Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2018; 6(6): 99-109
Published online Jun 16, 2018. doi: 10.12998/wjcc.v6.i6.99
Comparison of simplified and traditional pericardial devascularisation combined with splenectomy for the treatment of portal hypertension
Ya-Fei Zhang, Hong Ji, Hong-Wei Lu, Le Lu, Lei Wang, Jin-Long Wang, Yi-Ming Li
Ya-Fei Zhang, Hong Ji, Hong-Wei Lu, Le Lu, Lei Wang, Jin-Long Wang, Yi-Ming Li, Department of General Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Author contributions: Li YM conceived the research and critically reviewed and revised the paper; Zhang YF, Ji H, Lu HW and Lu L designed the research and analysed the data; Zhang YF and Li YM performed the research; all authors participated in the operations; Zhang YF drafted the paper.
Supported by National Natural Science Foundation of China, No. 81170454.
Institutional review board statement: The study was reviewed and approved by the Second Affiliated Hospital of Xi’an Jiaotong University Institutional Review Board.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this study.
Data sharing statement: No additional data are available.
STROBE statement: The guidelines of the STROBE statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yi-Ming Li, MD, Department of General Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University, No. 157 Xiwu Road, Xi’an 710004, Shaanxi Province, China. liyiming@xjtu.edu.cn
Telephone: +86-29-87679746 Fax: +86-29-87679746
Received: April 5, 2018
Peer-review started: April 8, 2018
First decision: April 23, 2018
Revised: April 27, 2018
Accepted: May 30, 2018
Article in press: May 31, 2018
Published online: June 16, 2018
Abstract
AIM

To compare the clinical outcomes of patients with portal hypertension (PH) who underwent treatment with splenectomy plus simplified pericardial devascularisation (SSPD) or splenectomy plus traditional pericardial devascularisation (STPD).

METHODS

We conducted a single-centre retrospective study of 1045 PH patients treated with either SSPD (S Group, 357 patients) or STPD (T Group, 688 patients) between January 2002 and February 2017. In all, 37 clinical indicators were compared to evaluate the efficacy of SSPD.

RESULTS

Perioperative indicators in the S Group were significantly better than those in the T Group (P < 0.05). In both groups, the postoperative long-term portal vein diameter and Model for End-Stage Liver Disease score were significantly lower than those in the preoperative and postoperative short-term groups (P < 0.05). The incidence of complications in the S Group was significantly lower than that in the T Group (P < 0.05). Compared to the T Group, postoperative short-term WBC (white blood cell) and platelet counts were significantly lower and the short-term Hb (haemoglobin) level was significantly higher in the S Group (P < 0.05). In the S Group, postoperative long-term total bilirubin, direct bilirubin, alanine transaminase, and aspartate transaminase and postoperative serum creatinine and cystatin C levels were significantly lower than those in the T Group (P < 0.05), and postoperative albumin was significantly higher than that in the T Group (P < 0.05).

CONCLUSION

Compared to STPD, SSPD is a simple and easy procedure resulting in less tissue damage. Patients recovered smoothly and steadily with fewer complications. Short-term liver and kidney function damage was less severe, and long-term liver function recovery was better. Therefore, SSPD is worthy of clinical promotion and application for the treatment of PH.

Keywords: Simplified pericardial devascularisation, Clinical outcome, Splenectomy, Portal hypertension

Core tip: We performed the use of splenectomy plus simplified pericardial devascularisation (SSPD) in 2002. In this study, we compared the clinical data of patients treated with SSPD or splenectomy plus traditional pericardial devascularisation to evaluate the efficacy of SSPD. A total of 1045 portal hypertension patients were included, and the results suggest that SSPD is simple and easy to perform, resulting in less tissue damage and a reduced inflammatory reaction. Patients recovered smoothly and steadily after SSPD, with lower rates of thrombosis and other complications. Liver and kidney function damage are less severe and long-term liver function recovery is better.