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Background and purpose:Cirrhosis is the late stage of kinds of chronic liver diseases. Surgical treatment to cirrhosis includes liver transplantation, portal vein devascularization or shunt and so on. But they are mostly open surgery, with more trauma, slower recovery and more complications. With the development of laparoscopic technique, laparoscopic splenectomy is gradually applied to hypersplenism caused by portal hypertension in patients with liver cirrhosis, which makes treatment of hypersplenism to be minimally invasive treatment. This article focuses on clinical evaluation of laparoscopic splenectomy for hypersplenism caused by portal hypertension in patients with liver cirrhosis.Method:Use query system of The first Affiliated Hospital of Jilin University to collect medical record(which accepted laparoscopic splenectomy due to hypersplenism caused by portal hypertension and liver cirrhosis) from February 1,2008 to February 1,2011.All data includes 40 cases, including 21 cases of laparoscopic splenectomy(LS) and 19 of open splenectomy(OS). Through retrospective analysis and comparison between the clinical indicators (operation time, blood loss, complication rate, etc.), changes of routine blood test, liver function, renal function and drainage fluid amylase, the study carry out the clinical evaluation of laparoscopic splenectomy for hypersplenism caused by portal hypertension in patients with liver cirrhosis.Results:1. Clinical parameters:laparoscopic group and open group of extubation time was (4.71±1.62) days, (6.74±2.42) days respectively, which had statistically significant, P <0.01 (Figure 4.1); postoperative hospital stay was (7.86±1.39) days, (10.00±1.94) days, which also have statistically significant, P<0.01 (Figure 4.1); operation time, blood loss, blood transfusion, postoperative fasting time, hospital costs were not statistically significant; LS postoperative complication rate was 19.0%, including 1 case of ascites,1 case of abdominal bleeding,1 case of pleural effusion,1 case of portal vein thrombosis; OS postoperative complication rate was 36.8%, including 1 case of ascites,1 case of pleural effusion,4 cases of ascites associated with pleural effusion,1 case of portal vein thrombosis, they were not statistically significant;2. Routine blood test:laparoscopic group and open group of white blood cells were increased compared with that before surgery, and was statistically significant (P<0.05), and white blood cells of OS after operation increased more significantly compared with LS group, they were statistically significant (P<0.05); platelets of two groups were both increased compared with that before surgery, and was statistically significant (P<0.05), but there was no significant difference between them; hemoglobin of two groups after operation had no significant difference compared with that before surgery, but there was significant difference in hemoglobin between them in 6-8 days and 1-2 after operation (P<0.05);3. Liver function:ALT of LS group decreased compared with that before surgery, and was statistically significant (P<0.05), ALT of OS group in 1-2 days after operation was higher than that before surgery, but with no statistically significant changes. There was no significant difference between two groups in ALT; AST of LS in 3-5 days after operation decreased, with statistical significance (P<0.05), AST of OS in 1-2 days after operation was higher than that before surgery, but with no statistically significant changes. There was no significant difference between two groups in AST; ALP of LS group and OS group decreased after surgery compared with the preoperative ALP, and was statistically significant (P<0.05), but with no significant changes between them; GGT of LS group and OS group in 1-2 days were lower than that before surgery, and was statistically significant (P<0.05), between the two groups was no significant difference; ALB and CHE of LS group and OS group compared with the preoperative ALB and CHE decreased, except CHE of OS in 1-2 days after operation, the other were statistically significant compared with that before surgery (P <0.05), and ALB of two groups in 3-5 days increased, while CHE continued to decrease. ALB and CHE of two groups was no significant difference in change; TBIL of LS group and OS group in 1-2 days after surgery increased than before surgery, but with no statistical significance, there were significantly different between the two groups before and after surgery in TBIL(P<0.05); LS group and OS group compared with the preoperative patients increased DBIL, where LS group was statistically significant compared with tnat before surgery; the two groups before surgery have significant difference (P<0.05), while no significant difference in change after surgery; postoperative and preoperative IBIL of LS group and OS group have no statistical significance, while there was significant variation between them (P<0.05); 4. Renal function and drainage fluid amylase comparison:LS group was reduced compared with the preoperative blood urea nitrogen, and was statistically significant (P <0.05), OS group were higher than the preoperative blood urea nitrogen, but no statistically significant changes, between the two groups had significant differences; creatinine and drainage fluid amylase of the two groups before and after surgery had no significant change, so was between the two groups.Conclusion:1. LS is safe, effective and feasible for hypersplenism caused by portal hypertension in patients with liver cirrhosis;2. For patients with hypersplenism due to cirrhosis, LS compared with OS has the advantages of minimally invasive, less trauma for patients, less effect on liver function, nearly no effects on renal function, less postoperative extubation time and postoperative hospital stay time.3. This paper is retrospective comparative studies, which needs prospective studies and animal model experiments to confirm in the future.Keywords:Cirrhosis, portal hypertension, hypersplenism, laparoscopic splenectomy, clinical evaluation
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