Results
Survival Rate
The 4- and 11-year survival rates were 94 (61/65) and 60 % (39/65), respectively. Four patients died. Two patients survived for 152 and 278 days. The cause of death was complete occlusion of the portal vein as a result of portal thrombosis. Two patients survived for 2 and 4 years. The cause of death was hepatic carcinoma complicating liver failure (Fig. 2a).
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Figure 2.
a Cumulative survival rates after subtotal splenectomy plus fixation of the retrosternal omentum majus (SSFROM) for portal hypertension (PHT). The 4- and 11-year survival rates were 94 and 60 %. b Cumulative nonbleeding rates after SSFROM for PHT. Postoperative recurrent bleeding ccurred in eleven patients (17 %). The 4- and 10-year non-bleeding rates were both 83 %
Recurrent Bleeding Rate
Post-operative recurrent bleeding occurred in 11 patients (17 %), due to esophageal varices in eight patients and from a gastric varix in three patients. All of the patients were cured with conservative therapy. Of the 11 patients who bled post-operatively, seven had a history of pre-operative bleeding and four were complicated with portal thrombosis post-operatively. The 4- and 10-year non-bleeding rates were both 83 % (54/65; Fig. 2b). No patients have died from esophagogastric variceal bleeding to data. Post-operative endoscopy of the stomach showed exacerbation of esophagogastric varices in 11 patients and prophylactic endoscopic injection sclerotherapy was performed, after which neither re-bleeding nor re-exacerbation occurred. Portal thrombosis occurred in six patients (9 %), from pre-operative partial portal thrombosis and post-operative exacerbation to complete occlusion of the portal vein in two patients (Fig. 3).
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Figure 3.
CT scan showed that patients was complicated with portal thrombosis at 4.5 months post-operatively
Change in Peripheral Blood Cells
The white blood cell and platelet counts were associated with a significant rise 6 years post-operatively in 48 patients and 11 years in 16 patients post-operatively (P < 0.01; Fig. 4a).
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Figure 4.
a Changes in the white blood cell (WBC) count and platelet count at 6- and 11- years, after SSFROM for PHT (*P < 0.01). b Change in portal venous diameter at 6- and 11- years, after SSFROM for PHT (*P < 0.01). c Changes in portal venous flow volume, and splenic artery flow volume at 6- and 11- years, after SSFROM for PHT (*P < 0.01). d Changes in splenic length and splenic thickness at 6- and 11- years, after SSFROM for PHT (*P < 0.01). e Change in splenic square area. at 6- and 11- years, after SSFROM for PHT (*P < 0.01). f Changes in levels of serum IgA, IgM and IgG at 6 and 11 years, after SSFROM for PHT (*P > 0.05). g Change in levels of serum Tuftsin at 6 and 11 years, after SSFROM for PHT (*P > 0.05). h Changes in levels of serum macrophage colony-stimulating factor (M-CSF) and granulocyte-macrophage colony-stimulating factor and (GM-CSF) at 6 and 11 years, after SSFROM for PHT (*P < 0.01). i Changes in proportion of serum CD3+ T cells, CD4+ T cells, and CD8+ T cells at 6 and 11 years, after SSFROM for PHT (*P < 0.01)
Change in Hemodynamics of the Splenic Artery and Portal Vein
There were significant differences between the pre- and post-operative portal venous diameter, portal venous flow volume, and splenic artery flow volume (P < 0.01; Fig. 4b, c).
Change in Splenic Volume
There were significant differences between the pre- and post-operative splenic length, splenic thickness, and splenic square area (P < 0.01; Fig. 4d, e).
Change in Immunologic and Related Indices
There were no significant differences between the IgA, IgM, IgG, and Tuftsin levels pre- and post-operatively (P > 0.05; Fig. 4f, g). The serum levels of M-CSF and GM-CSF were decreased significantly, and there was a significant difference between the pre- and post-operative values (P < 0.01; Fig. 4 h). The proportion of CD3+ T cells, CD4+ T cells, and CD8+ T cells was increased post-operatively compared with pre-operative values (P < 0.01; Fig. 4i).
Change in Splenic Function
A CT scan revealed that the blood supply of the residual spleen was normal (Fig. 5a, b). Isotope scanning with Tc showed that the residual splenic phagocytic function had recovered (Fig. 5c).
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Figure 5.
a CT scan revealed splenomegaly pre-operatively. b CT scan revealed that the blood supply of the residual spleen was normal (arrow) at 1-year, after SSFROM for PHT. c Isotope scanning with 99mTc showed that the residual splenic phagocytic function had recovered (arrow) at 4-years, after SSFROM for PHT. d DSA showed an established collateral circulation between the portal vein and superior vena cava (arrow) at 1 month, after SSFROM for PHT
Portal-azygous Collateral Circulation
Fifteen patients had indwelling catheters placed in the omental vein 1 month post-operatively. DSA showed that omental venous blood flowed into the superior vena cava. These results confirmed an established collateral circulation between the portal vein and superior vena cava (Fig. 5d).