Comparison Of Efficacy Of Laparoscopic Splenectorny Combined With Pericardial Vascular Dissection And Double Interve Ntional Therapy In The Treatment Of Hepatocirrhosis,esophagogastric Fundus Hemorrhage Complicated With Hypersplenism

Objective:To explore the safety and clinical efficacy of elective laparoscopic splenectomy with pericardial vascular dissection and double interventional therapy(percutaneous percutaneous coronary vein embolization combined with partial splenic artery embolization)in the treatment of cirrhosis of esophageal and gastric varices and hypersplenism,so as to provide a better basis for clinical treatment.Method:1.Retrospective analysis was used to select patients with esophagogastric disorders from January 2011 to December 2018 Bottom varices rupture hemorrhage merge in port visits the china-japan union hospital of jilin university of parallel elective laparoscopic splenectomy plus cardiac blood vessels around from broken and double interventional therapy(percutaneous by liver gastric coronary vein embolization combined partial splenic artery embolization of 60 patients with liver cirrhosis were followed,including 38 men and 22 women.Two groups of patients were due to the recent history of gastrointestinal bleeding in hospital and merge the splenic function,preoperative after drug treatment and three cavity 2 capsule in stable condition after tube compression hemostasis,and treatment of liver function before the Child-Pugh rating for grade A or grade B,the comprehensive and objective evaluation of important organs such as heart and lung function in patients with suitable for surgery,no obvious contraindication,signed informed consent with the family after surgical treatment of patients.According to the different surgical treatment methods,the patients were divided into two groups.The first group was splenectomy plus pericardial vascular dissection.The 35 patients were 56.14±8.402 years old.The other group was treated with percutaneous coronary vein embolization combined with partial splenic embolization.There were 25 patients with an average age of 57.76±9.330 years.The postoperative follow-up results of the two groups were collected,and the postoperative success rate,surgical complications,improvement of hypersplenism,indexes of liver function,rate of return of esophageal and gastric varices,rate of redelivery of blood,and survival rate of the two groups were compared.The operators are all surgeons or interventional surgeons and their teams with rich experience in theory and practice,who have completed the operation several times.2.SPSS19.0 statistical software was used for data analysis.The measurement data were expressed as mean ± standard deviation(M±SD),and the number of counting data was represented as n and %.Group comparison before and after the treatment using paired t test,two groups of patients with preoperative liver function during different periods after operation,the platelet count hematology indexes such as the comparison of using single factor analysis of variance,comparing two groups the same time use independent sample t-test,esophageal gastric varices outcome rate,further hemorrhage rate,survival rate compared by chi-square test,P < 0.05,said the difference was statistically significant.Results:Two patients in the group of laparoscopic splenectomy and pericardial vascular devascularization died of postoperative complications.One patient in the double intervention(PTVE+PSE)group died of gastrointestinal bleeding after surgery,and the rest were discharged successfully.The total rate of postoperative complications was 31.4% in the splenectomy plus pericardial vascular dissection group,and 20% in the double-intervention(PTVE+PSE)group(2=1.897,P=0.168).Hypersplenism was alleviated in the splenectomy plus pericardial vascular detachment group and the double-intervention group(PTVE+PSE).Compared with the platelet count in the two groups,t values were 4.197,16.454,and 14.625,respectively,1 month after surgery,6months after surgery,and 12 months after surgery,and p values were all less than 0.05,indicating statistically significant differences between the two groups.The t value of alanine transaminase in the two groups was 0.620 and the p value was less than 0.05 compared with the independent sample test,showing statistically significant difference.The t values at 6 months and 12 months after the operation were 3.189 and 2.088,respectively,and the p values were all greater than 0.05,with no statistically significant difference.The effective rate of esophageal and gastric fundus varices after splenectomy and pericardial vascular dissection was 100% in the group and 48% in the PTVE+PSE group(2=31.452,P=0.000).The cumulative rate of rebleeding was8.5% in the splenectomy group plus pericardial vascular dissection group and 20% in the double-intervention(PTVE+PSE)group(2=1.424,P=0.233).The 1-year cumulative survival rate was 94.2% in the splenectomy plus pericardial vascular dissection group,and 96% in the double-intervention(PTVE+PSE)group(2=0.09,P=0.764).Conclusion:The hemostatic effect of laparoscopic splenectomy plus pericardial vascular dissection and double interventional therapy(PTVE+PSE)on cirrhotic esophageal and gastric fundus varices was clear,and there was no significant difference between the two.The incidence of complications in laparoscopic splenectomy plus cardia dissection was similar to that of PTVE+PSE.Laparoscopic splenectomy with pericardial vascular dissection and PTVE+PSE had no significant effect on postoperative liver function(ALT).In the treatment of hypersplenism,the increase of platelets was more obvious and the effect was better after laparoscopic splenectomy and pericardial vascular dissection.Compared with PTVE+PSE,laparoscopic splenectomy combined with pericardial vascular devascularization is more effective for esophageal and gastric fundus vein flexion.During the 1-year follow-up period,the effect of laparoscopic splenectomy plus pericardial vascular devascularization was similar to that of double interventional therapy(PTVE+PSE)in the prevention of re-bleeding due to the rupture of esophageal and gastric varices in cirrhosis.During the 1-year follow-up period,laparoscopic splenectomy plus pericardial vascular dissection and double interventional therapy(PTVE+PSE)had no significant effect on the survival rate.