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Objective To study whether portal vein thrombosis can be prevented by partial splenectomy combined with portoazygos devascularization,by preserving the integrity of the blood flow of the inferior splenic vessels.Methods 156 patients with portal hypertension and megalosplenia were divided into two groups.62 patients in group A who underwent partial splenectomy and 94 patients in group B who underwent total splenectomy.The postoperative complications,levels of WBC and PLT,volumes of residual spleen,hepatic vein pressure gradient (HVPG),and prevalence of portal vein thrombosis between the two groups were compared.Results The surgery time of group A was slightly higher than group B [(189.0± 38.5) vs.(128.0±36.3) min,P＜0.05].The blood loss of group A was slightly higher than that of group B [(328.0±68.9) vs.(294.0±49.1) ml,P＜0.05].The postoperative infection rate,change in HVPG and rehemorrhage rate between the two groups showed no significant differences (P＞0.05).The elevation in Leucocyte after operation of the two groups were the same,peaking on day 3.The platelet count of group A increased more gently than group B (2 weeks vs 1 week),and its peak was closer to the normal threshold (P＜0.05).The thrombosis rate of the portal vein system in group A was significantly lower than group B within 1 year (P＜0.01).The residual spleen did not enlarge after operation (P＞0.05).Conclusion Subtotal splenectomy combined with pericardial devascularization in patients with portal hypertension and megalosplenia preserved the blood flow of the subsplenic polar vessels and reduced the incidence of portal vein thrombosis.
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Objective To study the safety and feasibility of laparoscopic total splenectomy (LTS) and laparoscopic partial splenectomy (LPS) in the diagnosis and treatment of benign splenic tumors by comparing the perioperative and follow-up data between these two operative approaches.Methods We retrospectively analyzed the clinical data of 57 patients who underwent laparoscopic surgery for benign splenic tumors from December 2009 to April 2016.These patients were divided into the LTS and the LPS groups.The clinical data including the preoperative,intraoperative,postoperative and follow-up data were analyzed.Results When compared with the LPS group,the LTS group had shorter operation time [(97.0 ± 22.1)min vs.(135.0 ± 24.6) min,P ＜ 0.05] and less blood loss [(33.3 ± 19.5) min vs.(90.6 ± 55.1)min,P ＜ 0.05],but there were no significant differences between the two groups in the length of hospital stay,the duration of drainage tube placement,the amount of postoperative analgesics as well as the incidences of pulmonary infection,postoperative pancreatic fistula and other complications after surgery.These incidences were low in the two groups.Conclusion Laparoscopic surgery,including LTS and LPS,were safe and feasible in treating benign splenic tumors.
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OBJETIVO: Avaliar o efeito da esplenectomia total e parcial (hemiesplenectomia e esplenectomia subtotal) no lipidograma de cães. MÉTODO: Foram operados 38 animais, adultos, machos, mestiços, com peso entre 13kg e 15kg. No pré-operatório, depois do exame clínico e jejum de 12 horas de uma dieta-padrão, foram realizados hemograma e lipidograma. Após anestesia geral com tiopental sódico os cães foram submetidos à laparotomia mediana supra e infra-umbilical. Procedeu-se no grupo 1, de sete cães, apenas à manipulação do baço (simulado); no grupo 2, de nove cães, à hemiesplenectomia cranial; no grupo 3, de nove cães, à esplenectomia subtotal, com preservação do pólo inferior do baço, após ligadura e secção dos troncos principais dos vasos esplênicos próximos ao hilo; e no grupo 4, de 13 cães, à esplenectomia total. RESULTADOS: No grupo 4 (esplenectomia total), quando comparamos os valores do lipidograma dos diferentes períodos pós-operatórios com os do pré-operatório, os nossos resultados mostraram que houve aumento significante do colesterol total em todos os períodos pós-operatórios (p < 0,05, p < 0,01). O HDL aumentou significantemente no 7º (p < 0,01) e 28º dias de pós-operatório (PO) (p < 0,05), e não significantemente (p>0,05) no 56º PO. O LDL aumentou significantemente no 56º PO (p < 0,01) em relação também aos demais períodos do pós-operatório. Os triglicerídeos e VLDL não apresentaram alterações significantes. Nos animais dos grupos 1 e 3 não houve alterações significantes. Nos do grupo 2, houve aumento significante do colesterol no 7º PO. Não houve diferença estatisticamente significante de peso entre os remanescentes das esplenectomias parciais. CONCLUSÕES: A análise dos resultados nos permitiu concluir que a esplenectomia total induz aumento significante do colesterol total, das frações HDL e LDL, enquanto os níveis de triglicerídios e a fração VLDL não sofrem alterações; a conservação da metade inferior do baço ou a esplenectomia ...
BACKGROUND: The purpose of this study was to evaluate the effect of partial (hemi-splenectomy and subtotal splenectomy) and total splenectomy in the dogs lipidic profile. METHOD: Thirty eight (38) mongrel male dogs, with weight varying between 13 Kg and 15 Kg were operated. After clinical evaluation and twelve hour fasting of standard diet, preoperatively hemogram and lipidic profile were evaluated. After general anaesthesia with sodium thiopental, the dogs were submitted to an upper and lower median laparotomy. Group I, seven dogs, just manipulation of the spleen (sham-control); group II, nine dogs upper hemisplenectomy; group III, nine dogs, subtotal splenectomy with preservation of inferior pole, after the ligature and section of the splenic artery and vein near the hilus; group IV, thirteen dogs, total splenectomy was performed. RESULTS: Our results, when we compared to the lipid values of the different post-operative periods with preoperative data, showed that in group IV (total splenectomy) there was a significant increase of the total cholesterol in all post-operative periods (p < 0,05, p < 0,01). The high-density lipoprotein(HDL) was significantly augmented in the 7th ( p < 0,01) and 28th (p < 0,05) post-operative day and at not significantly (p > 0,05) on the 56th post-operative time. The low-density lipoprotein (LDL) increased significantly in the 56th post-operative (p < 0,01). Triglyceride and very-low density lipoproteins (VLDL) did not present significant changes. Animals of group 1 and 3 did not present significant changes. In group 2 there was a significant increased in cholesterol on the 7th post-operative day. There was no difference between the weight of the spleen remaining after partial splenectomy. CONCLUSIONS: We conclude that total splenectomy causes significant elevation in the total cholesterol, HDL and LDL, while triglycerides and VLDL don't change; - the preservation of the inferior lower half of the spleen ...