Spleen autotransplantation plus portaazygous devascularization in the treatment of portal hypertension / 中国普通外科杂志

ABSTRACT

Objective To evaluate spleen autotransplantation with lower esophagus transection for the treatment of portal hypertension by three-dimensional dynamic contrast-enhanced magnetic resonance angiography (3D-DCE MRA). Methods Twenty-eight patients were randomly divided into study group undergoing splenic autotransplantation and cardia-esophageal devascularization plus lower esophagus transection and control group without splenic transplantation. The cross section area, blood velocity and blood flow of main portal vein (MPV) were measured by 3D-DCE MRA, and the blood flow, collateral circulation of transplanted spleen were assessed. Results The cross section areas (cm ) of MPV of the two groups decreased postoperatively ( study group 1. 80 ? 0. 69 vs. 1. 20 ? 0. 73 , t = 13.96, P = 0. 00; control group 1. 78 ? 0. 43 vs. 1. 29 ? 0. 57, t = 11. 38, P = 0. 00). The mean blood velocity ( cm/s) of MPV decreased postoperatively (study group 9. 85 ? 0. 09 vs. 7. 06 ? 1. 98, t = 18. 98 , P = 0. 00; control group 10. 01 ?0. 43 vs. 8. 19 ?2. 44, t =22. 32, P =0. 00) in the two groups, and the mean blood velocity ' of MPV in study group was lower postoperatively than that in control group ( t = - 8. 02, P = 0. 00 ) . The mean blood flow (ml/s) of MPV decreased postoperatively (study group 15. 05 ? 2. 43 vs. 10. 52 ? 2. 55, 1 = 16.93, P=0. 00; control group 14. 81 ?2. 29 vs. 11.58 ?2. 96, t = 15. 90, P=0. 00) , and the mean blood flow of MPV in study group was lower postoperatively than that in control group (t = - 2. 73, P = 0. 02). Extensive collateral circulation developed around the transplanted spleen. Conclusions 3D-DCE MRA clearly shows the autotransplantated spleen and portal hemodynamics. It is an important non-invasive way to evaluate the result of the procedures.