| Background : Portal hypertension (PHT) is still a more common and difficult clinic syndrome .It has a high incidence rate and mortality rate. The treatments for Portal hypertension like drugs, endoscopy, interventional therapy, surgery and liver transplantation have a greater progress in recent years. Especially some interventional therapies improved quickly, like transjugular intrahepatic portosystemic shunt (TIPPS) and splenic artery embolization(SAE) . Surgical treatments for Portal hypertension are mainly to prevent and control the hemorrhage of esophageal varices. The major modus operandi are portosystemic shunts and splenectomy with periesophagogastric devascularization .Despite prophylactic surgery is still controversial, splenectomy with periesophagogastric devascularization is still the first choice for the patients who associated with splenomegaly and hypersplenism, esophageal varices .Because of the portal hypertension patient's liver function, blood coagulation, immune function and response are different from the others, each surgery is a burden for patients ,even leads to death. Traditional open surgery has some disadvantages such as big injures, long time to recovery and some complications .so it is important to consider the choice of surgery. With the rapid development of laparoscopic technology and related equipment innovation, the laparoscopic technology have been used in a large domain .It provide a new therapy for the treatment of liver cirrhosis and portal hypertension. The first laparoscopic splenectomy ( LS) performed successfully in the Royal Hospital of Australia Lisbon in 1991. In China, the fist case was reported in 309 Hospital in 1994. Nowadays laparoscopic splenectomy with periesophagogastric devascularization has been increasingly used in many hospitals in our country. Due to the establishment of pneumoperitoneum and the difficulty of the operation, Sometimes ,we need to take a 5cm incision to complete the operation .It is still need to study the real difference in trauma ,recovery and immune system response between laparoscopic surgery and laparotomy and more research about laparoscopic surgery.Objective: To investigate the clinical effect between laparoscopic splenectomy with periesophagogastric devascularization and open surgery on immune system and wound response , provide a guide for clinic treatment.Methods: Collect the clinical data of 60 patients who have diagnosed with liver cirrhosis, portal hypertension and esophageal varices and needed surgery from 2007 to 2010 in our hospital . The patients were divided into open surgery group and laparoscopic surgery group, with 30 cases in each group. In LS group ,16cases were performed by hand-assisted laparoscopic surgery,14cases were performed by total laparoscopic surgery. Some clinic date were analyzed comparatively, such as the large of spleen , postoperative hospitalization, passage of gas by anus, the blood loss and so on .The level and diversity of multiple immunoassays like TNF-α,CRP,IL-6,were tested and comparatively analyzed in preoperative and postoperative different periods.Results: Compared to open surgery, laparoscopic splenectomy with periesophagogastric devascularization was slightly longer on operative time (p<0.05), but declined on postoperative hospitalization, passage of gas by anus and the blood loss(p<0.05). It is no significantly difference in postoperative complications such as Pancreatic leakage, pulmonary infection, postoperative infection (p>0.05). The level of CRP, IL-6 and TNF-αincreased quickly in postoperative than preoperative (p<0.01)and also significantly increased in open surgery than laparoscopic splenectomy(p<0.01). Conclusion: Laparoscopic splenectomy with periesophagogastric devascularization is to be a feasible,effective and safe surgical procedure .It has the merits of minimally invasive surgery like less influence imunune system, wound responses and faster recovery. |
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