The Comparison Of Laparoscopic Splenectomy By Two Different Technique Of Splenic Pedicle Dissection

Obejective To discuss the advantages and limitations of primary splenic pedicle dissection technique and secondary splenic pedicle dissection technique in laparoscopic splenectomy(LS),and compare the influence of two metheds on immune function of patients after splenectomy.Metheds 1.We reviewed databases of 85 patients who had undergone LS from October 2012 to September 2016,retrospectively.We divided all patients into two groups on the basis of the size of spleen.In 25 patients with massive splenomegaly,13 patients were performed LS through primary splenic pedicle dissection technique(PSPD)and 12 patients were performed LS through secondary splenic pedicle dissection technique(SSPD).In 60 patients with normal-sized spleen or moderate splenomegaly,28 patients were performed LS through PSPD and 32 patients were through SSPD.We compared perioperative and postoperative data and accessed the effect and economic benefit of two metheds.2.Choose 23 patients with normal-size spleen or moderate splenomegaly who had undergone LS from January 2015 to September 2016,whose immune function were normal or almost normal.PSPD had been used in 11 patients and SSPD had been used in 12 patients.we analyzed the effects of the two methods on the immune function by detecting the changes of immune indexes before and after the operation.Results 1.Laparoscopic splenectomy was completed in 80 patients,5 patients were turn to open.In the massive splenomegaly group,the conversion rate was 7.9% for PSPD and 33.3% for SSPD,complication rate was 38.46% vs 16.67%,time of operation was 170.35±58.36 mins vs260.43±98.46 mins,intraoperative bleeding was 132.5±58.65 ml vs 245.5±100.85 ml,postoperation hospital stay was 4.5±1.3days vs 7.8±3.52 days,transfusion requirement was 1.53±1.02 U vs3.28±1.48 U,surgery cost was 12856.76±1258.53 yuan vs 8685.6±923.64 yuan,respectively.And the differences of all these were significant(P<0.05).In the normal-size spleen or moderate splenomegaly group,the complication rate was 42.1% vs 20%,surgery cost was 10837.45±965.32 yuan vs 7052.43±878.46 yuan(P<0.05),other perioperative findings were no significant differences between PSPD and SSPD techniques.2.The postoperative IgM,IgA and C4 levels decreased in both groups,the IgM decreased significantly and did not restore to normal on the day 5 postoperatively,but there were no significant differences between two groups.The IgG and C3 levels decreased on the day 1postoperatively in both groups(P<0.05),but the indexes in SSPD group decreased slightly and restored to normal on the day 3 postoperatively,while the indexes in PPSD decreased significantly and restored to normal on day 5.The differences between two groups was significant.Conclusion SSPD can reduce the incidence of pancreatic fistula and splenic fever,reduce the operation cost,decrease the damage and immunosuppression,and is benefited for patients with normal-sized spleen or moderate splenomegaly.However,it is not safe and feasible for patients with massive splenomegaly because of the high conversion rate and hign-risk.