Abstract
Objective To investigate the feasibility and safety, and short-term therapeutic effect of laparoscopic azygoportal disconnection without splenectomy for cirrhotic portal hypertension (PLT count>50×109/L). Methods Clinical data of 48 patients with bleeding portal hypertension and secondary hypersplenism (PLT count>50×109/L) undergoing laparoscopic splenectomy and azygoportal disconnection (LSD, n=26) vs. laparoscopic azygoportal disconnection (LD, n=22) between January 2014 and August 2015 were analyzed. Results Operative time (82±29) min, intraoperative blood loss 20(10-50) ml, days of postoperative fever 0(0-3) d, rate of postoperative fever 10/22, postoperative hospital stay (7.0±1.3) d, and WBC counts (3.8±1.6)×109/L, PLT counts 64(49-88)×109/L, and the incidence of portal vein thrombosis on POD 7(14%), were significantly less in LD group than in LSD group [(180±41) min, 80(20-500) ml, 2(0-4) d, (22/26), (10.8±3.0) d, (9.1±3.1)×109/L, 156(78-630)×109/L, (42%)], (t=9.637, Z=-4.746, Z=-2.314, χ2=8.224, t=5.794, t=7.785, Z=-5.508, χ2=4.742, all P<0.05). Immune function was better in LD group than in splenectomy group at postoperative month 3. The serum proportion of CD4+ (58±11) and the CD4+ /CD8+ ratio (1.9±0.7) at postoperative month 3 were significantly higher after LD than after LSD [(43±14), (1.2±0.9)], (t=-3.755, t=-2.509, all P<0.05). Conclusion Laparoscopic azygoportal disconnection without splenectomy is safe and effective for esophagogastric variceal hemorrhage and moderate hypersplenism (PLT>50×109/L) secondary to portal hypertension. Key words: Hypertension, portal; Splenectomy; Laparoscopes
Published Version
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