I. Preoperative preparation and postoperative management Preoperative routine blood tests, biochemical tests (liver function, kidney function), gastroscopy or barium meal of the esophagus, ultrasound, and spiral CT of the abdomen. Assess the size of the spleen and the function of the liver to provide a basis for the degree or amount of embolization. Oral antibiotics should be given 3 d before surgery to inhibit intestinal bacteria, because the period after PSE with reduced blood flow and pressure in the splenic artery may allow the backflow of bacterial-bearing portal blood into the spleen and cause infection of the infarcted splenic tissue to form an abscess, and the commonly used antibiotics are quinolones. Low protein diet. To keep the stool usual, prophylactic application of Dulcolax (lactulose), etc. can soften the stool and keep the intestinal tract acidified to reduce the occurrence of hepatic coma. The prolongation of prothrombin time (PT) should preferably not exceed 70% of the normal value, if it exceeds, the PT can be improved by preoperative sedation of prothrombin complex, platelets, lithotripsy, VitK1, etc. After the operation, the puncture site should be thoroughly hemostatic, bandaged with pressure for 6 hours, and absolute bed rest for more than 24 hours. 24 hours should be spent in close observation of the patient’s vital signs, with special attention to the patient’s mental and respiratory conditions. The patient’s vital signs should be closely observed within 24 hours, paying special attention to the patient’s mental and respiratory conditions. Postoperative anti-inflammatory treatment for 5 days to 2 weeks, routine liver protection and symptomatic treatment. For mild postoperative pain in the splenic area, tramadol hydrochloride capsules can be given orally, and if moderate or severe pain occurs, dulcolax or fentanyl patches (Doregis) are given for analgesia. Appropriate postoperative hormone use can reduce inflammation and edema to reduce the occurrence of complications such as pleural fluid, ascites, and eruption. For those with significantly elevated platelets on the third postoperative day, such as PLT ≥ 400×109/L, anticoagulation therapy such as force antithrombosis, pansentin, and low molecular dextran should be given appropriately to prevent coagulopathy. The postoperative fever rate is 60% to 90%, and the body temperature can reach about 38.5°C. Symptomatic treatment should be administered according to the situation. The peripheral blood picture should be observed from 48 hours to several weeks after surgery, and ultrasound and CT examination should be used to observe the extent of splenic embolism and the occurrence of splenic abscess. The common postoperative reaction and postoperative complications of PSE is post-embolization syndrome: its incidence is almost 100%, but the degree varies, and it may include transient fever, left upper abdominal discomfort, loss of appetite, different degrees of pain in the splenic area, and eruption. It can be gradually relieved by the treatment of anti-inflammation, pain relief and fever reduction with antibiotics, and mostly disappears in about a week. The occurrence of embolic syndrome is related to ischemic necrosis and inflammatory exudation of splenic tissue. The severity of embolic syndrome is closely related to the degree of embolism. When the degree of embolism is greater than 50%, the incidence of embolic syndrome increases significantly and its duration is prolonged. Complications after PSE for cirrhosis with hypersplenism depend mainly on the degree of embolization and the patient’s preoperative liver function status. In addition to the artificial operation factors that can occur extra splenic embolism and the corresponding clinical symptoms, the common complications are as follows: 1. Splenic abscess and liquefied necrosis: the incidence is 10%-15%, and the incidence generally increases with the increase of the embolism scope. Its liquefied necrosis accounts for more than 95%, and only very few abscesses occur. Coagulative necrosis usually occurs after splenic embolization, and liquefied necrosis is mainly caused by the large embolization area based on the giant spleen and the difficulty of absorbing necrotic tissue, so liquefied necrosis is common in more than 70% of the embolized area. The occurrence of abscesses is mostly due to poor sterilization of the catheter and embolization material, and postoperative slowing of blood flow and retrograde infection of intestinal bacteria. Smaller abscesses and liquefied necrosis can be cured by conservative treatment, and those with diameters greater than 4 cm are treated with ultrasound or fluoroscopic localization of puncture and drainage. Strict aseptic operation during surgery and routine use of antibiotics after surgery are the keys to prevent the occurrence of splenic abscess. 2. Left pleural effusion and left lower pneumonia: post-embolization splenic infarction and peritoneal tension often present with left upper abdominal pain. The pain may cause restriction of respiratory movement and poor bronchial drainage, and is complicated by left lower pneumonia and pleural effusion. Analgesia, encouraging patients to breathe deeply and using antibiotics to prevent the occurrence of pneumonia are used according to the specific situation. A small amount of pleural fluid can be left untreated, while a large amount should be extracted. 3, pancreatitis: related to the misembolization of the pancreatic artery branches, using symptomatic treatment can generally be cured. 4. Other rare complications: portal vein thrombosis, peritonitis, abdominal bleeding, splenic rupture, upper gastrointestinal bleeding, liver and kidney failure, etc. Clinical efficacy The clinical efficacy of PSE is mainly manifested by the elevation of blood cells and hemodynamic improvement: 1. increase several times to ten times, and then slowly decrease to normal level. The general postoperative response rate for hypersplenism can reach more than 90%, and those who remain normal one year after surgery reach 70%-90%. Overall, young women and those with larger spleens respond better, while male patients and female elderly patients respond less well. In some patients, the platelet count did not reach normal levels even though it was elevated, and in two cases we encountered, it even dropped at one point. Even so, bleeding and other clinical symptoms in such patients improved significantly, and the addition of danazol (600-800 mg daily) improved the cure rate; 2. Leukocytes: the response rate was 100%. Within 24 hours after surgery, it can rise to more than twice the basal level, and then slowly drop to normal level; 3. Red blood cells and hemoglobin: the change is not obvious in the short term after surgery, and it takes 3~6 months to rise to the peak. 4. Hemodynamic changes: decrease in splenic blood flow, increase in hepatic and superior mesenteric artery blood flow, decrease in splenic and portal vein diameter, significant decrease in hepatic vein wedge pressure, and significant decrease in bleeding rate from ruptured esophageal varices; 5. 6.Significant reduction of the spleen and improvement of the painful straining and limited physical activity caused by the giant spleen; 7.No significant changes in immune function measurements including IgG, IgM, C3, lymphocyte conversion rate and giant rosette formation rate. The persistence and development of portal hypertension in cirrhosis is the main cause of postoperative splenic hyperplasia and recurrence of hypersplenism, and the degree of embolism plays an important role in the control of postoperative splenic hyperplasia. muguerza et al. observed the long-term changes in spleen volume after PSE with the degree of embolism ranging from 50% to 90%, resulting in the first year after PSE Iida et al. further demonstrated that the residual spleen volume remained within 20% after 2 years in those with more than 80% embolization, whereas in those with less than 60% embolization, the spleen volume rebounded significantly in the early stages after PSE. This indicates that the degree of embolization directly affects the splenic hyperplasia after PSE, and the degree of postoperative splenic volume recovery is related to the degree of embolization. The results of the study by Professor Zhu Kangshun of Zhongshan III Hospital showed that WBC and PLT gradually decreased over time after PSE, and their decreasing trend was related to the degree of PSE embolization, which further proved the influence of the degree of embolization and postoperative splenic hyperplasia on the long-term outcome. In those with a greater degree of embolization, postoperative splenic hyperplasia was slow because the periphery of the spleen was mostly embolized, and the proliferation of a larger peripheral fibrous tissue further limited the congestion and enlargement of the spleen and inhibited splenic hyperplasia. In cases of greater embolization, it is also possible to inhibit splenic hyperplasia by reducing portal vein pressure and reducing the initiating factors of hypersplenism. In those with a smaller degree of embolization, the infarct is less extensive and the splenic tissue surrounding the infarcted area quickly compensates for hypersplenism by proliferation, leading to a recurrence of hypersplenism in a shorter period of time. Furthermore, for those with embolism degree ≥ 60%, the efficacy of correcting hypersplenism can reach 4~5 years after surgery; for those with embolism degree 50%~59%, the correction of hypersplenism can reach 1-2 years after surgery; for those with embolism degree less than < 50%, the WBC and PLT can drop to below normal value within 1 month after surgery. V. PSE should be carried out reasonably and appropriately in patients with cirrhotic hypersplenism There are different clinical characteristics between cirrhotic hypersplenism and other types of hypersplenism: patients with cirrhosis are mostly combined with different degrees of liver function damage; patients with low resistance are easily combined with infection; due to the presence of portal hypertension, they are mostly accompanied by different degrees of esophageal varices and ascites. It can be seen that for patients with cirrhosis, PSE treatment may be more likely to induce infections, liver and kidney failure, hepatic coma, and gastrointestinal bleeding. Therefore, in patients with hypersplenism in cirrhosis, the degree of embolization should not be increased by blindly pursuing the embolization effect, but the appropriate range of embolization should be mastered according to the individual differences in liver function of patients. For patients with Child C grade, the tolerance to external influences is even lower, and patients may induce abdominal infection and hepatic coma due to milder postoperative reactions and the application of postoperative analgesics, therefore, these patients should be embolized in 2~3 times, with the first embolization not exceeding 40% to reduce post-embolization reactions, and postoperative supportive therapy and stool patency should be strengthened to reduce intestinal toxin aspiration and retrograde infection of intestinal bacteria. The chance of retrograde infection of intestinal bacteria should be reduced. In patients with Child grade A or B, the embolization should not exceed 70% on one occasion, because as the degree of embolization increases, the postoperative reaction also increases, and the patient may suffer from severe splenic pain and inflammatory exudation leading to abdominal infection and gastrointestinal bleeding. In patients with giant spleen, serious postoperative reactions and complications can occur with embolization of 50% to 60%, and small amounts of multiple embolizations should be taken, with each embolization being 30% to 40%.