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splenectomy in living donor liver transplantation and risk factors of portal vein thrombosis

Hepatobiliary & Pancreatic Diseases International 2019年第4期18卷 337-342页

作者： Nobuhiko Kurata Yasuhiro Ogura Satoshi Ogiso Yasuharu Onishi Hideya Kamei Yasuhiro Kodera Department of Transplantation and Endocrine Surgery(Surgery II) Nagoya University Graduate School of MedicineNagoyaJapan Department of Transplantation Surgery Nagoya University Hospital65 Tsurumai-choShowa-kuNagoya 466-8560Japan Department of Gastroenterological Surgery(Surgery II) Nagoya University Graduate School of MedicineNagoyaJapan

Background:Graft inflow modulation(GIM)during adult-to-adult living donor liver transplantation(LDLT)is a common strategy to avoid small-for-size syndrome,and some transplant surgeons attempt small size graft strategy with frequent GIM procedures,which are mostly performed by splenectomy,in ***,splenectomy can cause serious complications such as portal vein thrombosis and overwhelming postsplenectomy ***:Forty-eight adult-to-adult LDLT recipients were enrolled in this study and retrospectively *** applied the graft selection criteria,which routinely fulfill graft-to-recipient weight ratio≥0.8%,and consider GIM as a backup strategy for high portal venous pressure(PVP).Results:In our current strategy of LDLT,splenectomy was performed mostly due to hepatitis C and splenic arterial aneurysms,but splenectomy for GIM was intended to only one patient(2.1%).The final PVP values≤20 mmHg were achieved in all recipients,and no significant difference was observed in patient survival or postoperative clinical course based on whether splenectomy was performed or ***,6 of 18 patients with splenectomy(33.3%)developed postsplenectomy portal vein thrombosis(PVT),while none of the 30 patients without splenectomy developed PVT after *** was identified as a risk factor of PVT in this study(Psplenectomy ***:Using sufficient size grafts was one of the direct solutions to control PVP,and allowed GIM to be reserved as a backup *** should be avoided as much as possible during LDLT because splenectomy was found to be a definite risk factor of *** splenectomy cases with a lower final PVP,a close follow-up is required for early detection and treatment of PVT.

关键词： Living donor liver transplantation splenectomy Portal venous pressure Graft-to-recipient weight ratio Portal vein thrombosis

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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 *** is the largest immune organ and immune center in the peripheral *** the relationship between behavior and immunity has been demonstrated in physiology and diseases,the role of the spleen in behavior is not *** 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 *** did not induce changes in general locomotion,circadian rhythms,learning and memory,or depression/anxiety-related *** further investigate the effects of spleen on stress susceptibility,we established mouse models of depression through chronic unpredictable mild *** behavioral performances of mice subjected to splenectomy showed no differences from control *** 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

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Acute extensive portal and mesenteric venous thrombosis after splenectomy:Treated by interventional thrombolysis with transjugular approach

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World Journal of Gastroenterology 2009年第24期15卷 3038-3045页

作者： Mao-Qiang Wang Han-Ying Lin Li-Ping Guo Feng-Yong Liu Feng Duan Zhi-Jun Wang Department of Interventional Radiology Chinese PLA General Hospital Beijing 100853 China

AIM:To present a series of cases with symptomatic acute extensive portal vein(PV)and superior mesenteric vein(SMV)thrombosis after splenectomy treated by transjugular intrahepatic approach catheter-directed thrombolysis. METHODS:A total of 6 patients with acute extensive PV-SMV thrombosis after splenectomy were treated by transjugular approach catheter-directed thrombolysis. The mean age of the patients was 41.2 *** access to the portal system via the transjugular approach,pigtail catheter fragmentation of clots, local urokinase injection,and manual aspiration thrombectomy were used for the initial treatment of PV-SMV thrombosis,followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV,which was performed for three to six days. Adequate anticoagulation was given during treatment, throughout hospitalization,and after discharge. RESULTS:Technical success was achieved in all 6 *** improvement was seen in these patients within 12-24 h of the *** complications were *** 6 patients were discharged 6-14 d(8±2.5 d)after *** mean duration of follow-up after hospital discharge was 40±16.5 *** and contrast-enhanced computed tomography confirmed patency of the PV and SMV,and no recurrent episodes of PV-SMV thrombosis developed during the follow-up period. CONCLUSION:Catheter-directed thrombolysis via transjugular intrahepatic access is a safe and effective therapy for the management of patients with symptomatic acute extensive PV-SMV thrombosis.

关键词： Mechanical thrombectomy Portal vein splenectomy Superior mesenteric vein Thrombolysis Thrombosis

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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 *** 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 *** Yellow Injection,Danshen Injection,Danhong Injection,and Compound Danshen Dropping Pill achieved good curative effect alone or combined with anticoagulant *** addition,Compound Biejia Ruangan Tablet and Anluo Huaxian Pill can also significantly improve the hemodynamic disorders of portal vein system in patients with *** 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

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Comparative study of the effects of terlipressin versus splenectomy on liver regeneration after partial hepatectomy in rats

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Hepatobiliary & Pancreatic Diseases International 2017年第5期16卷 506-511页

作者： Tom Florian Ulmer Anne Weiland Georg Lurje Christian Klink Anne Andert Hamid Alizai Christoph Heidenhain Ulf Neumann Department of General Visceral and Transplantation Surgery RWTH Aachen University Hospital Aachen Germany Department of Urology Helios Hospital Berlin-Buch Germany

BACKGROUND: Post-hepatectomy liver failure as a result of insufficient liver remnant is a feared complication in liver surgery. Efforts have been made to find new strategies to support liver regeneration. The aim of this study was to investigate the effects of terlipressin versus splenectomy on postoperative liver function and liver regeneration in rats undergoing 70%partial hepatectomy. METHODS: Seventy-two male Wistar rats were randomly assigned into three groups(n=24 in each group): 70% partial hepatectomy as control(PHC), 70% partial hepatectomy with splenectomy(PHS) or 70% partial hepatectomy with a micropump for terlipressin administration(PHT). Eight rats in each group were sacrificed on postoperative day(POD) 1,3 and 7. To assess liver regeneration, immunohistochemical analysis of liver tissue using bromodeoxyuridine(BrdU) and Ki-67 labeling was performed. Portal venous pressure, serum concentrations of creatinine, urea, albumin, bilirubin and prothrombin time as well as liver-, body-weight and their ratio were determined on POD 1, 3 and ***: The liver-, body-weight and their ratio were not statistically different among the groups. On POD 1, 3 and 7 portal venous pressure in the intervention groups(PHT:8.13 ±1.55, 10.38±1.30, 6.25±0.89 cm H2O and PHS: 7.50±0.93,8.88 ±2.42, 5.75±1.04 cm H2O) was lower compared to the control group(PHC: 8.63±2.06, 10.50±2.45, 6.50±2.67 cmH2O). Hepatocyte proliferation in the intervention groups was delayed, especially after splenectomy on POD 1(Brd U: PHS vs PHC, 20.85% ±13.05% vs 28.11%±10.10%; Ki-67, 20.14%±14.10% vs 23.96% ±11.69%). However, none of the differences were statistically ***: Neither the administration of terlipressin nor splenectomy improved liver regeneration after 70% partial hepatectomy in rats. Further studies assessing the regulation of portal venous pressure as well as extended hepatectomy animal models and liver function tests will help to further investigate mechanisms of live

关键词： liver regeneration liver failure terlipressin splenectomy hepatectomy

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Case Report:Wernicke encephalopathy following splenectomy in a patient with liver cirrhosis:a case report and review of the literature

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2010年第6期11卷 433-436页

作者： Xia-ping ZHANG Yuan-qiang LU Wei-dong HUANG Department of Emergency the First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003China

Objective:To report a case of Wernicke encephalopathy in the early stage after ***:A nonalcoholic female patient with hepatitis B-related cirrhosis and hypersplenism underwent splenectomy in a local *** surgical complications occurred and the patient recovered ***,on the eighth postoperative day she developed psychiatric and neurological disturbance without an obvious *** was then admitted to our *** magnetic resonance imaging(MRI) with FLAIR T2 showed symmetric high-signal intensities in the periaqueductal area of the midbrain,which were consistent with Wernicke *** was thus given in-tramuscular thiamine ***:After the administration of thiamine,the patient's confused mental state resolved within 3 d,and her dystaxia gradually improved over the next 5 *** brain MRI with FLAIR T2 was re-examined one month after the episode,and showed nearly complete resolution of the previously abnormal signal intensities in the periaqueductal area of the ***:Physicians should be aware of the possibility of acute Wernicke encephalopathy,especially in patients with liver dysfunction.

关键词： Wernicke encephalopathy Liver cirrhosis Thiamine splenectomy

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Effectiveness and safety of splenectomy for gastric carcinoma:A meta-analysis

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World Journal of Gastroenterology 2009年第42期15卷 5352-5359页

作者： Kun Yang Xin-Zu Chen Jian-Kun Hu Bo Zhang Zhi-Xin Chen Jia-Ping Chen Department of Gastrointestinal Surgery West China Hospital Sichuan University No. 37 Guo Xue Xiang Chengdu 610041 Sichuan Province China

AIM： To evaluate the impact of splenectomy on longterm survival, postoperative morbidity and mortality of patients with gastric cancer by performing a metaanalysis METHODS： A search of electronic databases to identify randomized controlled trials in The Cochrane Library trials register, Mediine, CBMdisc （Chinese Biomedical Database） and J-STAGE, etc was performed. Data was extracted from the studies by 2 independent reviewers. Outcome measures were survival, postoperative morbidity and mortality and operation-related events. The meta-analyses were performed by RevMan 4.3. RESULTS： Three studies comprising 466 patients were available for analysis, with 231 patients treated by gastrectomy plus splenectomy. splenectomy could not increase the 5-year overall survival rate [RR = 1.17, 95% confidence interval （CI） 0.97-1.41]. The postoperative morbidity （RR = 1.76, 95% CI 0.82-3.80） or mortality （RR = 1.58, 95% CI 0.45-5.50） did not suggest any significant differences between the 2 groups. No significant differences were noted in terms of number of harvested lymph nodes, operation time, length of hospital stay and reoperation rate. Subgroup analyses showed splenectomy did not increase the survival rate for proximal and whole gastric cancer. No obvious differences were observed between the 2 groups when stratified by stage. Sensitivity analyses indicated no significant differences regarding the survival rates （P 〉 0.05）. CONCLUSION： splenectomy did not show a beneficial effect on survival rates compared to splenic preservation. Routinely performing splenectomy should not be recommended.

关键词： Gastric cancer splenectomy Survival rate Morbidity Operative surgical procedure Postoperative period Treatment outcome

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Non-invasive evaluation of liver stiffness after splenectomy in rabbits with CCl_4-induced liver fibrosis

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World Journal of Gastroenterology 2016年第46期22卷 10166-10179页

作者： Ming-Jun Wang Wen-Wu Ling Hong Wang Ling-Wei Meng He Cai Bing Peng Department of Pancreatic Surgery West China Hospital Sichuan University Department of Ultrasound West China Hospital

AIM To investigate the diagnostic performance of liver stiffness measurement(LSM) by elastography point quantification(Elast PQ) in animal models and determine the longitudinal changes in liver stiffness by Elast PQ after splenectomy at different stages of *** Liver stiffness was measured in sixty-eight rabbits with CCl4-induced liver fibrosis at different stages and eight healthy control rabbits by Elast PQ. Liver biopsies and blood samples were obtained at scheduled time points to assess liver function and degree of fibrosis. Thirty-one rabbits with complete data that underwent splenectomy at different stages of liver fibrosis were then included for dynamic monitoring of changes in liver stiffness by Elast PQ and liver function according to blood *** LSM by Elast PQ was significantly correlated with histologic fibrosis stage(r = 0.85, P splenectomy(especially F1) may delay liver fibrosis *** Elast PQ is an available, convenient, objective and non-invasive technique for assessing liver stiffness in rabbits with CCl4-induced liver fibrosis. In addition, liver stiffness measurements using Elast PQ can dynamically monitor the changes in liver stiffness in rabbit models, and in patients, after splenectomy.

关键词： Fibrosis stages splenectomy Elastography point quantification Liver stiffness Non-invasive technique

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Synchronous splenectomy and hepatectomy for patients with hepatocellular carcinoma and hypersplenism:A casecontrol study

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World Journal of Gastroenterology 2015年第8期21卷 2358-2366页

作者： Xiao-Yun Zhang Chuan Li Tian-Fu Wen Lu-Nan Yan Bo Li Jia-Yin Yang Wen-Tao Wang Li Jiang Department of Liver Surgery and Liver Transplantation Centre West China Hospital of Sichuan University

AIM:To investigate whether the use of synchronoushepatectomy and splenectomy(HS)is more effective than hepatectomy alone(HA)for patients with hepatocellular carcinoma(HCC)and ***:From January 2007 to March 2013,84consecutive patients with HCC and hypersplenism who underwent synchronous hepatectomy and splenectomy in our center were compared with 84 well-matched patients from a pool of 268 patients who underwent hepatectomy *** short-term and longterm outcomes of the two groups were analyzed and ***:The mean time to recurrence was 21.11±12.04 mo in the HS group and 11.23±8.73 mo in the HA group,and these values were significantly different(P=0.001).The 1-,3-,5-,and 7-year disease-free survival rates for the patients in the HS group and the HA group were 86.7%,70.9%,52.7%,and 45.9%and 88.1%,59.4%,43.3%,and 39.5%,respectively(P=0.008).Platelet and white blood cell counts in the HS group were significantly increased compared with the HA group one day,one week,one month and one year postoperatively(Psplenectomy and micro-vascular invasion were significant independent prognostic factors for disease-free ***,tumor number,and recurrence were independent prognostic factors for overall ***:Synchronous hepatectomy and hepatectomy potentially improves disease-free survival rates and alleviates hypersplenism without increasing the surgical risks for patients with HCC and hypersplenism.

关键词： Hepatocellular carcinoma Hypersplenism splenectomy

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Hand-assisted laparoscopic splenectomy is a useful surgical treatment method for patients with excessive splenomegaly: A metaanalysis

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World Journal of Clinical Cases 2019年第3期7卷 320-334页

作者： Yong Huang Xiao-Yun Wang Kai Wang Department of General Surgery Hepato-Biliary-Pancreatic Surgery Division The Second Affiliated Hospital of Nanchang University Department of Operating Room The Second Affiliated Hospital of Nanchang University

BACKGROUND Hand-assisted laparoscopic splenectomy(HALS) can help overcome the drawbacks of laparoscopic splenectomy(LS) while maintaining its *** To evaluate the efficacy and advantages of HALS for *** The relevant literature was reviewed using the PubMed, EMBASE, Cochrane,Ovid Medline, and Wanfang databases to compare the clinical outcomes of HALS and LS. Odds ratios or mean differences were calculated with 95% confidence intervals for fixed-effects and random-effects models. Overall, 754 patients from16 trials who met the inclusion criteria were *** In pure splenectomy, blood loss volume(P splenectomy and devascularization of the upper stomach(DUS), the operative time(P = 0.04) was significantly shorter and blood loss volume(P < 0.001) andconversion rate(P = 0.05) were significantly lower in the HALS + DUS group than in the LS + DUS group. However, no significant difference was observed in hospital stay length, timing of diet, and complications between the two *** HALS is an ideal surgical treatment method for splenomegaly because it can maximize the benefits for patients while maintaining the advantages of LS.

关键词： Hand-assisted Laparoscopic splenectomy Splenomegaly Devascularization

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