Effect Of Laparoscopic Splenectomy And Azygoportal Disconnection On Patients With Liver Cirrhosis

Objective:Prospectively compare the clinical data of 2 years follow-up in patients with portal hypertension in liver cirrhosis,who underwent laparoscopic splenectomy and azygoportal disconnection(LSD)in our hospital.It aims to investigate the LSD on blood routine,coagulation routine,liver function and liver fibrosis in patients of cirrhosis with upper gastrointestinal bleeding and hypersplenism,further study the clinical significance and value of LSD on patients with liver cirrhosis.Methods:The clinical data of 102 cirrhotic patients with portal hypertension and upper gastrointestinal hemorrhage and hypersplenism,who were admitted to the Northern Jiangsu People's Hospital from September 2014 to January 2016 were collected.The patient completed the LSD by the same surgical team during the hospital.These patients were compared with preoperative,postoperative 1 week,postoperative 3 months,postoperative 6 months,postoperative 12 months,postoperative 1 8 months,postoperative 24 months the changes of white blood cell,hemoglobin,platelets,total bilirubin,albumin,prothrombin time,international normalized ratio,Child-Pugh score,antithrombin ?.protein C,protein S,procollagen type ?,type ? collagen,laminin and hyaluronidase,and the results were compared and analyzed.Results:1.All patients had no secondary surgery due to abdominal bleeding after LSD,and had no serious complications,no hepatic encephalopathy and no refractory ascites.All patients were successfully discharged after surgery.2.It was found that the white blood cell,hemoglobin,and platelets of peripheral blood in cirrhotic patients with portal hypertension significantly raised at postoperative 1 week,postoperative 3 months,postoperative 6 months,postoperative 12 months,postoperative 18 months,postoperative 24 months after LSD compared with preoperative(all P<0.05).Among them,hemoglobin gradually increases in postoperative follow-up,platelets reach a peak at postoperative 1 week,then decrease and tend to be stable3.The levels of total bilirubin in peripheral blood were significantly decreased compared with preoperative at postoperative 1 week,postoperative 3 months,postoperative 6 months,postoperative 12 months,postoperative 18 months,postoperative 24 months after LSD(all P<0.001),and showed a gradual decrease trend;The levels of albumin in peripheral blood temporarily decreased at postoperative 1 week,but significantly raised compared with preoperative at postoperative 3 months,postoperative 6 months,postoperative 12 months,postoperative 18 months,postoperative 24 months after LSD(all P<0.05),and which were gradually increased;The prothrombin time and international normalized ratio in peripheral blood increased slightly at postoperative 1 week,but significantly decreased at postoperative 3 months,postoperative 6 months,postoperative 12 months,postoperative 18 months,postoperative 24 months after LSD compared with preoperative(all P<0.001),and both them showed a gradual decrease trend;The Child-Pugh score increased at postoperative 1 week,but then showed a gradual decline trend,and significantly decreased compared with preoperative at postoperative 6 months,postoperative 12 months,postoperative 18 months and postoperative 24 months(all P<0.05)4.The plasma antithrombin ?,protein C and protein S in peripheral blood of patients after LSD were significantly reduced at postoperative 1 week(P<0.05),but from postoperative 3 months three indicators all were raised compared with preoperative and showed a gradual increase.The levels of plasma antithrombin III were significantly raised compared with preoperative at postoperative 3 months,postoperative 6 months,postoperative 12 months,postoperative 18 months,postoperative 24 months(all P<0.05).The levels of plasma protein C were significantly raised compared with preoperative at postoperative 18 months and postoperative 24 months(all P<0.05);The levels of plasma protein S were significantly raised compared with preoperative at postoperative 6 months,postoperative 12 months,postoperative 18 months and postoperative 24 months(all P<0.05)5.The serum content of procollagen type III in peripheral blood showed a decreasing trend after LSD,which were significantly decreased compared with preoperative at postoperative 3 months,postoperative 6 months,postoperative 12 months,postoperative 18 months and postoperative 24 months(all P<0.001);The type IV collagen in peripheral blood were significantly decreased compared with preoperative at postoperative 1 week,postoperative 3 months,postoperative 6 months,postoperative 12 months,postoperative 18 months,postoperative 24 months after LSD(all P<0.001),and showed a gradual decline trend;The laminin in peripheral blood showed a gradual decline after LSD,which were significantly decreased compared with preoperative at postoperative 24 months(P<0.05);The hyaluronidase were significantly raised at postoperative 1 week,(P<0.05),but then showed a gradual decline,which were significantly decreased compared with preoperative at postoperative 24 months(P<0.05).Conclusions:1.It is safety and efficacy that LSD in the treatment of cirrhotic portal hypertension with upper gastrointestinal bleeding and hypersplenism.2.LSD can increase the levels of peripheral blood white blood cell,hemoglobin and platelets in patients with cirrhosis.3.LSD can reduce total bilirubin,increase albumin levels,decrease prothrombin time,international normalized ratio and Child-Pugh score,which is beneficial to improve liver function in patients with cirrhosis.4.LSD can improve the content of peripheral antithrombin III.protein C and protein S in patients with liver cirrhosis,which is beneficial to improve the liver synthesis function of patients with liver cirrhosis.5.LSD can reduce the content of type III procollagen,type IV collagen,laminin and hyaluronidase in peripheral blood,which is beneficial to improve liver fibrosis and delay the development of cirrhosis.