Feasibility And Safety Of Laparoscopic Splenectomy For Traumatic Splenic Rupture

Objective: The traditional treatment of Traumatic Splenic Rupture(TSR)is usually Open Splenectomy(OS).While Laparoscopic Splenectomy(LS)is mainly used for the treatment of hematologic pathological spleen and benign or malignant splenic tumors.With the development of multidisciplinary cooperative diagnosis and treatment mode and the emergence of various advanced medical instruments and hemostatic materials,it is possible to treat TSR with LS.However,the choice of clinical indications and feasibility of LS in the treatment of TSR have not yet been determined.In this paper,the safety and feasibility of LS in the treatment of TSR were discussed by analyzing the clinical data of patients with traumatic splenic rupture undergoing LS.Methods: The clinical data of 182 patients with TSR caused by various reasons in Department of Hepatobiliary and Pancreatic Surgery of our hospital from January 2014 to December 2020 were retrospectively analyzed.According to the specific operation methods(40 cases in LS group and 142 cases in OS group),the preoperative,intraoperative and postoperative data of the two groups were analyzed and compared.Result: There was no significant difference in gender,age,cause of trauma,admission time after injury,preoperative blood pressure and heart rate between the two groups(P > 0.05).Preoperative hematocrit(Hct)in OS group was lower than that in LS group(P < 0.05);ISS in OS group was higher than that in LS group(P < 0.05),and the proportion of patients using vasoactive drugs in OS group was higher than that in LS group(P < 0.05).According to AAST and Tianjin classification standard,the distribution of TSR in LS group was lower than that in OS group(P < 0.05).The operation time of OS group was shorter than that of LS group(P < 0.05),but the amount of blood loss was more than that of LS group(P < 0.05).There were statistically significant differences in TSR grading between the two groups under the two grading standards,and the consistency of preoperative and intraoperative grading of spleen injury under the two grading standards was good.But there was no statistically significant difference in intraoperative blood transfusion between the two groups.However,the incidence of postoperative complications in LS group was lower than that in OS group(P < 0.05).Conclusion: 1.Preoperative HCT and ISS can be used as the systematic evaluation index of LS operation indication selection,and the classification of spleen injury severity based on hemodynamic stability and AAST classification can be used as the basis of LS operation indication selection;2.Under the premise of correct selection of operation indication,LS treatment of moderate TSR is safe and feasible.