Treatment strategy of left-sided portal hypertension complicated with hypersplenism caused by pancreatic pseudocyst_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LU Shan , LU Huimin , ZHANG Ling , YANG Dujiang , HU Weiming ,  ZHANG Zhaoda

Department of Pancreatic Surgery, West China Hospital, Chengdu 610041, P. R. China;

Corresponding?author：

ZHANG Zhaoda, Email: zhangzhaoda@medmail.com.cn

Keywords：

left-sided portal hypertension; pancreatic pseudocyst; hypersplenism; splenectomy

DOI：

10.7507/1007-9424.201712075

Video：

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Objective To explore treatment strategy of pancreatic pseudocyst induced left-sided portal hypertension (LSPH) complicated with hypersplenism. Methods The clinical data of 49 cases of pancreatic pseudocyst induced LSPH complicated with hypersplenism from January 2010 to June 2015 in this hospital were retrospectively analyzed. Among them, 36 patients who were not complicated with upper gastrointestinal bleeding were designed to splenectomy group and non-splenectomy group based on splenectomy or not. The epidemiological and clinical features, intraoperative and postoperative results of these two groups were compared. Results There were 38 males and 11 females with age ranging from 22 to 67 years old. As for 13 patients suffering LSPH complicated with hypersplenism caused by pancreatic pseudocyst with upper gastrointestinal bleeding, one patient didn’t accept splenectomy, then the upper gastrointestinal bleeding recurred and the hypersplenism was not alleviated after operation; Whereas, the hypersplenisms were relieved in the others patients after operation. In the 36 patients without upper gastrointestinal bleeding who were complicated with hypersplenism, 23 patients were performed splenectomy (splenectomy group) and 13 patients were not (non-splenectomy group). In the splenectomy group, the blood loss, operation time, and intraoperative blood transfusion were significantly more than those of the non-splenectomy group (P<0.05). The hospital stay and the discharged laboratory examinations had no significant differences between the splenectomy group and the non-splenectomy group (P>0.05) except for the platelet count. Furthermore, the incidence of the postoperative upper gastrointestinal bleeding was lower (P<0.05) and the relief rate of hypersplenism was higher (P<0.05) in the splenectomy group as compared with the non-splenectomy group. Conclusions For pancreatic pseudocyst induced LSPH with hypersplenism, we should be vigilant and early intervent. Usually, primary focus can be treated only. However, splenectomy can effectively relieve hypersplenism and prevent recurrent bleeding for patients with upper gastrointestinal bleeding or patients with close adhesion of pancreas tail and spleen inflammatory lesions and constricting splenic hilus.

Citation： LU Shan, LU Huimin, ZHANG Ling, YANG Dujiang, HU Weiming, ZHANG Zhaoda. Treatment strategy of left-sided portal hypertension complicated with hypersplenism caused by pancreatic pseudocyst. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(5): 553-558. doi: 10.7507/1007-9424.201712075 Copy

1.	Sakorafas GH, Sarr MG, Farley DR, et al. The significance of sinistral portal hypertension complicating chronic pancreatitis. Am J Surg, 2000, 179(2): 129-133.
2.	文峰, 陳東風. 左側門脈高壓癥. 肝臟, 2016, 21(5): 407-410.
3.	Talukdar R, Sundaram M, Nageshwar Reddy D. Endoscopic vs surgical drainage of pancreatic pseudocysts. Gastroenterology, 2014, 146(1): 319-320.
4.	Nasa M, Choudhary N, Patil G, et al. Mediastinal pancreatic pseudocyst. J Dig Endosc, 2016, 7(1): 20.
5.	廖泉, 趙玉沛, 張太平, 等. 假性胰腺囊腫的外科手術治療. 中華肝膽外科雜志, 2004, 10(12): 814-816.
6.	黃萬昌, 葉俊宏. 區域性門脈高壓胃底靜脈曲張的影像診斷與介入治療. 臨床醫學研究與實踐, 2017: 150-152.
7.	郝婷婷, 馬曉鵬, 戴光榮, 等. 肝硬化門靜脈高壓患者食管靜脈曲張 CT 表現預測首次上消化道出血的價值. 胃腸病學和肝病學雜志, 2017, 26(1): 29-31.
8.	劉雪蓮, 楊見權. 脾功能亢進癥治療進展. 實用肝臟病雜志, 2013, 16(4): 382-384.
9.	蔡玲, 張玫, 趙丹丹, 等. 2 056 例上消化道出血病因構成及相關因素分析. 首都醫科大學學報, 2015, 36(6): 978-981.
10.	Greenwald HM, Waseh MG. The roentgenologic demonstration of esophageal varices as a diagnostic aid in chronic thrombosis of the splenic vein. J Pediatr, 1939, 14(1): 57-65.
11.	K?klü S, Coban S, Yüksel O, et al. Left-sided portal hypertension. Dig Dis Sci, 2007, 52(5): 1141-1149.
12.	K?klü S, Yüksel O, Arhan M, et al. Report of 24 left-sided portal hypertension cases: a single-center prospective cohort study. Dig Dis Sci, 2005, 50(5): 976-982.
13.	Weber SM, Rikkers LF. Splenic vein thrombosis and gastrointestinal bleeding in chronic pancreatitis. World J Surg, 2003, 27(11): 1271-1274.
14.	Moossa AR, Gadd MA. Isolated splenic vein thrombosis. World J Surg, 1985, 9(3): 384-390.
15.	時宇, 潘萌, 聶深鈺, 等. 胰源性門脈高壓癥 238 例. 中國老年學雜志, 2015, 35(17): 5000-5001.
16.	石瑞春, 楊志偉, 楊理華. 胰源性區域性門脈高壓癥的臨床表現、診治及療效. 世界華人消化雜志, 2014, 22(26): 4003-4007.
17.	Stabile BE, Wilson SE, Debas HT. Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis. Arch Surg, 1983, 118(1): 45-51.
18.	Flati G, Andrén-Sandberg A, La Pinta M, et al. Potentially fatal bleeding in acute pancreatitis: pathophysiology, prevention, and treatment. Pancreas, 2003, 26(1): 8-14.
19.	Ono Y, Matsueda K, Koga R, et al. Sinistral portal hypertension after pancreaticoduodenectomy with splenic vein ligation. Br J Surg, 2015, 102(3): 219-228.
20.	凌新建, 昝建寶, 余宏鑄. 腹腔鏡與開腹脾切除術在治療肝硬化所致脾功能亢進中的對比研究. 中國現代醫學雜志, 2016, 26(22): 54-58.
21.	汪志偉, 柴琛. 胰腺假性囊腫的治療研究進展. 中國普外基礎與臨床雜志, 2017, 24(1): 115-119.
22.	邢謙哲, 王毅軍, 袁強, 等. 肝炎肝硬化病人脾切除術后門靜脈血栓形成的相關因素分析. 中華肝膽外科雜志, 2010, 16(12): 918-921.
23.	Zhang X, Wang Y, Yu M, et al. Effective prevention for portal venous system thrombosis after splenectomy: a meta-analysis. J Laparoendosc Adv Surg Tech A, 2017, 27(3): 247-252.
24.	Madoff DC, Denys A, Wallace MJ, et al. Splenic arterial interventions: anatomy, indications, technical considerations, and potential complications. Radiographics, 2005, 25 Suppl 1: S191-S211.

1. Sakorafas GH, Sarr MG, Farley DR, et al. The significance of sinistral portal hypertension complicating chronic pancreatitis. Am J Surg, 2000, 179(2): 129-133.
2. 文峰, 陳東風. 左側門脈高壓癥. 肝臟, 2016, 21(5): 407-410.
3. Talukdar R, Sundaram M, Nageshwar Reddy D. Endoscopic vs surgical drainage of pancreatic pseudocysts. Gastroenterology, 2014, 146(1): 319-320.
4. Nasa M, Choudhary N, Patil G, et al. Mediastinal pancreatic pseudocyst. J Dig Endosc, 2016, 7(1): 20.
5. 廖泉, 趙玉沛, 張太平, 等. 假性胰腺囊腫的外科手術治療. 中華肝膽外科雜志, 2004, 10(12): 814-816.
6. 黃萬昌, 葉俊宏. 區域性門脈高壓胃底靜脈曲張的影像診斷與介入治療. 臨床醫學研究與實踐, 2017: 150-152.
7. 郝婷婷, 馬曉鵬, 戴光榮, 等. 肝硬化門靜脈高壓患者食管靜脈曲張 CT 表現預測首次上消化道出血的價值. 胃腸病學和肝病學雜志, 2017, 26(1): 29-31.
8. 劉雪蓮, 楊見權. 脾功能亢進癥治療進展. 實用肝臟病雜志, 2013, 16(4): 382-384.
9. 蔡玲, 張玫, 趙丹丹, 等. 2 056 例上消化道出血病因構成及相關因素分析. 首都醫科大學學報, 2015, 36(6): 978-981.
10. Greenwald HM, Waseh MG. The roentgenologic demonstration of esophageal varices as a diagnostic aid in chronic thrombosis of the splenic vein. J Pediatr, 1939, 14(1): 57-65.
11. K?klü S, Coban S, Yüksel O, et al. Left-sided portal hypertension. Dig Dis Sci, 2007, 52(5): 1141-1149.
12. K?klü S, Yüksel O, Arhan M, et al. Report of 24 left-sided portal hypertension cases: a single-center prospective cohort study. Dig Dis Sci, 2005, 50(5): 976-982.
13. Weber SM, Rikkers LF. Splenic vein thrombosis and gastrointestinal bleeding in chronic pancreatitis. World J Surg, 2003, 27(11): 1271-1274.
14. Moossa AR, Gadd MA. Isolated splenic vein thrombosis. World J Surg, 1985, 9(3): 384-390.
15. 時宇, 潘萌, 聶深鈺, 等. 胰源性門脈高壓癥 238 例. 中國老年學雜志, 2015, 35(17): 5000-5001.
16. 石瑞春, 楊志偉, 楊理華. 胰源性區域性門脈高壓癥的臨床表現、診治及療效. 世界華人消化雜志, 2014, 22(26): 4003-4007.
17. Stabile BE, Wilson SE, Debas HT. Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis. Arch Surg, 1983, 118(1): 45-51.
18. Flati G, Andrén-Sandberg A, La Pinta M, et al. Potentially fatal bleeding in acute pancreatitis: pathophysiology, prevention, and treatment. Pancreas, 2003, 26(1): 8-14.
19. Ono Y, Matsueda K, Koga R, et al. Sinistral portal hypertension after pancreaticoduodenectomy with splenic vein ligation. Br J Surg, 2015, 102(3): 219-228.
20. 凌新建, 昝建寶, 余宏鑄. 腹腔鏡與開腹脾切除術在治療肝硬化所致脾功能亢進中的對比研究. 中國現代醫學雜志, 2016, 26(22): 54-58.
21. 汪志偉, 柴琛. 胰腺假性囊腫的治療研究進展. 中國普外基礎與臨床雜志, 2017, 24(1): 115-119.
22. 邢謙哲, 王毅軍, 袁強, 等. 肝炎肝硬化病人脾切除術后門靜脈血栓形成的相關因素分析. 中華肝膽外科雜志, 2010, 16(12): 918-921.
23. Zhang X, Wang Y, Yu M, et al. Effective prevention for portal venous system thrombosis after splenectomy: a meta-analysis. J Laparoendosc Adv Surg Tech A, 2017, 27(3): 247-252.
24. Madoff DC, Denys A, Wallace MJ, et al. Splenic arterial interventions: anatomy, indications, technical considerations, and potential complications. Radiographics, 2005, 25 Suppl 1: S191-S211.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Treatment strategy of left-sided portal hypertension complicated with hypersplenism caused by pancreatic pseudocyst

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