| Objective:To compare the effects of total laparoscopic selective and nonselective paraesophagogastric devascularization for the treatment of portal hypertension.Methods:Retrospective analysis of the clinical data of patients with portal hypertension admitted in our department from May 2010 to December 2013, treatment was completed by the same group of surgeons,treatment of 24 cases (control group) with non selective cardia peripheral vascular disconnection (splenectomy plus cardiac peripheral vascular disconnection), Totally 27 cases (experience group) were treated by complete laparoscopic selective cardiac peripheral vascular disconnection (splenectomy plus selective cardiac peripheral vascular disconnection).Recorded the following observation index data:gender, age, height, weight, BMI, length of spleen diameter, etiology classification, Child-Pugh score, preoperative endoscopic treatment, ASA classification, operative time, intraoperative bleeding, postoperative anal exhaust time, spleen nest drainage tube removal time, hospitalization time, complications. Compared to the experience group and the control group, the preoperative and postoperative day 1,day 3,day 7 routine blood test, liver function test, preoperative and postoperative 3 months gastroscope observation esophageal and gastric varices improvement,postoperative follow-up rebleeding incidence.Results:The operation were successfully completed,in two groups no conversion to open surgery.Perioperative indicators, the operation time of the experimental group was shorter than the control group.The difference between the two groups was statistically significant (P<0.05). Experimental group blood loss was less than the control group.The difference between the two groups was statistically significant (P<0.05). Anal exhaust time of experimental group was earlier than the control group. The difference between the two groups was statistically significant (P<0.05). Experimental group after spleen removal of drainage tube was earlier than the control group. The difference between the two groups there was statistically significant (P<0.05). Experimental group postoperative hospital stay was shorter than the control group. The difference between the two groups was statistically significant (P<0.05). WBC and PLT in both group were elevated postoperative (P<0.05), but no statistical difference between the two groups (P> 0.05).The HGB of both group were reduced after surgery, but there was no significant difference (P>0.05), and no statistical difference between the two groups (P>0.05). ALT, AST and TBIL significantly increased in two groups on postoperation day 1 (P<0.05),however, there was no significantly difference between the two groups (P>0.05).Postoperative 7th day in the experimental group, the levels of ALT, AST, TBIL compared with the preoperative decreased and was statistically significant (P< 0.05), the control group, the levels of ALT, AST, TBIL were higher than before the operation.The difference was not statistically significant (P> 0.05), but the difference between the two groups was statistically significant (P< 0.05).In the experimental group and control group on the 1st day, the 3rd day ALB were lower than before the operation.The difference was statistically significant (P< 0.05), but between the two groups no significant difference.The experimental group and after surgery in the control group on the 7th day of ALB compared with the preoperative decreased, the difference was not statistically significant(P>0.05).The difference between the two groups had no statistical significance(P> 0.05).Postoperative complications occurred in the experimental group was 25.9%,including 1 case of pancreatic fistula,2 cases of splenic fever,2 cases of ascites,1 case of pleural effusion,portal vein thrombosis in 1 case.In the control group,postoperative complication rate was 62.5%,2 cases of splenic fever, ascites 6 cases,3 cases of pleural effusion, pulmonary infection in 1 case,portal vein thrombosis in 3 cases, the two groups had no perioperative deaths. Between the two groups was statistically significant (P<0.05).23 patients of experimental group were performed with 2 years of follow-up, follow-up rate was 85.19%, postoperative 1 year return blooded 4.35%,postoperative 2 years return blooded rate 13.04%, 21 patients of control group completed 2 years of follow-up, follow-up rate was 91.67%, postoperative 1 year return blooded was 27.27%, postoperative 2 years return blooded 40.91%, the difference between the two groups has statistical significance (P<0.05).Conclusion:The clinical efficacy of laparoscopic selective cardia peripheral vascular disconnection in the treatment of portal hypertension is better than that of laparoscopic non selective cardiac peripheral vascular disconnection, which is worthy of clinical application. |
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