Department of Surgery and Science, Kyushu University, Fukuoka, Japan.
Hepatol Res. 2013 Sep;43(9):933-41. doi: 10.1111/hepr.12040. Epub 2013 Jan 14.
Whether hepatic function can recover in cirrhotic patients after splenectomy remains controversial.
All consecutive Japanese patients with hepatic cirrhosis due to hepatitis C who had undergone elective splenectomy in Kyushu University Hospital between January 2008 and December 2009 were included in this retrospective study. Prothrombin time, serum albumin and total bilirubin concentrations were reviewed before and after splenectomy and analyzed to clarify whether splenectomy improves hepatic function in patients with cirrhosis and to determine the factors predictive of improvement in hepatic function.
Prothrombin time and total serum bilirubin concentration improved after splenectomy; however, serum albumin concentrations did not increase significantly. Twelve months after splenectomy, total serum bilirubin had decreased by over 0.3 mg/dL in 52.3% of patients and prothrombin time had improved by over 10% in 52.3% of patients. Multiple linear regression analysis identified hepatic vein waveform (HVWF) type I (P = 0.0174) and spleen weight (P = 0.0394) as independent predictors of improvement in prothrombin time and preoperative total serum bilirubin (P = 0.0002) as the only independent predictor of decrease in total bilirubin. Total bilirubin and prothrombin time were significantly improved after splenectomy in patients with HVWF type I, however, they were not improved in patients with HVWF type II.
Prothrombin time and total bilirubin improve in approximately half of cirrhotic patients within a year after splenectomy. HVWF type I and splenomegaly may be predictive factors for improvement in prothrombin time after splenectomy in patients with cirrhosis due to hepatitis C.
肝硬化患者脾切除术后肝功能能否恢复仍存在争议。
本回顾性研究纳入了 2008 年 1 月至 2009 年 12 月期间在九州大学医院因丙型肝炎导致肝硬化而接受择期脾切除术的所有连续日本患者。回顾性分析了脾切除术前和术后的凝血酶原时间、血清白蛋白和总胆红素浓度，以阐明脾切除术是否改善肝硬化患者的肝功能，并确定预测肝功能改善的因素。
脾切除术后凝血酶原时间和总血清胆红素浓度改善；然而，血清白蛋白浓度无明显升高。脾切除术后 12 个月，52.3%的患者总血清胆红素下降超过 0.3mg/dL，52.3%的患者凝血酶原时间改善超过 10%。多元线性回归分析发现肝静脉波形（HVWF）Ⅰ型（P=0.0174）和脾脏重量（P=0.0394）是凝血酶原时间改善的独立预测因素，术前总血清胆红素（P=0.0002）是总胆红素下降的唯一独立预测因素。HVWF Ⅰ型患者脾切除术后总胆红素和凝血酶原时间明显改善，而 HVWF Ⅱ型患者则无改善。
大约一半的肝硬化患者在脾切除术后 1 年内凝血酶原时间和总胆红素改善。HVWF Ⅰ型和脾肿大可能是丙型肝炎肝硬化患者脾切除术后凝血酶原时间改善的预测因素。
