Comparative Study Between Simplified Devascularization And Standard Devascularization In The Treatment Of Portal Hypertension

Objective:To compare the clinical efficacy between simplified devascularization and standard devascularization in the treatment of portal hypertension.Methods:We conducted a retrospective analysis of 34 patients with portal hypertension with severe hyperspleenism(severe oesophageal varices considering red sign)who underwent surgical resection in Second Hospital of Jilin University between October 2014 to October 2017.Among the 34 cases,simple devascularization was performed in 14 cases(Experimental group)and standard devascularization was performed in remaining 20 cses(Control group).Results:(1)Duration of surgery and amount of blood loss: The average duration of surgery and amount of blood loss in the experimental group was 127.5±28.9 min and 178.5±125.1 ml respectively while in the control group it was 170.5±55.8 min and 328.0±100.7 ml respectively.Both the duration of surgery and amount of blood loss was less in the experimental group than in the control group(p<0.005).(2)Post operative results: The anus exhaust time and post operative hospital stay in the experimental group were significantly lower than those in the control group(P < 0.05).But there was no statistically significant difference in platelet recovery time,portal vein diameter,varicosity as well as improvement of liver function between the two groups(p>0.005).(3)Portal vein diameter: Portal vein diameter was decreased in both groups after operation compared to before operation(p<0.005),but there was no statistical significance in the reduction of portal vein diameter between the two groups(P > 0.05).(4)Change in liver function: Liver function was deteriorated in both groups after operation than before operation(p<0.005),but there was no significant difference in the range of liver function between the two groups(P > 0.05).(5)Postoperative complications and follow up: The incidence of gastrointestinal discomfort was lower in experimental group than in the control group(p<0.005),but no statistically significant difference was found in the occurance of portal vein thrombosis,hepatic encephalopathy,Incisional infection,hydrothorax as well as ascites and other complications in both groups(p>0.005).Conclusion:From this retrospective study we concluded that,simplified devascularization is superior to standard devascularization for prevention.The operative procedure was comparatively easy in simple devascularization which helped to resolve hyperspleenism as well as esophageal varices and bleeding with ease.Gastrointestinal physiological anatomy and function was preserved in simple devascularization that helped to significantly reduce postoperative gastrointestinal upset.Therefore,simplified disconnection is a safe and effective operation.It has clinical feasibility.It also can be used for reference for treatment of hypersplenism and prevention of portal hypertensive esophageal varices bleeding in primary hospitals.