Splenic autotransplantation and oesophageal transection anastomosis in patients with portal hypertension (26 years clinical observation)

Abstract

The surgical treatment methods for cirrhosis patients complicated with portal hypertension are complicated. In this study, we evaluated the effectiveness of a new treatment strategy: splenic auto-transplantation and oesophageal transection anastomosis on 274 patients from three aspects: clinical observation, splenic immunology and portal dynamics. From 1979 to 2005, 274 cirrhosis patients with portal hypertension who underwent the new treatment strategy were followed up to observe different clinical indexes, which were then compared with those of the traditional surgery treatment. From 1999 to 2002, a randomized control trial (RCT) was performed on 40 patients to compare their immune function after operation. From 1994 to 2004, another RCT was carried out on 28 patients to compare the portal dynamics through three-dimensional dynamic contrast enhanced MR angiography (3D DEC MRA) investigation after operation. Among 274 patients (mean age 41.8 years), the emergency operative mortality (4.4%), selective operative mortality (2.2%), complication rate (17.9%), morbidity of hepatic encephalopathy (<1%), bleeding rate of portal hypertension gastritis (PHG) (9.1%), and morbidity of hepatic carcinoma (8%) were similar to those under traditional operation; the spleen immunology function (Tuftsin, IgM) decreased among the groups 2 months after operation. Through 3D DCE MRA, the cross section area, the velocity and volume of blood flow of main portal vein decrease significantly after operation in both groups, the auto transplantation group was significantly lower in velocity and volume of blood flow than in the control group. Splenic auto transplantation and esophageal transection anastomosis are a safe, effective, and reasonable treatment strategy for portal hypertension with varicial bleeding. It can not only correct hypersplenism but also completely stanch blood, and auto transplanted spleen in the retroperitoneal space can preserve immune function and establish abroad collateral circulation.