Huang Long, Li Qing-Lin, Yu Qing-Sheng, Peng Hui, Zhen Zhou, Shen Yi, Zhang Qi
Department of No. 1 Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China.
Anhui University of Traditional Chinese Medicine, Anhui University of Traditional Chinese Medicine, Hefei 230038, Anhui Province, China.
World J Gastrointest Surg. 2024 Feb 27;16(2):318-330. doi: 10.4240/wjgs.v16.i2.318.
Partial splenic embolization (PSE) has been suggested as an alternative to splenectomy in the treatment of hypersplenism. However, some patients may experience recurrence of hypersplenism after PSE and require splenectomy. Currently, there is a lack of evidence-based medical support regarding whether preoperative PSE followed by splenectomy can reduce the incidence of complications.
To investigate the safety and therapeutic efficacy of preoperative PSE followed by splenectomy in patients with cirrhosis and hypersplenism.
Between January 2010 and December 2021, 321 consecutive patients with cirrhosis and hypersplenism underwent splenectomy at our department. Based on whether PSE was performed prior to splenectomy, the patients were divided into two groups: PSE group ( = 40) and non-PSE group ( = 281). Patient characteristics, postoperative complications, and follow-up data were compared between groups. Propensity score matching (PSM) was conducted, and univariable and multivariable analyses were used to establish a nomogram predictive model for intraoperative bleeding (IB). The receiver operating characteristic curve, Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA) were employed to evaluate the differentiation, calibration, and clinical performance of the model.
After PSM, the non-PSE group showed significant reductions in hospital stay, intraoperative blood loss, and operation time (all = 0.00). Multivariate analysis revealed that spleen length, portal vein diameter, splenic vein diameter, and history of PSE were independent predictive factors for IB. A nomogram predictive model of IB was constructed, and DCA demonstrated the clinical utility of this model. Both groups exhibited similar results in terms of overall survival during the follow-up period.
Preoperative PSE followed by splenectomy may increase the incidence of IB and a nomogram-based prediction model can predict the occurrence of IB.
部分脾栓塞术（PSE）已被提议作为脾切除术治疗脾功能亢进的替代方法。然而，一些患者在PSE后可能会出现脾功能亢进复发，需要进行脾切除术。目前，关于术前PSE后行脾切除术是否能降低并发症发生率，缺乏循证医学支持。
探讨术前PSE后行脾切除术治疗肝硬化合并脾功能亢进患者的安全性和治疗效果。
2010年1月至2021年12月，我科连续321例肝硬化合并脾功能亢进患者接受了脾切除术。根据脾切除术前行PSE与否，将患者分为两组：PSE组（n = 40）和非PSE组（n = 281）。比较两组患者的特征、术后并发症及随访数据。进行倾向评分匹配（PSM），并采用单因素和多因素分析建立术中出血（IB）的列线图预测模型。采用受试者工作特征曲线、Hosmer-Lemeshow拟合优度检验和决策曲线分析（DCA）评估模型的区分度、校准度和临床性能。
PSM后，非PSE组的住院时间、术中失血量和手术时间均显著缩短（均P = 0.00）。多因素分析显示，脾脏长度、门静脉直径、脾静脉直径和PSE史是IB的独立预测因素。构建了IB的列线图预测模型，DCA证明了该模型的临床实用性。随访期间两组患者的总生存率相似。
术前PSE后行脾切除术可能会增加IB的发生率，基于列线图的预测模型可以预测IB的发生。
