The Clinical Analysis Of Effects Of Pericardical Devascularization With Splenectomy And Combined Devascularization And Distal Splenorenal Shunt For Patients With Portal Hypertension

Objective By analyzing the different effects of pericardical devascularization with splenectomy and combined devascularization and distal splenorenal shunt for patients with portal hypertension, and exploring the best reasonable operation in the surgical treatments of portal hypertension. Methods A retrospective analysis of clininal data of 24 cases of portal hypertension patients admitted for operation from January 2000 to Decemember 2004 , 12 underwent pericardical devascularization with splenectomy or plus esophageal transection(PCDV group),the remaining 12 underwent combined devascularization and distal splenorenal shun(tcombined operation group),variations of the free portal pressure(FPP),esophagogastric varices,albumin were measured or tested intraoperatively and pre-post-operatively and clinical effects were examined .Results The average value of FPP of PCDV group and combined operation group reduced 9.50 cmH2O and 14.17cmH2O respectively after operation, there's significant difference compared to preoperative value(both P<0.01), and also post-operatively (P<0.01) between two groups; Rates of no change,obvious improvement,complete disappearance of esophagogastric varices of PCDV group and combined operation group are respectively(45.5%/18.2%),(54.5%/63.6%),(0%/18.2%),the rate of obvious improvement of the latter is greatly higher than of the former; The average value of albumin of PCDV group and combined operation group lessened 0.55g/L,1.93g/L respectively after surgery (3-6 months),there's no difference compared to preoperative value(both P<0.01), and either postoperatively (P<0.01) between two groups (P<0.01);At 6～12 months, none of patient rebleeding or died,in PCDV group, splenic vein thrombosis occurred in 1 cases and ascites in 3 cases, in combined group ,hepatic encepalopathy occurred in 1 cases and ascites in 1 cases. Conclusions Compared to PCDV,combined operation is not only more effectively decrease the portal pressure,but also maintain a high level of normal hepatopetal portal pressure;what's more,it can more effectively eradicate or improve variceal and more useful in preventing and controling bleeding;Little influence on liver function and little difference between two operations;on clinical effects, combined operation is better than PCDV. In summom , combination operation is more reasonable treatment method.