Vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection / 中华普通外科杂志

ABSTRACT

Objective To investigate the clinical safety and value of vagus nerve-preserving versus conventional laparoscopic splenectomy and azygoportal disconnection.Methods A total of 60 cirrhotic patients with bleeding portal hypertension undergoing modified laparoscopic splenectomy and azygoportal disconnection between Apr 2015 and Sep 2016 were retrospectively analyzed.Patients were divided into nonvagus nerve-preserving (n =37) and vagus nerve-preserving group (n =23).Results Operative time (169 ± 42) min,and incidences of postoperative complications (102/370),delayed gastric emptying (35/37),epigastric fullness (22/37),diarrhea (26/37) in non-vagus nerve-preserving group were all more than those in vagus nerve-preserving group [(147 ± 21) min,(21/230),(2/23),(2/23),(2/23)] (t =2.684,x2 =29.583,44.272,15.229,21.606,all P ＜ 0.05).There was no significant between-group difference in body weight at admission and on postoperative day 7 (POD 7) between the two groups.However,body weight in vagus nerve-preserving group was significantly higher on postoperative 6 month (POM) compared with that in non-vagus nerve-preserving group [(63 ± 10) kg vs.(70 ± 12) kg,t =2.546,P ＜ 0.05].There was no significant between-group difference in ALB levels at admission and on POD 7 between the two groups.However,ALB levels in vagus nerve-preserving group at POM 6 were significantly higher than those in non-vagus nerve-preserving group [(42 ±6) g/L vs.(46 ±5) g/L,t =-2.607,P ＜ 0.05].Conclusion Vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection for cirrhotic portal hypertension is safe,feasible and with good therapeutic effect.