Clinical Effect Of Laparoscopic Splenectomy And Selective Esophagogastric Devascularization On Patients With Cirrhosis And Portal Hypertension

ObjectiveTo explore and analyze the effects of laparoscopic splenectomy and selective esophagogastric devascularization on patients with liver cirrhosis,and comprehensively evaluate the efficacy of the operation.Methods42 patients with cirrhosis and portal hypertension who underwent laparoscopic splenectomy and selective esophagogastric devascularization in our hospital from January 2015 to June 2020 were selected.42 patients who received endoscopic treatment during the same period were selected as the control group.WBC,PLT,PT,TBIL,ALT,AST,ALB,liver volume.MELD score,degree of esophageal and gastric varices before and after treatment in the two groups of patients,whether rebleeding were collected,and the operation time and intraoperative bleeding of the surgical patients,perioperative complications,portal vein diameter and flow rate before and after surgery,and whether portal vein thrombosis happened were also collected.Repeated measures analysis of variance and chi-square test were used to analyze the data of the two groups of patients.The t-test was used to perform a single factor test on the influencing factors of postoperative portal vein thrombosis in surgical patients,and logistic regression analysis was performed after screening the different factors.ResultsAll patients successfully completed surgery or endoscopic treatment.In the operation group,the operation time was 305.47±84.16 min,and the blood loss was 205.24±233.86ml.There is no complications occurred in all 42 patients.And hospital stay after operation was 13.21±4.88 days.After treatment,WBC and PLT in surgical group were higher than before operation(F=51.401,37.357,P<0.001),and WBC and PLT in surgical group were higher than those in endoscopic group at all time points after treatment(t=9.8 1 6,1 3.723,9.3 99 and 8.046,11.598,13.409,P<0.001);the liver volume in the surgical group after treatment was larger than that before the operation(F=87.035,P<0.001),and each time point after treatment was higher than that in the endoscopic group(t=8.034,9.571,P<0.001);the ALB of the surgical group and the endoscopy group did not change significantly before and after treatment(F=1.933,1.743,both P>0.05),but the ALB of the surgical group was higher than that of the endoscopy group at each time point after treatment(t=2.968,5.480,5.493,P<0.001);TBIL and ALT of surgical group and endoscopy group before and after treatment were significantly lower than before treatment(F=11.426,13.755 and 34.954,15.181,P<0.001),however,there was a significant difference in TBIL between the two groups at each time point only on the 5th day after treatment(t=3.304,P<0.05),while ALT was lower in the surgical group than in the endoscopic group at each time point after treatment(t=4.178,10.658,13.219,P<0.001);after treatment,the degree of esophageal and gastric varices in the surgical group were significantly relieved(χ2=25.987 and 16.921,P<0.001),but there was no significant relief in the endoscopic group(χ2=5.126 and 5.116,P>0.05),the degree of esophageal varices was significantly relieved in the surgical group in the third month after treatment(χ2=6.924,P<0.05),the degree of gastric varices in the sixth month after treatment in surgical group was significantly relieved than those in endoscopic group(χ2=9.364,P<0.05);in the six months after treatment,the rebleeding rate of the surgical group was significantly lower than that of the endoscopic group(χ2=4.086,P<0.05);there was no significant difference in PT,MELD,AST at each time point between the two groups after treatment(P>0.05),and there was no statistical difference in PT,MELD,AST between the two groups at each time point(P>0.05).Regarding the influencing factors of postoperative portal vein system thrombosis,univariate analysis found that the preoperative portal vein diameter,preoperative portal velocity,postoperative WBC,and postoperative portal velocity of the thrombosis group and the non-thrombosis group were statistically significant(P>0.05).There were no significant differences in age,gender,Child-Pugh class,operation time,intraoperative bleeding,preoperative WBC,preoperative and postoperative PLT,PT,postoperative portal vein diameter,etc.(P>0.05);Logistics multivariate regression analysis showed that preoperative portal vein diameter and flow velocity were the influencing factors of portal vein thrombosis after operation(OR=4.966,0.285,P<0.05).ConclusionLaparoscopic splenectomy and selective esophagogastric devascularization is safe and available.Compared with endoscopy,it can not only treat hypersplenism,but also promote the recovery of liver function,relieve esophageal and gastric varices,and reduce rebleeding rate,but portal vein system thrombosis can occur after surgery,the internal diameter and flow velocity of the portal vein before surgery are influencing factors and need to be tested.