Clinical application of laparoscopic splenectomy combined with devascularization in megalosplenia and portal hypertension / 国际外科学杂志

ABSTRACT

Objective:To investigate the clinical application and efficacy of laparoscopic splenectomy combined with disconnection in megalosplenia and portal hypertension.Methods:The clinical data of 58 patients with splenomegaly of portal hypertension treated in the Department of Hepatobiliary and Pancreatic Surgery of Huangshi Central Hospital of Eastern Hubei Medical Group from January 2016 to January 2020 were analyzed retrospectively, they were divided into laparoscopy group ( n=34) and laparotomy group ( n=24), Laparoscopic splenectomy combined with devascularization was performed in the laparoscopic group, and open splenectomy combined with devascularization was performed in the open group.The general data, operation time, intraoperative bleeding, postoperative exhaust time, postoperative hospital stay and the incidence of postoperative complications (abdominal bleeding, B/C pancreatic leakage, abdominal infection, etc.) were compared between the two groups. The measurement data obeying normal distribution was expressed by mean±standard deviation ( Mean± SD), and the t test was used comparison between groups, and the chi-square test or Fisher exact probability was used comparison between enumeration data. Results:The surgery was successful in both two groups. 2 cases in the laparoscopic group were converted to laparotomy, There was no death in perioperative period.The operation time of laparoscopy group was (205.3±28.6) min and that of laparotomy group was (156.4±20.7) min, which was significantly longer than that of laparotomy group ( P=0.012). The intraoperative bleeding volume of laparotomy group was (327.2±39.5) mL, which was significantly higher than that of laparoscopy group (246.5±32.3) mL. there was significant difference between the two groups ( P<0.05). The postoperative exhaust time and postoperative hospital stay in the laparoscopic group were (2.6±1.4) d and (9.7±2.3) d, the laparotomy group were (3.8±1.5) d and (12.9±2.7) d respectively. The laparoscopy group was shorter than the laparotomy group. The difference between the two groups was statistically significant ( P<0.05). There were 0 case of abdominal bleeding, 2 cases of B/C pancreatic leakage and 3 cases of abdominal infection in the laparoscopic group, 1 case of abdominal bleeding, 2 cases of B/C pancreatic leakage and 5 cases of abdominal infection in the open group. The incidence of postoperative complications in the laparoscopic group was lower than that in the open group, but there was no significant difference between the two groups( χ2=2.807, P=0.088). Conclusions:Laparoscopic splenectomy combined with devasculation is safe and feasible, with advantages such as little trauma, quick recovery of postoperative intestinal function and short hospital stay, which benefit patients. However, the operation is difficult and requires high technical and psychological quality of surgeons.