| Objective: The clinical data of two groups of patients with hypersplenism caused by portal hypertension were collected,sorted and counted by laparoscopic splenectomy and open splenectomy.To compare and analyze the difference of clinical application between laparoscopic splenectomy and open surgery in the treatment of hypersplenism of portal hypertension,and to provide certain guiding significance for clinical laparoscopic surgery in the treatment of hypersplenism of portal hypertension.Methods: From January 2014 to December 2017,a total of 59 patients with the diagnosis of liver cirrhosis,portal hypertension and hyperspleenism underwent spleenectomy in the Second Hospital of Jilin University.Out of 59 patients,30 received open spleenectomy whereas remaining 29 patients received laparoscopic spleenectomy.Laparotomy was performed in 2 of those laparoscopic splenectomy patients because of uncontrolled haemorrhage.Relevant data of each patient such as type of hepatitis,liver function tests,size of spleen,operation time,post operative complications,operation cost was collected and analyzed statistically.Results: Of the analyzed 27 cases who received laparoscopic splenectomy(LS),there was 16 male and 11 female patients with the median age of 51.96±6.43 years.26 patients had hepatitis B induced liver cirrhosis,1 patient had hepatitis C induced liver cirrhosis.15 patients were classified as Child-Pugh A and 12 patients were Child-Pugh B.In the operative splenectomy(OS)group,18 were male and 12 were female with the median age of 52.43±6.43 years.26 patients had hepatitis B induced liver cirrhosis,4 had hepatitis C induced cirrhosis.15 were classified as child-pugh A and 15 were classified as child-pugh B.The diameter of the spleen was 16.84±1.37 cm in LS group while it was 17.04±1.60 cm in the operative group(p=0.611)respectively.The average operative time was 210.56 ± 33.41 min in the LS group whereas it was 124.00 ± 28.99 min in OS group(p<0.001)respectively.the intraoperative bleeding volume was 249.63 ± 51.25 ml in the LS group whereas it was 471.00 ± 152.07 ml in OS group(p<0.001)respectively.The overall hospital stay was 7 days(7-9)in LS group vs 13.5 days(10-16)in OS group(p<0.001)respectively.Postoperative gastrointestinal function recovery time was 3(3-4)days in LS group whereas it was 5(3-5)days in OS group(p=0.003).The drain was removed in 6(5-7)days in LS group where as it was removed in 10(7.75-10)days in OS group(p<0.001).The total cost from the time of admission to discharge was 73609.48 ± 5502.674 yuan in LS group and 64807.62 ± 10860.206 yuan in OS group(P=0.015).In postoperative period,1 patient had pleural effusion and 1 patient had portal veous thrombosis in LS group with complication rate of 7.4%.In OS group,4 patients had pleural and peritoneal effusion,3 had pulmonary infection,1 had portal venous thrombosis and 1 had splenic fever with total complication rate of 36.7%(p=0.009).Conclusion: 1.Higher hospitalization cost and Longer operation time were noted in case of laparoscopic surgery group than operative surgery group but there was less intraoperative bleeding,earlier recovery of gastrointestinal function,shorter duration of hospital stay as well as lower incidence of complications in laparoscopic surgery group;2.Laparoscopic splenectomy is a complicated procedure with high grade,so surgeons need to be very experience to perform laparoscopic splenectomy.With the innovation of new equipments,surgeons also need to be more innovative.More and more splenectomy should be performed in carefully selected cases which will eventually help to shorten the operative time;3.Laparoscopic splenectomy is effective,safe and feasible.Laparoscopic splenectomy will gradually shorten the operation time and reduce the cost of hospitalization with the help of new instruments,good techniques and with the use in carefully selected cases in good and well established centers. |
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