Partial Splenic Embolization Versus Splenectomy for the Management of Hypersplenism in Cirrhotic Patients

被引:142
作者
Amin, Mahmoud A. [1 ]
El Gendy, Mohamed M. [1 ]
Dawoud, Ibrahim E. [1 ]
Shoma, Ashraf [1 ]
Negm, Ahmed M. [1 ]
Amer, Talal A. [2 ]
机构
[1] Mansoura Univ Hosp, Mansoura Fac Med, Dept Gen Surg, Mansoura 35516, Egypt
[2] Mansoura Univ Hosp, Mansoura Fac Med, Dept Radiol, Mansoura 35516, Egypt
关键词
IDIOPATHIC PORTAL-HYPERTENSION; ESOPHAGEAL-VARICES; THROMBOSIS; DISEASE;
D O I
10.1007/s00268-009-0095-2
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background Hypersplenism occurs in patients with chronic liver disease, and splenectomy is the definitive treatment. However, the operation may be hazardous in patients with poor liver function. In recent years, partial splenic embolization (PSE) has been widely used in patients with hypersplenism and cirrhosis. This study was conducted to assess the safety and efficacy of PSE compared to splenectomy in the management of hypersplenism in cirrhotic patients. Methods This study comprised 40 patients with hypersplenism secondary to cirrhosis. They were divided into two groups, each including 20 patients. The first group of patients were treated by PSE using polyvinyl alcohol particles to achieve embolization of at least 50%, of the distal branches of the splenic artery. Postembolization arteriography and computed tomography were performed to document the extent of devascularization. Patients in the second group were treated by splenectomy with or without devascularization and left gastric ligation according to the presence or absence of esophageal varices. Results There was marked improvement in platelet and leukocytic counts in both groups, and the counts remained at appropriate levels during the follow-up period. All patients in the first group had problems related to postembolization syndrome that abated by the first week. One patient in the first group died from myocardial infarction. No deaths occurred in the second group. Asymptomatic portal vein thrombosis developed in one patient in the first group that was treated with anticoagulation, and another patient developed splenic abscess treated by splenectomy with a good outcome. In the second group, three patients developed portal vein thrombosis, one of them being readmitted 4 months postoperatively with mesenteric vascular occlusion; that patient underwent a resection anastomosis with good outcome. Conclusions Partial splenic embolization is an effective therapeutic modality for the treatment of hypersplenism secondary to chronic liver disease. It is a simple, rapid procedure that is easily performed under local anesthesia; and it allows preservation of adequate splenic tissue to safeguard against overwhelming infection.
引用
收藏
页码:1702 / 1710
页数:9
相关论文
共 26 条
[1]  
Abou El Hoda MF, 1996, EGYPT J SURG, V15, P5
[2]  
Balaji SJ., 2005, JIACM, V6, P291
[3]  
BELLI L, 1989, SURG GYNECOL OBSTET, V169, P46
[4]  
DWIVEDI MK, 2002, J RADIOL IMAGING, V12, P371
[5]  
EGUCHI A, 1991, ARCH SURG-CHICAGO, V126, P752
[6]   SELECTIVE SHUNT VERSUS NONSHUNT SURGERY FOR MANAGEMENT OF BOTH SCHISTOSOMAL AND NONSCHISTOSOMAL VARICEAL BLEEDERS [J].
EZZAT, FA ;
ABUELMAGD, KM ;
ALY, MA ;
FATHY, OM ;
ELGHAWLBY, NA ;
ELFIKY, AM ;
ELBARBARY, MH .
ANNALS OF SURGERY, 1990, 212 (01) :97-108
[7]   SPLENIC ABSCESS - PRESENTATION, TREATMENT OPTIONS, AND RESULTS [J].
FAUGHT, WE ;
GILBERTSON, JJ ;
NELSON, EW .
AMERICAN JOURNAL OF SURGERY, 1989, 158 (06) :612-614
[8]   Comparison of two different percutaneous splenic artery interventions in the treatment of hypersplenism: Preliminary report [J].
Firat, A ;
Boyvat, F ;
Moray, G ;
Aytekin, C ;
Karakayali, H ;
Haberal, M .
TRANSPLANTATION PROCEEDINGS, 2005, 37 (02) :1094-1098
[9]   PARTIAL SPLENIC EMBOLIZATION FOR HYPERSPLENISM IN RENAL-TRANSPLANTATION [J].
GERLOCK, AJ ;
MACDONELL, RC ;
MUHLETALER, CA ;
PARRIS, WCV ;
JOHNSON, HK ;
TALLENT, MB ;
RICHIE, RE ;
KENDALL, RI .
AMERICAN JOURNAL OF ROENTGENOLOGY, 1982, 138 (03) :451-456
[10]   Long-term results of initial and repeated partial splenic embolization for the treatment of chronic idiopathic thrombocytopenic purpura [J].
Kimura, F ;
Itoh, H ;
Ambiru, S ;
Shimizu, H ;
Togawa, A ;
Yoshidome, H ;
Ohtsuka, M ;
Shimizu, Y ;
Shimamura, F ;
Miyazaki, M .
AMERICAN JOURNAL OF ROENTGENOLOGY, 2002, 179 (05) :1323-1326