Abstract: Objective:To investigate the clinical value of autologous blood transfusion in the modified laparoscopic splenectomy plus pericardial devascularization.
Methods:The clinical data of 77 patients with liver cirrhosis and portal hypertension who were admitted to the Clinical Medical College of Yangzhou University between January 2012 and December 2013 were retrospectively analyzed. All the 77 patients underwent modified laparoscopic splenectomy plus pericardial devascularization, including 31 patients receiving autologous blood transfusion (autologous blood transfusion group) and 46 patients receiving nonautologous blood transfusion (nonautologous blood transfusion group)．Intra and postoperative clinical parameters were compared between the 2 groups. All patients were followed up till June 2014 by outpatient examination, and the electronic gastroscopy, routine blood test and liver function test were carried out. The measurement data with the normal distribution were presented as ±s and analyzed by the t test, count data were analyzed using the t test and the chisquare test.
Results:The level of hemogglobin (Hb) of the autologous blood transfusion group was (118±16)g/L at postoperative day 1, which was significantly higher than (106±16)g/L before operation, the level of Hb of the nonautologous blood transfusion group was (103±16)g/L at postoperative day 1, which was significantly lower than (113±15)g/L before operation, showing a significant difference (t=-11.889, 10.201, P<0.05). Eleven patients had postoperative fever in the autologous blood transfusion group, which was significantly more than 7 patients in the nonautologous blood transfusion group. The duration of postoperative fever in the autologous blood transfusion group was (3.0±2.3)days, which was significant different from (3.8±2.9)days in the nonautologous blood transfusion group. The level of Hb of the autologous blood transfusion group at postoperative day 1 was significantly higher than that of the nonautologous blood transfusion group. There were significant differences in the above indexes between the 2 groups (χ²=4.247, t=2.210,-4.131, P<0.05). Pancreatic fistula occurred in 1 patient in the autologous blood transfusion group and 1 in the nonautologous blood transfusion group, and they were cured successfully by conservative treatment. No patient died perioperatively and no occurence of infection and bleedingralated complications. All the 72 patients were followed up for 6 to 27 months (median, 16 months) with the rate of followup of 93.5%(72/77). All the 72 patients were confirmed with a significant decreasing or disapearing of esophagogastric varices by electronic gastroscopy at postoperative month 3, and were recovered by the retest of routine blood and liver function.
Conclusion:Autologous blood transfusion in the modified laparoscopic splenectomy plus pericardial devascularization is safe and feasible, with the advantages of improving of Hb level, reducing of the cases of fever and shortening of the durations of fever after operation.