The Efficacy Evaluation Of Splenectomy And Pericardial Devascularization For Treatment Of Portal Hypertension

Objective: To evaluate the efficacy and review our experience of splenectomy and pericardial devascularization for treatment of portal hypertension.Methods: The clinical data of 242 cases with portal hypertension after splenectomy and pericardial devascularization performed by our department were reviewed retrospectively. The mortality were reviewed with a statistical analysis by using the SPSS 17.0 software and the Chi-square test or the Fisher probabilities in 2×2 table.Results: All the 242 patients were operated. Twenty patients were performed by Emergency operation, and 190 patients by elective operation,32 patients by prevent operation. There were 210 cases with a bleeding history, including hematemesis, black stool or both. The total hemostasis rate was 96.19%(202/210),and the perioperative mortality was 5.37%(13/242).The main causes of death were upper gastrointestinal bleeding, shock due to intraabdominal hemorrhage, hepatic failure. The mortality of patients with grade B Liver function in emergency and elective surgery had no statistically significant different(P>0.05);The mortality of patients with grade C liver function in emergency were higher than in the elective(P<0.01);The mortality contrast of the emergency operation in the different liver function,grade A had no death,the mortality of grade C were higher than that of the grade B(P<0.01);The mortality contrast of the elective operation in the different liver function, grade A had no death, the mortality of grade C were higher than that of the grade B(P<0.01);the mortality of grade C liver function were higher than that of the grade B(P<0.01).Conclusion:1.Splenectomy and pericardial devascularization is the preferred operation for treatment of portal hypertension,which has a well hemostasis rate and obvious recent efficacy.2.Reasonable operation time and choice indication,totally porto-azygos disconnection are the important measures to improve the efficacy.Patients with liver function of grade A or B have high success rate in emergency operationPatients have no bleeding history previous,but have high-risk at risk of bleeding,preventive surgery is feasible;4.How to treat the Upper Gastrointestinal rebleeding after operation? Do not operate blindly.