Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2018; 6(6): 99-109
Published online Jun 16, 2018. doi: 10.12998/wjcc.v6.i6.99
Comparison of simplified and traditional pericardial devascularisation combined with splenectomy for the treatment of portal hypertension
Ya-Fei Zhang, Hong Ji, Hong-Wei Lu, Le Lu, Lei Wang, Jin-Long Wang, Yi-Ming Li
Ya-Fei Zhang, Hong Ji, Hong-Wei Lu, Le Lu, Lei Wang, Jin-Long Wang, Yi-Ming Li, Department of General Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Author contributions: Li YM conceived the research and critically reviewed and revised the paper; Zhang YF, Ji H, Lu HW and Lu L designed the research and analysed the data; Zhang YF and Li YM performed the research; all authors participated in the operations; Zhang YF drafted the paper.
Supported by National Natural Science Foundation of China, No. 81170454.
Institutional review board statement: The study was reviewed and approved by the Second Affiliated Hospital of Xi’an Jiaotong University Institutional Review Board.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this study.
Data sharing statement: No additional data are available.
STROBE statement: The guidelines of the STROBE statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yi-Ming Li, MD, Department of General Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University, No. 157 Xiwu Road, Xi’an 710004, Shaanxi Province, China. liyiming@xjtu.edu.cn
Telephone: +86-29-87679746 Fax: +86-29-87679746
Received: April 5, 2018
Peer-review started: April 8, 2018
First decision: April 23, 2018
Revised: April 27, 2018
Accepted: May 30, 2018
Article in press: May 31, 2018
Published online: June 16, 2018
ARTICLE HIGHLIGHTS
Research background

Splenectomy plus pericardial devascularisation is the main surgical treatment for portal hypertension (PH) caused by virus hepatitis. However, the procedure of splenectomy plus traditional pericardial devascularisation (STPD) is complex with high rates of postoperative rebleeding and complications. A simplified pericardial devascularisation was extremely needed. We developed a splenectomy plus simplified pericardial devascularisation (SSPD), whose better short-term and long-term prognosis compared to STPD were reported in the present study.

Research motivation

The procedure of SSPD is simple and easy to perform resulting in less tissue damage and less liver and kidney function injury, which is worthy of clinical promotion and application.

Research objectives

The main objectives of this retrospective study were to evaluate the short-term and long-term clinical efficacy of SSPD vs STPD.

Research methods

We retrospectively analyzed the perioperative indicators, short-term and long-term prognosis indicators and complications and short-term and long-term blood biochemical indexes of 1045 PH patients who underwent SSPD or STPD. The patients were divided into an S Group (underwent SSPD) and a T Group (underwent STPD). We analyzed the short-term and long-term clinical efficacy of SSPD vs STPD.

Research results

Perioperative indicators in the S Group (underwent SSPD) were significantly better than those in the T Group (underwent STPD). In both groups, the postoperative long-term portal vein diameter and MELD score were significantly lower than those in the preoperative and postoperative short-term groups. The incidence of complications in the S Group was significantly lower than that in the T Group. Compared to the T Group, postoperative short-term white blood cell and platelet counts were significantly lower and the short-term haemoglobin level was significantly higher in the S Group. In the S Group, postoperative long-term total bilirubin, direct bilirubin, alanine transaminase, and aspartate transaminase and postoperative serum creatinine and cystatin C levels were significantly lower than those in the T Group, and postoperative albumin was significantly higher than that in the T Group.

Research conclusions

SSPD is a simple and easy procedure resulting in less tissue damage and less liver and kidney function injury, which is worthy of clinical promotion and application, especially in primary hospitals.

Research perspectives

Long-term survival and hemodynamic indexes should be further studied between the two operation types in the future research.