Effect of splenic autotransplantation combined with lower esophagus transection on immune functions and portal hemodynamics in hepatic cirrhosis with portal hypertension patients
HUO Jing-shan, CHEN Ji-sheng , CHEN Ru-fu, WU Zhuo, ZHANG Hong-wei, OU Qing-jia. Department of General Surgery,Foshan traditional Chinese medicine,Foshan, Guangdong Province, 528000, China Corresponding author: CHEN Ji-sheng, E-mail: CherJS@hotmail.com
Objective To investigate the effect of splenic autotransplantation combined with lower esophagus transection on immune functions and portal hemodynamics in hepatic cirrhosis with portal hypertension patients. Method 20 patients with liver cirrhosis complicated with portal hypertension were randomly allocated into 2 groups: splenic autotransplantation(n=10), in which patients underwent splenectomy with retroperitoneal splenic autotransplantation and gastroesophageal devascularization (modified Sugiura operation), and control group(n=10), in which only splenectomy and gastroesophageal devascularization were performed. Serum tuftsin and IgM were measeured. Dynamic scintigraphy with technetium 99mTC-labeled heat-damaged erythrocytes was performed. The cross section area, blood velocity and flow and collateral circulation of portal parameters were comparatively evaluated 3D DEC MRA, and the fragment, size, blood flow and collateral circulation of retroperitoneal transplanted spleen were comparatively assessed. Results The preoperative levels of serum tuftsin and IgM showed no statistical difference between groups. However, Serum tuftsin and IgM decreased remarkably in the control group (P0.05) while that in splenic autotransplantation group remained stable. Autotransplantation group showed the transplanted splenic fragment during follow-up. At 6-month after operation, the cross section areas of MPV in both two groups significantly decreased (study group t=13.96, P=0.00; control group t=11.38,P=0.00). The mean blood velocity and the mean blood flow volumeof MPV after operation were lower (study group t=18.98,P=0.00; control groupt=22.32, P=0.00), and those in study group were lower than that in control group (t=-8.02, P=0.00). The transplanted spleen had extensive collateral circulation. Conclusions Partial splenic autotransplantation combined with lower esophagus transection in the treatment of hepatic cirrhosis complicated portal hypertension not only preserves splenic immune function, but also ploys a role in devascularization and shunting for portal hemodynamics.