Year : 2017 | Volume
: 50 | Issue : 3 | Page : 101--106
Eighty percent partial splenic embolization is a safe and effective procedure in management of cirrhotic hypersplenism
Bor-Gang Wu1, Andy Shau-Bin Chou2, Guan-Jin Ho1, Ming-Che Lee1
1 Department of Surgery, Buddhist Tzu Chi General Hospital; School of Medicine, Tzu Chi University, Hualien, Taiwan
2 Department of Medical Imaging, Buddhist Tzu Chi General Hospital; School of Medicine, Tzu Chi University, Hualien, Taiwan
Background: Partial splenic embolization (PSE) has been proposed in patients with cirrhotic hypersplenism in cases when thrombocytopenia causes clinical manifestations or if there are contraindications to subsequent therapeutic procedures. We provide a retrospective review of the safety and favorable treatment results of 80% splenic embolization in patients with cirrhotic hypersplenism in our institute.
Methods: Thirteen consecutive patients with cirrhotic hypersplenism were included in a 4-year study period. The indications for PSE were as follows: percutaneous treatment of hepatocellular carcinoma (HCC) (n = 3), transarterial chemoembolization plus hepatic arterial infusion chemotherapy for HCC (n = 2), preparation for major surgery (n = 5), and severe purpura (n = 3). PSE was performed with up to 80% reduction of splenic blood flow by radiological intervention. A tight protocol of prophylactic antibiotics was introduced. Patient demographics, procedure-related complication, and efficacy of PSE were analyzed.
Results: The mean follow-up time was 26.1 ± 12.3 months. All the patients tolerated the procedure. The minor complication of postembolization syndromes such as fever and abdominal pain occurred in 38.5% and 61.5% of patients, respectively. Only a major complication of transient ascites needs diuretic therapy occurred in two patients. Pre-PSE platelet count was 35,077 ± 11,049/mm3, and it significantly increased 1 week after PSE, with a mean increase of platelet count to 384% of pre-PSE level (P < 0.001). The effect of PSE sustained to maintain the platelet count significantly at a mean level of 112,636 ± 33,341/mm3, 114,571 ± 30,696/mm3, and 118,000 ± 31,035/mm3 at 12, 24, and 36 months, respectively.
Conclusion: Our series demonstrated that 80% PSE is a safe and effective method to treat patients with cirrhotic hypersplenism. It could not only increase the platelet count within a short period of time but also maintain it at an acceptable level for a long duration. Under a tight protocol of prophylactic antibiotic and delicate technique of PSE, there was no any septic complication developed in our series.
Department of Surgery, Buddhist Tzu Chi General Hospital, 707, Section 3, Chung-Yang Road, Hualien
|How to cite this article:|
Wu BG, Chou AS, Ho GJ, Lee MC. Eighty percent partial splenic embolization is a safe and effective procedure in management of cirrhotic hypersplenism.Formos J Surg 2017;50:101-106
|How to cite this URL:|
Wu BG, Chou AS, Ho GJ, Lee MC. Eighty percent partial splenic embolization is a safe and effective procedure in management of cirrhotic hypersplenism. Formos J Surg [serial online] 2017 [cited 2020 Oct 22 ];50:101-106
Available from: https://www.e-fjs.org/article.asp?issn=1682-606X;year=2017;volume=50;issue=3;spage=101;epage=106;aulast=Wu;type=0