S L Harilal, Pottakkat Biju, Raja Kalayarasan, Gnanasekaran Senthil
Department of Surgical Gastroenterology, JIPMER, Puducherry, India.
Ann Hepatobiliary Pancreat Surg. 2024 Feb 29;28(1):48-52. doi: 10.14701/ahbps.23-080. Epub 2024 Jan 5.
BACKGROUNDS/AIMS: 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.
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.
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.
The splenic hilum can be controlled well and bleeding can be minimised with early mobilization and delayed arterial ligation.
背景/目的：脾切除术是门静脉高压症确定性治疗、分流手术或去血管化手术中最常施行的手术。由于常并存多发侧支静脉曲张、脾肿大、肝功能差和血小板减少，脾切除术在技术上具有挑战性。早期动脉结扎和晚期游离（EALDEM）是门静脉高压症脾切除术的传统方法。早期游离脾脏可很好地控制脾门。我们旨在比较早期游离和延迟动脉结扎（EMDAL）技术与传统脾切除术技术在门静脉高压症患者中的效果。
在2011年9月至2022年9月的研究期间，173例患者在我院接受了门静脉高压症的手术干预。其中，114例采用传统脾切除术方法（早期动脉结扎和晚期脾脏游离），59例采用EMDAL技术进行脾切除术。比较两组的人口统计学数据。每组使用Mann-Whitney检验分析术中及术后结果。每组至少随访12个月。
两种手术方法组的人口统计学和手术类型具有可比性。传统组的中位失血量高于EMDAL组。两种手术的中位手术时间具有可比性。传统组Clavien-Dindo III/IV级并发症的报告更为频繁。
早期游离和延迟动脉结扎可很好地控制脾门并使出血最小化。
