Effect Of Total Laparoscopic Splenectomy Combined With Endoscopic Variceal Ligation On Portal Hypertension In Hepatitis B Cirrhosis Patients

Objective: To investigate the effect and safety of totallaparoscopic splenectomy combined with endoscopic variceal ligation onportal hypertension in hepatitis B cirrhosis patients. Methods: Sixtypatients with portal hypertension of hepatitis B cirrhosis accepted fordevascularization in our hospital were studied continuously from January2008to April2011. All patients were divided into two groups: with totallaparoscopic splenectomy combined with endoscopic variceal ligation(Laparoscopic Ligation Group, n=30) or open splenectomy combinedwith pericardial devascularization (Traditional Open Group, n=30). Theclinical safety related indicators including mean operative time,intraoperative blood loss, postoperative plasma drainage volume,postoperative anal exsufflation time and postoperative complicationswere recorded, and clinical efficacy related indicators includinginflammatory factors C-reactive protein, portal hemodynamics, liverfunction, the recurrence of esophageal varices and upper gastrointestinalbleeding and portal hypertension gastropathy classification were studied.Results: All operations were completed successfully. Mean operativetime (271±20min vs.262±27min) and hospitalization costs (36263±2960yuan vs.35060±3154yuan) have no significant differencebetween two groups (P＞0.05). intraoperative blood loss(228±70ml vs.350±69ml), postoperative plasma drainage volume (496±232ml vs.752±372ml), postoperative plasma drainage volume (2.1±0.7d vs.3.6±0.9d), postoperative hospital stay (12±2d vs.17±2d) andpostoperative complications such as fever, ascites, wound infection,pleural effusion and portal vein thrombosis were decreased significantlyin laparoscopic ligation group compared with traditional open group (P＜0.05). The postoperative CRP levels on1and3day were higher thanpreoperative in the two groups (P<0.05), however postoperative CRPlevels showed a decreasing trend after3day, and the CRP levels inlaparoscopic ligation group were decreased markedly compared withtraditional open group (P＜0.05). The white blood cell counts wererestored to normal, and the platelet count rose to100×109/L or more onpostoperative2weeks in the two groups. The portal vein diameter, portalvein maximum velocity and portal vein flow volume were decreasedsignificantly on postoperative2weeks (P＜0.05), but that of laparoscopicligation group were decreased compared with traditional open group (P＜0.05). All patients were followed up for12months. The liver function ofpostoperative remained unchanged in the two groups. Postoperativevariceal recurrence rates were3.3％in laparoscopic ligation group and56.7％in traditional open group (P＜0.05). Rebleeding rate was3.3％ in laparoscopic ligation group and20％in traditional open group(P＜0.05). Portal hypertension gastropathy remained unchanged inlaparoscopic ligation group (P＞0.05) and exacerbated in traditional opengroup (P＜0.05). Conclusion: Total laparoscopic splenectomy combinedwith endoscopic variceal ligation was an effective way to treat withhepatitis B cirrhosis patients with portal hypertension. Comparing withtraditional open operation, it was less trauma and recovery, fewercomplications, could decline the portal blood flow effectively, lower rateof varicose vein recurrence and bleeding and less portal hypertensiongastropathy. Endoscopic variceal ligation was simple and repeatable.Therefore, it was to find better treatment strategies for portalhypertension in cirrhotic patients.