■近端脾肾分流术(PSRS)通常在有症状的非肝硬化门静脉纤维化(NCPF)中进行。在非出血NCPF患者中,脾切除联合内治疗的结果尚未得到很好的研究。我们在此旨在研究非出血NCPF患者中PSRS和脾切除术之间的短期和长期手术结果。
■纳入2008年至2016年连续接受脾切除术或PSRS的非出血NCPF患者。术后对患者进行了临床和生化检查,根据需要进行多普勒超声和上消化道内镜检查。比较围手术期参数为手术时间,失血,住院时间和发病率。比较的长期结局指标是门静脉高压症(PHTN)相关出血的发生率,静脉曲张等级的变化,分流通畅,分流并发症和脾-门静脉轴血栓形成。
■在40例无出血状态的患者中,24例行脾切除术,16例行PSRS。基线特征包括手术指征,PSRS和脾切除术的生化检查和静脉曲张分级具有可比性.两组围手术期发病率无明显差异。中位随访时间为42个月(12-72个月),PSRS组静脉曲张程度的下降明显高于对照组(p=0.03),有症状的PHTN相关的UGIB在PSRS和脾切除术中无显著性差异(p=0.5).在PSRS组中,3例(18.3%)患者发生分流血栓形成(n=1)和脑病(n=2),而脾切除术组2例患者发生了脾孔轴血栓形成。
■在有手术指征的非出血NCPF患者中,内治疗的脾切除术是PSRS的替代方案。
UNASSIGNED: Proximal splenorenal shunt (PSRS) is usually done in symptomatic non-cirrhotic portal fibrosis (NCPF). The outcomes of splenectomy with endotherapy in non-bleeder NCPF patients has not been well studied. We here by aimed to study the post-surgical outcomes on short and long-term basis between PSRS and splenectomy among non-bleeder NCPF patients.
UNASSIGNED: The consecutive non-bleeder NCPF patients whom underwent either splenectomy or PSRS from 2008 to 2016 were enrolled. The patients were followed up post-surgery clinically and biochemical investigations, Doppler ultrasound and upper gastrointestinal endoscopy were done as required. The peri-operative parameters compared were operative time, blood loss, hospital stay and morbidity. The long-term outcome measures compared were incidence of portal hypertension (PHTN) related bleed, change in grade of varices, shunt patency, shunt complications and thrombosis of spleno-portal axis.
UNASSIGNED: Among 40 patients with non-bleeder status, 24 underwent splenectomy and 16 underwent PSRS. The baseline characteristics including indication of surgery, biochemical investigations and grade of varices were comparable between PSRS and splenectomy. The peri-operative morbidity was not significantly different between two groups. The median follow up duration was 42 months (12-72 months), the decrement in grade of varices was significantly higher in PSRS group (p=0.03), symptomatic PHTN related UGIB was non-significant between PSRS and splenectomy (p=0.5). In PSRS group, 3 (18.3%) patients had shunt thrombosis (n=1) & encephalopathy (n=2) while in splenectomy group two patients developed thrombosis of splenoportal axis.
UNASSIGNED: Splenectomy with endotherapy is alternative to PSRS in non-bleeder NCPF patients with indications for surgery.