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| 1 | Portal vein thrombosis in liver cirrhosis显示文摘Portal vein thrombosis(PVT) is considered to be a frequent complication of liver cirrhosis. However, unlike PVT in patients without cirrhosis, very few data are available on the natural history and management of PVT in cirrhosis, despite its association with potentially life-threatening conditions, such as gastroesophageal bleeding and acute intestinal ischemia. Moreover, no consensus regarding PVT in cirrhosis exists. Suggested causes of PVT in cirrhosis include reduced portal blood flow velocity, multiple congenital or acquired thrombophilic factors, inherited or acquired conditions, and derangement of liver architecture. However, the understanding of PVT in cirrhosis is incomplete. In addition, information on the management of PVT in cirrhosis is inadequate. The aims of this review are to:(1) assemble data on the physiopathological mechanism, clinical findings, diagnosis and management of PVT in cirrhosis;(2) describe the principal factors most frequently involved in PVT development; and(3) summarize the recent knowledge concerning diagnostic and therapeutic procedures. | Nao Kinjo Hirofumi Kawanaka Tomohiko Akahoshi Yoshi-hiro Matsumoto Masahiro Kamori Yoshihiro Nagao Naotaka Hashimoto Hideo Uehara Morimasa Tomikawa Ken Shirabe Yoshihiko Maehara | 2014 | World Journal of Hepatology2014，6，2： | 38 |
| 2 | Changes of immune function in patients with liver cirrhosis after splenectomy combined with resection of hepatocellular carcinoma显示文摘OBJECTIVE: To study the changes of immune function in liver cirrhosis patients after splenectomycombined with resection of hepatocellular carcinoma (HCC).METHODS: Sixteen patients with HCC associated with liver cirrhosis were divided into two groups:splenectomy combined with hepatectomy (splenectomy group n=7) and hepatectomy (non-splenectomygroup, n=9). T lymphocyte subsets such as CD4, CD8, CD4/CD8 and Th lymphocyte cytokines such asinterferon γ (IFN-γ), IL-2, IL-10 in 7 ml peripheral venous blood before operation and 2 months afteroperation were examined and compared between the two groups.RESULTS: There was no significant difference in pre-operative CD4, CD8, CD4/CD8, IL-2, IFN-γ,IL-10 levels in the two groups. Two months after operation, the levels of CD4 (38.2%±3.7%), CD4/CD8(1.7±0.3), IFN-γ (104.4±14.9 pg/ml), 1L-2 (98.6±18.6 pg/ml) were increased and those of CD8(23.7±3.7 pg/ml), IL-10 (55.5±11.2 pg/ml) levels were decreased in the splenectomy group. Thelevels of CD4 (32.5%±4.0%), CD4/CD8 (1.1±0.1), IFN-γ(70.5±12.6 pg/ml), IL-2(80.9±13.5pg/ml) in the non-splenectomy group were much lower than those in the splenectomy group, but the levelsof CD8 (29.4%±4.0%), IL-10 (89.4±10.0 pg/ml) in the non-splenectomy group were significantlyhigher than those in the splenectomy group (P<0.05).CONCLUSIONS: Splenectomy combined with hepatectomy for HCC patients associated with livercirrhosis does not decrease but promote the recovery of T lymphocyte subsets and Th1/Th2 cytokines fromimbalance and improve anti-tumor immune function of the patients. | Zhi-Xin Cao Xiao-Ping Chen Zai-De Wu the Hepatic Surgery Center, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China | 2003 | Hepatobiliary & Pancreatic Diseases International2003，2，4： | 34 |
| 3 | Abnormal splenic artery diameter/hepatic artery diameter ratio in cirrhosis-induced portal hypertension显示文摘AIM:To determine an optimal cutoff value for abnormal splenic artery diameter/proper hepatic artery diameter(S/P) ratio in cirrhosis-induced portal hypertension.METHODS:Patients with cirrhosis and portal hypertension(n = 770) and healthy volunteers(n = 31) underwent volumetric computed tomography threedimensional vascular reconstruction to measure the internal diameters of the splenic artery and proper hepatic artery to calculate the S/P ratio.The cutoff value for abnormal S/P ratio was determined using receiver operating characteristic curve analysis,and the prevalence of abnormal S/P ratio and associations between abnormal S/P ratio and major complications of portal hypertension were studied using logistic regression.RESULTS:The receiver operating characteristic analysis showed that the cutoff points for abnormal splenic artery internal diameter and S/P ratio were > 5.19 mm and > 1.40,respectively.The sensitivity,specificity,positive predictive value,and negative predictive value were 74.2%,45.2%,97.1%,and 6.6%,respectively.The prevalence of an abnormal S/P ratio in the patients with cirrhosis and portal hypertension was 83.4%.Patients with a higher S/P ratio had a lower risk of developing ascites [odds ratio(OR) = 0.708,95%CI:0.508-0.986,P = 0.041] and a higher risk of developing esophageal and gastric varices(OR = 1.483,95%CI:1.010-2.175,P = 0.044) and forming collateral circulation(OR = 1.518,95%CI:1.033-2.230,P = 0.034).After splenectomy,the portal venous pressure and maximum and mean portal venous flow velocities were reduced,while the flow rate and maximum and minimum flow velocities of the hepatic artery were increased(P < 0.05).CONCLUSION:The prevalence of an abnormal S/P ratio is high in patients with cirrhosis and portal hypertension,and it can be used as an important marker of splanchnic hemodynamic disturbances. | Dao-Bing Zeng Chuan-Zhou Dai Shi-Chun Lu Ning He Wei Wang Hong-Jun Li | 2013 | World Journal of Gastroenterology2013，19，8： | 28 |
| 4 | Laparoscopic splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension显示文摘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. | Xiao-Li Zhan Yun Ji Yue-Dong Wang | 2014 | World Journal of Gastroenterology2014，20，19： | 24 |
| 5 | Synchronous splenectomy and hepatectomy for patients with hepatocellular carcinoma and hypersplenism:A casecontrol study显示文摘AIM:To investigate whether the use of synchronoushepatectomy and splenectomy(HS)is more effective than hepatectomy alone(HA)for patients with hepatocellular carcinoma(HCC)and hypersplenism.METHODS:From January 2007 to March 2013,84consecutive patients with HCC and hypersplenism who underwent synchronous hepatectomy and splenectomy in our center were compared with 84 well-matched patients from a pool of 268 patients who underwent hepatectomy alone.The short-term and longterm outcomes of the two groups were analyzed and compared.RESULTS:The mean time to recurrence was 21.11±12.04 mo in the HS group and 11.23±8.73 mo in the HA group,and these values were significantly different(P=0.001).The 1-,3-,5-,and 7-year disease-free survival rates for the patients in the HS group and the HA group were 86.7%,70.9%,52.7%,and 45.9%and 88.1%,59.4%,43.3%,and 39.5%,respectively(P=0.008).Platelet and white blood cell counts in the HS group were significantly increased compared with the HA group one day,one week,one month and one year postoperatively(P<0.001).Splenectomy and micro-vascular invasion were significant independent prognostic factors for disease-free survival.Gender,tumor number,and recurrence were independent prognostic factors for overall survival.CONCLUSION:Synchronous hepatectomy and hepatectomy potentially improves disease-free survival rates and alleviates hypersplenism without increasing the surgical risks for patients with HCC and hypersplenism. | Xiao-Yun Zhang Chuan Li Tian-Fu Wen Lu-Nan Yan Bo Li Jia-Yin Yang Wen-Tao Wang Li Jiang | 2015 | World Journal of Gastroenterology2015，21，8： | 17 |
| 6 | Modified laparoscopic splenectomy and azygoportal disconnection combined with cell salvage is feasible and might reduce the need for blood transfusion显示文摘AIM:To investigate perioperative outcomes in patients undergoing modified laparoscopic splenectomy and azygoportal disconnection(MLSD)with intraoperative autologous cell salvage.METHODS:We retrospectively evaluated outcomes in79 patients admitted to the Clinical Medical College of Yangzhou University with cirrhosis,portal hypertensive bleeding and secondary hypersplenism who underwent MLSD without(n=46)or with intraoperative cell salvage and autologous blood transfusion,including splenic blood and operative hemorrhage(n=33),between February 2012 and January 2014.Their intraoperative and postoperative variables were compared.These variables mainly included:operation time;estimated intraoperative blood loss;volume of allogeneic blood transfused;visual analog scale forpain on the first postoperative day;time to first oral intake;initial passage of flatus and off-bed activity;perioperative hemoglobin(Hb)concentration;and red blood cell concentration.RESULTS:There were no significant differences between the groups in terms of duration of surgery,estimated intraoperative blood loss and overall perioperative complication rate.In those receiving salvaged autologous blood,Hb concentration increased by an average of 11.2±4.8 g/L(P<0.05)from preoperative levels by the first postoperative day,but it had fallen by 9.8±6.45 g/L(P<0.05)in the group in which cell salvage was not used.Preoperative Hb was similar in the two groups(P>0.05),but Hb on the first postoperative day was significantly higher in the autologous blood transfusion group(118.5±15.8g/L vs 102.7±15.6 g/L,P<0.05).The autologous blood transfusion group experienced significantly fewer postoperative days of temperature>38.0℃(P<0.05).CONCLUSION:Intraoperative cell salvage during MLSD is feasible and safe and may become the gold standard for liver cirrhosis with portal hypertensive bleeding and hypersplenism. | Guo-Qing Jiang Dou-Sheng Bai Ping Chen Jian-Jun Qian Sheng-Jie Jin Jie Yao Xiao-Dong Wang | 2014 | World Journal of Gastroenterology2014，20，48： | 16 |
| 7 | Surgical treatment for hepatocellular carcinoma and secondary hypersplenism显示文摘BACKGROUND: Hepatocellular carcinoma (HCC) is a common disease with high mortality and serious effect on the life quality of patients. Operation is still the most effective treatment. Currently, in China, patients with HCC are often complicated by hepatitis B related liver cirrhosis and secondary hypersplenism. This study was undertaken to evaluate the effect and indications of synchronous hepatectomy and splenectomy for HCC patients with hypersplenism. METHODS: The clinical records and treating processes of 24 patients with HCC and hypersplenism during the period of January 1991 to July 2004 were analyzed retrospectively. RESULTS: Sixteen patients underwent hepatectomy and splenectomy, including extensive devascularizasion around the cardia (9 patients). Seven patients were treated with microwave ablation and splenectomy plus extensive esophagogastric devascularization. One patient underwent hepatectomy combined with microwave ablation and splenectomy plus extensive esophagogastric devascularization. There were no deaths during the operation. During the first week after operation, the symptoms of hypersplenism disappeared and the platelet (Plt) and white blood cell (WBC) counts were significantly elevated (Plt: 247×109/L vs. 45.9×109/L, WBC: 13.0×109/L vs.3.3×109/L,P<0.01). CONCLUSIONS: Synchronous splenectomy can increase the safety of hepatectomy in selected patients with HCC and secondary hypersplenism by reducing bleeding complications. Splenectomy enhances patients’ immunity against tumor in a long period as well. | Qian Wang, Kai Sun, Xiang-Hong Li, Bao-Gang Peng and Li-Jian Liang Department of Hepatobiliary Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China | 2006 | Hepatobiliary & Pancreatic Diseases International2006，5，3： | 14 |
| 8 | Laparoscopic splenectomy:Current concepts显示文摘Since early 1990's,when it was inaugurally introduced,laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications.Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen.However some contraindications still apply.The evolution of the technology has allowed though,cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches.Moreover,the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications.Today,laparoscopic splenectomy is considered safe,with better outcomes in comparison to open splenectomy,and the increased experience of surgeons allows operative times comparable to those of an open splenectomy.In this review we discuss the indications and the contraindications of laparoscopic splenectomy.Moreover we analyze the standard and modified surgical approaches,and we evaluate the short-term and long-term outcomes. | Evangelos P Misiakos George Bagias Theodore Liakakos Anastasios Machairas | 2017 | World Journal of Gastrointestinal Endoscopy2017，9，9： | 14 |
| 9 | Perioperative advantages of modified laparoscopic vs open splenectomy and azygoportal disconnection显示文摘AIM: To investigate perioperative outcomes in patients undergoing modified laparoscopic splenectomy or open splenectomy and azygoportal disconnection for portal hypertension.METHODS: This study included 44 patients who underwent modified laparoscopic splenectomy and azygoportal disconnection(MLSD) and 71 who underwent open procedures for portal hypertension. Blood samples were collected before surgery and on days 1, 3, and 7 after surgery. Markers of liver and renal function, C-reactive protein(CRP), interleukin-6(IL-6), and procalcitonin(PCT) were measured, and perioperative variables were compared between the two groups.RESULTS: The modified laparoscopic group showed significantly better and faster recovery, better liver and renal function, and fewer complications than the open group. CRP, IL-6, and PCT concentrations on postoperative days 1, 3, and 7 were significantly lower in the modified laparoscopic group than in the open group.CONCLUSION: MLSD was associated with lower inflammatory immune responses, less impairment of liver and renal function, and faster and better recovery. | Guo-Qing Jiang Ping Chen Jian-Jun Qian Jie Yao Xiao-Dong Wang Sheng-Jie Jin Dou-Sheng Bai | 2014 | World Journal of Gastroenterology2014，20，27： | 14 |
| 10 | Laparoscopic versus Open Splenectomy and Devascularization for Massive Splenomegaly Due to Portal Hypertension显示文摘Although the clinical benefit of laparoscopic splenectomy and devascularization(LSD) has been elaborated in many studies,its application in massive splenomegaly remains controversial.We conducted a retrospective research to assess the curative efficacy of LSD for massive splenomegaly due to portal hypertension.Forty-seven patients with massive splenomegaly due to portal hypertension were enrolled in this study,and divided into two groups.Twenty-one patients underwent open splenectomy and devascularization(OSD) from June 2010 to October 2012(OSD group).From March 2013 to February 2015,LSD was performed on 26 patients(LSD group).Perioperative variables were analyzed.Compared to OSD,LSD was associated with less blood loss(241.9±110.0 m L vs.319.0±139.5 m L,P<0.05),more rapid resumption of oral diet(2.46±0.95 days vs.3.76±1.09 days,P<0.05),and shorter postoperative hospital stay(5.35±1.65 days vs.7.24±1.55 days,P<0.05).It was concluded that for patients with massive splenomegaly due to portal hypertension,LSD is feasible and as safe as OSD. | 刘尧 赵龙 唐勇 张宇 施申超 谢付骁 万赤丹 | 2016 | Journal of Huazhong University of Science and Technology(Medical Sciences)2016，36，6： | 13 |
| 11 | Combined Laparoscopic Splenectomy and Esophagogastric Devascularization versus Open Splenectomy and Esophagogastric Devascularization for Portal Hypertension due to Liver Cirrhosis显示文摘This study was conducted to compare the feasibility,safety and effectiveness of the combined-laparoscopic splenectomy and esophagogastric devascularization(C-LSED)with open splenectomy and esophagogastric devascularization surgery(OSED)in patients with portal hypertension due to liver cirrhosis.From February 2014 to June 2018,68 patients with portal hypertension were diagnosed as having serious gastroesophageal varices and/or hypersplenism in our center.Thirty patients underwent C-LSED and 38 patients received OSED.Results and outcomes were compared retrospectively.No patients of C-LSED group required an intraoperative conversion to open surgery.Significantly shorter operating time,less blood loss,lower transfusion rates,shorter postoperative hospital stay,lower rates of complications were found in C-LSED group than in C-LSED group(P<0.05).No death and rebleeding were documented in both groups during the follow-up periods of one year Postoperative endoscopy revealed that varices in the patients of both groups were alleviated significantly from severe to mild,and in a part of cases,the varices disappeared.The final results suggest that the C-LSED technique is superior to open procedure,due to slightly invasive,simplified operative procedure,significantly shorter operating time,less intraoperative bleeding and lower post-operative complication rates.And C-LSED offers comparable long-term effects to open surgery. | Hong-ping LUO Zhan-guo ZHANG Xin LONG Fei-long LIU Xiao-ping CHEN Lei ZHANG Wan-guang ZHANG | 2020 | Current Medical Science2020，40，1： | 12 |
| 12 | 腹腔镜脾切除术的要点与难点显示文摘脾脏是人体最大的免疫器官,具有造血及免疫功能。脾切除的手术指征包括:脾脏外伤、脾肿瘤、门脉高压症及遗传性球形红细胞增多症、特发性血小板减少性紫癜等血液系统疾病。1991年澳大利亚Delaitre等[1]首次报道了腹腔镜脾切除术(laparoscopic splenectomy,LS),国内胡三元等[2]、许红兵等[3]于1994年率先在国内开展LS。较开放脾切除术,LS具有微创、术后康复快、 | 展翰翔 胡三元 | 2016 | 腹腔镜外科杂志2016，21，8： | 11 |
| 13 | Laparoscopic distal pancreatectomy with or without splenectomy: spleen-preservation does not increase morbidity显示文摘BACKGROUND: The indications for laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and its morbidity compared with laparoscopic distal pancreatectomy with splenectomy (LDPS) are ill-defined. This study aimed to share the indications for spleen-preservation and investigate the safety and outcome of LSPDP at our institution. METHODS: A retrospective review of patients who were scheduled to receive laparoscopic surgery for distal pancreatic lesions was conducted. The indications, surgical procedures, intra-operative data, and outcomes of the two procedures were collected and compared by statistical analysis. RESULTS: LDPS and LSPDP were successfully performed in 16 and 21 patients respectively, whereas they were converted to open surgery in 9 patients. There were no significant differences in age, gender, operation time, blood loss, and conversion rate between the LDPS and LSPDP groups. The mean tumor size showed an inter-group difference (5.05 vs 2.53 cm, P<0.001). There were no significant differences in complication and morbidity rates between the two groups. All patients remained alive without recurrence during a follow-up of 9 to 67 months (median 35).CONCLUSION: LSPDP has a morbidity and outcome comparable to LDPS. | Yu-Pei Zhao, Xiao Du, Meng-Hua Dai, Tai-Ping Zhang, Quan Liao, Jun-Chao Guo, Lin Cong ,Ge Chen Department of General Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730, China | 2012 | Hepatobiliary & Pancreatic Diseases International2012，11，5： | 8 |
| 14 | Predictive Value of Inflammation Biomarkers in Patients with Portal Vein Thrombosis显示文摘Background and Aims:To investigate the usefulness of inflammation biomarkers to serve as a predictors of portal vein thrombosis(PVT)postoperatively(post)in patients with portal hypertension after splenectomy and periesophagogastric devascularization.Methods:A total of 177 liver cirrhosis patients were recruited from January 2013 to December 2017.They were divided into a PVT group(n=71)and a non-PVT group(n=106),according to ultrasound examination findings at 7-day post.Inflammation biomarkers involving platelet-to-lymphocyte ratio(PLR),neutrophil-to-lymphocyte ratio(NLR),monocyte-to-lymphocyte ratio(MLR),red blood cell distribution width-to-platelet ratio(RPR),mean platelet volume-to-platelet ratio(MPR)preoperatively(pre)and at 1,3,7-days post were recorded.Results:The univariate logistic regression analysis indicated that PLR(pre)(odds ratio(OR)=3.963,95%confidence interval(CI)=2.070–7.587,p<0.000),MLR(pre)(OR=2.760,95%CI=1.386–5.497,p=0.004),PLR(postday 7)(OR=3.345,95%CI=1.767–6.332,p=0.000)were significantly associated with the presence of PVT.The multivariate logistic regression analysis results indicated that PLR(pre)(OR=3.037,95%CI=1.463–6.305,p=0.003),MLR(pre)(OR=2.188,95%CI=1.003–4.772,p=0.049),PLR(post-day 7)(OR=2.166,95%CI=1.053–4.454,p=0.036)were independent factors for predicting PVT.Conclusions:The PLR(pre),MLR(pre),and PLR(post-day 7)are predictors of portal vein thrombosis post in patients with portal hypertension after splenectomy and periesophagogastric devascularization. | Jian-Bo Han Qing-Hua Shu Yu-Feng Zhang Yong-Xiang Yi | 2021 | Journal of Clinical and Translational Hepatology2021，9，3： | 7 |
| 15 | Primary splenic angiosarcoma with liver metastasis: A case report and literature review显示文摘Primary splenic angiosarcoma(PSA) is an unusual and highly malignant vascular tumour with a high rate of metastatic. Moreover, the research on prognosis of the disease is poor. The epidemiology, etiology, clinical diagnosis and treatment of the disease remain challenging, because case reports of the disease are few in number. In accordance with other malignant tumors, PSA is very aggressive, and the majority of patients in which this disease is found are at an advanced stage. Almost all patients die within 12 mo of diagnosis irrespective of treatment. We report here a woman who had complained of upper bellyache and anorexia for 10 d. Magnetic resonance imaging showed enlargement of the spleen with multiple heterogeneous masses in the lower pole of the spleen. A hand-assisted laparoscopic splenectomy was performed which allowed histopathologic diagnosis. The patient was diagnosed with PSA and liver metastasis, and succumbed to the disease 35 d after surgery. The literature was finished combined with the clinical features, diagnosis and management of PSA. | Kai-Feng Yang Yong Li De-Long Wang Jun-Wu Yang Sen-Yan Wu Wei-Dong Xiao | 2016 | World Journal of Gastroenterology2016，22，12： | 7 |
| 16 | Incidence of portal vein thrombosis after splenectomy and its influence on transjugular intrahepatic portosystemic shunt stent patency显示文摘BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is widely accepted as an alternative to surgery for management of complications of portal hypertension.TIPS has been used to treat portal vein thrombosis (PVT) in many centers since the 1990s.Although TIPS has good therapeutic effects on the formation of PVT,the effect of PVT on TIPS stenting has rarely been reported.Patients with splenectomy and pericardial devascu-larization have a high incidence of PVT,which can markedly affect TIPS stent patency and increase the risk of recurrent symptoms associated with shunt stenosis or occlusion.AIM To investigate the incidence of PVT after splenectomy and its influence on the patency rate of TIPS in patients with cirrhosis and portal hypertension.METHODS Four hundred and eighty-six patients with portal hypertension for refractory ascites and/or variceal bleeding who required TIPS placement between January 2010 and January 2016 were included in this retrospective analysis.Patients without prior splenectomy were defined as group A (n = 289) and those with prior splenectomy as group B (n = 197).The incidence of PVT before TIPS was compared between the two groups.After TIPS placement,primary patency rate was compared using Kaplan–Meier analysis at 3,6,9 and 12 mo,and 2 and 3 years.The clinical outcomes were analyzed.RESULTS Before TIPS procedure,the incidence of PVT in group A was lower than in group B (P = 0.003),and TIPS technical success rate in group A was higher than in group B (P = 0.016).The primary patency rate in group A tended to be higher than in group B at 3,6,9 and 12 mo,2 years and 3 years (P = 0.006,P = 0.011,P = 0.023,P = 0.032,P = 0.037 and P = 0.028,respectively).Recurrence of bleeding and ascites rate in group A was lower than in group B at 3 mo (P ≤ 0.001 and P = 0.001),6 mo (P = 0.003 and P = 0.005),9 mo (P = 0.005 and P = 0.012),12 mo (P = 0.008 and P = 0.024),2 years (P = 0.011 and P = 0.018) and 3 years (P = 0.016 and P = 0.017),respectively.During 3-years follow-up,the 1-,2- and 3-year survival rate in group A were higher than in group B (P = 0.008,P = 0.021,P = 0.018,respectively),but there was no difference of the incidence of hepatic encephalopathy (P = 0.527).CONCLUSION Patients with prior splenectomy have a high incidence of PVT,which potentially increases the risk of recurrent symptoms associated with shunt stenosis or occlusion. | Fang Dong Shi-Hua Luo Li-Juan Zheng Jian-Guo Chu He Huang Xue-Qiang Zhang Ke-Chun Yao | 2019 | World Journal of Clinical Cases2019，7，17： | 7 |
| 17 | Impact of simultaneous splenectomy and orthotopic liver transplantation in patients with end-stage liver diseases and splenic hyperfunction显示文摘BACKGROUND:Whether splenectomy can be performed simultaneously during liver transplantation in patients with end-stage liver diseases complicated by hypersplenism remains controversial. This study aimed to compare the impact of simultaneous splenectomy on high-and low-risk liver transplant patients with end-stage liver diseases and severe hypersplenism. METHODS:Forty-two patients with end-stage liver diseases complicated by severe hypersplenism who had undergone orthotopic liver transplantation were enrolled in this study. Splenectomy was performed in 19 of the patients. The 42 patients were grouped according to the risk of liver diseases and operations they received. Patients were considered to be at high-risk if they had at least one of the following conditions: preoperative prothrombin time >5 seconds, portal vein thrombosis, and severe perisplenitis. High-risk patients who had undergone splenectomy were classified into group A, whereas high-risk patients who had not undergone splenectomy were classified into group B. Low-risk patients who had undergone splenectomy were classified into group C, and low-risk patients who had spleen preservation were classified into group D. Operative time, intraoperative blood loss, postoperative bleeding, pulmonary infection, perioperative mortality, and postoperative platelet recovery were analyzed. RESULTS: Operative time and intraoperative blood loss were greater in group A than in groups B-D (P<0.01), but there was no significant difference between groups C and D (P>0.05). In group A, 3 patients had postoperative bleeding, 5 had pulmonary infection, and 2 had perioperative mortality,which was higher than any other group, but postoperative bleeding, pulmonary infection, and perioperative mortality were similar to those in groups C and D. In patients undergoing simultaneous splenectomy, platelet counts recovered within 6 months after surgery. Thrombocytopenia was sustained in 3 of the 23 patients who did not undergo simultaneous splenectomy. CONCLUSION: Splenectomy should be avoided during orthotopic liver transplantation in high-risk patients, but this procedure does not increase the operative risk in low-risk patients and may be a valuable method to ensure good postoperative platelet recovery. | De-Wei Li, Cheng-You Du, Bin Fan, Ping Huang, Shi-Qiao Luo , Qiang He Department of Hepatobiliary Surgery, First Affiliated Hospital, Chongqing Medical University, Chongqing 400016,China | 2012 | Hepatobiliary & Pancreatic Diseases International2012，11，5： | 7 |
| 18 | Invasive group B streptococcal infection in a patient with post splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension显示文摘BACKGROUND:Splenectomy in patients with liver cirrhosis(LC)is expected to become more common owing to its efficacy on portal hemodynamics.In this report we describe an alarming case of group B streptococcus(GBS)infection after splenectomy in a patient with LC.METHODS:A 72-year-old woman with a history of LC was admitted to our emergency department because of respiratory failure.The patient had received left lateral segmentectomy of the liver and splenectomy three months before admission.Pulmonary examination revealed significant wheezing during inspiration and expiration,but no crackles and stridor.Chest radiography and CT showed no infiltrates.A presumptive diagnosis of bronchial asthma caused by upper respiratory infection was made.Four days after admission,GBS infection was confirmed by blood culture and penicillin G was administered.Antibiotics were given intravenously for a total of 12 days.RESULTS:The patient was discharged on the 12th day after admission.CONCLUSIONS:Although efficacy of splenectomy in patients with LC has been reported,immune status should be evaluated for a longer period.Patients who have undergone splenectomy are highly susceptible to bacteria;moreover,LC itself is an independent risk factor for mortality in patients with sepsis.Since prophylaxis against GBS has not been established,immediate action should be taken.Emergency physicians should be aware of invasive GBS infection in the context of the critical risk factors related to splenectomy and LC,particularly the expected increase of splenectomy performed in LC patients. | Tomoya Okazaki Toru Hifumi Arisa Manabe Hikari Matsumura Satoshi Egawa Hideyuki Hamaya Nastuyo Shinohara Koshiro Takano Hajime Shishido Yuko Abe Kenya Kawakita Masanobu Hagiike Yasuhiro Kuroda | 2016 | World Journal of Emergency Medicine2016，7，1： | 6 |
| 19 | Partial splenectomy using a laparoscopic bipolar radiofrequency device:A case report显示文摘We report a 51-year-old female patient with a solitary lymphangioma located in the upper splenic pole which was managed successfully with laparoscopic partial splenectomy.Surgery lasted 170 min and did not require blood transfusions.The patient recovered well post-operatively and was asymptomatic at the 3-mo follow-up.She had a normal platelet count and no recurrence on ultrasonography or computed tomography.Laparoscopic partial splenectomy is a safe,minimally invasive technique for the treatment of solitary splenic lymphangiomas in the splenic pole.We performed the procedure using the HabibTM 4X device.This laparoscopic bipolar radiofrequency device ensured a 'bloodless' splenic parenchymal resection. | Wei-Dong Wang Jie Lin Zhi-Qiang Wu Qing-Bo Liu Jing Ma Xiao-Wu Chen | 2015 | World Journal of Gastroenterology2015，21，11： | 6 |
| 20 | Recent trends from the results of clinical trials on gastric cancer surgery显示文摘The Japan Clinical Oncology Group has recently conducted large scale clinical trials with findings that have revealed pivotal strategies for the treatment of resectable gastric cancer surgery.These findings include the fact that D3 lymphadenectomy does not improve survival rates when compared to D2 lymphadenectomy,and it is not recommended for resectable gastric cancer.Also,a transhiatal approach is recommended,instead of the left thoraco-abdominal approach,for the treatment of adenocarcinoma of the esophago-gastric junction or gastric cardia which has invaded≤3 cm of the esophagus.Gastrectomy with splenectomy and bursectomy had been recommended as a part of the D2 lymphadenectomy.However,the results of the recent clinical trials revealed that splenectomy should be avoided in total gastrectomy with D2 lymphadenectomy for proximal gastric cancer and that bursectomy should be avoided in gastrectomy with D2 lymphadenectomy for resectable gastric cancer.Both splenectomy and bursec-tomy were found to be unable to improve survival,but instead increased operative morbidity.These trials revealed that the above-mentioned invasive and aggressive procedures did not provide sufficient survival benefits and that gastric cancer surgery may be trending from an“invasive to less invasive”and“aggressive to more conservative”approach. | Takashi Kiyokawa Takeo Fukagawa | 2019 | Cancer Communications2019，39，1： | 6 |
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