Effect of splenectomy combined with pericardial vascular dissection on liver function and hemodynamics in patients with cirrhosis of the portal vein

doi:10.3877/cma.j.issn.1674-0793.2018.02.010

Abstract

Abstract:

Objective

To study the effect on liver function, portal vein pressure and blood flow for portal hypertension (PHT) patients after splenectomy+pericardial devascularization.

Methods

From June 2012 to June 2017, ninety-six patients underwent PHT in Hechi People's Hospital, and were divided into two groups according to random number table method, the observation group (48 cases) treated by surgery, the control group (48 cases) received conservative treatment. Patients in the observation group were detected before surgery of hepatic artery and portal vein flow, diameter, average rate Valley, velocity and peak velocity, while detected prothrombin time (PT), total bilirubin (TBIL), albumin (ALB) and alanine aminotransferase (ALT) level change before and after treatment.

Results

(1) Before treatment, the concentration of TBIL and ALT in the control group was (54.28±23.04) mmol/L and (88.05±33.72) U/Lrespectively, which decreased to (41.63±20.11) mmol/L, (67.92±35.73) U/L after treatment (t=2.866, 2.839, P=0.043, 0.036). PT, TBIL, ALB and ALT concentrations in the observation group before treatment were (19.83±2.80) s, (52.64±20.51)mmol/L, (25.06±4.15) g/L, (86.40±35.16) U/L, which decreased to (15.96±2.74) s, (28.78±11.30) mmol/L, (30.03±2.53)g/L, (41.37±24.39) U/L after treatment, respectively (t=6.844, 7.059, 7.084, 7.291, P=0.013, 0.024, 0.008, 0.005). (2) Compared with preoperation, portal vein flow and diameter of the patients in the observation group were significantly decreased (t=9.289, 10.883, P=0.005, 0.026), hepatic artery flow, diameter, velocity, peak velocity and velocity were increased significantly (t=9.180, 22.045, 10.281, 21.044, 9.277, P=0.014, 0.028, 0.028, 0.019, 0.023). The differences were statistically significant. (3) Free portal pressure of patients in the observation group was(29.09±1.37) mmHg after opening; pressure was significantly reduced to (22.68±1.18), (20.29±1.09) mmHgafter splenic artery ligation and splenectomy, respectively (t=24.561, 10.308, P=0.035, 0.042); while after the disconnection, the pressure increased significantly to (23.39±1.20) mmHg (t=13.248, P=0.036).

Conclusion

Splenectomy combined with pericardial vascular dissection can improve the liver function of PHT patients, reduce portal pressure and blood flow, and increase the blood flow of the hepatic artery.

Key words: Hypertension, portal, Liver cirrhosis, Splenectomy, Blood volume determination, Pericardial paraesophsgastric devascularization

Weiming Ling, Hongfei Li, Qinglu Huang. Effect of splenectomy combined with pericardial vascular dissection on liver function and hemodynamics in patients with cirrhosis of the portal vein[J]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(02): 115-119.

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References 18

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组别		PT（s）	t值^a	P值^a	TBIL（mmol/L）	t值^a	P值^a	ALB（g/L）	t值^a	P值^a	ALT（U/L）	t值^a	P值^a
观察组			6.844	0.013		7.059	0.024		7.084	0.008		7.291	0.005
	治疗前	19.83±2.80			52.64±20.51			25.06±4.15			86.40±35.16
	治疗后	15.96±2.74^a			28.78±11.30^a			30.03±2.53^a			41.37±24.39^a
对照组			1.809	0.164		2.866	0.043		0.533	0.281		2.839	0.036
	治疗前	19.86±2.90			54.28±23.04			24.89±4.37			88.05±33.72
	治疗后	18.74±3.16			41.63±20.11			24.47±3.27			67.92±35.73
	t值^bc	1.194, 10.804			2.065, 9.380			1.472, 11.704			0.897, 12.389
	P值^bc	0.159, 0.038			0.340, 0.027			0.208, 0.021			0.193, 0.019

组别		PT（s）	t值^a	P值^a	TBIL（mmol/L）	t值^a	P值^a	ALB（g/L）	t值^a	P值^a	ALT（U/L）	t值^a	P值^a
观察组			6.844	0.013		7.059	0.024		7.084	0.008		7.291	0.005
	治疗前	19.83±2.80			52.64±20.51			25.06±4.15			86.40±35.16
	治疗后	15.96±2.74^a			28.78±11.30^a			30.03±2.53^a			41.37±24.39^a
对照组			1.809	0.164		2.866	0.043		0.533	0.281		2.839	0.036
	治疗前	19.86±2.90			54.28±23.04			24.89±4.37			88.05±33.72
	治疗后	18.74±3.16			41.63±20.11			24.47±3.27			67.92±35.73
	t值^bc	1.194, 10.804			2.065, 9.380			1.472, 11.704			0.897, 12.389
	P值^bc	0.159, 0.038			0.340, 0.027			0.208, 0.021			0.193, 0.019

时间点	流量（ml/min）	内径（cm）	均速（cm/s）	峰速（cm/s）	谷速（cm/s）
术前	1 720.31±156.84	1.34±0.06	25.57±1.98	28.17±3.04	20.19±4.02
术后	1 149.30±151.63	0.96±0.05	24.97±1.26	27.61±3.06	21.07±2.18
t值	9.289	10.883	1.771	0.899	1.333
P值	0.005	0.026	0.107	0.163	0.192

时间点	流量（ml/min）	内径（cm）	均速（cm/s）	峰速（cm/s）	谷速（cm/s）
术前	1 720.31±156.84	1.34±0.06	25.57±1.98	28.17±3.04	20.19±4.02
术后	1 149.30±151.63	0.96±0.05	24.97±1.26	27.61±3.06	21.07±2.18
t值	9.289	10.883	1.771	0.899	1.333
P值	0.005	0.026	0.107	0.163	0.192

时间点	流量（ml/min）	内径（cm）	均速（cm/s）	峰速（cm/s）	谷速（cm/s）
术前	180.57±25.17	0.33±0.02	31.99±3.17	64.19±5.87	18.69±1.53
术后	385.72±24.39	0.42±0.02	50.04±3.46	88.09±6.10	28.08±1.69
t值	9.180	22.045	10.281	21.044	9.277
P值	0.014	0.028	0.028	0.019	0.023

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