Partial Splenic Embolization for Hypersplenism Associated With Biliary Atresia

Abstract

Purpose : To investigate the factors of increasing platelet count after partial splenic embolization (PSE) for hypersplenism associated with biliary atresia. Methods : Since 1995, 10 children with hypersplenism associated with biliary atresia (4 boys and 6 girls, ranging in age from 2 to 11 years) were subjected to PSE according to our protocol. According to the platelet-increasing ratio, which was calculated by platelet count of one year after PSE as compared to before PSE, the 10 patients were divided into two groups : effective group (platelet-increasing ratio≧2 ; n=6) and noneffective group (platelet-increasing ratio<2 ; n=4). The two groups were compared retrospectively using clinical data. Results : The pretreatment status and backgrounds of the patients were clinically homogeneous between the two groups except for the male and female ratio. The splenic embolized ratio measured with enhanced CT scanning 1 to 2 weeks after PSE was significantly higher in the effective group (84.7±11.7% versus 51.6±7.5%, mean±SD) and had a significant correlation with the platelet-increasing ratio (γ=0.723). The types of formations of the portal-systemic collaterals were not significantly different between the two groups. All the patients showed transient and mild liver dysfunction after PSE ; however, no patients had significant complications. The length of hospital stay was significantly longer in the effective group. Conclusions : We propose that more than 70% of the spleen should be embolized utilizing a careful technique to obtain satisfactory results that increase platelet count.