目的 探讨脾占位性病变的临床诊断特点和治疗对策。方法 回顾性分析68例脾占位性病变患者的临床资料。结果 超声和CT是诊断脾占位性病变的主要方法。68例脾占位性病变中良性48例，恶性20例。手术治疗47例，其中脾切除37例，脾切除加胰尾切除2例，脾部分切除3例，脾切除加脾窝引流4例，单纯脾囊肿去顶减压1例。1例脾脓肿行脾切除术后发生肺部感染，经抗感染治疗后痊愈； 1例脾脓肿行脾切除术后，发生脾窝脓肿，感染严重，被迫再次开腹行脓肿引流术，其余良性病变经手术治疗后效果好； 恶性病变术后效果差。结论 脾占位性病变良性多见，恶性少见； 影像学检查是诊断脾占位性病变的主要手段。脾切除对成年人是一种有效的治疗方法，良性预后好，恶性预后差； 对儿童、青少年脾良性病变，脾部分切除是一种很好的选择。
Objective To compare the difference of the changes of platelet counts after splenectomy between the patients with splenic rupture and patients with cirrhosis and portal hypertension, and to analyze the possible reasons and clinical significance. Methods The platelet count of 47 splenic rupture patients and 36 cirrhosis patients who had been carried out splenectomy from July 2008 to December 2009 in our hospital were counted, and the differences in platelet count and it’s change tendency of two groups were compared. Results In the splenic rupture group，the platelet count of all 47 patients increased abnormally after operation, the maxlmum value of platelet count among 300×109/L-600×109/L in 6 cases，600×109/L-900×109/L in 21 cases，and above 900×109/L in 20 cases. In the cirrhosis group，the maxlmum value of platelet count after operation was above 300×109/L in 26 cases，100×109/L-300×109/L in 8 cases，and below 100×109/L in 2 cases. The difference of maxlmum value of platelet count in the two groups had statistic significance（P=0.00）. Compared with the cirrhosis group, the platelet count increased more significant and decreased more slow in splenic rupture group（P＜0.05）.The abnormal days and rising range of platelet count were higher in patient with Child A than Child B and C（P=0.006，P=0.002）. Conclusions The change of platelet count after operation in splenic rupture group was obviously different from cirrhosis group because of the difference of the liver function and body situation of patients. To patients with splenic rupture or cirrhosis, appropriate treatment based on the platelet count and liver function could obtain good therapeutic effect.
Objective To explore the methods， clinical effects， and application value of laparoscopic splenectomy combined with pericardial devascularization. Methods The clinical data of 23 patients with liver cirrhosis and portal hypertension who performed laparoscopic splenectomy combined with pericardial devascularization between july 2009 and july 2012 in our hospital were analyzed retrospectivly. Results In 23 cases， 2 cases were converted laparotomy due to bleeding， 21 cases were successfully performed laparoscopic splenectomy combined with pericardial devascularization. The operative time was 230-380 minutes （average 290 minutes）. The intraoperative blood loss was 300-1 500 mL （average 620 mL）. The postoperative fasting time was 1-3 days （average 2 days）. The postoperative hospital stay was 8-14 days （average 10 days）. Conclusion Laparoscopic splenectomy combined with pericardial devascularization is a feasible， effective， and safe procedure as well as minimally invasive hence is applicable for patients with portal hypertension and hypersplenism．
Pancreatic sinistral portal hypertension (PSPH) is a clinical syndrome resulting from pancreatic disease that blocks splenic vein return, which includes acute and chronic pancreatitis, pancreatic tumors, and iatrogenic factors related to pancreatic surgery. Most PSPH patients present with isolated gastric varices, splenomegaly and hypersplenism, with normal liver function, and upper gastrointestinal bleeding caused by varices in the fundus of the stomach is the most serious clinical manifestation. The treatment of PSPH can be divided into the treatment of portal hypertension in the spleen and stomach region, including close follow-up, medication, endoscopic therapy, splenic artery embolization and splenectomy, etc. The primary diseases of pancreas are mainly treated for acute pancreatitis, chronic pancreatitis and pancreatic tumor. In particular, PSPH related to pancreatic surgery should be concerned.
Objective To discuss surgical skills and clinical value of laparoscopic splenectomy with behind splenic hilus tunnel-building technique. Method The clinical data of 1 patient with HBV-related hepatic cirrhosis combined splenomegaly and hypersplenism treated in the Second Affiliated Hospital of Chongqing Medical University was discussed and summarized. Results The patient underwent the laparoscopic splenectomy with surgical approach of from bottom to top, front to back, and shallow to deep. The key point of the tunnel-building technique was fully exposed the upper and lower poles of the splenic pedicle. The operative time was 70 min, the intraoperative blood loss was 50 mL, and the discharge time was 5 d after operation. Conclusion Laparoscopic splenectomy with behind splenic hilum tunnel-building technique is safe and feasible, especially for beginners.
ObjectiveTo analyze risk factors of rebleeding after laparoscopic selective pericardial devascularization combined with splenectomy.MethodsThe clinical data of 147 cases of portal hypertension treated by the laparoscopic selective devascularization combined with splenectomy from February 2014 to September 2018 were retrospectively analyzed. The univariate analysis was used to find the difference between the rebleeding group (n=20) and the non-bleeding group (n=127), then the multivariate logistic regression analysis was selected for screening out the most closely related risk factors for the rebleeding.ResultsThe rebleeding occurred in 20 of 147 patients (13.6%). There were differences in the platelet count, prothrombin time, serum albumin, diameter of main portal vein, classification of liver function, ascites, hepatic encephalopathy, and portal hypertensive gastropathy between the rebleeding group and the non-bleeding group (P<0.050). The classification of liver function ［OR=3.444, 95% CI (1.211. 9.793）, P=0.020］, ascites ［OR=2.859, 95% CI (1.069, 7.645), P=0.036］, hepatic encephalopathy ［OR=4.265, 95% CI（1.121, 16.230）, P=0.033］, and portal hypertensive gastropathy ［OR=6.744, 95% CI (1.675, 27.156), P=0.007］, and platelet count ［OR=4.744, 95% CI (1.073, 20.969), P=0.040］ were the independent factors for the postoperative rebleeding by the logistic regression analysis.ConclusionFor patients with risk factors of rebleeding, preoperative treatment should be actively taken and postoperative prevention of rebleeding should be highly vigilant.
Objective To summarize the effect of the splenectomy in patients with portal hypertension on the occurrence and recurrence of hepatocellular carcinoma. Methods The related literatures about the splenectomy in patients with hepatocirrhosis combined with portal hypertension or patients with hepatocellular carcinoma combined with portal hypertension in recent years were reviewed. Results At present, most academics considered that, for patients with hepatocirrhosis combined with portal hypertension, splenectomy could reduce the occurrence of hepatocellular carcinoma. For patients with hepatocellular carcinoma combined with portal hypertension, splenectomy+hepatectomy didn’t increase the perioperative mortality, and it could reduce the recurrence rate of hepatocellular carcinoma. Conclusion Splenectomy for patients with portal hypertension is safe, and it can inhibit the occurrence and progress of hepatocellular carcinoma, however, the specific mechanism remain needs further study.
【Abstract】ObjectiveTo explore the appropriate surgical management of the primary hepatocellular carcinoma with hypersplenism. MethodsOf 67 patients who has primary hepatocellular carcinoma with hypersplenism, 17 cases had hepatectomy combined with splenectomy, 7 cases had hepatectomy only, and the other 43 patients were treated with hepatic artery embolization and splenic artery embolization. ResultsThe symptoms of hypersplenism disappeared and the hemogram became normal 30 d after operation in 17 patients who had hepatectomy combined with splenectomy, but worsened in 7 patients who only had simple hepatectomy and 6 cases of those patients were treated with splenic artery embolization 3-7 months after operation. In 43 patients treated with hepatic artery embolization and splenic artery embolization, 79%（34/43）had improved hypersplenism symptoms and the hemogram became normal. ConclusionThe treatment of primary hepatocellular carcinoma with hypersplenism should be strived for hepatectomy combined with splenectomy. If the liver mass cannot be resected, hepatic artery embolization and splenic artery embolization should be chosen.