Clinical Retrospective Study On Laparoscopic Splenectomy And Open Splenectomy

Objective: To evaluate the feasibility and safety of total laparoscopic splenectomy and open splenectomy,and further to find the optimal method for splenectomy.Methods: 1.The clinical data of 115 patients who underwent splenectomy in our hospital from May 2009 to May 2013 were retrospectively analyzed.Among them,68 cases were performed by laparoscopic splenectomy(LS group),and 47 cases by conventional open splenectomy(OS group).General data,Surgical related index and recent clinical endpoints of the two groups patients were compared and analyzed to evaluate the safety and advantages of surgical methods and draw conclusions.2.The clinical data of 68 patients with LS were analyzed in subgroup,which were divided into two groups: LSa(n=34)Endo-GIA procedure and LSb(n=34)anatomical splenic pedicle disconnection for laparoscopic splenectomy.The clinical indexes of the two groups were compared and analyzed to find a more ideal way of laparoscopic splenectomy.Results: There were no significant differences between LS and OS group in the common data included age,gender,BMI,diameter of spleen,disease category and preoperative liver function,respectively(P > 0.05).Iintraoperative blood transfusion volume of LS group was significantly lower than the OS group(P < 0.05),but there was significantly lower operation duration in OS group(P < 0.05).LS group significantly reduced recent clinical endpoints included postoperative ventalation time,postoperative analgesia time,postoperative abdominal bleeding,postoperative abdominal bleeding duration,drainage of ascetic fluid,drainage of ascetic fluid duration,hyperamylasemia,high-amylase of ascetic fluid and hospitalization time,respectively,as compared with OS group(P < 0.05).There was significantly lower ascensional range of endpoints referred to stress response(Cortisol,Epinephrine,Norepinephrine and Angiotensin II)at first,third,fifth and seventh day of postoperation in LS group,respectively,as compared with OS group(P < 0.05).The decreased levels of IgG and C3 in LS group at 1,3,5 and 7 days after surgery were significantly lower than those in OS group,and the difference was statistically significant(P < 0.05).There was no significant difference in age,gender,BMI,spleen diameter,proportion of giant spleen,disease type and preoperative liver function between LSa group and LSb group(P > 0.05).The operation time of LSa group was significantly less than that of LSb group.Perioperative indicators such as intraoperative blood loss,hyperamylasemia,increased amylase in abdominal drainage fluid,postoperative peritoneal blood infiltration,duration of peritoneal blood infiltration,ascites drainage volume,duration of ascites drainage and hospitalization cost in LSa group were significantly greater than those in LSb group,and the differences between the two groups were statistically significant(P < 0.05).However,there were no significant differences between LSa and LSb at rates of postoperative complication such as portal vein thrombosis and fever,respectively(P > 0.05).Conclusions: Laparoscopic operation is safer and efficient choice for splenectomy because of its more advantages applied in the Minimally Invasive Surgical Technology.The two methods for laparoscopic splenectomy are safe and feasible,but compared with Endo-GIA procedure,the anatomical splenic pedicle disconnection for laparoscopic splenectomy has the advantages of less intraoperative blood loss and lower price.It is worthy of promotion and application.