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, 陈东风. 左侧门脉高压症. 肝脏, 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, 赵玉沛, 张太平, 等. 假性胰腺囊肿的外科手术治疗. 中华肝胆外科杂志, 2004, 10(12): 814-816.
6.	黄万昌, 叶俊宏. 区域性门脉高压胃底静脉曲张的影像诊断与介入治疗. 临床医学研究与实践, 2017: 150-152.
7.	郝婷婷, 马晓鹏, 戴光荣, 等. 肝硬化门静脉高压患者食管静脉曲张 CT 表现预测首次上消化道出血的价值. 胃肠病学和肝病学杂志, 2017, 26(1): 29-31.
8.	刘雪莲, 杨见权. 脾功能亢进症治疗进展. 实用肝脏病杂志, 2013, 16(4): 382-384.
9.	蔡玲, 张玫, 赵丹丹, 等. 2 056 例上消化道出血病因构成及相关因素分析. 首都医科大学学报, 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.	Köklü S, Coban S, Yüksel O, et al. Left-sided portal hypertension. Dig Dis Sci, 2007, 52(5): 1141-1149.
12.	Köklü 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.	时宇, 潘萌, 聂深钰, 等. 胰源性门脉高压症 238 例. 中国老年学杂志, 2015, 35(17): 5000-5001.
16.	石瑞春, 杨志伟, 杨理华. 胰源性区域性门脉高压症的临床表现、诊治及疗效. 世界华人消化杂志, 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, 昝建宝, 余宏铸. 腹腔镜与开腹脾切除术在治疗肝硬化所致脾功能亢进中的对比研究. 中国现代医学杂志, 2016, 26(22): 54-58.
21.	汪志伟, 柴琛. 胰腺假性囊肿的治疗研究进展. 中国普外基础与临床杂志, 2017, 24(1): 115-119.
22.	邢谦哲, 王毅军, 袁强, 等. 肝炎肝硬化病人脾切除术后门静脉血栓形成的相关因素分析. 中华肝胆外科杂志, 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, 陈东风. 左侧门脉高压症. 肝脏, 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, 赵玉沛, 张太平, 等. 假性胰腺囊肿的外科手术治疗. 中华肝胆外科杂志, 2004, 10(12): 814-816.
6. 黄万昌, 叶俊宏. 区域性门脉高压胃底静脉曲张的影像诊断与介入治疗. 临床医学研究与实践, 2017: 150-152.
7. 郝婷婷, 马晓鹏, 戴光荣, 等. 肝硬化门静脉高压患者食管静脉曲张 CT 表现预测首次上消化道出血的价值. 胃肠病学和肝病学杂志, 2017, 26(1): 29-31.
8. 刘雪莲, 杨见权. 脾功能亢进症治疗进展. 实用肝脏病杂志, 2013, 16(4): 382-384.
9. 蔡玲, 张玫, 赵丹丹, 等. 2 056 例上消化道出血病因构成及相关因素分析. 首都医科大学学报, 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. Köklü S, Coban S, Yüksel O, et al. Left-sided portal hypertension. Dig Dis Sci, 2007, 52(5): 1141-1149.
12. Köklü 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. 时宇, 潘萌, 聂深钰, 等. 胰源性门脉高压症 238 例. 中国老年学杂志, 2015, 35(17): 5000-5001.
16. 石瑞春, 杨志伟, 杨理华. 胰源性区域性门脉高压症的临床表现、诊治及疗效. 世界华人消化杂志, 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, 昝建宝, 余宏铸. 腹腔镜与开腹脾切除术在治疗肝硬化所致脾功能亢进中的对比研究. 中国现代医学杂志, 2016, 26(22): 54-58.
21. 汪志伟, 柴琛. 胰腺假性囊肿的治疗研究进展. 中国普外基础与临床杂志, 2017, 24(1): 115-119.
22. 邢谦哲, 王毅军, 袁强, 等. 肝炎肝硬化病人脾切除术后门静脉血栓形成的相关因素分析. 中华肝胆外科杂志, 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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