■脾切除术是门静脉高压症的明确治疗或分流手术或断流术的一部分,是最常用的手术。脾切除术在技术上具有挑战性,因为多发性侧支静脉曲张频繁共存,脾肿大,肝功能差,和血小板减少症.早期动脉结扎和晚期动员(EALDEM)是门静脉高压症脾切除术的传统方法。早期脾动员可以很好地控制肺门。我们旨在比较早期动员和延迟动脉结扎(EMDAL)技术与传统脾切除术技术在门静脉高压症患者中的作用。
■在2011年9月至2022年9月的研究期间,有173例患者在我们机构接受了门静脉高压症的手术干预。在这些患者中,114例接受了常规的脾切除术(早期动脉结扎和晚期脾动员),而59例接受了EMDAL技术的脾切除术。比较两组人口统计学特征。使用Mann-Whitney检验分析各组的术中和术后结果。每组至少随访12个月。
■两个手术方法组的人口统计学和手术类型具有可比性。常规组的中位失血量高于EMDAL方法。在两种外科手术中,手术的中位持续时间相当。在常规组中,Clavien-DindoIII/IV级并发症的发生率更高。
■通过早期动员和延迟动脉结扎,可以很好地控制脾门并最大程度地减少出血。
UNASSIGNED: Splenectomy is the most frequently performed procedure as definitive management or as part of shunt surgery or devascularization in portal hypertension. Splenectomy is technically challenging because of the frequent coexistence of multiple collateral varices, splenomegaly, poor liver function, and thrombocytopenia. Early arterial ligation and late mobilization (EALDEM) is the traditional method for splenectomy in portal hypertension. Early spleen mobilization offers good control of the hilum. We aim to compare the effect of the early mobilization and delayed arterial ligation (EMDAL) technique with that of the conventional splenectomy technique in patients with portal hypertension.
UNASSIGNED: During the study period from September 2011 to September 2022, 173 patients underwent surgical intervention for portal hypertension at our institution. Among these patients, 114 underwent the conventional method of splenectomy (early arterial ligation and late splenic mobilization) while 59 underwent splenectomy with the EMDAL technique. Demographics were compared between the two groups. Intraoperative and postoperative outcomes were analyzed using the Mann-Whitney test in each group. A minimum follow-up of 12 months was performed in each group.
UNASSIGNED: Demographics and type of surgical procedure were comparable in the two surgical method groups. Median blood loss was higher in the conventional group than in the EMDAL method. The median duration of surgery was comparable in the two surgical procedures. Clavien-Dindo grade III/IV complications were reported more frequently in the conventional group.
UNASSIGNED: The splenic hilum can be controlled well and bleeding can be minimised with early mobilization and delayed arterial ligation.