title: Long-term efficacy of subtotal splenectomy due to portal hypertension in cirrhotic patients.
abstract: BACKGROUND
  Portal hypertension (PHT) requires invasive measures to prevent rupture and bleeding of esophagogastric varices; however, the long-term results of subtotal splenectomy plus fixation of the retrosternal omentum majus (SSFROM) have not been reported. Specifically, the advantages and disadvantages of surgery that preserves the spleen and the long-term hematologic effects have not been described.
  
  
  METHODS
  Our studies relating to SSFROM commenced in February 1999. As of April 2014 we have performed 256 subtotal splenectomies The records of 65 patients with PHT who underwent SSFROM were reviewed retrospectively.
  
  
  RESULTS
  Four patients died within 4 years of surgery, with a 4-year survival rate of 94 %; the 11-year survival rate was 60 %. Eleven patients (17 %) had re-bleeding from esophagogastric varices. The white blood cell and platelet counts were higher 6 and 11 years post-operatively compared with pre-operative values (P < 0.01). Portal venous diameter, portal venous flow volume, splenic artery flow volume, as well as splenic length, thickness, and average cross-sectional areas were shown to be significantly constricted or decreased (P < 0.01). The proportion of serum CD3+ T cells, CD4+ T cells, and CD8+ T cells was increased (P < 0.01), while the serum levels of macrophage colony-stimulating factor and granulocyte-macrophage colony-stimulating factor were significantly decreased (P < 0.01). There was no significant change in the serum levels of IgA, IgM, IgG, and Tuftsin (P > 0.05). DSA demonstrated that 15 cases formed collateral circulations between the portal vein and superior vena cava.
  
  
  CONCLUSIONS
  SSFROM provide long-term hemostasis for esophagogastric variceal bleeding in PHT and corrected hypersplenism. SSFROM is an effective treatment for patients with PHT in whom long-term survival is expected.
authors.affiliation: Center of General Surgery, The 89th Hospital of People's Liberation Army, West Beigong Road 256, Weifang, 261021, China.
authors.forename: Haibo
authors.initials: H
authors.lastname: Chu
authors.affiliation: Center of General Surgery, The 89th Hospital of People's Liberation Army, West Beigong Road 256, Weifang, 261021, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Han
authors.affiliation: Department of Postgraduate, Weifang Medical University, Weifang, 261042, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Center of General Surgery, The 89th Hospital of People's Liberation Army, West Beigong Road 256, Weifang, 261021, China.
authors.forename: Yongbo
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of General Surgery, Changyi People's Hospital, Changyi, 261300, China.
authors.forename: Fengguo
authors.initials: F
authors.lastname: Jian
authors.affiliation: Department of General Surgery, Weifang Traditional Chinese Medicine Hospital, Weifang, 261041, China.
authors.forename: Weihua
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Pathology, The 89th Hospital of People's Liberation Army, Weifang, 261021, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.affiliation: Center of General Surgery, The 89th Hospital of People's Liberation Army, West Beigong Road 256, Weifang, 261021, China. jianhuazhaowf@163.com.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Zhao
mesh_terms: D000328:Adult; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006971:Hypersplenism / Q000601:surgery; D006975:Hypertension, Portal / Q000150:complications* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D010976:Platelet Count; D011169:Portal Vein / Q000503:physiopathology; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013157:Splenic Artery / Q000503:physiopathology; D015996:Survival Rate; D016896:Treatment Outcome