The Clinical Comparative Study Of Laparoscopic Splenectomy And Open Splenectomy

Background Spleen is the body’s largest substantive immune organ,the largest lymphatic organ,and splene-related surgery accounts for a considerable proportion in surgical operations.Spleen-related diseases mainly include certain hematopoietic system diseases,infectious diseases,congestive splenomegaly,spleen-occupying diseases,splenic injury,splenic aneurysm and splenic infarction.In recent years,splenectomy,either as a single treatment or as an auxiliary treatment,is more popular than in the past,and is an effective means to treat diseases such as splenomegaly,hypersplenism,splenic space-occupying lesions,splenic injury and splenic malformation.In recent years,with the rapid development of science and technology and the significant improvement of people’s living standards,laparoscopic splenectomy is favored by more and more doctors and patients due to its small incision,aesthetic appearance and fast postoperative recovery.However,some scholars and clinical workers believe that laparoscopic splenectomy is difficult to be popularized in a wide range.First,laparoscopic splenectomy requires high requirements for surgical instruments and surgeons’ clinical skills,so laparoscopic splenectomy is difficult to be carried out in the primary hospitals,which account for the vast majority of the medical system.Secondly,for some relatively complicated operations,such as the giant spleen caused by hypersplenism in liver cirrhosis or the severe adhesion of the abdominal cavity caused by previous surgeries,the flexibility of open splenectomy is not as good as that of open splenectomy,and it is easy to turn to open surgery.Thirdly,in the face of splenic rupture and massive hemorrhage caused by partial trauma,laparoscopy is difficult to achieve the purpose of hemostasis by removing the spleen in the shortest time due to the large amount of intraperitoneal hemorrhage,difficultexposure of the surgical field,and difficulty in controlling the hemorrhage.Fourthly,compared with traditional laparoscopic splenectomy,laparoscopic splenectomy requires more equipment such as cutting stapler,which is not covered by medical insurance in most regions.Therefore,it is still a great burden for some families with general economic conditions.Objective This study based on the same period because of the splenic function,splenic tumor,spleen injury of laparoscopic resection of spleen or cases of open splenectomy were analyzed,comparing laparoscopic resection of spleen and the advantages and disadvantages of open resection of spleen,provide reference for the choice of the ways of clinical surgery.Methods Patients who underwent splenectomy in hongkou hospital and songjiang hospital of Shanghai first people’s hospital from June 2014 to February 2019 were collected from the department of hepatobiliary and pancreatic surgery and the department of gastroenterology of Shanghai first people’s hospital.The selected patients were aged 25 to 60 years old and had no special complications(such as fracture,other organ injury,heart disease,etc.).Divided into open surgery group and the laparoscopic surgery group respectively,collect patients’ basic information,operation time,intraoperative blood loss,postoperative complications,preoperative and postoperative liver function,blood routine,coagulation function,incision length,length of hospital stay,fees,analysis of different surgical methods on patients with intraoperative and postoperative complications,and economic differences.Results(1)There were 29 cases in the splenectomy group with liver cirrhosis and hypersplenism,including 12 cases in the laparotomy group and 17 cases in the laparoscopy group.Comparison between the open group and the laparoscopic group: There was no significant difference in liver function(ALT)before operation,the first day after operation,the third day after operation and the fifth day after operation.There was no significant difference in PT before operation,the first day after operation and the third day after operation.There was no statistical difference in platelet changes before operation,the first day after operation,the third day after operation and the fifth day after operation.(2)There were 40 cases in the splenotomy group with liver cirrhosis and hypersplenism,including 30 cases in the laparotomy group and 10 cases in the laparoscopy group.Comparison between the open group and the laparoscopic group:There was no statistical difference in the changes of liver function(ALT)before surgery.The improvement of liver function(ALT)on the first day after surgery,the third day after surgery and the fifth day after surgery was better in the laparoscopic group than in the open group.There was no significant difference in PT before operation,the first day after operation and the third day after operation.There was no statistical difference in platelet changes before operation,the first day after operation,the third day after operation and the fifth day after operation(3)There were 51 cases in the splenic rupture group,including 39 cases in the open group and 12 cases in the laparoscopic group.Comparison between the open group and the laparoscopic group:There was no significant difference in liver function(ALT)before operation,the first day after operation,the third day after operation and the fifth day after operation.There was no significant difference in PT before operation,the first day after operation and the third day after operation.There was no statistical difference in platelet changes before operation,the first day after operation,the third day after operation and the fifth day after operation.(4)There were 30 cases in the splenic tumor group,including 10 cases in the open group and 20 cases in the laparoscopic group.Comparison between the open group and the laparoscopic group:There was no significant difference in liver function(ALT)before operation,the first day after operation,the third day after operation and the fifth day after operation.There was no significant difference in PT before operation,the first day after operation and the third day after operation.There was no statistical difference in platelet changes before operation,the first day after operation,the third day after operation and the fifth day after operation.Conclusion Compared with open splenectomy,laparoscopic splenectomy has the advantages of small surgical wound,quick postoperative recovery and fewer complications,but the operation time is relatively long and the hospitalization cost is relatively high.There were no significant differences in intraoperative blood loss,blood transfusion,postoperative changes in coagulation function and postoperative changes in platelets.For patients with cirrhosis and hypersplenism who underwent splenectomy,the improvement of liver function in the laparoscopic group was better than that in the open group.For traditional open splenectomy,patients with child-pugh grade C need to actively improve their liver function to grade B or above before surgery,while laparoscopic splenectomy has obvious advantages for patients with child-pugh grade C.