The Clinical Study Of Laparoscopic Splenectomy Combined Periesophagogastric Devascularization

Objectives:The aim of this study was to analyze intraoperative conditions and postoperative recovery for laparoscopic splenectomy combined with periesophagogastric devascularization(LSD)with those for open splenectomy combined with periesophagogastric devascularization(OSD).To investigate the efficacy,feasibility,safety and advantage of LSD.Methods:From January 2015 to August 2017,26 patients chose LSD and 24 patients underwent the OSD due to portal hypertension in liver cirrhosis in the Second Affiliated Hospital of Nanchang University.Results and outcomes were compared retrospectively.Results:There were no significant differences in preoperative patient characteristics of the two groups.The intraoperative blood loss(236.53±121.55 ml vs.447.92±307.68 ml,P < 0.05),except the autologous blood transfusions(0.71±1.23 u vs.1.52±1.35 u,P < 0.05),platelet transfusions(90.00±150.20 ml vs.239.58±50.81 ml,P < 0.05)were less in the LSD than the OSD group.However,Operating time was longer in the LSD group(313.85±81.00 min vs.250.83±69.29 min,P < 0.05).The LSD group had earlier Postoperative anus exhausting time than the OSD group(2.00±0.85 d vs.2.88±0.74 d,P < 0.05)and shorter hospital stays(8.54±1.90 d vs.11.58±3.53 d,P < 0.05).Postoperative platelet count(PLT),ascites drainage,alanine aminotransferase(ALT)and Pain Score were monitored for the first week after surgery.PLT was similar in two groups(P > 0.05).The LSD group had less ascites drainage in 3,5 and 7 days after operation(P < 0.05)and lower ALT in 5 and 7 days after operation(P < 0.05).Postoperative Pain Score was lower in the LSD than the OSD group(P < 0.05).Postoperative Short-term complications were observed,and overall complications were significantly lower in the LSD than the OSD group(P < 0.05).In the LSD group,there were portal vein thrombosis in 1 patient,splenic heat in 1 patient and pleural effusion in 1 patient.While in the OSD group,there were pancreatic leakage,heat spleen and portal vein thrombosis in 1 patient,spleen heat in 2 patients,poor recovery of gastrointestinal dynamic consolidation with peritoneal effusion in 2 patients,and incision infection with pleural effusion in 1 patient,Incision infection in 2 patients,portal vein thrombosis in 3 patients.All complications of patients in two groups recovered after symptomatic treatment.Conclusions:Compared with OSD,LSD has advantages of reducing intraoperative blood loss,reducing ascites drainage,relieving pain,shortening hospital stays,minimally invasive intervention,less Short-term complications and faster postoperative recovery.LSD offers a good alternative for the management of portal hypertension.