A Comparative Study Of Hand-assisted Laparoscopic And Open Modified Sugiura Procedure

Objective:To compare prospectively effects of Hand-assisted laparoscopic(HALS) modified sugiura procedure and OPEN modified sugiura procedure on stress response and immunologic function of patients with portal hypertension,reveal the regularity of physiological and pathological change in human body following HALS modified sugiura procedure,evaluate patients' traumatic reaction after HALS modified sugiura procedure,and explore the mechanism of minimal invasion from HALS modified sugiura procedure。Methods:25 patients with portal hypertension were randomly divided into HALS modified sugiura procedure and OPEN modified sugiura procedure group randomly,and total 3 cases were eliminated according to our protocol.Data of 11 HALS modified sugiura procedure and 11OPEN modified sugiura procedure were studied and analyzed.Data of patients were recorded,including length of incision,surgical duration,intraoperative blood loss;postoperative eating date,time and volume of drain,,hospital stay,complications,hospital costs.All patients' venous blood were sampled to measure liver function,stress markers(CRP,IL-1β,IL-6,TNF, WBC,N)and immunologic markers(C3,C4,CD3,CD4,CD8)before operation, at operative endpoint,in the morning of the 1^st,3^rd,7^thday after operation.Results:The average length of incision in HALS group was one fourth shorter than that in OPEN group.Intraoperative blood loss,surgical duration,postoperative eating date and hospital costs was no statistical difference between two groups. postoperative time and volume of drain,hospital stay in HALS group was decreased compared with OPEN group(P＜0.05).HALS modified sugiura procedure after one day began to get out of bed activities,and OPEN modified sugiura procedure was the first three days.Pleural effusion occurred in HALS group,but pleural effusion and wound infection occurred in 2 patient in OPEN group.ALT increased in both groups,which were greater in OPEN group compared with HALS group(P＜0.05)in the 7th day after operation.Postoperative level of stress markers in HALS group elevated quickly,and most of them reached a peak in the postoperative next morning.Preoperative level of stress markers was different from the postoperative(P＜0.05).As compared with OPEN group,increased level of stress markers was significantly lower and postoperative decrease of them was faster in HALS group.In both groups,level of immunologic markers was decreased compared with the preoperative level(P＜0.05),which reached the lowest value in the postoperative next morning,but recovered gradually.The decreased level and speed in HALS group were less than that in OPEN group with statistical significance.The level of CD4/CD8 after HALS modified sugiura procedure was no statistical difference compared the preoperative level(P＞0.05).Conclusions:Hand-assisted laparoscopic modified sugiura procedure results in a stress response,which repressed of patients,but it was minor compared with OPEN modified sugiura procedure.The data immunologic suggested that traumatic reaction of HALS modified sugiura procedure is less than that of OPEN modified sugiura procedure.HALS modified sugiura procedure proves the feasible and safe the method to treat the patients with portal hypertension.