Abstract: Objective:To explore the clinical efficacy and safety of complex splenectomy.
Methods:The retrospective cohort study was adopted. The clinical data of 235 patients including 135 from Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 67 from Shanghai Jiaotong University Affiliated First People′s Hospital, 26 from Shanghai Jiaotong University Affiliated Sixth People′s Hospital, 7 from 85 Hospital of PLA who underwent complex splenectomy from January 2005 to December 2015 were collected. All the patients received total splenectomy after splenic artery ligation. The observation indexes included: (1) surgical situations, (2) major complications including intraperitoneal hemorrhage, pulmonary complication, left subphrenic abscess and peritoneal effusion, (3) followup situations: portal vein (PV) complications (splenic venous thrombophlebitis, thrombosis of splenic vein and main portal vein thrombosis), survival of patients. The followup using outpatient examination and telephone interview was performed up to March 2016, and patients received regularly ultrasound reexamination, computed tomography (CT) rescan, routine blood retest and coagulation function. Measurement data with normal distribution were presented as ±s, and count data were analyzed using the chisquare test.
Results:(1) Surgical situations: of 235 patients, 200 patients underwent secondary spleen pedicle severance and 35 patients underwent nonsecondary spleen pedicle severance. Volume of intraoperative blood loss and duration of splenic resection were (268±103)mL and (82±29)minutes. (2) Major complications: of 31 patients with postoperative complications, intraperitoneal hemorrhage was detected in 12 patients, pulmonary complication in 17 patients, left subphrenic abscess in 3 patients and massive peritoneal effusion in 21 patients. Some patients were combined with multiple symptoms. The patients with above complications were cured after reoperations and nonoperative treatments. (3) Followup situations: PV complications: splenic venous thrombo-phlebitis was detected in 16 patients, thrombosis of splenic vein in 17 patients, thrombosis of splenic vein combined with main portal vein thrombosis in 7 patients, and they were improved after the treatments of antiinflammation, anticoagulation and thrombolysis. The thrombi rate after splenectomy was 32.4%(12/37) in patients with schistosomarelated cirrhosis and 8.1%(12/149) in patients with HBVrelated cirrhosis, with a statistically significant difference (χ²=10.9, P<0.05). Survival of patients: of 235 patients, 228 were followed up for (7.9±4.2)years, with good survival.
Conclusion:Complex splenectomy is safe and effective, and the key procedure determining the safety of complex splenectomy includes careful preoperative evaluation, delicate surgical technique, proper splenic pedicle severance and peritoneal wounds.