Clinical Analysis Of Laparoscopic Splenectomy And Open Splenectomy In The Treatment Of Cirrhosis And Portal Hypertension

Objective To investigate the difference between laparoscopic splenectomy and open splenectomy in the treatment of cirrhotic portal hypertension,and to discuss the feasibility and security of combined pericardial devascularization or hepatectomy.Methods A retrospective analysis was made of 88 patients who underwent splenectomy for cirrhosis and portal hypertension from January 2015 to December 2017 in the General Surgery Department of the First Affiliated Hospital of Suzhou University.Among them,46 were in the open group(12 cases combined pericardial devascularization,2 cases combined hepatectomy)and 42 were in the endoscopic group(14 cases combined pericardial devascularization,2 cases combined hepatectomy).The general conditions(age,gender,CHILD-Pugh classification),operation time,intraoperative bleeding volume,hospitalization days,spleen size,postoperative complications were compared between the two groups.The changes of white blood cells,platelets,alanine aminotransferase,glutathione aminotransferase,total bilirubin,albumin and CHILD-Pugh scores before and after operation were compared between the two groups.All data were analyzed and studied by Excel 2013 and SPSS 21.0.The measurement data in normal distribution were described by mean±standard deviation and T-test is used.The measurement data in non-normal distribution were described by median(P25 P75),and Mann-Whitney U test was used for comparison between the two groups.Counting data were described by percentage,chi-square test and Fisher’s exact test when necessary.P<0.05 indicated that there was significant difference between the two groups.Results There was no significant difference in age,gender,proportion of CHILD-Pugh grading,number of esophageal and gastric varices,and number of hepatocellular carcinoma(P>0.05).There was no significant difference in preoperative leucocyte,platelet,alanine aminotransferase,glutathione aminotransferase,total bilirubin and albumin levels(P>0.05).The operation time of laparotomy group was significantly shorter than that of laparoscopy group(136.50±47.31 min vs 191.95±62.92 min,P=0.000),and intraoperative bleeding was higher than that of laparoscopy group(300(200 500),range(20-2000)ml vs 200(100 425),range(20-2500)ml,P=0.006).The days of hospitalization were higher than that of laparoscopy group(15.74±5.76 days vs 12.95±6.67 days,P=0.038).The size of spleen was higher than that of laparoscopy group(917.73±532.34ml vs 762.83±528.23ml,P=0.000).There was no significant difference in postoperative complications,including upper gastrointestinal bleeding,portal vein thrombosis,hepatic encephalopathy,gastrointestinal perforation and hepatic insufficiency between laparotomy group and laparoscopy group(P>0.05).The leucocyte and platelet levels after operation were significantly different from those before operation(P>0.05).There were 32 patients with CHILD grade A before operation in the open group.The levels of AST,ALT and ALB before operation and after operation were compared and P>0.05,which has no statistical significance.The levels of TBIL before operation were 25.91±11.92 umol/L,after operation were 17.75±8.65 umol/L,P<0.05.There was statistical difference between the two groups.The CHILD-Pugh score was 5.72±0.46 before operation and 5.34±0.60 after operation.The P value was<0.05.There was a statistical difference between the two groups.There were 14 patients with CHILD grade B before operation in the open group.The levels of AST,ALT and TBIL before and after operation were compared and P>0.05,which has no statistical significance.The levels of ALB before operation were 24.89±13.71 g/L,after operation were 38.51 ±5.78 g/L,P<0.05.There was statistical difference between the two groups.The preoperative CHILD-Pugh score was 7.43±0.756 and the postoperative CHILD-Pugh score was 6.36±0.93,the P value was<0.05.There was statistical difference between the two groups.There were 28 patients with CHILD grade A before operation in laparoscopic group.The levels of AST,ALT,ALB and CHILD-Pugh score before operation and after operation were compared and P>0.05,which has no statistical significance.The levels of TBIL before operation were 20.02±8.01 umol/L,after operation were 14.16±6.62 umol/L,P<0.05.There was statistical difference between the two groups.There were 14 patients with CHILD grade B before operation in laparoscopic group.The levels of AST and ALT before and after operation were compared and P>0.05,which has no statistical significance.The levels of ALB before operation were 33.66±4.95 g/L,after operation were 39.14±6.67 g/L,P<0.05.There was statistical difference between the two groups.The levels of TBIL before operation were 33.59±14.02 umol/L,after operation were 18.11±9.75 umol/L,P<0.05.There was statistical difference between the two groups.The preoperative CHILD-Pugh score was 7.43±0.514 and the postoperative CHILD-Pugh score was 5.93±0.829,the P value was<0.05.There was statistical difference between the two groups.Conclusion1.Splenectomy can effectively improve the levels of low white blood cells and low platelets in patients with cirrhosis,portal hypertension and hypersplenism.2.Laparoscopic splenectomy has the advantages of shorter hospitalization time and less bleeding than open splenectomy,but the operation time is longer,and there is no significant difference in the complications between them.3.Laparoscopic splenectomy is proved to be safe and effective.There was no significant difference between endoscopic group combined with pericardial devascularization and open group in postoperative complications.Laparoscopic splenectomy combined with hepatectomy could be performed under certain indications.4.Splenectomy can improve liver function in patients with cirrhosis and portal hypertension,and it is more effective for patients with CHILD-Pugh grade B.