Comparative Study Of Partial Splenic Artery Embolization And Hand-assisted Laparoscopic Splenectomy In The Treatment Of Cirrhosis With Hypersplenism

Purpose:To compare the efficacy,adverse reactions and influencing factors of partial splenic artery embolization and hand-assisted laparoscopic splenectomy in the treatment of portal hypertension with hypersplenism in cirrhosis,and to explore a treatment plan with clear efficacy,high safety and fewer complications.Method:1.Case data of 135 patients with cirrhosis and hypersplenism treated in the First Affiliated Hospital of Nanchang University from July 2014 to September 2020 were collected,which were divided into PSE group（70 cases）and HALS group（65 cases）according to different treatment methods.Among them,PSE group is further divided into A₁group（30%≤embolization area<50%）in 42 cases,A₂group（50%≤embolization area<60%）in 13 cases,and A₃group（60%≤embolization area<70%）in 15 cases according to the difference in the proportion of intraoperative embolizat-ion.The embolization site of PSE group is the branch embolization of middle and lower splenic arteries,and the embolization material during the operation is the mixture of gelatin sponge,gentamicin and dexamethasone.2.General data of enrolled patients were collected（gender,age,child-pugh classification of liver function,liver and kidney function,coagulation function,total length of hospital stay,hospitalization cost,time to start intestinal exhaust and time to start taking fluids after surgery）.WBC,PLT,RBC counts and hemoglobin levels were collected before surgery,3 days after surgery,1 week after surgery and 1 month after surgery.3.The incidence of postoperative near and long-term complications in PSE group,HALS group and PSE group with different embolization area was observed.Result:1.Postoperative PLT,WBC,RBC count and hemoglobin level changes of patientsCompared with the preoperative results,the WBC and PLT counts in PSE group and HALS group were increased 3 days,1 week and 1 month after surgery,with statistical significance（P<0.05）.Compared with the preoperative level,the RBC count and HB level of PSE group and HALS patients were slightly decreased after surgery,with no statistical significance（P>0.05）.The preoperative blood count（WBC,PLT and RBC count）of PSE group and HALS group is not different,but the WBC and PLT count of HALS group is significantly higher than PSE group at different time points after surgery,the difference is statistically significant（P<0.05）.RBC count and HB level in HALS group were closer than PSE group at different time points after surgery,and the difference was not statistically significant（P>0.05）.In PSE group(group A₁,Group A_2,group A₃),postoperative WBC,PLT,RBC counts and HB levels are significantly different with statistical significance（P<0.05）,and the larger the embolization area is,the more obvious the postoperative PLT,WBC,RBC counts rise.2.Comparison of postoperative clinical data of patientsCompared with preoperative,the INR and PT of postoperative coagulation function in PSE group and HALS group were slightly decreased,with no statistical significance（P>0.05）.The postoperative albumin of PSE group and HALS group was slightly higher than that before surgery,with no statistical significance（P>0.05）.Postoperative TBIL and AST in PSE and HALS groups were lower than those before surgery,and the difference was not statistically significant（P>0.05）.The ALT of PSE group after surgery was higher than that before surgery（102±17 vs 27.9±17.9,P>0.05）,but the ALT of HALS group after surgery was lower than that before surgery（31±17.7U/L vs 36.4±33U/L,P>0.05）,the difference was not statistically significant.Compared with the HALS group,the PSE group had a shorter time to start intestinal exhaust（0.994±0.44d vs 3.7±7.13d,P<0.05）and a shorter time to start fluid intake（0.559±0.101d vs 3.74±0.71,P<0.05）.The length of hospitalization was shorter（14.16±5d vs 18.57±6.2d,P<0.05）,and the difference was statistically significant.However,the total hospitalization cost of PSE group is higher than that of HALS group（30507±12203 vs 23848±5395,P<0.05）.3.Comparison of postoperative complications in patientsIn PSE group,there are 41 cases（41/70）of abdominal pain,35 cases（35/70）of fever,3 cases（3/70）of pleural effusion,2 cases（2/70）of abdominal effusion,1 case（1/70）of portal vein thrombosis,and 50 cases（71.4%）of total postoperative complications,most of which are abdominal pain combined with fever.In the HALS group,there were 2 cases（2/65）of postoperative abdominal pain,20 cases（20/65）of fever,1 case（1/65）of pleural effusion,3 cases（3/65）of abdominal effusion,24 cases（24/65）of incision pain,20 cases（20/65）of postoperative portal vein thrombosis,27cases（41.5%）of total postoperative complications.The postoperative complications of HALS group were mostly incision pain,fever and portal vein thrombosis（PVST）.In PSE group,there are 27 cases（27/42）of postoperative complications in group A1,9 cases（9/13）in group A2,and 14 cases（14/15）in group A3.Chi-square test was used to analyze the postoperative complications of patients with different embolization areas,showing statistically significant differences（P<0.05）.In the PSE group,1 patient（1/60）was found to have a small amount of fluid in the abdominal cavity and 1 patient（1/60）was found to have portal vein thrombosis.The total complication rate was 3.33%.Portal vein thrombosis was found in 12 of 62patients in HALS group one month after surgery,with a total complication rate of19.35%.Conclusion:1.After partial splenic artery embolization and hand-assisted laparoscopic splenectomy,the peripheral blood white blood cell and platelet counts were significantly improved,and the white blood cell and platelet counts showed a slight downward trend 1 week after surgery,which was statistically significant compared with the preoperative results（P<0.05）.Hand-assisted laparoscopic splenectomy is better than partial splenic artery embolization in improving peripheral blood white blood cell and platelet count,and the long-term effect needs further study.2.Partial splenic artery embolization（PSE）is more minimally invasive,has faster postoperative intestinal recovery time and shorter hospital stay,and can be used as an alternative surgical method for hand-assisted laparoscopic splenectomy（HALS）,especially for elderly patients with many underlying diseases who cannot tolerate general anesthesia.However,the hospitalization cost of partial splenic artery embolization（PSE）is higher than that of hand-assisted laparoscopic splenectomy（HALS）,which may be related to more intraoperative consumables and postoperative complications.3.The coagulation function and liver function of patients after partial splenic artery embolization（PSE）and hand-assisted laparoscopic splenectomy（HALS）are not significantly improved,which is different from literature reports,which may be related to the short follow-up time and small sample size in this study.4.The incidence of short-term complications after partial splenic artery embolization（PSE）is higher than that after hand-assisted laparoscopic splenectomy（HALS）,and the higher the embolization area,the more obvious improvement in postoperative peripheral blood WBC,PLT and RBC counts,but the higher the incidence of postoperative complications.