Comparative Clinical Study Of Hand Assistant Laparoscopic Splenectomy Plus Porta-agygous Revascularization Versus Laparotomy

Objective:To evaluate the clinical application value of the hand assistant laparoscopic splenectomy plus Porta-agygous devascularization by comparing with the open procedure.Methods:From January 2008 to June 2009,29 patients with portal hypertension were treated by hand assistant laparoscopic splenectomy plus porta-agygous devascularization,29 patients were treated by laparotomy on the same term. The purpose was to compare the two groups' clinical outcomes of the operative time,hemorrhage volume,fever time,the time of recover pass gas,pain time,hospital stay,the surgical complication,the postoperative liver function,the recurrence rate of hemorrhage.Results:①The results of the operation situation studyAll the operations were successfully proceeded. The operative time was (143±42) minutes in laparoscopic surgery(LS) and (211±47) minutes in open surgery(OS), which had a significant difference between the groups (P<0.01); the intraoperative blood loss was (212±126) ml in LS and (306±119) ml in OS, which had a significant difference between the groups (P<0.01); the postoperative fever time was(1.6±1.4)days in LS and(3.6±2.3)days in OS, which had a significant difference between the groups(P<0.01); the postoperative pain time was (1.2±0.5) days in LS and (2.8±0.9) days in OS, which had a significant difference between the groups (P<0.01); the time of recover pass gas was (68±18) hours in LS and (98±20) hours in OS, which had a significant difference between the groups (P<0.01); the postoperative hospital stay was (8.3±1.5) days in LS and(12±1.8) days in OS, which had a significant difference between the groups (P<0.01).②The surgical complicationThe cut infection rate was 0%(0 case) in LS and 13.8%(4 cases) in OS, which had a significant difference between the groups (P<0.05).The subphrenic infection rate was 6.8%(2 cases) in LS and 10.3%(3cases) in OS, which had no significant difference between the groups (P>0.05).③The recurrence rate of hemorrhage during one yearThe recurrence rate of hemorrhage was 3.4%(1 cases) in LS and 6.8%(2 cases) in OS, which had no significant difference between the groups (P>0.05).④The results of the liver function studyThe postoperative Tbil was (17.6±8.6)μmmol/L in LS and (24.1±10.3)μmmol/L in OS, which had a significant difference between the groups (P<0.05). The postoperative AST was (32.8±12.1) U/L in LS and (57.4±47.2) U/Lin OS, which had a significant difference between the groups (P<0.05).Conclusions:The operative time of the laparoscopic group was much less than the open one(P<0.05), also were the fever time,ventilation time,pain time,hospital stay,the surgical complication,the postoperative liver function. There were no differences between the two groups in the recurrence of hemorrhage during one year(P>0.05). The hand assistant laparoscopic splenectomy plus porta-agygous devascularization is feasible and safe for portal hypertension treatment,and has less trauma to the body,better than laparotomy.