Formosan Journal of Surgery

ORIGINAL ARTICLE
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

Correspondence Address:
Ming-Che Lee
Department of Surgery, Buddhist Tzu Chi General Hospital, 707, Section 3, Chung-Yang Road, 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.


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