The traditional therapy of pancytopenia is splenectomy. Of the various indications for splenctomy, massive splenomegaly has the greatest morbidity and mortality. Serious posts plenectomy morbidity occur especially in immunosuppressed patients and
patients with severe underlying disease. Many patients with advanced liver cirhosis do not tolerate major surgery when they bleed. Partial splenic embolization (PSE) is a relatively new but increasingly utilized method of treating hypersplenism.
We
treated 21 patients(14 pathients by splenectomy, 7 patients by PSE) for hypersplenism at Wonkwany UniversityHospital during 8 years from january 1985 to July 1993 and reviewed and analyzed clinical all of the medical records.
@ES The result was as follow:
@EN 1) Male to female ratio was 1 : 1.1 The peak incidence was in the age group 30~50 years.
2) The causes of primary hypersplenism were hereditary spherocytosis in 3 cases(14%) and idiopathic thrombocytopenic purpura(ITP) in 2 cases(10%). The causes of secondary hypersplenism were liver cirrhosis in 13 cases(62%), portal hypertension
in
2
cases(10%), hepatoma in one case(5%).
3) The common symptoms were fatigue, dizziness, epigastric pain, epigastri discomfort and melena in orders.
4) The most common complications after PSE were LUQ pain in 5 cases(71.4%) and fever in 5 cases(71.4%). The most common complications of splenectomy were atelectasis in 2 cases(14.3%).
5) There was statistically a significant difference between before PSE and after PSE in assessment of WBC count(P<0.05). Also there was statistically a significant difference between before splenoctomy and after splenectomy in assessment of WBC
count(P<0.05).
6) There was not statistically a significant difference between before PSE and after PSE in assessment of platelet cout(p>0.05). There was statistically a signifficant difference between before splenectomy and after splenectomy in assessment of
platelet cout(P<0.05).
7) The average postoperative hiospital stay were 22.3±13.0 days in PSE groups, and 17.0±13.0 days in splenectomy group(P>0.05).
8) the mortality was 14%(1 of 7) in PSE group and the cause of death was hepatic failure, There was no death after splenectomy.
|