Intraoperative obeservation of laparoscopic splenectomy assisted with splenic artery embolization in patients with hypersplenism secondary to portal hypertension and splenomegaly

Abstract

Objective To discuss introperative value of laparoscopic splenectomy (LS) treatment assisted with preoperative splenic artery embolization (SAE) in the patients with the hypersplenism secondary to portal hypertension and splenomegaly. Methods The clinical data of 38 patients with the hypersplenism secondary to portal hypertension and splenomegaly admitted to the First People′s Hospital of Wenling from April 2015 to April 2018 were analyzed. Among them, 21 patients underwent LS alone (alone group) and 17 patients underwent LS assisted with preoperative SAE (combined group). Including length of the spleen and liver function Child-Pugh grade, operative time, blood transfusion rate, intraoperative blood loss, intraoperative blood transfusion volume and conversion rate were compared between two groups. Then the clinical value of LS treatment assisted with preoperative splenic artery embolization was discussed. Results The splenic volume of combined group was significantly reduced after SAE: (627 ± 195) cm3 vs. (998 ± 251) cm3, P<0.05. The conversion rate was 23.8%(5/21) in alone group, while no patient required open surgery in the combined group. Compared with that in alone group, operative time of the combined group was shorter [(143 ± 27) min vs. (189 ± 33) min], the blood loss volume was less [(155 ± 49) ml vs. (302 ± 76) ml)], and the differences were statistically significant (P<0.05). The blood transfusion rates of combined group was lower [2/17 vs. 33.3% (7/21)], and intraoperative blood transfusion volume was less [(192 ± 42) ml vs. (399 ± 87) ml]. The differences were statistically significant (P<0.05). Conclusions LS treatment assisted with preoperative SAE has some advantages, such as shorter operative time, lower surgical laparotomy rate, less intraoperative blood transfusion, less bleeding and shorter length of stay. Key words: Splenectomy laparoscopic; Splenic artery embolization; Hypersplenism; Comparative study