ABSTRACT
Objective To study the impact of surgical teamwork in totally laparoscopic splenectomy and pericardial devascularization (LSPD) in the treatment of portal hypertension,and advice on technical hints.Methods A retrospective study was conducted on the clinical features of eighty-four patients who underwent totally laparoscopic splenectomy and pericardial devascularization in the Second Affiliated Hospital of Kun Ming Medical University from January,2014 to December,2017.Results Totally laparoscopic procedures were performed successfully in 80 patients.The procedure was converted to hand-assisted laparoscopic splenectomy and pericardial devascularization in 3 patients because of uncontrollable bleeding.One patient who initially underwent laparoscopic cholecystectomy developed an intraoperative blood loss of 1 500 ml.The surgery was terminated and was continued one week later after stabilization of the patient.Of the 80 patients who underwent totally LSPD,the operation time ranged from 116.0 to 243.0 (146.0 ± 33.0) min.The intraoperative blood loss ranged from 60.0 to 600.0 (214.0 ± 31.0) ml.Routine coagulation function and portal vein color Doppler ultrasound examination carried out within 3 months after surgery detected postoperative portal vein thrombosis in four patients.They responded successfully to antiplatelet and anticoagulant therapy.There were no perioperative deaths,variceal bleeding,gastrointestinal fistula and infection.Conclusions With proper surgical steps and skilled laparoscopic technique carried out by an experienced team of surgeons,totally laparoscopic splenectomy and pericardial devascularization was safe and effective in treating portal hypertension.Strict perioperative management provided a guarantee for the safe operation.
ABSTRACT
Objective To investigate the clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization.Methods The retrospective cross-sectional descriptive study was adopted.The clinical data of 64 patients who underwent laparoscopic splenectomy combined with pericardial devascularization at the Second Affiliated Hospital of Kunming Medical University from April 2012 to June 2015 were collected.Observed indexes included (1) treatment outcomes,including surgical procedures,operation time,volume of intraoperative blood loss,time of postoperative enteral recovery,time of postoperative drainage tube removal,duration of postoperative hospital stay,occurrence of complications,(2) follow-up situation.The follow-up using reexaminations of blood routine,liver function,coagulation function,gastroscopy and color Doppler ultrasonography of portal vein was performed regularly at postoperative month 1,2,3,6,12,24 until reemergence of gastrointestinal hemorrhage.The final deadline was death of patients and performance of liver transplantation.Measurement data with normal distribution were presented as-x ± s.Results (1) Treatment outcomes:of 64 patients,62 underwent total laparoscopic splenectomy combined with pericardial devascularization successfully.One patient was transffered to hand-assisted laparoscopic splenectomy combined with pericardial devascularization due to uncontrollable hemorrhage.One patient received laparoscopic cholecystectomy firstly with volume of blood loss of about 1 500 mL and terminated surgery after infusion of suspension red blood cells of 6 U and plasma of 900 mL,and underwent laparoscopic splenectomy combined with pericardial devascularization again next week.No postoperative hemorrhage,pancreatic leakage or death occurred during the perioperative period.The operation time,volume of intraoperative blood loss,time of postoperative enteral recovery,time of postoperative drainage tube removal and duration of postoperative hospital stay were (146 ± 33) minutes,(214 ± 31) mL,(24 ± 4) hours,7 days and (14 ± 6) days,respectively.Nine patients had postoperative pleural effusion and recovered after thoracic drainage and thoracentesis.(2) Follow-up situation:All the 64 patients were followed up for an average time of 19.7 months (range,3.0-23.0 months).Reexamination of gastroscopy showed improvement of varicosed veins of lower esophagus and fundus of stomach.During the postoperative 3 months,4 patients had portal vein thrombosis with level of PLT ＞ 700 × 109/L.For patients with D-Dimer ＞ 5,low molecular weight heparin of 0.4 U was injected subcutaneously until D-Dimer ＜ 2.Three patients were loss to follow-up at postoperative month 6 without upper gastrointestinal hemorrhage,hepatic encephalopathy or liver failure.Conclusion Laparoscopic splenectomy combined with pericardial devascularization is safe and effective for portal hypertension,and rigorous perioperative management offers guarantee for surgical safety.