Clinical efficacy of total laparoscopic splenectomy for portal hypertension and its influence on hepatic hemodynamics and liver function  

作　　者：Rui-Zhao Qi Zhi-Wei Li Zheng-Yao Chang Wei-Hua Chang Wen-Lei Zhao Chuan Pang Ying Zhang Xing-Long Hu Feng Liang 

机构地区：[1]Department of General Surgery,5th Medical Center,Chinese PLA General Hospital,Beijing 100039,China [2]Department of Hepatobiliary,The 3rd People’s Hospital of Shenzhen,Shenzhen 518112,Guangdong Province,China

出　　处：《World Journal of Gastrointestinal Surgery》2023年第8期1684-1692,共9页世界胃肠外科杂志（英文版）（电子版）

基　　金：The study was reviewed and approved by the Chinese PLA General Hospital Institutional Review Board(Approval No.2010068D).

摘　　要：BACKGROUND The liver hemodynamic changes caused by portal hypertension(PH)are closely related to various complications such as gastroesophageal varices and portosystemic shunts,which may lead to adverse clinical outcomes in these patients,so it is of great clinical significance to find treatment strategies with favorable clinical efficacy and low risk of complications.AIM To study the clinical efficacy of total laparoscopic splenectomy(TLS)for PH and its influence on hepatic hemodynamics and liver function.METHODS Among the 199 PH patients selected from October 2016 to October 2020,100 patients[observation group(OG)]were treated with TLS,while the remaining 99[reference group(RG)]were treated with open splenectomy(OS).We observed and compared the clinical efficacy,operation indexes[operative time(OT)and intraoperative bleeding volume],safety(intraperitoneal hemorrhage,ascitic fluid infection,eating disorders,liver insufficiency,and perioperative death),hepatic hemodynamics(diameter,velocity,and flow volume of the portal vein system),and liver function[serum alanine aminotransferase(ALT),serum aspartate aminotransferase(AST),and serum total bilirubin(TBil)]of the two groups.RESULTS The OT was significantly longer and intraoperative bleeding volume was significantly lesser in the OG than in the RG.Additionally,the overall response rate,postoperative complications rate,and liver function indexes(ALT,AST,and TBil)did not differ significantly between the OG and RG.The hepatic hemodynamics statistics showed that the pre-and postoperative blood vessel diameters in the two cohorts did not differ statistically.Although the postoperative blood velocity and flow volume reduced significantly when compared with the preoperative values,there were no significant inter-group differences.CONCLUSION TLS contributes to comparable clinical efficacy,safety,hepatic hemodynamics,and liver function as those of OS in treating PH,with a longer OT but lesser intraoperative blood loss.

关 键 词：Total laparoscopic splenectomy Open splenectomy Portal hypertension Clinical efficacy Hepatic hemodynamics and liver function 

分 类 号：R656.61[医药卫生—外科学]