short-term efficacy of splenectomy versus partial splenic embolization for liver cirrhosis and hypersplenism: a meta-analysis

ObjectiveTo systematically evaluate the therapeutic effects of partial splenic embolization (PSE) and splenectomy for liver cirrhosis and hypersplenism. MethodsThe Medline, Embase, Web of Science, CNKI, Wanfang Data, and VIP were searched to collect the articles on PSE and splenectomy for liver cirrhosis and hypersplenism published between January 1, 2005 and May 30, 2015. The inclusion of articles was performed by two investigators independently, and after quality assessment and data extraction, RevMan 5.3 was applied for the Meta-analysis. ResultsA total of 10 control studies involving 638 patients were included. The results of the pooled analysis of 4 studies showed that the peripheral platelet counthad a significant difference between the PSE group and the splenectomy group at 1 week after surgery (WMD=-65.71, 95%CI：-120.24 to -11.18, P=0.02), but showed no significant difference at 1 month after surgery (WMD=068, 95%CI：-8.16-9.52, P=0.88). The results of the pooled analysis of 2 studies showed that at 1 month after surgery, the PSE group had a significantly higher number of natural killer cells than the splenectomy group (WMD=6.03, 95%CI: 3.80-8.26, P＜0001), but there was no difference in this number at 1 year after surgery between the two groups (WMD=3.60, 95%CI：1.25-5.96, P=0.003). The results of the pooled analysis of 3 studies showed that the PSE group had a significantly shorter hospital stay than the splenectomy group (WMD=-2.52, 95%CI：-3.36 to -1.67, P＜0.001). ConclusionCompared with the splenectomy group, the short-term increase in platelet count after surgery is alleviated in the PSE group, while there is no significant difference in long-term platelet count; PSE has significant advantages in maintaining the reserve function of immune system, shortening the length of hospital stay, and reducing complications in postoperative patients.