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Abstract：
BACKGROUND: Partial splenic embolization (PSE) has been suggested as an alternative to splenectomy in the treatment of hypersplenism. However, some patients may experience recurrence of hypersplenism after PSE and require splenectomy. Currently, there is a lack of evidence-based medical support regarding whether preoperative PSE followed by splenectomy can reduce the incidence of complications.
OBJECTIVE: To investigate the safety and therapeutic efficacy of preoperative PSE followed by splenectomy in patients with cirrhosis and hypersplenism.
METHODS: Between January 2010 and December 2021, 321 consecutive patients with cirrhosis and hypersplenism underwent splenectomy at our department. Based on whether PSE was performed prior to splenectomy, the patients were divided into two groups: PSE group (n = 40) and non-PSE group (n = 281). Patient characteristics, postoperative complications, and follow-up data were compared between groups. Propensity score matching (PSM) was conducted, and univariable and multivariable analyses were used to establish a nomogram predictive model for intraoperative bleeding (IB). The receiver operating characteristic curve, Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA) were employed to evaluate the differentiation, calibration, and clinical performance of the model.
RESULTS: After PSM, the non-PSE group showed significant reductions in hospital stay, intraoperative blood loss, and operation time (all P = 0.00). Multivariate analysis revealed that spleen length, portal vein diameter, splenic vein diameter, and history of PSE were independent predictive factors for IB. A nomogram predictive model of IB was constructed, and DCA demonstrated the clinical utility of this model. Both groups exhibited similar results in terms of overall survival during the follow-up period.
CONCLUSIONS: Preoperative PSE followed by splenectomy may increase the incidence of IB and a nomogram-based prediction model can predict the occurrence of IB.
OBJECTIVE: To investigate the safety and therapeutic efficacy of preoperative PSE followed by splenectomy in patients with cirrhosis and hypersplenism.
METHODS: Between January 2010 and December 2021, 321 consecutive patients with cirrhosis and hypersplenism underwent splenectomy at our department. Based on whether PSE was performed prior to splenectomy, the patients were divided into two groups: PSE group (n = 40) and non-PSE group (n = 281). Patient characteristics, postoperative complications, and follow-up data were compared between groups. Propensity score matching (PSM) was conducted, and univariable and multivariable analyses were used to establish a nomogram predictive model for intraoperative bleeding (IB). The receiver operating characteristic curve, Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA) were employed to evaluate the differentiation, calibration, and clinical performance of the model.
RESULTS: After PSM, the non-PSE group showed significant reductions in hospital stay, intraoperative blood loss, and operation time (all P = 0.00). Multivariate analysis revealed that spleen length, portal vein diameter, splenic vein diameter, and history of PSE were independent predictive factors for IB. A nomogram predictive model of IB was constructed, and DCA demonstrated the clinical utility of this model. Both groups exhibited similar results in terms of overall survival during the follow-up period.
CONCLUSIONS: Preoperative PSE followed by splenectomy may increase the incidence of IB and a nomogram-based prediction model can predict the occurrence of IB.
摘要：
背景：部分脾栓塞术（PSE）已被建议作为脾切除术的替代治疗脾功能亢进。然而,部分患者在PSE后可能出现脾功能亢进复发,需要脾切除术.目前,关于术前PSE后行脾切除术是否能降低并发症的发生率,目前缺乏循证医学支持.
目的：探讨肝硬化脾功能亢进患者术前PSE联合脾切除术的安全性和疗效。
方法：2010年1月至2021年12月，321例肝硬化和脾功能亢进患者在我科接受脾切除术。根据是否在脾切除术前进行PSE,将患者分为PSE组(n=40)和非PSE组(n=281)。患者特征,术后并发症,并对随访资料进行组间比较。进行倾向评分匹配(PSM)，单变量和多变量分析用于建立术中出血的列线图预测模型(IB).接收机工作特性曲线,Hosmer-Lemeshow拟合优度测试,和决策曲线分析(DCA)用于评估差异，校准,和模型的临床表现。
结果：PSM后，非PSE组住院时间显着减少，术中失血,和操作时间（所有P=0.00）。多因素分析显示，脾脏长度，门静脉直径,脾静脉直径,PSE史是IB的独立预测因素。建立了IB的列线图预测模型，DCA证明了该模型的临床实用性。两组在随访期间的总生存期方面表现出相似的结果。
结论：术前PSE后脾切除可能会增加IB的发生率，基于列线图的预测模型可以预测IB的发生。
目的：探讨肝硬化脾功能亢进患者术前PSE联合脾切除术的安全性和疗效。
方法：2010年1月至2021年12月，321例肝硬化和脾功能亢进患者在我科接受脾切除术。根据是否在脾切除术前进行PSE,将患者分为PSE组(n=40)和非PSE组(n=281)。患者特征,术后并发症,并对随访资料进行组间比较。进行倾向评分匹配(PSM)，单变量和多变量分析用于建立术中出血的列线图预测模型(IB).接收机工作特性曲线,Hosmer-Lemeshow拟合优度测试,和决策曲线分析(DCA)用于评估差异，校准,和模型的临床表现。
结果：PSM后，非PSE组住院时间显着减少，术中失血,和操作时间（所有P=0.00）。多因素分析显示，脾脏长度，门静脉直径,脾静脉直径,PSE史是IB的独立预测因素。建立了IB的列线图预测模型，DCA证明了该模型的临床实用性。两组在随访期间的总生存期方面表现出相似的结果。
结论：术前PSE后脾切除可能会增加IB的发生率，基于列线图的预测模型可以预测IB的发生。
