The Application Analysis Of Three Kinds Of Surgical Treatments For Portal Hypertension

Objective1.Explore the feasibility and efficacy of the10cases of the modified left gastric venous caval shunttreatment for portal hypertension, And to provide clinical reference for the operation to further promoteimplementation.2.Comparison of efficacy and complications of45patients who underwent surgical treatment of differentsurgical treatment of portal hypertension in patients with, explore a reasonable surgical treatment of portalhypertension surgery.Methods:1. Collect10cases modified left gastric venous-caval shunt treatment of portal hypertension in patientswith clinical data, observation the intraoperative and postoperative free portal pressure value and changesin blood flow, and the results of postoperative recovery of liver function, anastomotic status andpostoperative complications, do the retrospective analysis.2.Collect the clinical data of45patients who accepted the surgery treatment for portal hypertension, inthe First Affilliated Hospital of Shihezi university from March2008to December2011.Amongthem,17patients were treated by modified Sugiura procedure, and were set to transection devascularizationgroup;18patients were treated by devascularization procedure,and were set to devascularizationgroup;10patients were treated by modified left gastric venous-caval shunt,and were set to LGCS group.Comparative analysis and summary of the three groups of gastroesophageal varices changes andcomplications.Results1.10cases were performed successfully, preoperative and postoperative free portal vein pressure differencehas significance(p<0.05), after splenectomy and shunt free portal vein pressure values were notsignificant(p>0.05), preoperative and postoperative blood flow change was statistically significant(p<0.05).After a month or so liver function gradually returned to normal, examination of postoperative portal veinCT imaging and color Doppler ultrasound, directly or indirectly proved8patients with anastomotic patency,2cases of anastomotic thrombosis. No hemorrhage and hepatic encephalopathy. Follow-up of6months to48months, average16months of follow-up, no lost and no death case.2.The complication rate in LGCS group was lower than that in group devascularization(p<0.01), Nostatistically significant difference compared with transection devascularization group (P>0.05).Devascularization group of2cases of death(11.76%), transection devascularization group of1case ofdeath(5.56%), LGCS group mortality was lower than the other two groupsï¼›Three groups of operationmode of preoperative and postoperative gastroesophageal varices difference had statisticalsignificance(p<0.001), three kinds of operation mode of gastroesophageal varices were significantlyinfluence,three groups of patients after the operation of esophageal and gastric varices are improved;*p<0.001for the devascularization group compared with transection devascularization group, thedifference was statistically significant;#p<0.001for the transection devascularization group compared withLGCS group, the difference was statistically significant;â–³p>0.05for the LGCS group compared withdevascularization group, The difference was not statistically significant.Conclusion:1. Modified left gastric venous-caval shunt operation is relatively simple, recent rebleedingprevention effect is satisfactory; Postoperative portal vein pressure can keep certain degree. Have smaller influence for portal vein blood flow and liver function. It may be one of the ways of the ideal surgicaltreatment for portal hypertension.2. Modified left gastric venous-caval shunt direct shunt blood flow ofgastric varices of esophagus into the inferior vena cava, Operation little trauma and less complications.Recent rebleeding prevention effect is good, the short-term survival rate is satifactory. Such as can beeffective in preventing postoperative thrombosis of vascular occlusion, it can achieve more satisfactoryresults, LGCS deserves further study and promotion.