Objective:To investigate the clinical effect of totally laparoscopic three-step procedure in splenectomy for portal hypertension.Methods:Retrospective analysis of the clinical data of 50 patients with hepatitis b cirrhosis of the portal hyperten-sion were selected and divided into study group(group A)and control group(group B)according to different surgical plans,in-cluding 20 in group A,with a complete laparoscopy of the three steps to remove the macrospleen,the group B had 30 cases,and the spleen was removed by laparoscopic spleen.The operation methods,operation time of splenectomy,intraoperative blood loss,specimen weight,postoperative blood loss,hospital stay,postoperative complications,autologous blood recovery rate,spare foreign blood transfusion rate and laparoscopic conversion rate were compared between the two groups.Results:All operations were completed successfully.Compared with group B,the operation time of splenectomy in group A was shorter(P＜0.05).The intraoperative blood loss in group A was reduced(P＜0.05).There were no significant differences in laparoscopic conver-sion rate,exogenous blood transfusion rate,postoperative complication rate,and specimen weight between the two groups(P＞0.05).The autologous blood recovery rate,postoperative blood loss and length of hospital stay in group A were lower than those in group B(P＜0.05).Conclusion:Laparoscopic secondary splenic pedicle vascular disconnection for splenomegaly has the advantages of high risk of intraoperative bleeding,long operation time and technical difficulty.The total laparoscopic three-step approach is simpler,shorter operation time,less intraoperative blood loss,fewer complications,and has good clinical therapeutic effect.