| ObjectiveOur aim was to compare and analyze the clinical efficacy of laparoscopic and open splenectomy plus selective pericardial devascularization for portal hypertension,and to explore the criteria and optimization of operation.MethodFrom December 2015 to December 2017,the clinical data of58 cases of cirrhotic portal hypertension treated by operation were analyzed retrospectively in the hepatological surgery department of the first hospital of Jilin university.They were divided into two groups(laparoscopic group and open group),including 35 cases of laparoscopic group and 23 cases of laparotomy group.To contrast and analyze the clinical data of two patients before operation(age,gender,etiology,albumin(ALB),prothrombin time,total bilirubin(TBIL),Child classification of liver function,alanine aminotransferase(ALT),cholinesterase(CHE),white blood cell(WBC),red blood cell(RBC),hemoglobin(Hb)and platelet(PLT),portal vein diameter,spleen diameter)and intraoperative clinical data(operation time and intraoperative bleeding volume)and postoperative clinical data(gastrointestinal function recoverytime,postoperativehospitalizationtime,postoperative first day peritoneal drainage,abdominal cavity drainage tube pulled out of time,total hospitalization the cost of data)and the occurrence of complications(bleeding,pancreatic fistula,portal vein thrombosis,gastroparesis,incision infection,pleural effusion and ascites).T test was used among the data groups,and X~2 test was used among the count data groups,and the SPSS23.0 software was used for statistical processing.ResultsCompared with the two groups,the operation time of the laparoscopic group was 220.77±59.07min,and the intraoperative bleeding was 311.06±224.62ml.The operation time of the open group was 136.83±51.05min,and the amount of bleeding during the operation was 219.57±133.09ml.Compared with the open group,the laparoscopic group was slightly longer than the open group in the operation time,and the difference between the two groups was statistically significant(P<0.01).There was no significant difference in the amount of bleeding between the two groups(P>0.05).The recovery time of gastrointestinal function in laparoscopic group was 2.97±0.79d,and the recovery time of gastrointestinal function in open group was 3.86±1.18d.The recovery time of gastrointestinal function in laparoscopic group was shorter than that in open group,and the difference was statistically significant(P<0.05).Intermsofpostoperative hospitalization time,the laparoscopic group was 7.89±1.30d,and the open group was 9.74±3.98d.The time of hospitalization in the laparoscopic group was shorter than that in the open group,and the difference was statistically significant(P<0.05).The peritoneal drainage was 112.71±107.42ml in the first day after laparoscopic surgery and 94.35±60.96ml in the open group.The difference between the two groups was not statistically significant(P>0.05).In the extraction time of abdominal drainage tube,the laparoscopic group was 4.37±1.52d,and the open group was 5.13±1.82d.The difference between the two groups was not statistically significant(P>0.05).The total cost of hospitalization in the laparoscopic group was 79973.49±19688.96 yuan,and the total cost of hospitalization in the open group was 71475.74±17172.41 yuan,and the difference between the two groups was not statistically significant(P>0.05).There was no significant difference in postoperative complications between the two groups(P>0.05).ConclusionWith the continuous upgrading of surgical instruments and continuous improvement of the level of surgeons and more wide laparoscopic surgical indications,laparoscopic splenectomy and selective pericardial devascularization with small trauma,quick recovery,less complications advantages,to strictly grasp the indications on the basis,it is worthy of clinical promotion. |
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