Adams D B, Mauterer D J, Vujic I J, Anderson M C
Department of Surgery, Medical University of South Carolina, Charleston 29425.
South Med J. 1990 Sep;83(9):1021-4. doi: 10.1097/00007611-199009000-00010.
Splenic vein occlusion due to chronic pancreatitis may result in "left-sided portal hypertension," which is associated with gastric variceal hemorrhage. Intraoperative hemorrhage is also a major problem in this patient group, and it has been suggested that preoperative splenic arterial occlusion offers a means to diminish intraoperative blood loss. In order to assess the benefit of preoperative control of arterial inflow on intraoperative blood loss, we reviewed retrospectively 16 cases of chronic pancreatitis and associated splenic vein occlusion in patients who had splenectomy. There was a significant difference in estimated intraoperative blood loss in the two patient groups (P less than .05). Preoperative inflow control was obtained with a wedge balloon catheter or autologous clot embolization with an estimated mean blood loss of 1771 mL in seven patients. Nine patients had splenectomy without inflow control, with a mean estimated intraoperative blood loss of 3332 mL. The mean difference was 1560 mL. Preoperative control of splenic artery inflow can diminish intraoperative blood loss during splenectomy in the presence of splenic vein occlusion associated with chronic pancreatitis.
慢性胰腺炎导致的脾静脉闭塞可能会引发“左侧门静脉高压”，这与胃静脉曲张出血有关。术中出血也是该患者群体中的一个主要问题，有人提出术前脾动脉闭塞可作为减少术中失血的一种方法。为了评估术前控制动脉血流对术中失血的益处，我们回顾性分析了16例因慢性胰腺炎伴脾静脉闭塞而行脾切除术的患者。两组患者的估计术中失血量存在显著差异（P<0.05）。7例患者通过楔形球囊导管或自体血凝块栓塞实现了术前血流控制，估计平均失血量为1771毫升。9例患者未进行血流控制就接受了脾切除术，术中估计平均失血量为3332毫升。平均差值为1560毫升。在存在与慢性胰腺炎相关的脾静脉闭塞的情况下，术前控制脾动脉血流可减少脾切除术中的术中失血。
