Partial splenectomy may prevent portal vein thrombosis after hassab surgery in patients with megalosplenia / 中华肝胆外科杂志

ABSTRACT

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.