AIM To compare the clinical outcomes of patients with portal hypertension(PH) who underwent treatment with splenectomy plus simplified pericardial devascularisation(SSPD) or splenectomy plus traditional pericardial de...AIM To compare the clinical outcomes of patients with portal hypertension(PH) who underwent treatment with splenectomy plus simplified pericardial devascularisation(SSPD) or splenectomy plus traditional pericardial devascularisation(STPD).METHODS We conducted a single-centre retrospective study of 1045 PH patients treated with either SSPD(S Group, 357 patients) or STPD(T Group, 688 patients) between January 2002 and February 2017. In all, 37 clinical indicators were compared to evaluate the efficacy of SSPD.RESULTS Perioperative indicators in the S Group were significantly better than those in the T Group(P < 0.05). In both groups, the postoperative long-term portal vein diameter and Model for End-Stage Liver Disease score were significantly lower than those in the preoperative and postoperative short-term groups(P< 0.05). The incidence of complications in the S Group was significantly lower than that in the T Group(P < 0.05). Compared to the T Group, postoperative shortterm WBC(white blood cell) and platelet counts were significantly lower and the short-term Hb(haemoglobin) level was significantly higher in the S Group(P < 0.05). In the S Group, postoperative long-term total bilirubin, direct bilirubin, alanine transaminase, and aspartate transaminase and postoperative serum creatinine and cystatin C levels were significantly lower than those in the T Group(P < 0.05), and postoperative albumin was significantly higher than that in the T Group(P < 0.05).CONCLUSION Compared to STPD, SSPD is a simple and easy procedure resulting in less tissue damage. Patients recovered smoothly and steadily with fewer complications. Short-term liver and kidney function damage was less severe, and long-term liver function recovery was better. Therefore, SSPD is worthy of clinical promotion and application for the treatment of PH.展开更多
AIM To analyse the postoperative survival of patients with portal hypertension and determine the factors that influence survival and construct nomograms.METHODS We retrospectively followed 1045 patients who underwent ...AIM To analyse the postoperative survival of patients with portal hypertension and determine the factors that influence survival and construct nomograms.METHODS We retrospectively followed 1045 patients who underwent splenectomy plus pericardial devascularisation(SPD) between January 2002 and December 2017. Two SPD types are used in our department: splenectomy plus simplified pericardial devascularisation(SSPD) and splenectomy plus traditional pericardial devascularisation(STPD). The Kaplan-Meier method and Cox regression analysis were used to evaluate the prognostic effects of multiple parameters on overall survival(OS), diseasespecific survival(DSS) and bleeding-free survival(BFS). Significant prognostic factors were combined to build nomograms to predict the survival rate of individual patients.RESULTS Five hundred and fifty-seven(53.30%) patients weresuccessfully followed with 192 in the SSPD group and 365 in the STPD group; 93(16.70%) patients died, of whom 42(7.54%) died due to bleeding. Postoperative bleeding was observed in 84(15.10%) patients. The 5-and 10-year OS, DSS and BFS rates in the group of patients who underwent SSPD were not significantly different from those in patients who underwent STPD. Independent prognostic factors for OS were age, operative time, alanine transaminase level and albumin-bilirubin score. Independent prognostic factors for BFS were male sex, age, intraoperative blood loss and time to first flatus. Independent prognostic factors for DSS were the Comprehensive Complication Index and age. These characteristics were used to establish nomograms, which showed good accuracy in predicting 1-, 3-and 5-year OS and BFS.CONCLUSION SSPD achieves or surpasses the long-term survival effect of traditional pericardial devascularisation and is worthy of clinical promotion and application. Nomograms are effective at predicting prognosis.展开更多
基金Supported by National Natural Science Foundation of China,No.81170454
文摘AIM To compare the clinical outcomes of patients with portal hypertension(PH) who underwent treatment with splenectomy plus simplified pericardial devascularisation(SSPD) or splenectomy plus traditional pericardial devascularisation(STPD).METHODS We conducted a single-centre retrospective study of 1045 PH patients treated with either SSPD(S Group, 357 patients) or STPD(T Group, 688 patients) between January 2002 and February 2017. In all, 37 clinical indicators were compared to evaluate the efficacy of SSPD.RESULTS Perioperative indicators in the S Group were significantly better than those in the T Group(P < 0.05). In both groups, the postoperative long-term portal vein diameter and Model for End-Stage Liver Disease score were significantly lower than those in the preoperative and postoperative short-term groups(P< 0.05). The incidence of complications in the S Group was significantly lower than that in the T Group(P < 0.05). Compared to the T Group, postoperative shortterm WBC(white blood cell) and platelet counts were significantly lower and the short-term Hb(haemoglobin) level was significantly higher in the S Group(P < 0.05). In the S Group, postoperative long-term total bilirubin, direct bilirubin, alanine transaminase, and aspartate transaminase and postoperative serum creatinine and cystatin C levels were significantly lower than those in the T Group(P < 0.05), and postoperative albumin was significantly higher than that in the T Group(P < 0.05).CONCLUSION Compared to STPD, SSPD is a simple and easy procedure resulting in less tissue damage. Patients recovered smoothly and steadily with fewer complications. Short-term liver and kidney function damage was less severe, and long-term liver function recovery was better. Therefore, SSPD is worthy of clinical promotion and application for the treatment of PH.
基金Supported by the National Natural Science Foundation of China,No.81170454,No.30772049 and No.30571765
文摘AIM To analyse the postoperative survival of patients with portal hypertension and determine the factors that influence survival and construct nomograms.METHODS We retrospectively followed 1045 patients who underwent splenectomy plus pericardial devascularisation(SPD) between January 2002 and December 2017. Two SPD types are used in our department: splenectomy plus simplified pericardial devascularisation(SSPD) and splenectomy plus traditional pericardial devascularisation(STPD). The Kaplan-Meier method and Cox regression analysis were used to evaluate the prognostic effects of multiple parameters on overall survival(OS), diseasespecific survival(DSS) and bleeding-free survival(BFS). Significant prognostic factors were combined to build nomograms to predict the survival rate of individual patients.RESULTS Five hundred and fifty-seven(53.30%) patients weresuccessfully followed with 192 in the SSPD group and 365 in the STPD group; 93(16.70%) patients died, of whom 42(7.54%) died due to bleeding. Postoperative bleeding was observed in 84(15.10%) patients. The 5-and 10-year OS, DSS and BFS rates in the group of patients who underwent SSPD were not significantly different from those in patients who underwent STPD. Independent prognostic factors for OS were age, operative time, alanine transaminase level and albumin-bilirubin score. Independent prognostic factors for BFS were male sex, age, intraoperative blood loss and time to first flatus. Independent prognostic factors for DSS were the Comprehensive Complication Index and age. These characteristics were used to establish nomograms, which showed good accuracy in predicting 1-, 3-and 5-year OS and BFS.CONCLUSION SSPD achieves or surpasses the long-term survival effect of traditional pericardial devascularisation and is worthy of clinical promotion and application. Nomograms are effective at predicting prognosis.
