A Study On The Effects Of Splenectomy Combined With Devascularization On The Progression Of Liver Cirrhosis And Liver Function In SASS Patients

Objective: To investigate whether splenic artery steal syndrome(SASS)could be an effective therapeutic target for increasing hepatic artery perfusion,improving liver function and delaying the progression of cirrhosis in patients with decompensated cirrhosis.Methods: According to the inclusion and exclusion criteria of SASS,87 patients with hepatitis B cirrhosis,portal hypertension and hypersplenism who carried out splenectomy and pericardial devascularization in General Surgery Department of Nanchang University Infectious Diseases Hospital were selected.35 patients who met the diagnostic criteria of SASS were divided into SASS group and the other 52 patients were into non-SASS group.The preoperative,intraoperative and postoperative indexes of the two groups were compared.Results: There was no significant difference between SASS group and non-SASS group in preoperative indexes including gender,age,height,weight,CTP grade of liver function and ASA grade of anesthesia.There was no significant difference between the two groups in intraoperative indexes including operation time,blood transfusion volume and blood loss volume(P>0.05).There was no significant improvement in the MELD score on postoperative 3 days of the two groups,and there was no significant difference between the two groups(P>0.05).The MELD score on postoperative 7 days,the diameter and blood flow velocity of hepatic artery on postoperative 14 days in both groups were significantly better than those of preoperation(P<0.05).The MELD score of SASS group was lower than that of control group on postoperative 7 days(P<0.05),and the diameter and blood flow velocity of hepatic artery in SASS group increased significantly than that of the control group on postoperative 14 days(P<0.05).The degree of cirrhosis in both groups were improved 3 months after operation compared with that preoperation(P<0.05),and the degree of improvement of cirrhosis in SASS group was significantly better than that in non-SASS group(P<0.05).Conclusions: Splenectomy and pericardial devascularization surgery can increase the hepatic arterial perfusion in patients with cirrhotic SASS,thus improve liver function and delay the progression of liver cirrhosis.Introducing the concept of cirrhotic SASS into clinical practice can benefit more patients with portal hypertension and hypersplenism.