title: Successful Splenectomy for Hypersplenism in Wilson's Disease: A Single Center Experience from China.
abstract: Splenomegaly and pancytopenia are common in Wilson's disease (WD) and splenectomy is one of the conventional treatments for splenomegaly and the associated pancytopenia. However, splenectomy remained controversial for hypersplenism in WD as it was reported that splenectomy leaded to serious emotional and neurological deterioration in WD patients with hypersplenism. In the current study, we present our experiences in 70 WD patients with hypersplenism who had undergone splenectomy, outlining the safety and efficacy of splenectomy in WD. The clinical database of 70 WD patients with hypersplenism who had undergone splenectomy in our hospital between 2009 and 2013 were reviewed and followed-up regularly. Before splenectomy, all the patients accepted a short period of anti-copper treatment with intravenous sodium 2, 3-dimercapto-1-propane sulfonate (DMPS). All the patients demonstrated a marked improvement in platelet and leucocyte counts after splenectomy. No severe postoperative complication was observed. In particular, none of the 37 patients with mixed neurologic and hepatic presentations experienced neurological deterioration after splenectomy, and none of the patients with only hepatic presentations newly developed neurological symptoms. During the one year follow-up period, no patient presented hepatic failure or hepatic encephalopathy, no hepatic patient newly developed neurological presentations, and only 3 patients with mixed neurologic and hepatic presentations suffered neurological deterioration and these 3 patients had poor compliance of anti-copper treatment. Quantative analysis of the neurological symptoms in the 37 patients using the Unified Wilson's Disease Rating Scale (UWDRS) showed that the neurological symptoms were not changed in a short-term of one week after splenectomy but significantly improved in a long-term of one year after splenectomy. Additionally, compared to that before splenectomy, the esophageal gastric varices in most patients significantly improved one year after splenectomy. Thus, we may conclude that splenectomy is a safe and effective therapeutic measure for hypersplenism in WD patients who had been preoperatively treated with DMPS for powerful anti-copper therapy.
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230031, China.
authors.forename: Liang-Yong
authors.initials: LY
authors.lastname: Li
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230031, China.
authors.forename: Wen-Ming
authors.initials: WM
authors.lastname: Yang
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230031, China.
authors.forename: Huai-Zhen
authors.initials: HZ
authors.lastname: Chen
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230031, China.
authors.forename: Yun-Hu
authors.initials: YH
authors.lastname: Wu
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230031, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Fang
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230031, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230031, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Institute of Neurology, Anhui University of Traditional Chinese Medicine, Hefei 230061, China.
authors.forename: Yong-Sheng
authors.initials: YS
authors.lastname: Han
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D001772:Blood Cell Count; D002648:Child; D002681:China; D003131:Combined Modality Therapy; D003300:Copper / Q000097:blood; D005260:Female; D006527:Hepatolenticular Degeneration / Q000097:blood / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D006801:Humans; D006971:Hypersplenism / Q000473:pathology*; D008111:Liver Function Tests; D008297:Male; D013156:Splenectomy / Q000009:adverse effects; D013163:Splenomegaly / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003300:Copper