Effects of Partial Splenic Embolization of Severe Functional Disturbances of Coagulation-Fibrinolysis System Associated with Liver Cirrhosis and its Application on Hepatectomy for Hepatocellular Carcinoma

Hajime Yokoi, Kentaro Yamagiwa, Takashi Higashiguchi, Takashi Noguchi, Yoshifumi Kawarada, Ryuji Mizumoto

First Department of Surgery, Mie University School of Medicine

The present clinical study was undertaken to evaluate the effects of partial splenic embolization (PSE) on hypersplenism with severe functional disturbances of the coagulation-fibrinolysis system associated with liver cirrhosis. This was an attempt to achieve radical hepatectomy for hepatocellular carcinoma. [1] Effects of PSE on hypersplenism associated with liver cirrhosis: Functional disturbances of coagulation-fibrinolysis system in 16 patients with liver cirrhosis improved after PSE, but it had disappeared within one month ater PSE in patients with a splenic infarction area of less than 70%, while it had been maintained even after one year in patients with an infarction area of more than 70% with shrinkage of splenic volume. However,2 out of 5 patients with an infarction area of more than 90% developed splenic cyst. [2] Results of hepatectomy for hepatocellular carcinoma: Among 9 patients with potential DIC risk according to our criteria, 4 (44.4%) developed DIC and died of liver failure within 6 months after hepatectomy without PSE, whereas all 9 patients undergoing hepatectomy after PSE, including 6 cases with potential DIC risk, had an uneventful postoperative course with well maintained function of the coagulation-fibrinolysis system and lessened splenic volume one year after hepatectomy. And they showed appreciable hepatic regeneration.

Key words
partial splenic embolization, liver cirrhosis, coagulation-fibrinolysis system, hepatectomy, liver regeneration

Reprint requests
Hajime Yokoi First Department of Surgery, Mie University School of Medicine
2-174 Edobashi, Tsu, 514 JAPAN

Accepted
October 11, 1989

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