AIM： To compare the outcomes of laparoscopic and open splenectomy and azygoportal devascularization for portal hypertension. METHODS： From June 2006 to March 2009, laparoscopic splenectomy and azygoportal disconnect...AIM： To compare the outcomes of laparoscopic and open splenectomy and azygoportal devascularization for portal hypertension. METHODS： From June 2006 to March 2009, laparoscopic splenectomy and azygoportal disconnection （LSD） were performed on 28 patients with cirrhosis, bleeding due to portal hypertension, and secondary hypersplenism. Success was achieved in 26 patients. Demographic, intraoperative, and postoperative variables of the patients were compared. RESULTS： Success of laparoscopic splenectomy and azygoportal disconnection was achieved in all but two patients （7.14%） who required open splenectomy and azygoportal devascularization （OSD）. The operation time was significantly longer in patients undergoing LSD than in those undergoing OSD （235 ± 36 min vs 178 ± 47 rain, P 〈 0.05）. The estimated intraoperative blood loss was much more in patients receiving OSD than in those receiving LSD （420 ± 50 mL vs 200 ± 30 mL, P 〈 0.01）. The proportion of patients undergoing laparoscopic and open splenectomy and azygoportal disconnection who received transfusion of packed red blood cells during or after the operation was 23.08% and 38.46%, respectively （P 〈 0.05）. The time of first oral intake was faster in patients after LSD than in those after OSD （1.5 ± 0.7 d vs 3.5 ± 1.6 d, P 〈 0.05）. The hospital stay of patients after LSD was shorter than that of patients after OSD （6.5 ± 2.3 d vs 11.7 ± 4.5 d, P 〈 0.05）. The pain requiring medication was less severe in patients after LSD than in those after OSD （7.69% vs 73.08%, P 〈 0.001）. The overall complication rate was lower in patients after LSD than in those after OSD （19.23% vs 42.31%, P 〈 0.05）.CONCLUSION： Laparoscopic splenectomy and azygoportal disconnection are the feasible, effective, and safe surgical procedure, and are advantageous over minimally invasive surgery for bleeding portal hypertension and hypersplenism.展开更多
Since the first laparoscopic splenectomy(LS)was reported in 1991,LS has become the gold standard for the removal of normal to moderately enlarged spleens in benign conditions.Compared with open splenectomy,fewer posts...Since the first laparoscopic splenectomy(LS)was reported in 1991,LS has become the gold standard for the removal of normal to moderately enlarged spleens in benign conditions.Compared with open splenectomy,fewer postsurgical complications and better postoperative recovery have been observed,but LS is contraindicated for hypersplenism secondary to liver cirrhosis in many institutions owing to technical difficulties associated with splenomegaly,well-developed collateral circulation,and increased risk of bleeding.With the improvements of laparoscopic technique,the concept is changing.This article aims to give an overview of the latest development in laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension.Despite a lack of randomized controlled trial,the publications obtained have shown that with meticulous surgical techniques and advanced instruments,LS is a technically feasible,safe,and effective procedure for hypersplenism secondary to cirrhosis and portal hypertension and contributes to decreased blood loss,shorter hospital stay,and less impairment of liver function.It is recommended that the dilated short gastric vessels and other enlarged collateral circulation surrounding the spleen be divided with the LigaSure vessel sealing equipment,and the splenic artery and vein be transected en bloc with the application of the endovascular stapler.To support the clinical evidence,further randomized controlled trials about this topic are necessary.展开更多
AIM:To evaluate whether total splenic artery embolization(TSAE) for patients with hypersplenism delivers better long-term outcomes than partial splenic embolization(PSE).METHODS:Sixty-one patients with hypersplenism e...AIM:To evaluate whether total splenic artery embolization(TSAE) for patients with hypersplenism delivers better long-term outcomes than partial splenic embolization(PSE).METHODS:Sixty-one patients with hypersplenism eligible for TSAE(n = 27,group A) or PSE(n = 34,group B) were enrolled into the trial,which included clinical and computed tomography follow-up.Data on technical success,length of hospital stay,white blood cell(WBC) and platelet(PLT) counts,splenic volume and complications were collected at 2 wk,6 mo,and 1,2,3,4 years postoperatively.RESULTS:Both TSAE and PSE were technically successful in all patients.Complications were significantly fewer(P = 0.001),and hospital stay significantly shorter(P = 0.007),in group A than in group B.Postprocedure WBC and PLT counts in group A were significantly higher than those in group B from 6 mo to 4 years(P = 0.001),and post-procedure residual splenic volume in group A was significantly less than that observed in group B at 1,2,3 and 4 years post-procedure(P = 0.001).No significant differences were observed in red blood cell counts and liver function parameters between the two groups following the procedure.CONCLUSION:Our results indicate that TSAE for patients with hypersplenism not only delivers a better longterm outcome,but is also associated with lower complication rates and a shorter hospital stay than PSE.展开更多
文摘AIM： To compare the outcomes of laparoscopic and open splenectomy and azygoportal devascularization for portal hypertension. METHODS： From June 2006 to March 2009, laparoscopic splenectomy and azygoportal disconnection （LSD） were performed on 28 patients with cirrhosis, bleeding due to portal hypertension, and secondary hypersplenism. Success was achieved in 26 patients. Demographic, intraoperative, and postoperative variables of the patients were compared. RESULTS： Success of laparoscopic splenectomy and azygoportal disconnection was achieved in all but two patients （7.14%） who required open splenectomy and azygoportal devascularization （OSD）. The operation time was significantly longer in patients undergoing LSD than in those undergoing OSD （235 ± 36 min vs 178 ± 47 rain, P 〈 0.05）. The estimated intraoperative blood loss was much more in patients receiving OSD than in those receiving LSD （420 ± 50 mL vs 200 ± 30 mL, P 〈 0.01）. The proportion of patients undergoing laparoscopic and open splenectomy and azygoportal disconnection who received transfusion of packed red blood cells during or after the operation was 23.08% and 38.46%, respectively （P 〈 0.05）. The time of first oral intake was faster in patients after LSD than in those after OSD （1.5 ± 0.7 d vs 3.5 ± 1.6 d, P 〈 0.05）. The hospital stay of patients after LSD was shorter than that of patients after OSD （6.5 ± 2.3 d vs 11.7 ± 4.5 d, P 〈 0.05）. The pain requiring medication was less severe in patients after LSD than in those after OSD （7.69% vs 73.08%, P 〈 0.001）. The overall complication rate was lower in patients after LSD than in those after OSD （19.23% vs 42.31%, P 〈 0.05）.CONCLUSION： Laparoscopic splenectomy and azygoportal disconnection are the feasible, effective, and safe surgical procedure, and are advantageous over minimally invasive surgery for bleeding portal hypertension and hypersplenism.
文摘Since the first laparoscopic splenectomy(LS)was reported in 1991,LS has become the gold standard for the removal of normal to moderately enlarged spleens in benign conditions.Compared with open splenectomy,fewer postsurgical complications and better postoperative recovery have been observed,but LS is contraindicated for hypersplenism secondary to liver cirrhosis in many institutions owing to technical difficulties associated with splenomegaly,well-developed collateral circulation,and increased risk of bleeding.With the improvements of laparoscopic technique,the concept is changing.This article aims to give an overview of the latest development in laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension.Despite a lack of randomized controlled trial,the publications obtained have shown that with meticulous surgical techniques and advanced instruments,LS is a technically feasible,safe,and effective procedure for hypersplenism secondary to cirrhosis and portal hypertension and contributes to decreased blood loss,shorter hospital stay,and less impairment of liver function.It is recommended that the dilated short gastric vessels and other enlarged collateral circulation surrounding the spleen be divided with the LigaSure vessel sealing equipment,and the splenic artery and vein be transected en bloc with the application of the endovascular stapler.To support the clinical evidence,further randomized controlled trials about this topic are necessary.
文摘AIM:To evaluate whether total splenic artery embolization(TSAE) for patients with hypersplenism delivers better long-term outcomes than partial splenic embolization(PSE).METHODS:Sixty-one patients with hypersplenism eligible for TSAE(n = 27,group A) or PSE(n = 34,group B) were enrolled into the trial,which included clinical and computed tomography follow-up.Data on technical success,length of hospital stay,white blood cell(WBC) and platelet(PLT) counts,splenic volume and complications were collected at 2 wk,6 mo,and 1,2,3,4 years postoperatively.RESULTS:Both TSAE and PSE were technically successful in all patients.Complications were significantly fewer(P = 0.001),and hospital stay significantly shorter(P = 0.007),in group A than in group B.Postprocedure WBC and PLT counts in group A were significantly higher than those in group B from 6 mo to 4 years(P = 0.001),and post-procedure residual splenic volume in group A was significantly less than that observed in group B at 1,2,3 and 4 years post-procedure(P = 0.001).No significant differences were observed in red blood cell counts and liver function parameters between the two groups following the procedure.CONCLUSION:Our results indicate that TSAE for patients with hypersplenism not only delivers a better longterm outcome,but is also associated with lower complication rates and a shorter hospital stay than PSE.
