Optimize operation process and operation technique to reduce intraoperative and postoperative complications of laparoscopic splenectomy / 国际外科学杂志

ABSTRACT

Objective Laparoscopic splenectomy has become an effective method to treat the hypersplenism and splenomegaly caused by various diseases.Although laparoscopic technology is very mature at present,laparoscopic splenectomy is still associated with many complications.This study was based on the comparison of different processes and operation techniques of laparoscopic splenectomy,to summarize a more effective operation process and operation technique which can reduce the related complications of laparoscopic splenectomy.Methods The study reviewed the clinical data of 130 patients'who underwent laparoscopic splenectomy in our department from September 2015 to December 2017.According to different operation mode and operation technique these patients were divided into 6 groups.Operation process groups:group Ⅰ for arterial priority group (open the gastrocolic ligament and expose splenic artery,then dissociate ligament around the spleen,and finally divide from the spleen pedicel) had 73 cases;group 2 with the way of building a tunnel beneath spleen pedicel and dissecting spleen in situ had 57 cases.With regard to the way of breaking spleen pedicel:group 3 using stapler to break spleen's pedicel included 101 cases;group 4 using dissecting the secondary spleen pedicel included 29 cases.Whether blocking the splenic vein:group 5 whose splenic vein was not ligated had 95 cases;group 6 whose splenic vein was ligated coverd 35 cases.Analysis and comparison between groups about intraoperative and postoperative complications related to different groups were made.Measurement date were expressed as (-x ± s),t test was used for comparison between groups.Count data was expressed as rate(％),and chi-square test was used for comparison between groups.Results Group 2 has less blood loss [group 1:(356.0 ± 96.2) ml versus group 2:(220.9 ± 57.3) ml,P =0.016],shorter operation time [group 1:(156.0 ± 36) min versus group 2:(120.9 ± 55.4) min;P =0.038] and fewer complications [group 1:9.6％ (7/73) versus group 2:5.3％ (3/57);P =0.035].When compared with group 4,group 3 have more advantages in the intraoperative blood loss [group 3:(256.0 ± 85.1) ml versus group 4:(380.9 ± 107.3) ml;P=0.019],the operation time [group 3:(131.0±30.9) min versus group 4:(171.9 ±61.2) min;P=0.024],and the postoperative complications [group 3:6.95 ％ (7/101) versus group 4:10.3 ％ (3/29);P =0.048].When compared with group 5,group 6 has more advantages in the intraoperative blood loss [group 5:(250.0 ± 56.2) ml versus group 6:(320.9 ± 87.3) ml;P =0.012],the operation time [group 5:(136.0 ± 36.2) min versus group 6:(180.9 ± 57.3) min;P =0.013],and the postoperative complications [group 5:6.3％ (6/95) versus group 6:11.4％ (4/35);P=0.013].Conclusion Both the procedure of tunnel procedure in situ cutting spleen and the application of stapler can reduce the amount of bleeding,shorten the operation time,and reduce the occurrence of postoperative complications.The ligation of the splenic vein is not necessary because it increases the operation time,the risk of bleeding,and the occurrence of postoperative complications.