Clinical Value Of CTA On Laporoscopic Splenectomy With Amputation Of Secondary Structures Of The Spleen Pedicel

Objective Compare the clinical results of laparoscopic splenectomywith amputation of secondary structures of the spleen pedicel in ITPpatients who had done and not done the CTA scan to summarize the clinicalvalue of CTA on laparoscopic splenectomy with amputation of secondarystructures of the spleen pedicel.Methods Retrospectively analyse the clinical record of62ITPpatients from January2007to January2012in department of hepatobiliarysurgery,the First Affiliated Hospital of Chongqing Medical University.26Cases undergo preoperative CTA as CTA group, others36cases did notundergo preoperative CTA as control group. We collected and comparedthe data in the both groups of the age composition，the gender composition,the operative time，the intraoperative blood loss，the incidence of accessoryspleen during operation，the postoperative hospital stay and hospitalizationcost in the both groups. The relationship of the splenic artery and the tail ofthe pancreas, splenic artery anatomy, the number of splenic artery branchbetween preoperative imaging and intraoperative endoscopic observation were compared in CTA group. Assess the clinical value of CTA onlaparoscopic splenectomy with amputation of secondary structures of thespleen pedicel were assessed. Two sets of clinical data were statisticallyanalyzed by SPSS17.0,the mean and the rate were compared using theStudent t test and theχ~2-test in two groups，respectively,significance levelα is0.05.Results The preoperative imaging and intraoperative endoscopicsituation are consistent in CTA group which had no statistical significance（table1）. The gender composition(male/female) was10/16and14/22inCTA group and control group, respectively, no statistical significancebetween the groups (χ~2=0.001，P>0.05).The two groups were found thatthe accessory spleen, respectively2/26cases and4/36case,no statisticalsignificance between the groups (χ~2=0.202，P>0.05).The mean patient’agein CTA group and control group was (41.69±15.99) years and (39.72±18.09)years, respectively, no statistical significance between the group (t=0.444，P>0.05).The platelet count in CTA group and control group was (30.12±20.24)×109/L and (35.39.±18.68)×109/L, respectively, no statisticalsignificance between the group (t=1.059，P>0.05). The operative timewas (185.58±14.09)min and (215.00±22.01)min in CTA group and controlgroup, respectively, which had statistical significance between the groups(t=5.982，P<0.05).The intraoperative blood loss was (165.78±88.42)ml and(262.78±80.70)ml in CTA group and control group, respectively, which had statistical significance between the groups (t=4.487，P<0.05). Thepostoperative hospital stay was (8.46±1.48)days and (10.14±1.51)days inCTA group and control group, respectively, which had statisticalsignificance between the groups (t=4.349，P<0.05). The hospitalization costwas (30993.46±1961.81)￥and (28347.87±3058.31)￥in CTA groupand control group, which had statistical significance between the groups(t=3.869，P<0.05).Conclusion The hospitalization cost of CTA group is slightly higherthan control group. The anatomical structure of the spleen blood vesselsand the relationship between it and pancreas can be mastered beforesurgery in CTA group, which can guide better anatomy of spleen bloodvessels in surgery and also contribute to Hem-O-lok ligation and cut off ofthe blood vessels by using harmonic scalpel rather than the use ofEndo-GIA. CTA group displays shorter operative time, less bleeding andshorter hospital stay than control group. Therefore, it is feasible andvaluable that CTA scan for ITP patients who need the treatment of LS.