Use of Iodized Oil and Gelatin Sponge Embolization in Splenic Artery Coiling Reduces Bleeding from Laparoscopic Splenectomy for Cirrhotic Portal Hypertension Patients with Complicating Hypersplenic Splenomegaly: A Comparative Study

摘要

Objective: Laparoscopic splenectomy (LS) is relatively contraindicated in cirrhotic portal hypertension (CPH) patients with complicating hypersplenic splenomegaly (HS). This study aimed to evaluate the effectiveness and safety of incorporation of iodized oil and gelatin sponge embolization to conventional splenic artery embolization (cSAE) with coiling in CPH/HS patients undergoing LS. Patients and Methods: Between April 2012 and March 2014, eligible CPH/HS patients (n=56) were assigned to preoperative modified SAE (mSAE) with LS (mSAE+LS group, n=16), cSAE with LS (cSAE+LS group, n=20) or LS alone (LS group, n=20). Main outcome measures included frequency of conversion to laparotomy, operative time, intraoperative bleeding, and transfusion. Results: The three groups had similar baseline characteristics (all P.05). mSAE and cSAE similarly decreased LS conversion frequency (mSAE+LS versus cSAE+LS versus LS, 0.0% versus 10.0% versus 30.0%, P=.030) and operative time (15523 minutes versus 170 +/- 26 minutes versus 221 +/- 42 minutes, P.001) compared with LS alone. mSAE significantly reduced bleeding (178 +/- 22mL versus 250 +/- 27mL versus 328 +/- 67mL, P.001) compared with cSAE and LS alone. The three groups had similar postoperative recovery times and surgical morbidities (all P.05). Conclusions: In CPH/HS patients, preoperative SAE reduced LS conversion frequency and reduced operative time compared with LS alone, while mSAE further decreased volume of blood loss.