Clinical analysis of splenectomy and selective devascularization based on intra-operative free portal pressure

Objective To investigate the short-term and long-term outcomes in patients with portal hypertension who underwent splenectomy and selective gastroesophageal devascularization based on intraoperative free portal pressure (FPP).Methods The clinical data of 304 patients from June 2003 to September 2013 were retrospectively analyzed.71 patients underwent splenectomy and selective gastroesophageal devascularzation (group A) and 233 patients received splenectomy and classical gastroesophageal devascularzation (group B).The alteration of FPP,liver function,operation time,volume of blood loss and postoperative complications were compared between the two groups.Results The overall 1-,3-,5-and 10-year accumulative survival rates in all the patients were 95％,92％,85％ and 77％ respectively.Median survival of the liver was 93 months.The Child-Pugh score (6.21 ± 1.04 vs 6.41 ± 1.26; P ＜ 0.05) significantly decreased postoperatively in two weeks in all the patients.The postoperative complications including rebleeding rate (5.6％ vs24.1％,P＜0.05),grade Ⅰ and Ⅱ portal vein thrombosis (19.7％ vs 33.9％,P＜0.05) and delayed gastric function (0 vs 5.6％,P ＜0.05) were significantly different between group A and group B.There were no significant difference between grade Ⅲ and Ⅳ portal vein thrombosis (2.8％ vs 3.4％,P ＞ 0.05).The FPP decreased significantly in both groups,but it decreased more in group A than group B [(10.06 ±4.34)cmH2O(1 cmH2O =0.098 kPa) vs (8.26 ±4.82)cmH2O,P ＜0.01].Moreover,the operation time and the volume of blood loss in group A were significantly less than those in group B.Conclusions Cirrhotic patients with portal hypertension benefited from splenectomy and gastroesophageal devascularization.Selective gastroesophageal devascularization was more safe and effective in patients with portal hypertension. Key words: Portal hypertension;  Splenectomy;  Devascularzation;  Rebleeding rate