A Comparative Study Of Hand-assisted Laparoscopic And OPEN Modified Sugiura Procedure On Neuroendocrine Stress Response

ObjectiveTo compare prospectively effects of Hand-assisted laparoscopic (HALS) modified Sugiura procedure and OPEN modified Sugiura procedure on clinical indicators and neuroendocrine stress response of patients with portal hypertension, explore the size of the two surgical trauma on the body,and further analysis the minimally invasive of hand-assisted laparoscopic modified Sugiura operation,in order to guide clinical treatment better.Methods56patients with portal hypertension were randomly divided into HALS group (n=28) and OPEN group (n=28) from January2011to March2012. All operations were performed by the same group surgeons in general anesthesia. Data of patients were recorded:preoperative clinical indicators include gender, age, weight, spleen size(length, width, thickness), a history of upper gastrointestinal bleeding, Child-Pugh classification of liver function; intraoperative clinical indicators include length of incision, operative time, intraoperative blood loss; postoperative clinical indicators include anal exhaust time, eating time, postoperative abdominal drainage time, postoperative drainage fluid volume, postoperative hospital stay and postoperative complications.All patients’venous blood were sampled to measure the neuroendocrine indicators(Epinephrine,Norepinephrine,Adrenocorticotropic Hormone, Cortisol) in the morning of the1st day before operation,1st hour after the start of operation, the end of surgery,1st,2nd,4th day after operation.Results56surgeries in two groups were successful, no intraoperative complications.①Preoperative clinical indicators:gender, age, height, weight, spleen size(length, width and thickness), a history of upper gastrointestinal bleeding, Child-Pugh classification of liver function were no statistical difference between two groups. ②intraoperative clinical indicators:the operation time of the HALS group was longer than the OPEN group, the difference was not statistically significant; length of incision and intraoperative blood loss of HALS group was significantly less than the OPEN group, the difference was statistically significant.③Postoperative clinical indicators:anal exhaust time, eating time, postoperative drainage time, the number of abdominal drainage, and postoperative hospital stay of the HALS group were significantly less than the OPEN group, the difference was statistically significant; There are not postoperative complications in the HALS group,2patients of the OPEN group had pleural effusion,1patient has wound infection, but the difference was not statistically significant.④Neuroendocrine indicators:E, NE, ACTH and Cor indicators of two groups patients showed a trend that the first increase and the second downward. E, NE, ACTH and Cor indicators of HALS group reached its peak at the end of surgery and mostly recovered to the preoperative level in2days; E, NE, ACTH of the OPEN group reached its peak at the end of surgery, Cor reached its peak at the1st days after surgery, and mostly recovered to the preoperative level in4days. In a word:HALS group was smaller increase and more quickly recovery than the OPEN group.Conclusions①The HALS modified Sugiura surgery is safe and effective. It is not only has the same clinical efficacy with the OPEN modified Sugiura procedure, but also has the advantage of laparoscopic operation, such as a small incision, less blood loss, less interference of within environment, fewer complications, faster recovery of gastrointestinal function, shorter hospital stay.②Compared with the OPEN modified Sugiura procedure, the HALS modified Sugiura surgery responsed lightly, reduced the trauma of surgery on the body, maintained the stability of the body environment, in favor of the recovery of patients, especially those has portal hypertension who has a hepatitis background.