The Clinical Study Of Comparison Was Made Between Intervertional Devascularization And Surgical Devascularization

Objective To observe the clinical effect of treatment esophageal gastric varices in patients with cirrhotic PHT by intervertional devascularization and surgical devascularization .Materials and methods Department of the interventional radiology of Union hospital collect 73 cases of bleeding patients with liver cirrhosis and PHT were studied , Liver function Child-Pugh B degree 25 cases , Child-Pugh C degree 48 cases . Treatment combined percutaneous transhepatic obliteration﹙PTO﹚ and Paritial splenic embolization﹙PSE﹚.The liver and biliary tract surgery of Tongji hospital Collect 98 cases of patient with liver cirrhosis, Child-Pugh B degree 38 cases, Child-Pugh C degree 62 cases, These people was treatment by surgical devascularization .Observation postoperative rection and complications and length of stay and care cost,follow-up the rebleeding time and survival quality after the procedure. Compare with relationship factors of postoperative re-bleeding ,portal vein pressure,rebleeding time and survival Time, hepatic function.Results①The main compliction of Intervertional Devascularization are fever﹙76.9%﹚,bellyache﹙58.5%﹚,abdominal swelling﹙35.4%﹚. They were eased within 1 week. And there was no serious complication. The main complication of Surgical Devascularization are the death reat﹙3.1%﹚,melena﹙7.1%﹚,portal vein thrombosis﹙18.4%﹚,Infection include abscess and septicemia﹙5.1% ﹚.②The aveage portal pressure before and after Intervertional Devascularization were3.87±1.82kPa and 2.64±1.14kPa in 73 patients. The aveage portal pressure before and after pericardial and Surgical Devascularization were 3.93±1.28 kpa and 2.46±1.31 kpa .③The hepatic function after Intervertional Devascularization more improved than after Surgical Devascularization .④The average length of stay were 10.2 days in Intervertional Devascularization compared with 16.7 days in Surgical Devascularization and splenectomy,and the average care cost were 12,000 yuan in Intervertional Devascularization compared with 39,000 yuan in Surgical Devascularization.⑤There were three kinds of variceal outcome : disappearance﹙51.6%﹚,Ⅰdegree﹙38.2%﹚ ,Ⅱdegree﹙10.2%﹚after Intervertional Devascularization . After Surgical Devascularization disappearance﹙ 43.2%﹚,Ⅰd egree﹙36.8%﹚,Ⅱdegree﹙19.8%﹚.⑥During all cases, followed-up data , After Intervertional Devascularization the 1 , 2 , 3 , 4 , 5 year cumulative survival rates and rebleeding rates were 18.46% ,29.23 %,35.38% , 38.46% ,38.46% and 93.85% , 90.77% , 86.15% , 83.08% , 81.53% respectively . After Surgical Devascularization the 1 , 2 , 3 , 4 ,5 year cumulative survival rates and rebleeding rates were 27.36% , 36.72% , 42.58% , 45.67% , 48.93% and 79.63% , 75.48% , 72.32% , 70.15% , 69.68% respectively .Conclusion The Intervertional Devascularization procedure was designed suitablely .It was simple,safe to prevent form rebleeding .It had a significant clinical effect to liver fuction Child-pugh C degree and prevent form rebleeding . It could improve liver fuction and prolong the survival time for the later cirrhotic PHT.