Clinical Control Study Of Tunnel-building In-situ Laparoscopic Splenectomy Compared With Conventional Laparoscopic Splenectomy

Objective:To compare the safety and feasibility of tunnel-building in-situ laparoscopic splenectomy(TLS)and conventional laparoscopic splenectomy(CLS),and to summarize the key points of operation and clinical experience.Methods : 1)The clinical data of 150 patients undergoing laparoscopic splenectomy from January 2016 to October 2019 in the Second Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.According to the operation method,91 cases were divided into tunnel-building in-situ laparoscopic splenectomy group(TLS group)and 59 cases were divided into conventional laparoscopic splenectomy group(CLS group).The general data and perioperative related indexes of the two groups of patients were compared and analysis,to evaluate the safety and advantages of different surgical methods.2)Subgroup analysis were carried out on whether the cause is liver cirrhosis,to compare the clinical effects of tunnel-building in-situ laparoscopicsplenectomy in different diseases.Results : The baseline data of the two groups were comparable(P>0.05).Compared with CLS group,the operation time of TLS group was significantly shortened(74.40 ± 18.68 vs 84.24 ± 20.88 min,p=0.003),and the intraoperative blood loss was significantly reduced(130.33± 84.95 vs 178.81± 107.32 ml,p=0.003).There was no significant difference between the two groups in blood transfusion rate,operation conversion rate,postoperative pain degree,drainage time,postoperative hospital stay and complication rate(P>0.05).There were no deaths in this study.Subgroup analysis showed that the average operation time and blood loss of TLS group in liver cirrhosis subgroup were respectively(82.35±15.11)min and(152.35±92.62)ml,which was significantly lower than CLS group(P<0.05).However,in the non-cirrhosis subgroup,there is no significant difference between the two groups in comparing various perioperative indexes.(P>0.05)Conclusions :Compared with CLS,TLS is also safe and feasible.But TLS has shorter operation time and less intraoperative bleeding,especially for patients with cirrhosis,which is a minimally invasive operation worthy of promotion.