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Will partial splenic embolization followed by splenectomy increase intraoperative bleeding?

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World Journal of Gastrointestinal Surgery 2024年第2期16卷 318-330页

作者： Long Huang Qing-Lin Li Qing-Sheng Yu Hui Peng Zhou Zhen Yi Shen Qi Zhang Department of No.1 Surgery The First Hospital Affiliated to Anhui University of Traditional Chinese MedicineHefei 230031Anhui ProvinceChina Anhui University of Traditional Chinese Medicine Anhui University of Traditional Chinese MedicineHefei 230038Anhui ProvinceChina Department of Surgery The Second Hospital Affiliated to Anhui University of Traditional Chinese MedicineHefei 230061Anhui ProvinceChina

BACKGROUND 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.AIM To investigate the safety and therapeutic efficacy of preoperative PSE followed by splenectomy in patients with cirrhosis and hypersplenism.METHODS 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(n=40)and non-PSE group(n=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.RESULTS After PSM,the non-PSE group showed significant reductions in hospital stay,intraoperative blood loss,and operation time(all P=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.CONCLUSION Preoperative PSE followed by splenectomy may increase the incidence of IB and a nomogram-based prediction model can predict the occurrence of IB.

关键词： Partial splenic embolization splenectomy Hypertension,Portal Liver Cirrhosis Intraoperative bleeding

splenectomy: Indications in the General Surgery Department of Ignace Deen Hospital

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Surgical Science 2024年第4期15卷 219-224页

作者： Mamadou Sakoba Barry Boubacar Barry Sandaly Diakité Aboubacar Touré Aissatou Taran Diallo General Surgery Department Ignace Deen National Hospital at Conakry University Hospital Conakry Guinea Faculty of Health Sciences and Technology Gamal Abdel Nasser University of Conakry Conakry Guinea

Introduction: splenectomy is the surgical removal of the spleen. It can be performed during various pathologies, ranging from abdominal trauma to hemoglobinopathies. The progress made in the knowledge of the immune functions of the spleen and the fear of post-splenectomy infectious complications have favored the development of surgical or non-surgical splenic preservation techniques calling into question the dogma of splenectomy. The aim of this study was to determine the indications for splenectomy. Methodology: This was a retrospective, descriptive study lasting 5 years in the general surgery department of the Ignace Deen National Hospital. All files of splenectomized patients were included, our variables were clinical, therapeutic and progressive. Results: We collected 42 cases of splenectomies out of the 2478 surgical procedures performed, representing 1.7% of the department’s surgical activities. The average age was 44 years. The age group of 41 to 50 years was the most represented, i.e. 26% (n = 11) of cases. Sex ratio = 1. Abdominal pain was the reason for consultation in patients, i.e. 100% (n = 42) of cases. The antecedents were dominated by recurrent malaria with 52.3% (n = 22) of cases, then recurrent anemia in 21% (n = 9), and 16.7% (n = 7) had sickle cell disease. Splenomegaly was found in 31 patients, or 73.6%. Ultrasound was performed in all patients. The indications for splenectomy were: isolated splenomegaly with risk of rupture (38%, n = 16), hypersplenism (26%, n = 11) and trauma to the spleen (19.04%, n = 8). Total splenectomy was performed in all cases. The surgical consequences were favorable in 85.7%, (n = 36) with morbidity of 14% (n = 6) and mortality of 9.52% (n = 4). The average length of hospitalization was 10.4 days with extremes of 1 and 22 days. Conclusion: splenectomy constitutes a relatively common surgical procedure in our context. The indications for splenectomy were isolated splenomegaly with risk of rupture, hypersplenism and trauma to the spleen and total splenectomy was the

关键词： splenectomy Indications Ignace Deen

Systemic lupus erythematosus in a 15-year-old female with multiple splenic nodules:A case report

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World Journal of Clinical Cases 2024年第12期12卷 2128-2133页

作者： Mi Il Kang Hyeok Chan Kwon Division of Rheumatology Department of Internal MedicineDankook University College of MedicineCheonan-si 31116South Korea Division of Rheumatology Department of Internal MedicineDankook University HospitalDankook University College of MedicineCheonan-si 31116South Korea

BACKGROUND Systemic lupus erythematosus(SLE)is a chronic inflammatory disease primarily affecting young females.SLE can invade any organ,and various forms of splenic invasion have been reported.Manifestations include splenomegaly and splenic infarction,rupture,and calcification.The study encountered a rare case of splenic involvement,with nodules of various sizes without calcifications or ruptures.CASE SUMMARY A 15-year-old girl presented with arthralgia,weight loss,fever,increased levels of inflammatory markers,and positive antinuclear antibody test results.The patient was diagnosed with SLE.She was asymptomatic while taking steroids and hydroxychloroquine.Ten months after discharge,the patient developed a fever and abdominal pain.Lupus enteritis was suspected,and abdominopelvic computed tomography(AP-CT)was performed.There were no specific findings in the gastrointestinal tract,but multiple splenic nodules were observed.Infection or hemangioma was considered;however,no specific radiological findings were observed.A biopsy of the spleen was performed to determine the possibility of malignancy.The histological findings of the spleen included extensive periarteriolar necrosis with hematoxylin bodies and numerous karyorrhectic debris.Based on the biopsy results,the patient was diagnosed with an SLE flare-up and was maintained on high-dose steroids and immunosuppressants.CONCLUSION As disease activity increased,multiple nodules in the spleen that were previously unseen were observed using AP-CT and histologically confirmed.Spleen invasion by SLE can appear in multiple nodular forms and patterns.Therefore,physicians should consider these findings when differentiating these nodules from infections and malignancies.

关键词： Multiple nodules Spleen splenectomy Systemic lupus erythematosus Differential diagnosis Case report

splenectomy does not affect mouse behaviors

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Neural Regeneration Research 2023年第8期18卷 1789-1794页

作者： Jiao-Qiong Guan Pei-Sen Zhang Wen-Chao Zhang Bing-Qian Zhang Hai-Tao Wu Yue Lan Ti-Fei Yuan Department of Rehabilitation Medicine Guangzhou First People’s HospitalSchool of MedicineSouth China University of TechnologyGuangzhouGuangdong ProvinceChina Shanghai Key Laboratory of Psychotic Disorders Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghaiChina College of Life Science and Technology Beijing University of Chemical TechnologyBeijingChina Department of Neurobiology Beijing Institute of Basic Medical SciencesBeijingChina Key Laboratory of Neuroregeneration Co-innovation Center of NeuroregenerationNantong UniversityNantongJiangsu ProvinceChina Guangzhou Key Laboratory of Aging Frailty&Neurorehabilitation GuangzhouGuangdong ProvinceChina

The spleen is critical for immunity.It is the largest immune organ and immune center in the peripheral system.While the relationship between behavior and immunity has been demonstrated in physiology and diseases,the role of the spleen in behavior is not clear.To investigate the effects of the spleen on behaviors,we performed a refined splenectomy procedure on C57BL/6J mice and performed an open field test,circadian rhythm test,elevated plus maze,sucrose preference test,and Barnes maze test.splenectomy did not induce changes in general locomotion,circadian rhythms,learning and memory,or depression/anxiety-related behaviors.To further investigate the effects of spleen on stress susceptibility,we established mouse models of depression through chronic unpredictable mild stress.The behavioral performances of mice subjected to splenectomy showed no differences from control animals.These findings suggest that splenectomy does not cause changes in baseline behavioral performance in mice.

关键词： anxiety chronic unpredictable mild stress circadian rhythms depression immunity learning locomotion memory spleen splenectomy

Research Progress in Chinese Medicine Preparations for Promoting Blood Circulation and Removing Blood Stasis for Cirrhotic Patients with Portal Vein Thrombosis Following splenectomy

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Chinese Journal of Integrative Medicine 2022年第9期28卷 855-863页

作者： ZHANG Ding-qi MU Yong-ping XU Ying CHEN Jia-mei LIU Ping LIU Wei Key Laboratory of Liver and Kidney Diseases(Ministry of Education) Institute of Liver DiseasesShuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghai201203China Shanghai Key Laboratory of Traditional Chinese Clinical Medicine Shanghai201203China Institute of Interdisciplinary Complex Research Shanghai University of Traditional Chinese MedicineShanghai201203China

This article presented an overview of the therapeutic effects of Chinese medicine(CM)preparations for promoting blood circulation and removing blood stasis for patients with portal vein thrombosis(PVT)after splenectomy.Based on published clinical researches of CM preparations for PVT after splenectomy in patients with cirrhotic portal hypertension(CPH),this paper evaluated the incidence of PVT,and explored potential active components and mechanisms of CM preparations.Safflower Yellow Injection,Danshen Injection,Danhong Injection,and Compound Danshen Dropping Pill achieved good curative effect alone or combined with anticoagulant therapy.In addition,Compound Biejia Ruangan Tablet and Anluo Huaxian Pill can also significantly improve the hemodynamic disorders of portal vein system in patients with cirrhosis.Considering the role of CM preparations in ameliorating the incidence of PVT after splenectomy in patients with CPH,we suggested that future research should provide more attention to CM alone or CM combined with anticoagulant for cirrhosis with PVT.

关键词： portal vein thrombosis splenectomy cirrhotic portal hypertension Chinese medicine preparations promoting blood circulation and removing blood stasis

Machine learning predicts portal vein thrombosis after splenectomy in patients with portal hypertension: Comparative analysis of three practical models

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World Journal of Gastroenterology 2022年第32期28卷 4680-4696页

作者： Jian Li Qi-Qi Wu Rong-Hua Zhu Xing Lv Wen-Qiang Wang Jin-Lin Wang Bin-Yong Liang Zhi-Yong Huang Er-Lei Zhang Hepatic Surgery Center Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina Department of Trauma Surgery Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina

BACKGROUND For patients with portal hypertension(PH),portal vein thrombosis(PVT)is a fatal complication after splenectomy.Postoperative platelet elevation is considered the foremost reason for PVT.However,the value of postoperative platelet elevation rate(PPER)in predicting PVT has never been studied.AIM To investigate the predictive value of PPER for PVT and establish PPER-based prediction models to early identify individuals at high risk of PVT after splenectomy.METHODS We retrospectively reviewed 483 patients with PH related to hepatitis B virus who underwent splenectomy between July 2011 and September 2018,and they were randomized into either a training(n=338)or a validation(n=145)cohort.The generalized linear(GL)method,least absolute shrinkage and selection operator(LASSO),and random forest(RF)were used to construct models.The receiver operating characteristic curves(ROC),calibration curve,decision curve analysis(DCA),and clinical impact curve(CIC)were used to evaluate the robustness and clinical practicability of the GL model(GLM),LASSO model(LSM),and RF model(RFM).RESULTS Multivariate analysis exhibited that the first and third days for PPER(PPER1,PPER3)were strongly associated with PVT[odds ratio(OR):1.78,95%confidence interval(CI):1.24-2.62,P=0.002;OR:1.43,95%CI:1.16-1.77,P<0.001,respectively].The areas under the ROC curves of the GLM,LSM,and RFM in the training cohort were 0.83(95%CI:0.79-0.88),0.84(95%CI:0.79-0.88),and 0.84(95%CI:0.79-0.88),respectively;and were 0.77(95%CI:0.69-0.85),0.83(95%CI:0.76-0.90),and 0.78(95%CI:0.70-0.85)in the validation cohort,respectively.The calibration curves showed satisfactory agreement between prediction by models and actual observation.DCA and CIC indicated that all models conferred high clinical net benefits.CONCLUSION PPER1 and PPER3 are effective indicators for postoperative prediction of PVT.We have successfully developed PPER-based practical models to accurately predict PVT,which would conveniently help clinicians rapidly differentiate individuals at high risk of

关键词： Portal hypertension splenectomy Portal vein thrombosis Postoperative platelet elevation rate Practical model Machine learning

Distal pancreatectomy with or without radical approach, vascular resections and splenectomy: Easier does not always mean easy

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World Journal of Gastrointestinal Surgery 2023年第6期15卷 1020-1032页

作者： Lapo Bencini Alessio Minuzzo Oncology and Robotic Surgery Careggi Main Regional and University HospitalFlorence 50131Italy

Because distal pancreatectomy(DP)has no reconstructive steps and less frequent vascular involvement,it is thought to be the easier counterpart of pancreaticoduodenectomy.This procedure has a high surgical risk and the overall incidences of perioperative morbidity(mainly pancreatic fistula),and mortality are still high,in addition to the challenges that accompany delayed access to adjuvant therapies(if any)and prolonged impairment of daily activities.Moreover,surgery to remove malignancy of the body or tail of the pancreas is associated with poor long-term oncological outcomes.From this perspective,new surgical approaches,and aggressive techniques,such as radical antegrade modular pancreato-splenectomy and DP with celiac axis resection,could lead to improved survival in those affected by more locally advanced tumors.Conversely,minimally invasive approaches such as laparoscopic and robotic surgeries and the avoidance of routine concomitant splenectomy have been developed to reduce the burden of surgical stress.The purpose of ongoing surgical research has been to achieve significant reductions in perioperative complications,length of hospital stays and the time between surgery and the beginning of adjuvant chemotherapy.Because a dedicated multidisciplinary team is crucial to pancreatic surgery,hospital and surgeon volumes have been confirmed to be associated with better outcomes in patients affected by benign,borderline,and malignant diseases of the pancreas.The purpose of this review is to examine the state of the art in distal pancreatectomies,with a special focus on minimally invasive approaches and oncological-directed techniques.The widespread reproducibility,cost-effectiveness and long-term results of each oncological procedure are also taken into deep consideration.

关键词： Distal pancreatectomy Minimally invasive splenectomy Laparoscopic

Liver transplantation with simultaneous splenectomy increases risk of cancer development and mortality in hepatocellular carcinoma patients

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World Journal of Gastrointestinal Surgery 2022年第9期14卷 930-939页

作者： Hsiu-Lung Fan Chung-Bao Hsieh Shih-Ming Kuo Teng-Wei Chen Division of General Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 11409Taiwan Division of Pediatric Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 11409Taiwan

BACKGROUND splenectomy has previously been found to increase the risk of cancer development,including lung,non-melanoma skin cancer,leukemia,lymphoma,Hodgkin’s lymphoma,and ovarian cancer.The risk of cancer development in liver transplantation(LT)with simultaneous splenectomy remains unclear.AIM To compare hepatocellular carcinoma(HCC)recurrence and de novo malignancy between patients undergoing LT with and without simultaneous splenectomy.METHODS We retrospectively analyzed the outcomes of 120 patients with HCC within the University of California San Francisco criteria who received LT with(n=35)and without(n=85)simultaneous splenectomy in the Tri-Service General Hospital.Univariate and multivariate Cox regression analyses for cancer-free survival and mortality were established.The comparison of the group survival status and group cancer-free status was done by generating Kaplan–Meier survival curves and log-rank tests.RESULTS The splenectomy group had more hepatitis C virus infection,lower platelet count,higher-fetoprotein level,and longer operating time.splenectomy and age were both positive independent factors for prediction of cancer development[hazard ratio(HR):2.560 and 1.057,respectively,Psplenectomy and hypertension were positive independent factors for prediction of mortality.(HR:2.791 and 2.813 respectively,Psplenectomy group had a significantly worse cancer-free survival(CFS)and overall survival(OS)curve compared to the non-splenectomy group(5-year CFS rates:53.4%vs 76.5%,P=0.003;5-year OS rate:68.1 vs 89.3,P=0.002).CONCLUSION Our study suggests that simultaneous splenectomy should be avoided as much as possible in HCC patients who have undergone LT.

关键词： Hepatocellular carcinoma Liver transplantation splenectomy De novo malignancy Age Hypertension

Living donor liver transplantation combined with splenectomy in a child with Niemann-Pick disease type B:single-centre experience of perioperative anticoagulation regimen

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Hepatobiliary Surgery and Nutrition 2022年第3期11卷 498-501页

作者： Han Ding Jian Wang Yichi Zhang Shuai Zhao Bing Han Hao Cai Jinyang Gu Department of Transplantation Xinhua Hospital Affifiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina

Niemann-Pick disease(NPD)is a rare and life-threatening disease caused by the deficiency of acid sphingomyelinase activity which is characterized by intracellular accumulation of sphingomyelin within multiple organs(1).At present,few non-surgical treatment options are available for NPD apart from enzyme replacement therapy and allogeneic hematopoietic stem cell transplantation.However,neither surgical nor alternative therapies can modify the progression of neurological disorders,which makes the prognosis of NPD except type B bleak(2).NPD type B(NPD-B),known as one visceral form of NPD,is usually clinically manifested as hepatosplenomegaly but without neurological symptoms.Notably,pulmonary parenchymal involvement secondary to the accumulation of sphingomyelin in alveoli is also a feature of NPD-B(3).Scattered reports(4)indicated that liver transplantation(LT)have shown some preliminary results for NPD-B.Owing to the effect of diseased spleen on operation field and pancytopenia associated with hypersplenism,splenectomy is always performed in conjunction with LT.However.

关键词： splenectomy spleen involvement