Analysis The Clinical Effect Of Laparoscopic Splenectomy With Pericardial Devascularization

BackgroundThe common cause of portal hypertension(PHT)is cirrhosis caused by various reasons,mainly due to hepatitis cirrhosis in China.Upper gastrointestinal hemorrhage is the most common and treatable complication of PHT caused by esophageal gastricfundus variceal bleeding.The treatment of PHT tends to be diversified,mainly includes drug therapy,interventional therapy,endoscopic therapy,interruption surgery,shunt surgery,liver transplantation and so on.Surgical treatment of esophageal gastric-fundus variceal bleeding caused by portal hypertension has some advantages,such as near hemostasis effect was satisfactory and low recurrence bleeding rate.On the other hand,splenomegaly and severe hypersplenism require surgery.Therefore,surgery still plays an irreplaceable role in treatment of PHT.Classical pericardial vascular dissection is one of the mainstream surgical procedures for PHT in China because of it's a relatively simple operation and has precise hemostatic effect.However,traditional open surgery inevitably has the disadvantages of large surgical trauma,easy incision infection,and long postoperative recovery time.It is not recommended as a preventive operation for PHT treatment.With the continuous development of medical technology,minimally invasive laparoscopy technology has flourished and has been widely used in abdominal surgery,which has greatly improved the curative effect of PHT.However,due to liver dysfunction of portal hypertension,coagulopathy,huge spleen,hypersplenism,spleen adhesion,spleen and pericardial varices,laparoscopic splenectomy and pericardial vascular dissection are still a difficult and high-risk surgery.How to complete the operation safely,accurately,effectively and minimally invasively is still challenging.ObjectiveTo compare the clinical validity of traditional open splenectomy combined with pericardial vascular disconnection for symptomatic portal hypertension in liver cirrhosis.we hope to discuss the application and clinical validity of laparoscopic splenectomy combined with pericardial vascular disconnection.MethodThe clinical data of 69 patients who was diagnosed with cirrhosis with portal hypertension in Department of General Surgery of our hospital from November 2017 to October 2018 were reviewed retrospectively.Among them,48 patients had complete data and met the inclusive and exclusive criteria.And 24 patients who underwent laparoscopic splenectomy combined with pericardial vascular disconnection were divided into the laparoscopic group,24 patients who underwent open splenectomy and pericardial devascularization were divided into the open group.The following indicators and data of patients undergoing surgery in the laparoscopic group and the open group were compiled separately.Preoperative clinical data,including age,gender,etiology,Child-Pugh grade of liver function,esophageal varices,and Aspartate aminotransferase(AST),Alanine aminotransferase(ALT)one day before surgery.Intraoperative clinical data,including bleeding volume and operation time.Postoperative clinical data,including the time of the first postoperative exhaust,the time to extract abdominal drainage tube,the postoperative hospital-stay time,the liver function(AST,ALT)five days after surgery,postoperative complications(platelet count>500×10~9/L,Lung infections,gastric emptying disorders,incision infections,pancreatic leaks)and the pain scores 0n 1day,3day,5day after the surgery.Results1.There was no significant difference in the age,gender,liver function grade,esophageal and gastric varices in the laparoscopic group and open group(P>0.05).2.The amount of intraoperative blood loss in the laparoscopic group(292.45±100.62)ml was significantly less than that in the open group(396.23±121.12)ml(P<0.05).The operation time in the laparoscopic group(279.62±45.95)min was signifycantly longer than that in the open group(200.96±38.22)min(P<0.05).3.Compared with the AST,ALT and TBIL of the two groups before surgery,there was no significant difference(P>0.05).The ALT,AST five days after surgery in the laparoscopic group were(49.33±8.64)U/L,(47.54±6.93)U/L,which were lower than the open group(54.00±8.03)U/L,(52.08±7.94)U/L(P<0.05).4.The time of the first postoperative exhaust,the time to extract abdominal drainage tube and the total hospital-stay time in the laparoscopic grop were(2.92±0.88)d?(5.29±0.95)d?(10.88±1.54)d,which was significantly shorter than the open group(3.71±1.23)d?(7.42±1.35)d?(13.33±1.79)d(P<0.05).5.The total number of postoperative complications in the laparoscopic group was3(12.50%),which was lower than the open group 10(41.67%)(P<0.05).6.The pain scores in the laparoscopic group on 1d,3d,and 5d after the surgery were lower than those in the open group(P<0.05).ConclusionLaparoscopic surgery for cirrhotic portal hypertension has the advantages of smaller injury degree,quick recovery of the liver function,fewer postoperative complications,less postoperative pain and shorter hospital stay.It is one of the more ideal surgical methods for surgical treatment of portal hypertension.