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Study the background of portal hypertension (Portal hypertension, PHT) is still in the current of common clinical syndrome, its incidence is higher and more difficult to deal with higher mortality [1]. For the treatment of portal hypertension drugs, endoscopic, interventional therapy, surgery including liver transplantation, there had been great progress, especially interventional treatment such as transjugular intrahepatic portosystemic shunt (transjugular intrahepatic portosystemic shunt, TIPS) and splenic artery embolization (splenic artery embolization, SAE). The surgical treatment of portal hypertension is the prevention and control of esophageal and gastric variceal bleeding, the main method portosystemic shunt (including selective portosystemic shunt and non-selective portosystemic shunt) and door devascularization. way [3]. More severe hepatic dysfunction due to cirrhosis and portal hypertension patients themselves, poor clotting function, immune function and stress ability, any kind of surgery on patients who are burden, and even lead to the failure of liver function [4]. Especially traditional open surgery, there is damage combat, long recovery time, wound healing, the poor and other shortcomings, more needs to carefully grasp the indications for surgery. With the rapid development of laparoscopic techniques and equipment innovation, expanding the scope of its application, laparoscopy for the treatment of liver cirrhosis and portal hypertension provide a new treatment. The world's first laparoscopic splenectomy (1aparoscopics splenectomy, LS) Delaitre B [5] In 1991, the successful application of Lisbon Royal Hospital in Australia. The first case LS 309 hospitals in 1994 to succeed [6]. Currently has some hospitals line the laparoscopic splenectomy Minch devascularization. However, due to the difficulty of the establishment of pneumoperitoneum and instrumentation, sometimes time surgery takes longer even need another to take a small incision to complete the surgery. Compared with the traditional open surgery really there are differences in trauma and recovery of the body, and whether it has truly minimally invasive surgery immune how aspects of the present study was small, further clinical studies are needed to confirm that. Objective: To compare the analysis of differences in the clinical application of laparoscopic splenectomy plus esophageal devascularization and open surgery of peripheral vascular segment, and explore their impact on immune function and trauma response better guide clinical treatment. Methods: From December 2007 to January 2010 in our hospital diagnosed with cirrhosis and portal hypertension and associated hypersplenism, esophageal varices line of splenectomy plus door azygos vein Devascularization, 60 cases of patients clinical data, including laparotomy 30 cases, 30 cases of laparoscopic surgery. The laparoscopic group BOC laparoscopic surgery in 14 cases, 16 cases of hand-assisted laparoscopic, laparotomy neither. Pugh, spleen size, operative time, complications, length of stay to collect relevant information. And detect their preoperative and postoperative day 1, three days, five days IL-6, CRP, TNF-α level in peripheral blood. Collection of relevant data, comparative analysis of the two groups in the preoperative, perioperative, postoperative complications, costs, and immune trauma. Results: laparoscopic surgery and open surgery LS group were a little longer (p lt; 0.05), significantly reduced blood loss, postoperative exhaust time, bed time and length of hospital stay was significantly shorter (p lt; 0.05). LS group of post-operative complications, such as pancreatic fistula, pulmonary infection, wound infection rate than the OS group no significant difference (p gt; 0.05). The LS group cost of surgery was no significant difference (p gt; 0.05) than the OS group. Two surgical CRP, TNF-α and IL-6 indicators in the first postoperative day, three days, five days compared with preoperative increased (P lt; 0.01), indicating that surgery on the body impact. Between the two groups, the OS group after one day, three days, five days was significantly higher than the LS group (P lt; 0.01), show that the the LS groups on the body to produce lighter traumatic inflammation and immune dysfunction. more conducive to the recovery of immune function. Conclusion: laparoscopic splenectomy plus esophageal around and vascular devascularization is safe, feasible and efficacy than open surgery on immune lighter founding inflammatory response and immune dysfunction, laparoscopic surgical trauma reaction, less interference with immune function, rapid postoperative recovery.
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