The Clinical Analysis Of Esophagofundostomy Combined With Devascularization For The Treatment Of Portal Hypertension

Objective By analyzing the effect of the esophagofundostomy combined with devascularizationand devascularization for the treatment of portal hypertension, to provide a referencesurgery method for thetreatment of portal hypertension.Methods Retrospectiveiy analysis the clinical data of patients with portal hypertension who underwent surgical treatment in our hospital from February 2009 to August 2013,including esophagofundostomy combined with devascularization group 30 cases(research group), devascularization group 56cases(control- group), all patients with routine splenectomy. patients in research group underwent esophagofundostomy,on the basis of splenectomy and devascularization.The esophagus was cut off by pouch pliers above 3 ~ 4 cm of the cardia,Implant the Stapler headend in the proximal of esophagus and purse string suture it for standby application.And then inserted the stapler from the distal ofthe broken end of the esophagus completed anastomose of the lower esophagus and fundus of stomach. The control group patients merely had devascularization,we cut off the vagus nerve regularly, To expose high esophageal and ectopic high esophageal branch,and incision the diaphragm ofesophageal hiatus. Support therapy included anti-inflammatory, antimicrobial acid, hemostatic, nutritional support and so on was gave after surgury,And closely monitored liver function,according to the situation of ascites and plasma albumin to give blood plasma,albumin and diuretics to prevention and treatment the hepatic encephalopathy; Closely monitored platelets, to prevent portal vein thrombosis. Results None of patients died after surgery; The comparation of postoperative serum bilirubin, albumin and blood platelet was no statistically significant(P > 0.05); The incidence rate of hepatic encephalopathy in research group and control group were1/29( 3.4%)and 6/54(11.1%), respectively, three years mortality were 4 /2913.8% and13 /5424.1%,respectively, the incidence rate of hepatic encephalopathy and mortality rate in three years were no statistical difference(P > 0.05).The rebleeding rate in research group was lower than control group, there was a significant difference(P > 0.05).The research group was conspicuously superior to the control group in improving esophageal- gastric varices and there was a significant difference(P > 0.05). Conclude Compared with devascularization,esophagofundostomy combined with devascularization is better in blocking abnormal blood flow in lower esophagus stomach bottom muscularis and submucosa.It is precede in the aspect of reducing esophageal- gastric varices and prevention of rebleeding.