Xiaocheng Zhu, Libin Yao, Zhichao Li. Department of General Surgery, the Affiliated Hospital of Xuzhou Medical University
Objective: To evaluate the feasibility and safety of intermittent splenic artery occlusion combined with gelatin sponge compression in iatrogenic splenic injury.
Methods: A retrospective analysis of 18 I or?grade splenic injury cases related to gastric surgical procedures from 01-2013 to 12-2015 in the department of gastrointestinal surgery of the affiliated hospital of Xuzhou medical university. All patients were treated with intermittent splenic artery occlusion and gelatin sponge compression of wound to stop bleeding. The splenic artery was occluded intermittently (15min,10min, and 5min). Hemostatic effect was then observed after unblocking and compression. Meanwhile experimental animal studies were carried out. Beagles were randomly assigned to two groups (experimental and control) given blocking of splenic artery or not. The animal model of iatrogenic splenic injury was established under general anesthesia. Experimental group was treated with intermittent splenic artery blocking and gelatin sponge compression. Control group only with gelatin sponge compression. Blood and tissue samples were collected 2-hours before and after intervention in experimental and control groups. IL-1, SOD (superoxide dismutase), MPO, MDA and Caspase-3 of blood and tissue samples were investigated by ELISA. Results: 14 cases got successful hemostasis after 15 min splenic artery occlusion and wound compression, another 4 cases attained hemostasis in 25 minutes. There were no postoperative complications such as bleeding, abdominal abscess, spleen necrosis. Platelet counts of all patients were<500×109/L 3-weeks post-operatively. In experimental study, the control group was ineffective, and the experimental group successfully attained hemostasis. Serum markers before and after occlusion in the experimental group were IL-1 (124.36 ± 106.82 vs 121.16 ± 105.13), SOD (4.71 ± 2.72 vs 5.16 ± 1.83) and MDA (8.76 ± 6.45 vs 10.82 ± 7.49), Serum markers in two groups after occlusion/compression were IL-1 (121.16 ± 105.13 vs 162.83 ± 73.80), SOD (5.16 ± 1.83 vs 4.68 ± 2.78), MDA (10.82 ± 7.49 vs 9.56 ± 6.57), there were no significant differences (P> 0.05). Histological indicators before and after occlusion in the experimental group were MPO (0.62 ± 0.23 vs 0.68 ± 0.21), Caspase-3 (0.90 ± 0.29 vs 0.86 ± 0.26) respectively, and the indicators in two groups after occlusion/ compression were MPO (0.68 ± 0.21 vs 0.86 ± 0.23 after two sets of experiments), Caspase-3 (0.86 ± 0.26 vs 1.21 ± 0.18), no significant difference was founded (P> 0.05).
Conclusion: Intermittent splenic artery occlusion combined with gelatin sponge compression was a simple and effective therapeutic method to iatrogenic splenic injury.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80598
Program Number: P670
Presentation Session: Poster (Non CME)
Presentation Type: Poster
