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Portal veinous hemodynamics after subtotal splenectomy and portaazygous devascularization / 中华普通外科杂志
Chinese Journal of General Surgery ; (12): 20-23, 2010.
Article in Chinese | WPRIM | ID: wpr-390878
ABSTRACT
Objective To evaluate perioperative portal hemodynamic alterations in cirrhotic patients undergoing subtotal splenectomy,podicled spleen remnant retroperitoneal transplantation plus lower esophagus transection in the treatment of portal hypertension.Method Forty patients with cirrhotic portal hypertension were randomly allocated into 2 groupssplenic transplantation group (n = 20),in which patients underwent subtotal splenectomy with pedicled remnant spleen retroperitoneal transplantation and cardia-esophageal devascularization and transection,and control group (n = 20),in which splenectomy and cardia-esophageal devascularization and transection were performed.The cross section area,blood velocity and flow and collateral circulation of portal parameters were comparatively evaluated by 3D DEC MRA,and the size of remnant spleen,blood flow and collateral circulation of retroperitoneal transplanted spleen were comparatively assessed.Results At 6-month after operation,the disappearance of esophageal-gastric varices in two groups was similar,and the cross section areas of main portal vein (MPV) in two groups all decreased postoperatively,in study group it was (1.81±0.73) cm~2 vs.(1.20±0.52) cm~2,P < 0.01;in control group it was (1.78±0.52) cm~2 vs.(1.30±0.12) cm~2,p <0.01.The mean blood velocity of MPV decreased postoperatively,in study group it was (9.86±0.10) cm/s vs.(7.06±1.92) cm/s,P <0.01;In control group it was (10.0 ±0.6)cm/s vs.(8.2±2.4) cm/s,P <0.01.The mean blood flow velocity of MPV in study group was lower postoperatively than that in control group(P<0.01).The mean blood flow volume of MPV decreased postoperatively from (15.0±1.9) ml/s to (10.5 ±2.7)ml/s,P <0.01 in study group;and from (14.9±2.1) ml/s to (11.6±2.1) ml/s,P < 0.01 in control group.The mean blood flow volume of MPV in study group was lower postoperatively than that in control group(P<0.05).A significant collateral formation was observed around the retroperitoneally translocated pedicled remnant spleen.Conclusions Compared with splenectomy,subtotal splenectomy,retroperitoneal translocation of the pedicled remnant speen helps to preserve splenic function as well as to increase retroperitoneal collateral formation which is conducive to further decreasing the portal veinous pressure.

Full text: Available Index: WPRIM (Western Pacific) Language: Chinese Journal: Chinese Journal of General Surgery Year: 2010 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Language: Chinese Journal: Chinese Journal of General Surgery Year: 2010 Type: Article