| Objective:To compare the postoperative efficacy between periesophagogastric devascularization with splenic artery ligation and periesophagogastric devascularization with splenectomy in the treatment for portal hypertension combined with esophagogastric varices and hypersplenic.Methods:From January 2016 to January 2019,patients with portal hypertension(PHT)combined with esophagogastric varices and hypersplenism were diagnosed in The Second Affiliated Hospital of Kunming Medical University,and were cured in periesophagogastric devascularization with splenic artery ligation or periesophagogastric devascularization with splenectomy.This paper's analysis indicators include the gender,age,and(1)Preoperative indicators:Child-Pugh liver function grade,the diameter of spleen,White blood cell(WBC),Red blood cell(RBC),Platelet(PLT),Hemoglobin(HB)concentration,Alanine aminotransferase(ALT),Aspartate aminotransferase(AST),prothrombin time(PT);(2)Intraoperative indicators:Operation time,Volume of blood loss and Volume of blood transfusion,postoperative hospital stay,;(3)Postoperative indicators:complications(rebleeding,pulmonary infection,Splenic abscess,portal vein thrombosis)incidence,WBC,RBC,HB,PLT,ALT,AST on days 1,3,7,and 10 after surgery,7 days after surgery,3 months after surgery,1 year after surgery diameter of spleen,rebleeding and survival within 3 months and 1 year after surgery.Results:patients with portal hypertension(PHT)combined with esophagogastric varices and hypersplenism were 45 cases.periesophagogastric devascularization with splenic artery ligation were performed in 10 cases of group A,and periesophagogastric devascularization with splenectomy were performed in 35 cases of group B;(1)Preoperative indicators:There are no significant difference in gender,age,liver function grade,the spleen length between two groups.(2)Intraoperative indicators:The average blood loss during operation was 320±78.88ml and 1473±1438.69ml in group A and in group B.The blood loss was found significant in lower in group A than that in group B(P<0.05);The average operation time was 247.5±70.68min in group A and 408.85±131.12min in group B,the average operation time of group A was significant shorter than that of group B;group A including 1 patient was ransfused,9 patients were not transfused,group B including 24 patients were transfused,and 11 patients were not transfused.In group A,1 patient received blood transfusion,9 patients did not receive blood transfusion,and in group B,27 patients received blood transfusion,8 patients did not receive blood transfusion.beween two groups it's chi-square value was 14.917,and the difference was statistically significant(P<0.05).(3)Postoperative indicators:?Comparison of postoperative laboratory indexes:There were no significant difference between two groups(P>0.05).In group A,the PLT after operation on the 3rd,7th,and 10th were(149.20±43.78)×109/L,(220.30±73.57)×109/L,(256.00±42.23)×109/L,In group B,were(304.61 ± 120.68)×109/L,(327.84±98.99)×109/L,(443.92±68.44)×10 9/L,The PLT after operation on the 3rd,7th,and 10th after operation was significant smaller than that in group B;The PT after operation 1th of group A was 15.4±2.05s,group B was 18.69±2.68s,The PT after operation 1th of group A was significant smaller than that of group B.? Comparison of average postoperative hospital stay:Average postoperative hospital stay was 10.20±0.92 days in group A and 16.08 ± 1.61 days in group B,the postoperative hospital stay in group A was significantly less than that in group B.?Comparison of average spleen diameter:The average spleen diameter at 3 months and 1 year after surgery was 13.43 ± 0.94cm and 11.35±0.58cm in group A,and it was significantly lower than that before operation(P<0.05).?Comparison of postoperative child-pugh liver function:there were 8 cases of grade A Child in group A and 2 cases of grade B Child.There were 13 children of grade A in group B and 22 children of grade B,beween two groups it's chi-square value was 5.74,and The difference was statistically significant(P<0.05).?Comparison of complication:The total number of complications in group A was 2,and the total number of complications in group B was 20,beween two groups it's chi-square value was 4.294,and The difference was statistically significant(P<0.05).2 cases of lung infection in group A and 3 cases in group B,there were no significantly difference between two groups(P>0.05).1 case of portal vein thrombosis in group A,and 11 cases in group B,there were no significantly difference between two groups(P>0.05);there were no rebleeding patients in two groups,and no splenic abscess in group A.Conclusion:The results suggest periesophagogastric devascularization with splenic artery ligation compared with periesophagogastric devascularization and splenectomycan,maybe can preserving spleen and its function,shorten the operation time,reduce intraoperative bleeding?blood transfusion rate,reduce the impact on liver function,the low level of unusual postoperative platelet higher,quicker recovery,fewer complications,shorter hospitalization time,etc.However,due to the small number of cases,no large-scale systematic clinical study results have been done,so the efficacy,long-term effect and complications still more observing. |
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