Effect Of Laparoscopic Splenectomy For The Treatment Of Traumatic Splenic Rupture

Background The spleen is the most vulnerable abdominal organ in closed abdominal injuries,and the incidence of splenic rupture accounts for about 40-50%of abdominal injuries.With the advancement of technology and the improvement of human living standards,various modes of transportation are gradually used in people’s daily life,and the height of people’s living and living environment is constantly increasing,the proportion of closed abdominal or hypochondrial injuries caused by traffic accidents and falls from heights has increased,and has also become the main cause of traumatic splenic injuries.Because of its anatomical location and soft texture,the spleen is prone to rupture and bleeding when hit in the left quadrant of the ribcage or the left lower chest.In addition,the spleen is rich in blood vessels and has a large blood storage capacity,which often puts the patient’s life at risk in the event of splenic rupture due to the large amount of blood loss.Therefore,rapid and accurate assessment of the extent of splenic damage and timely and effective surgical intervention based on the patient’s condition is a key component in saving the life of a patient with splenic rupture.With the continuous development of splenic surgery techniques,laparoscopic techniques are beginning to be used in splenic surgery.Since Delaitre first reported laparoscopic splenectomy in 1992,laparoscopic splenectomy has gradually been used in emergency surgery for splenic injuries,from elective surgery for splenomegaly,hypersplenism and splenic tumours.More and more hospitals are performing laparoscopic treatment of traumatic splenic rupture,and research on laparoscopic splenectomy for the treatment of splenic injury warrants further study.Objective To compare the clinical data of patients with traumatic splenic rupture treated by laparoscopic splenectomy and open splenectomy,and to analyse the advantages and disadvantages of the two surgical procedures for the treatment of traumatic splenic rupture,and to explore the therapeutic effect of laparoscopic splenectomy for traumatic splenic rupture.Methods The clinical data of the patients with traumatic rupture of the spleen admitted to the Department of Acute Abdomen Surgery,the Second Hospital of Dalian Medical University from March 2014 to June 2021 were retrospectively analysed.35 cases were selected according to the exclusion criteria,of which 10 cases underwent intraoperative laparoscopic splenectomy（study group）and 25 cases underwent open splenectomy（control group）.The patients in the two groups were counted for operation mode,operation time,postoperative time to deflation,postoperative time to resume eating,length of hospital stay,daily negative pressure drainage,and perioperative complications,and the differences in operation mode between the two groups were statistically analysed to study the therapeutic effects of laparoscopic splenectomy.Results Both groups completed the surgery successfully without intraoperative accidents,changes in surgical approach,postoperative death or serious complications.Compared to the control group,the time to resume eating after surgery was significantly reduced in the study group（49.20±10.51h vs 75.36±19.75h,P<0.05）;the length of hospital stay was significantly shorter in the study group（11.40±2.46d vs 15.32±5.96d,P<0.05）.In both groups,the time to surgery（139.50±33.54min vs 167.80±71.63min）,time to postoperative evacuation（42.00±14.14h vs 52.80±20.494h）,intraoperative bleeding（240.00±45.95m L vs 226.00±107.16m L）and daily drainage(67.54±63.35 m L.d^-1 vs68.16±49.05 m L.d^-1)were not statistically significant（P>0.05）.In terms of the probability of postoperative complications,the study group was lower than the control group（10.0%vs 36%）,but no statistically significant difference（P>0.05）.In contrast,the larger surgical incision in the control group increased the incidence of abdominal infection and incisional liquefaction compared to the study group.Conclusion Laparoscopic splenectomy for traumatic splenic rupture has the advantages of shorter hospital stay,faster postoperative recovery and fewer postoperative complications compared with traditional open surgery and is a safe and reliable surgical procedure that deserves to be promoted as a routine procedure for the treatment of traumatic splenic rupture.