Significance Of Histological Grading Of Liver Cirrhosis In Guiding The Selection Of Surgical Methods Forpatients With Portal Hypertension

Objective:To explore the significance of histological grading of liver cirrhosis in guiding the selection of surgical methods for patients with portal hypertension(PHT).Methods:From August 2010 to December 2016,101 patients with portal hypertension treated by splenectomy plus pericardial devascularization(SPD)or splenic artery coarration(SAC)plus distal splenorenal shunt in Heze Municipal Hospital were divided into mild,moderate,and severe cirrhosis 3 groups according to the grading criteria of histological changes of liver cirrhosis(Laennec grading standard),The preoperative clinical data,perioperative index changes,and postoperative follow-up data were compared in every group to analyse the efficacy and safety of the two surgical procedures.At the same time,the data of the two surgical procedures in different degree of cirrhosis was compared to analyzed.the effect of surgical procedures on surgical effects.Comprehensively explore the guiding significance of histological grade of liver cirrhosis in the selection of surgical methods for patients with portal hypertension.Result:1.General condition: every groups showed no statistically significant differences in gender,age distribution,etiologic classification,history of upper gastrointestinal hemorrhage and Child-Pugh classification.2.Intraoperative conditions:2.1 Intragroup comparison: Within the light,moderate,and severe groups,the DSRS-SAC surgery duration and intraoperative average blood loss were significantly lower than SPD(P<0.05).2.2 Comparison between groups: with the increasing severity of liver cirrhosis,the urgery duration and average blood loss during surgery were increased.3.Portal hemodynamics and free portal pressure(FPP)changes:3.1 Preoperative and postoperative pairing comparisons:Within the light,moderate,and severe groups,two surgical postoperative portal vein velocity,portal vein flow and FPP were all significantly lower than preoperative values(P<0.05).3.2 Intragroup comparison: There was no statistical difference in portal vein flow and reduction after DSRS-SAC in all groups compared with SPD.The decrease in FPP after DSRS-SAC was higher than that after SPD(P<0.05).3.3 Comparison between groups: In all cases of the whole group,the preoperative portal vein diameter and preoperative FPP increased with the increase of cirrhosis.Preoperative portal vein velocity and preoperative portal vein flow decreased with the increase of cirrhosis;with the increasing severity of liver cirrhosis,postoperative portal velocity,portal vein flow reduction,reduction and decrease of FPP decrease were all decreased.4.Spleen thickness and blood cell changes:4.1 Preoperative and postoperative pairing comparisons: Within the light,moderate,and severe groups,both WBC and PLT counts were significantly higher than before surgery(P<0.05).The thickness of spleen after DSRS-SAC was significantly lower than before surgery(P<0.05).4.2 Intragroup comparisons: Within the mild and moderate groups,the mean counts of WBC and PLT after both operations rose to normal values.In the severe group,the average PLT count after DSRS-SAC was still lower than normal.The average counts of WBC and PLT after DSRS-SAC in three groups were significantly lower than those after SPD(P<0.05).4.3 Comparison between groups: In all cases,the preoperative thickness of spleen increased with the increase of cirrhosis.The preoperative blood cell count decreased with the increase of cirrhosis;with the increasing severity of liver cirrhosisand,the thickness of spleen were increased after DSRS-SAC.the count and reduction of WBC and PLT were decreased.5.Postoperative complications and follow-up:5.1 Complications:5.1.1 Intragroup comparisons: In the light,moderate,and severe groups,the incidence of portal venous system thrombosis(PVST),postoperative fever,and massive ascites after DSRS-SAC was lower than that of SPD.No hepatic encephalopathy occurred during the perioperative period.in all groups.5.1.2 Comparison between groups: The incidence of postoperative PVST,postoperative fever,and massive ascites both increased with the increase of cirrhosis.5.2 Postoperative follow-up: In the light,moderate,and heavy groups,the incidence of PVST and rebleeding after DSRS-SAC was lower than that of SPD.With the increase of cirrhosis,the incidence of long-term PVST and rebleeding after SPD increased..Conclusion:DSRS-SAC should be the first choice for surgical treatment of cirrhosis in patients with mild or moderate cirrhosis portal hypertension.For patients with severe cirrhosis,the efficacy of SPD and DSRS-SAC are significantly lower than those of mild and moderate cirrhosis.But contrast to SPD,DSRS-SAC can effectively reduce intraoperative average blood loss on the basis of retaining the splenic portal traffic branch;the incidence of long-term PVST and postoperative rebleeding is lower.Thus DSRS-SAC can be a trasitionaul treatment for patienst with severe cirrhosis to improve the quality of life and wait for the liver.transplant opportunities.