Effect of laparoscopic splenectomy combined with pericardial devascularization on cirrhotic portal hypertension

Liu Xueqing; Wang Wenbin; Yan Changqing; Qin Jianzhang; Duan Jiayue; Wang Tianyang; Liu Jianhua

doi:10.3760/cma.j.issn.1673-4777.2018.02.018

Abstract：Objective To analyze the effect of laparoscopic splenectomy combined with pericardial devascularization on cirrhotic portal hypertension.Methods Fifty-six patients with cirrhotic portal hypertension from December 2013 to March 2016 in the Second Hospital of Hebei Medical University were enrolled.Operation data of laparoscopic splenectomy combined with pericardial devascularization were analyzed.Results All patients successfully completed operation;9 cases had transection of splenic pedicle by laparoscopic cut stapler (Endo-GIA) or ligation and clipping;2 cases of splenomegaly had hand-assisted laparoscopic surgery;45 cases had routine surgical procedures.The average operation time was (221 ± 36) min (150-330 min);the average bleeding loss was (347 ±202)ml (80-1 400 ml).All patients exhausted in 1-3 d and they were extubated in 3-5 d after operation;the average drainage volume was (204 ± 52)ml (100-400 ml).Twelve patients had ascites caused by low protein.No postoperative hemorrhage,incision infection,pancreatic leakage,gastric leakage,diaphragmatic pleural effusion and colonic injury occurred.Twenty-four patients lost follow-up.In 32 patients with complete follow-up data,postoperative 1,3,7 d platelet count were (45 ± 17) × 109/L,(157 ±42) × 109/L,(299 ±39) × 109/L respectively;hypersplenism gradually alleviated;the average postoperative hospital stay time was (9.0 ± 1.0) d (7-15 d).Four patients had portal venous thrombosis.No hematemesis,melena and death occurred after operation.Conclusion Laparoscopic splenectomy combined with pericardial devascularization is safe and effective in treatment of cirrhotic portal hypertension.