Postoperative complications of laparoscopic splenectomy in patients with portal hypertension / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the incidence rate and risk factors for the complications after laparoscopic splenectomy in patients with portal hypertension. MethodsThe clinical data of 83 patients with portal hypertension, who were admitted to our hospital and underwent laparoscopic splenectomy from June 2009 to December 2014, were analyzed retrospectively. The incidence rate of the complications was analyzed using the Clavien-Dindo classification system and the risk factors for the complications were analyzed using chi-square test and logistic regression method. ResultsThe incidence rate of postoperative complications was 24.10% (20/83). According to the Clavien-Dindo classification system, the numbers of patients with grade Ⅰ, Ⅱ, Ⅲ, Ⅳ, and Ⅴ complications were 5, 3, 10, 2, and 0, respectively. The patients undergoing total laparoscopic splenectomy had a significantly higher incidence rate of postoperative complications than those undergoing hand-assisted laparoscopic splenectomy (32.59% vs 15.00%, χ2=3.966, P=0.046). According to the univariate analysis, the Child-Pugh class, application of the hand-assisted device, gastroesophageal vein ligation, and American Society of Anesthesiologists (ASA) grade were all risks factors for the postoperative complications (all P＜0.05). Further analysis using multiple logistic regression illustrated that Child-Pugh class B and ASA grade Ⅲ were independent risk factors for the postoperative complications (OR=0.328, 95%CI 0.129~0.834, P＜0.05; OR=0.294, 95%CI 0.150~0.573, P＜0.05). ConclusionPatients with portal hypertension undergoing laparoscopic splenectomy have a high incidence of postoperative complications and the occurrence of the complications is closely associated with the Child-Pugh class and the ASA grade.