Pursnani K G, Sillin L F, Kaplan D S
Department of Surgery, SUNY Health Science Center at Syracuse, New York 13210, USA.
Am J Surg. 1997 Mar;173(3):169-73. doi: 10.1016/s0002-9610(97)00006-8.
Portal hypertension is frequently associated with secondary hypersplenism, two common clinical manifestations of which are leukopenia and thrombocytopenia. Surgical portosystemic shunts alleviate portal hypertension but their effect on hypersplenism remains unpredictable. Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive procedure for portal decompression. From current reports it is not clear if TIPS improves hypersplenism in patients with portal hypertension. We present a retrospective review of our experience with TIPS to determine the effect on hypersplenism.
Sixty-five patients who had a TIPS procedure between December 1991 and June 1994 were evaluated retrospectively. The records were specifically reviewed for platelet and white blood cell counts performed before the procedure, within a week after the procedure, and then again within the subsequent 3 weeks. Hypersplenism was defined as thrombocytopenia (platelet count of <100,000/mm3), leukopenia (white blood cell count of <5,000/mm3), or both.
Thrombocytopenia alone was present in 33 patients and leukopenia alone in 4 patients before TIPS was performed. Both leukopenia and thrombocytopenia were present in 12 individuals. At least one of these indices of hypersplenism was present in 49 patients. Leukocyte count improved in 11 of 16 patients (69%) whereas platelet count improved in 34 of 45 patients (75%) within a week of the procedure. In the subsequent 3 weeks, leukopenia was relieved in 5 of 10 patients (50%) and thrombocytopenia in 21 of 28 patients (75%), respectively. Of the 12 patients who had both leukopenia and thrombocytopenia before TIPS, the indices improved in 4 patients (33%) within a week of the procedure. Thrombocytopenia was more consistently corrected as opposed to leukopenia, albeit in the short term.
The TIPS procedure is a promising, minimally invasive method of portal decompression that is effective in the treatment of complications of portal hypertension including secondary hypersplenism.
门静脉高压常伴有继发性脾功能亢进，其两个常见临床表现为白细胞减少和血小板减少。外科门体分流术可缓解门静脉高压，但其对脾功能亢进的影响仍不可预测。经颈静脉肝内门体分流术（TIPS）是一种用于门静脉减压的微创手术。从目前的报告来看，尚不清楚TIPS是否能改善门静脉高压患者的脾功能亢进。我们对TIPS的经验进行了回顾性分析，以确定其对脾功能亢进的影响。
回顾性评估了1991年12月至1994年6月期间接受TIPS手术的65例患者。特别查阅了术前、术后一周内以及随后3周内的血小板和白细胞计数记录。脾功能亢进定义为血小板减少（血小板计数<100,000/mm³）、白细胞减少（白细胞计数<5,000/mm³）或两者兼有。
在进行TIPS手术前，33例患者仅存在血小板减少，4例患者仅存在白细胞减少。12例患者同时存在白细胞减少和血小板减少。49例患者至少存在这些脾功能亢进指标中的一项。术后一周内，16例患者中有11例（69%）白细胞计数改善，45例患者中有34例（75%）血小板计数改善。在随后的3周内，10例白细胞减少患者中有5例（50%）白细胞减少得到缓解，28例血小板减少患者中有21例（75%）血小板减少得到缓解。在TIPS手术前同时存在白细胞减少和血小板减少的12例患者中，术后一周内4例患者（33%）指标有所改善。与白细胞减少相比，血小板减少在短期内更能持续得到纠正。
TIPS手术是一种有前景的、微创的门静脉减压方法，对治疗门静脉高压并发症包括继发性脾功能亢进有效。
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