| Portal hypertension(PHT)is one of the complications of decompensated cirrhosis.And gastroesophageal variceal hemorrhage due to PHT is main reason leading to high morbidity and mortality.Therefore,it is necessary to find out and targeting intervene on the risk of gastroesophageal varices bleeding in patients with portal hypertension.Cirrhotic Portal hypertension is a syndrome of abnormal hemodynamics of portal vein system in decompensated cirrhosis.In order to reduce portal pressure,the hemodynamics of portal vein system changes greatly at occurrence of PHT.Therefore,clarifying the hemodynamic changes of portal vein system is very important for us to understand and therapy PHT.The purpose of this study was to establish aneffective risk stratified model of gastroesophageal varices bleeding in portal hypertension,and to analyze the effect of laparoscopic splenectomy combined with pericardial devascularization on liver hemodynamics.It will help us to effectively evaluate the risk of bleeding and the effect of surgical treatment in clinical work.Objective: 1.To explore and analyze the main risk factors of gastroesophageal varices bleeding in portal hypertension and to establish a comprehensive and effective risk stratified model of bleeding.2.To explore and analyze the effect of laparoscopic splenectomy combined with pericardial devascularization on liver hemodynamicsMethods: 1.635 patients with cirrhotic portal hypertension treated in general surgery of the second affiliated by Hospital of Air Force Medical University from January 2003 to June 2018 were retrospectively collected.patients were subgrouped into the bleeding group(356 cases)and non-bleeding group(279 cases)according to history of To explore and analyze the main risk factors of the gastroesophageal varices bleeding in portal hypertension and to establish a comprehensive and effective risk stratified model of bleeding.Sixteen indicators including general information of patients,laboratory tests(including routine blood tests,liver,kidney and coagulation function tests),gastroscopy,and color doppler ultrasound were collected,Risk factors associated with bleeding events were screened by univariate and binary Logistic regression analysis.ROC curve and Youden index were used to determine the optimal cutoff value of relevant clinical indicators.Finally,a stratification model of bleeding risk was established by CART classification regression tree.2.Clinical data of 270 portal hypertension patients recieved laparoscopic splenectomy combined with pericardial devascularization in general surgery of the second affiliated by Hospital of Air Force Medical University between January 2011 and December 2017 were collected and reviewed.the basic information and hemodynamic changes including diameters of portal vein,superior mesenteric vein and hepatic artery,blood flow velocity and blood flow were observed.Results:1.Parameters including gender,diameter of esophageal and gastric varices,red sign,portal vein diameter,PLT,and PTA were recognized as the independent risk factors of upper gastrointestinal bleeding by univariate statistics analysis and binary Logistic regression analysis.CART statistical method was used to establish the stratification model of bleeding risk.The study subjects were divided into 6 subgroups with different bleeding risks on basis of red sign,gender,portal vein diameter,PTA,and PLT.The bleeding risks of different subgroups ranged from 13.5% to 81.7%.2.The diameter,the blood flow velocity and the blood flow of portal vein were observed significantly reduced after surgery(P<0.001).The diameter of superior mesenteric vein decreased significantly after surgery(P<0.001).There was no difference observed in the velocity of superior mesenteric vein(P=0.915).The mean blood flow volume of superior mesenteric vein was reduced after surgery,but no significant difference was identified(P=0.065).A marked increase in hepatic artery diameter was observed(P=0.001).The maximum blood flow velocity,minimum blood flow velocity and mean blood flow velocity of the hepatic artery all significantly increased after the operation(P<0.01).The hepatic artery blood flow was also observed significantly increased after operation(P=0.02).Conclusions:1.Gender,diameter of esophageal and gastric varices,red sign,portal vein diameter,PLT and PTA are the independent risk factors of gastroesophageal varices bleeding in portal hypertension.The stratification model of bleeding risk established by CART statistical method can predict the bleeding risk of different populations,and the range of bleeding risk is between 13.5% and 81.7%.2.laparoscopic splenectomy combined with pericardial devascularization might be an effective way to ameliorate the high dynamic circulation state of the portal venous system,increase hepatic artery blood flow without affecting superior mesenteric venous flow.Therefore,surgery operation may bring to a positive affect for patients with portal hypertension. |
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