Clinical Effect of Splenectomy Combined with Esophagogastric Devascularization in Patients with Idiopathic Non-Cirrhotic Portal Hypertension

Objective: To investigate the clinical effect of splenectomy combined with esophagogastric devascularization in patients with idiopathic non-cirrhotic portal hypertension (INCPH). Methods: A retrospective research method was used to analyze the clinical data of patients with INCPH hospitalized in the Ditan Hospital. The patients who had undergone splenectomy alone or splenectomy combined with esophagogastric devascularization (Hassab's surgery) were placed into the intervention group (20 patients), and the others, who received conservative treatment (drugs, therapeutic endoscopy and transjugular intrahepatic portosystemic shunt (TIPS)), were placed into the control group (26 patients). The laboratory indicators of the two groups, including blood routine, liver function, and coagulation function before and two weeks after treatment, were compared; And the serum liver fibrosis indicators of the intervention group before and 6 months after surgery were compared. The portal vein pressure in the observation group was also compared before splenec-tomy, after splenectomy and after devascularization. The portal blood flow of the intervention group before and two weeks after surgery were compared. Results: There was no significant difference in baseline data between the observation group and the control group before treat-ment (p > 0.05). White blood cell (WBC) and platelet (PLT) levels of the intervention group had returned to normal two weeks after surgery, compared with the control group, the difference was statistically significant (p < 0.05). However, the comparison of the hemoglobin (HGB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), total bilirubin (TBil), prothrombin time (PT), and prothrombin time activity (PTA) after treatment showed no statistically significant differences (p > 0.05). Liver fibrosis indicators decreased after surgery compared with before surgery, and the difference was statistically significant (p < 0.05). The portal vein flow volume and flow velocity in the intervention group after surgery were lower than before, whereas the hepatic artery flow volume after surgery was higher than before surgery; The differences were statistically significant (p < 0.05). After treatment, the incidence of ascites (15.0%) and venous rebleeding (10%) in the observation group were lower than those in the control group, and the difference was statistically significant (p < 0.05). However, the rate of portal vein thrombosis (45.0%) was significantly higher than that in the control group. No hepatic encephalopathy or death occurred in either group of patients during the follow-up period. Conclusions: Splenectomy combined with esophagogastric devascularization has a hemostatic effect on patients with INCPH. It can significantly reduce portal venous pressure, ensure blood flow into the liver, and reduce liver fibrosis-related indicators. Therefore, it is a safe and reliable treatment for INCPH.