DAAs)has bring hope for those with decompensated cirrhos and whom IFN is contraindicated or tolerated poorly,those who are waiting for LT or with recurrence of hepatitis C after LT.The treatment of patients with decompensated cirrhos is as follows.
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Objective To explore the efficacy of radiofrequency ablation (RFA) combined with splenectomy in patients with small hepatocellular carcinoma (sHCC) associated with hypersplenism.Metheds The data of 100 patients with sHCC associated with hypersplenism who received RFA or hepatectomy combined with splenectomy were analyzed retrospectively.The patients were divided into the observation group and the control group based on the intraoperative approach.Fifty-three patients who received RFA and splenectomy were in the observation group,and the remaining 47 patients who received hepatectomy and splenectomy were in the control group.Multiple intraoperative and postoperative factors were compared between the two groups.Results There were significant differences between the two groups in warm ischemia time,operation time,intraoperative blood loss,hospital stay,and amount of blood transfusion (P ＜ 0.05).The postoperative complication rate of the observation group (7.6％,4/53) was significantly lower than the control group (44.7 ％,21/47) (P ＜ 0.05).There were no significant differences in 1-,3-,and 5-year survival (respectively,100.0％,75.5％,and 67.9％ vs 97.9％,76.6％,and 68.1％) and in disease free survival (96.2％,57.5％,and 41.7％ vs 93.5％,58.3％,and 43.8％ respectively) between the two groups (P ＞ 0.05).Conclusion RFA combined with splenectomy can be considered as an alternative treatment for patients with sHCC associated with hypersplenism.
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Objective To explore the internal jugular vein liver inside door body bypass surgery (Transjugularintrahepatie portosystemic shunt,TIPS) and part of the spleen embolization (PaniM splenicembolization,PSE) after laparoscopic resection combined with spleen schistosomiasis compounds with cirrhosis of the liver function of spleen hyperthyroidism curative effect.Methods Fifty-two cases had schistosomiasis hepatocirrhosis with spleen function in patients with hyperthyroidism,doing any operation after a week PSE TIPS.Postoperative liver function and adopted to monitor changes,two weeks left hand done help type laparoscopic splenectomy.Results Fifty-two patients underwent TIPS and PSE after surgical treatment,blood picture and liver function back to normal,in two weeks or so do help laparoscopic resection of the hand of the spleen,five cases were transfered to open surgery,patients were cured and discharged.And the previous similar average hospitalization days compared with patients who shorten,average hospital expenses dropped,and less complications,little pain.Conclusion TIPS and PSE joint laparoscopic splenectomy are schistosomiasis compounds with cirrhosis of the liver function of spleen hyperthyroidism,definite effect not only,and safety,minimally invasive,has a good value of clinical application.
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To summarize the evolution of spleen surgery and prospects the future. The knowledge on the splenic function (anti-infection, cancer and certain blood effects)gradually promotes the reform of spleen surgery in clinical practical, resulting all kinds of spleen-preserving surgery when splenic injury. However,there is still controversy about spleen removal or reservation under the condition of portal hypertension in liver cirrhosis patients, because advantages and disadvantages between these different operations. Laparoscopic splenectomy is a major progress in recent years,the standard operation need to be further explored. Spleen transplantation in the treatment of hemophilia A is one of the characteristics of the spleen surgery in China, and this is the leading position in the world, now we will focus on how to prevent chronic spleen graft dysfunction. To keep the advanced international level, Chinese teams on spleen surgery are still required to deepen the related research and strengthen the academic communication in the future.
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PURPOSE: Concerns about patients experiencing overwhelming postsplenectomy sepsis have led to the development of splenic preservation procedures, and the advanced understanding of splenic vascular anatomy has permitted splenic preserving operations and conservative medical management. These are now accepted alternative procedure when dealing with pathologically benign splenic conditions and traumatic splenic injuries. The aim of the present paper was to evaluate the effectiveness and safety to this new spleen conserving procedure compare to open splenectomy. METHODS: From December 1999 through April 2004, five patients with splenic cysts who were treated by splenectomy and laparoscopic function preserving surgery (LFPS) were enrolled in this study. We analyzed the operation time, the amount of blood loss, the time to restart a regular diet, the hospital stay and the postoperative CT to retrospectively confirm the results of the operations. RESULTS: In four cases, the pathologic findings were splenic pseudocysts, and the other case was a cystic lymphangioma. The operative times were 138 minutes (range: 120~156 minutes) for LFPS and 130 minutes (range: 100~170 minutes) for total splenectomy. The amounts of blood loss were 20~30 cc for LFPS, and 20~800 cc for open splenectomy. For LFPS, the patients started their diet at postoperative day 1st and they were discharged at 4th (range: 3~5) day without complication. But for total splenectomy, normal diet was started at the 3rd day (range: 2~4) and they were discharged at the 11th day (range: 3~22) and one patient had complications. For LFPS, on the CT that was done 3 month after operation, we confirmed the complete excision of cysts without any operation related complication, there was no evidence of recurrence and the splenic parenchyme was preserved in a normal fashion in all cases. CONCLUSION: The success and relative ease of performing this laparoscopic function preserving procedure will pave the way for its future use in other selective cases involving splenic pathology.
Subject(s)
Humans , Diet , Length of Stay , Lymphangioma, Cystic , Operative Time , Pathology , Recurrence , Retrospective Studies , Sepsis , Spleen , SplenectomyABSTRACT
BACKGROUND: This study was to access the hemostatic effectiveness of transcatheter arterial embolization (TAE) in a blunt splenic injury. We evaluated the efficacy of using detailed angiographic examnination and embolization for the nonsurgical management of patients with spleen injury. METHODS: Blunt splenic injuries diagnosed by Computed tomography (CT) between January 1997 and December 1997 were prospectively studied according to our management algorithm. The first group (G1) consisted of patients who were observed only, the second grourp (G2) with consisted of patients receving a TAE, and the third group (G3) consisted of those receving a laparotomy. The criteria for a TAE were: 1) Type III or IV injury and 2) extravasation of contrast material revealed by CT. RESULTS: Of the total 46 patients with blunt splenic injury, 17 underwent emergency laparotomies because of associated injuries or unstable vital signs after resuscitation. Fourteen of the 17 had splenectomies and the other three had splenorrhaphies. The remaining 29 patients were considered for nonoperative management (63%), and 13 of them were selected for a TAE. Splenic angiography showed active bleeding in 12 and minor bleeding in one. The bleeding was successfully controlled by TAE in all 13 patients. Abdominal CT and scintigraphy taken after TAE disclosed well functioning spleens. The total splenic salvage rate was 63% in our patients. CONCLUSION: We could reduce the laparotomy rate and could preserve more spleens after application of TAE. Our success rate for splenic salvage should encourage more extensive use of a TAE for splenic injury.