Objective To discuss the therapeutic effectiveness of surgical approach to complex intrahepatolithiasis with biliary liver cirrhosis.Methods A case of complex intrahepatolithiasis with biliary liver cirrohosis, portal hypertension was treated with splenectomy and pericardial devascularization plus left hepatectomy and portal cholangio plasty with T tube drainage. Results Follow up one year and a half after operation, no symptom of cholangitis was found, and there is no relapse up to date. Conclusion Combined operation of hepatectomy with splenectomy is an ideal and effective treatment for complex intrahepatolithiasis with biliary liver cirrhosis.
Objective To investigate the reasonable indication of splenectomy in radical resection for advanced proximal gastric cancer (APGC). Methods Fifty patients with APGC were studied and classified into total gastrectomy with splenectomy (TGS) group (n=18) and total gastrectomy without splenectomy (TG) group (n=32). The operation time, hospitalized duration, complications, and lymphe node metastasis at the spleen hilus were compared between two groups. Results The operation time, hospitalized duration and subphrenic infection rate in the TGS group were significantly higher than those in the TG group (Plt;0.05). The rate of lymph node metasitasis of No.10 and No.11 in the TG group was not different from that in TGS group (Pgt;0.05). Conclusion Direct spleen and its vessel invasion are the reasonable indication of splenectomy in radical resection for APGC.
Objective To defect the level of platelet antibody-IgG (PA-IgG) in patients with congestive splenomegaly and hypersplenism and the change of PA-IgG level after splenectomy and subtotal splenectomy. Methods Twenty four cases of congestive splenomegaly and hypersplenism were investigated. Results The level of PA-IgG in 24 cases were higher than normal range (Ｐ＜0.01), while the platelet count were lower than normal range and there was a significant negative correlation between the level of PA-IgG and platelet count (r＝-0.4747, Ｐ＜0.05). After subtotal splenectomy or splenectomy, the level of PA-IgG descended, the platelet count raised and the negative correlation between the level of PA-IgG and platelet count disappeared. Conclusion The results suggest that there is a immunoregulation between PA-IgG and platelet. Perhaps spleen has some relation with the immunoregulation.
ObjectiveTo investigate clinical application value of totally laparoscopic splenectomy via anterior approach.
MethodsThe clinical data of 26 consecutive patients underwent totally laparoscopic splenectomy via anterior approach from March 2012 to June 2015 in this hospital were analyzed retrospectively. There were 11 males and 15 females. These patients included 2 cases of traumatic spleen ruptures, 4 cases of idiopathic thrombocytopenic purpuras, 1 case of hereditary spherocytosis, 3 cases of splenic cysts, 5 cases of autoimmunity hemolytic anemias, 2 cases of splenic hemangioma, 1 case of hematolymphangioma, 8 cases of cirrhosis portal hypertensions. The operative time, intraoperative bleeding, postoperative time to out-of-bed activity, the first flatus/bowel motion time, complications, and hospital stay were analyzed retrospectively.
ResultsTwenty-six patients were successfully carried out totally laparoscopic splenectomy via anterior approach. The average operation time was 93 min (72-120 min). The average blood loss was 60 mL (10-80 mL). The postoperative time to out-of-bed activity was 24 h. The first flatus/bowel motion time was 2-3 d. The average hospital stay was 7 d (6-9 d). The postoperative pancreatic fistula (Grade A) occurred in 1 patient, who recovered well on day 6 by postoperative drainage management. After 5-32 months of following-up, all patients recovered smoothly without any long-term complications.
ConclusionThe preliminary results of limited cases in this study show that totally laparoscopic splenectomy via anterior approach is feasible, safe, and minimally invasive.
ObjectiveTo study the indication and means in dissection lymph nodes of the No.10 and No.11 without splenectomy in radical gastrectomy for gastric cancer. MethodsAccording to the location, type of pathology, clinical and pathological classification, lymphatic drainage and spread of gastric carcinoma togather with the immunological function of spleen, selection of operative procedure without splenectomy should be considered, so the related literatures were reviewed. ResultsRetained spleen had been shown to improve 5year survival of patients with gastric cancer of stage Ⅰ,Ⅱ and Ⅲ,splenectomy had been shown to improve 5year survival of patients with gastric cancer of stage Ⅳ,whose carcinoma was infiltrating splenic and the lymph nodes of the No.10. The complications of different means of dissection of the lymph nodes made no difference.Conclusion Dissection of the lymph node without retained spleen or allogenic spleen transplantation is indicated for the patients with cancer of stage Ⅳ,whose spleen is invaded by the tumor.
ObjectiveTo explore the effect of partial splenic embolization on splenectomy plus devascularization of esophageal and gastric vein.
MethodsTwenty three cirrhosis patients with portal hypertension combined the hypersplenism (partial splenic embolization group), who received partial splenic embolization in our hospital from June 2010 to June 2015, as well as 30 cirrhosis patients with portal hypertension combined the hypersplenism without undergoing partial splenic embolization in the same period (non-partial splenic embolization group), were collected retrospectively. All patients underwent splenectomy plus devascularization of esophageal and gastric vein. Comparison of operation time, intraoperative blood loss, intraoperative blood transfusion volume, postoperative total flow of abdominal drainage tube, postoperative gastrointestinal function recovery time, hospital stay, and the incidence of complication was performed.
ResultsThe operation time[(3.56±0.70) h vs. (1.78±0.28) h], intraoperative blood loss (900 mL vs. 250 mL), intraoperative blood transfusion volume (800 mL vs. 200 mL), postoperative total flow of abdominal drainage tube (450 mL vs. 150 mL), postoperative gastrointestinal function recovery time[(43.38±18.68) h vs. (27.60±12.39) h], hospital stay (12 d vs. 7 d), and incidence of incision infection[34.8% (8/23) vs. 10.0% (3/30)] of partial splenic embolization group were all higher or longer than those corresponding indexes of non-partial splenic embolization group (P < 0.05). All patients of 2 groups were followed up by telephone visit for 6-58 months, and the median was 28-month. There was no recurrence of gastrointestinal hemorrhage during the follow-up period.
ConclusionsSplenectomy is more difficult, and maybe has more intraoperative blood loss and complications for cirrhosis patients with portal hypertension combined the hypersplenism, who received partial splenic embolization ever. For these patents, the recovery time is longer. We should make choice of partial splenic embolization or splenectomy directly according to the patients' situation, to implement individualized treatment, so we can make the biggest benefit for patients.
ObjectiveTo investigate the experience in the treatment of splnic malignant tumors with laparoscopy.
MethodsThe clinical data of 51 patients with splnic malignant tumor who underwent splenectomy between January 2009 and July 2015 were retrospectively reviewed. Patients were divided into two groups based on the surgical method: Open splenectomy (OS group, n=18) and laparoscopic splenectomy (LS group, n=33). The preoperative, intraoperative and postoperative data of the patients were collected and analysed, the differences of each index during perioperative period (general information), intraoperative data (operative time, estimated blood loss, the size of spleen, intraoperaive transfusion) and postoprative situation (hospital stays, the first oral intake, postoperative pancreatic fistula, rehaemorrhagia, abdominal infection or pulmonary infection and the like) were compared.
ResultsLS group compared with OS group, the operative time of LS group was significantly shorter than that of OS group [(103.64±16.92) min vs. (144.44±31.10) min, P=0.000〕, the amount of bleeding of LS group [M (Q25, Q75): 60 (50, 100)〕was significantly less than the OS group [M (Q25, Q75): 150 (115, 210)〕, P=0.000. The hospitalization time of LS group was significantly shorter than the OS group [(13.61±9.91) d vs. (9.03±3.09) d, P=0.017〕, and the LS group has a lower indication of the postoprative complications of fever and pulmonary infection (P=0.010 and P=0.003). Conciusions Laparoscopic splenectomy is feasible in the treatment of splenic malignant tumors, the employment of laparoscopy can shorten the operative time, has the advantages of less bleeding, the shorten hospital stays, lower indication of postoprative complications, and being worthy of further popularization and application.
【Abstract】Objective To explore the effect and indication of splenectomy in liver transplantation. Methods From January 2001 to April 2006, 260 patients underwent piggyback orthotopic liver transplantation (PBOLT), and 28 patients had undergone combined PBOLT and splenectomy (splenectomy group). These patients were compared to 56 randomly selected non-splenectomy patients from the same transplant period, meaningly two controls were selected for every non-splenectomy case. Two groups were analyzed with respect to rate of infection and survival rate, as well as biopsy-proven acute allograft rejection within 30 days after transplantation. Results Rate of infection in the splenectomy group was higher than that in the non-splenectomy patients (85.7% vs 55.4%, P＜0.05). Acute rejection and survival rates in the splenectomy group were lower than those in the non-splenectomy patients (3.6% vs 14.3%, P＜0.05; 46.4% vs 82.1%, P＜0.05). Conclusion Concomitant splenectomy with PBOLT has a significantly higher patient mortality rate; it is mainly due to its septic complications. At present, unless there is a certain indication for splenectomy, this procedure is not recommended.
Objective To explore and summarize the curative effect and experience of emergency devascularization for treatment of upper gastrointestinal bleeding due to portal hypertension. Melthods The clinical data of 42 patients with upper gastrointestinal bleeding due to portal hypertension， undergoing emergency devascularization from March 2006 to July 2011 in Shengjing Hospital of China Medical University were retrospectively analyzed. Results Of the 42 cases， 29 patients underwent emergency splenectomy plus esophagogastric devascularization， 8 patients underwent emergency spleen artery ligation plus esophagogastric devascularization， and 5 patients only underwent emergency esophagogastric devascularization. The hemostasis rate at 3 hours after emergent disconnection operation was 100%. One patient died of liver failure on 8 days after operation. Three patients supervened with hemorrhage in abdominal cavity on 2 days after operation， and succeeded in hemostasis by conservative treatment. Other patients were successfullydischarged from hospital after postoperative rehabilitation for 2-4 weeks. All cases were followed up regular in 1 year after operation， 5 patients were lost to follow-up. Among the 36 cases followed up， rehaemorrhagia occurred in 1 patientin 8 months after operation， cured by endoscopic variceal ligation subsequently. A primary liver cancer occurred in 1 patient during physical examination in 7 months after operation， followed by partial hepatectomy. Other patients could complete daily life and work. Conclusions The patients suffering from upper gastrointestinal bleeding due to portal hypertension are likely to benefit from appropriate operations. Decisive emergency devascularization can stop the bleeding rapidly and effectively， and save the lives of those patients.
Objective To study the effect of splenectomy on the anti-tumor immunity in rats with induced hepatocellular carcinoma (HCC). Methods At the second and fourth month of the induced HCC, the NK cell activity, TNF-α level and total lymphcyte in blood were measured in the group of splenectomy and the control group. Results There were no different in the total lymphcyte and TNF-α in the blood in two groups, but there were significant difference in the NK cell activity between the group of splenectomy and the control group (Ｐ＜0.05). Conclusion There are some change in the anti-tumor immunity after splenectomy in rats, in which NK cell activity is at low level continuously. TNF-α isn′t affected after the second month after splenectomy.
