Comparison Of Efficacy Between Laparoscopic Splenic Artery Ligation And Splenectomy Combined Periesophagogastric Devascularization For Cirrhotic Portal Hypertension

Objective: Through the comparative analysis of the clinical efficacy of laparoscopic splenic artery ligation combined periesophagogastric devascularization(LSALD)and laparoscopic splenectomy combined periesophagogastric devascularization(LSD)in the treatment of cirrhotic portal hypertension,to discusse the feasibility,effectiveness and advantages of LSALD compared with LSD.Methods:The clinical data of 80 patients with cirrhotic portal hypertension in the first department of general surgery of The Second Hospital of Hebei Medical University from January 2014 to December 2019 were collected.Among them,50 patients underwent laparoscopic splenic artery ligation combined with periesophagogastric devascularization(LSALD group)and 30 patients underwent laparoscopic splenectomy combined with periesophagogastric devascularization(LSD group).The blood routine,liver function before and after operation,intraoperative condition,postoperative recovery and prognosis of the two groups were compared and analyzed to explore the feasibility,safety and advantages of LSALD compared with LSD.Statistical analysis was carried out by using SPSS23.0 software.Mean ±standard deviation was used to describe the measurement data of normal distribution,t-test was used to compare the measurement data of non-normal distribution,mean(quarterback spacing)was used to describe the measurement data of non-normal distribution,nonparametric rank sum test was used for comparison between groups,and chi-square test was used for comparison of counting data between groups.The difference was statistically significant(P < 0.05).Results: There was no significant difference in sex,age,preoperative blood routine and liver function between the two groups(P > 0.05),but the operation time,intraoperative blood loss and blood transfusion rate in the splenic artery ligation group were significantly lower than those in the splenectomy group(P <0.05).The difference was statistically significant(P<0.05).The postoperative exhaust time in the splenic artery ligation group was shorter than that in the splenectomy group(P<0.05),and there was no significant difference in postoperative hospital stay between the two groups(P > 0.05).There was no significant difference in albumin,total bilirubin,glutamic pyruvic transaminase and glutamic oxaloacetic transaminase between the two groups(P > 0.05).One week after operation,white blood cell and platelet count and hemoglobin level were improved,and the difference was statistically significant(P<0.05).The white blood cell and platelet count in the splenectomy group was significantly higher than that in the splenic artery ligation group(P<0.05),but there was no significant difference in hemoglobin level between the two groups(P>0.05).In terms of postoperative complications,portal vein thrombosis occurred in 10 cases in splenectomy group and 6 cases in splenic artery ligation group,which was significantly higher than that in splenic artery ligation group(P<0.05).There was no significant difference in the incidence of other complications(P > 0.05).Conclusion:1.Laparoscopic splenic artery ligation combined with periesophagogsgastric devascularization is safe and feasible in the treatment of cirrhotic portal hypertension.2.Compared with laparoscopic splenectomy combined with periesophagogastric devascularization,laparoscopic splenic artery ligation combined with periesophagogastric devascularization retains spleen function and has the advantages of relatively simple operation method,short operation time,less intraoperative hemorrhage,quick postoperative recovery,low incidence of portal vein thrombosis,etc.As a spleen-preserving operation method,it is worthy of clinical application and promotion,but its long-term effect still needs further observation.