Search

Objective: To analyze the recent postoperative and long-term postoperative complications of open-splenectomy and disconnection in patients with portal hypertension. Methods: There were 1 118 cases with portal hypertension who underwent open splenectomy and azygoportal disconnection from April 2010 to September 2015 at Department of Surgery, People's Liberation Army 302 Hospital. Retrospective case investigation and telephone follow-up were conducted in October 2016. All patients had history of upper gastrointestinal bleeding before operation. Short-term complications after surgery were recorded including secondary laparotomy of postoperative abdominal hemostasis, severe infection, intake disorders, liver insufficiency, postoperative portal vein thrombosis and perioperative mortality. Long-term data including postoperative upper gastrointestinal rebleeding, postoperative survival rate and incidence of postoperative malignancy were recorded, too. GraphPad Prism 5 software for data survival analysis and charting. Results: Postoperative short-term complications in 1 118 patients included secondary laparotomy of postoperative abdominal hemostasis(1.8%, 21/1 118), severe infection(2.9%, 32/1 118), intake disorders(1.0%, 11/1 118), liver dysfunction (1.6%, 18/1 118), postoperative portal vein thrombosis(47.1%, 526/1 118)and perioperative mortality(0.5%, 5/1 118). After phone call following-up, 942 patients' long-term data were completed including 1, 3, 5 years postoperative upper gastrointestinal rebleeding rate(4.4%, 12.1%, 17.2%), 1, 3, 5-year postoperative survival rate(97.0%, 93.5%, 90.3%); the incidence of postoperative malignant tumors in 1, 3 and 5 years were 1.7%, 4.4% and 6.2%. Conclusions: Reasonable choosing of surgical indications and timing, proper performing the surgery process, effective conducting perioperative management of portal hypertension are directly related to the patient's short-term prognosis after portal hypertension. Surgical intervention can reduce the rates of patients with upper gastrointestinal rebleeding, improve survival, and do not increase the incidence of malignant tumors.

Objective: To compare the efficacies between transjugular intrahepatic portosystemic shunt (TIPS) and portoazygos devascularization (PAD) in the treatment of portal hypertension with variceal bleeding., Methods: From December 1993 to December 2010, 309 patients with portal hypertension and variceal bleeding were admitted. According to their general conditions and Child-Pugh grades, they were assigned to undergo TIPS (group A, n = 235) or PAD (group B, n = 74). Before operation, compared with the PAD group, the TIPS group possessed worse liver functions, more severe ascites and a greater frequency of bleeding. After operation, the therapeutic efficacies and changes of portal hemodynamics, recurrent variceal bleeding, post-operative encephalopathy and long-term survival were evaluated between two groups., Results: The postoperative portal pressure in the TIPS group ((42.6 ± 7.0) vs (26.3 ± 4.1) cm H2O) decreased much more than that in the PAD group ((38.7 ± 5.2) vs (33.5 ± 5.8) cm H2O, P < 0.01). The rebleeding rates during early postoperation were 0.85% (2/235) and 6.76% (5/74) in TIPS and PAD groups respectively, the occurring rates of hepatic encephalopathy 4.68% (11/235) and 4.05% (3/74) and the rates of operative mortality 1.70% (4/235) and 6.76% (5/74) respectively. Survival rates of 1, 3, 5 and 10 years were 98.30% (231/235) vs 92.24% (69/74), 92.41% (146/158) vs 88.06% (59/67), 80.77% (84/104) vs 79.25% (42/53), 51.43% (36/79) vs 51.85% (14/27) in TIPS and PAD groups respectively., Conclusions: As compared with PAD, TIPS offers the such advantages as less trauma, wider indication, faster hemostasis and satisfactory therapeutic efficacies. Especially for the emergency treatment of a patient with massive variceal bleeding and Child-Pugh C grade liver function, TIPS is a better option than PAD.

Objective: To analyze the long-term results of TIPS, TIPS with coronary vein occlusion (CVO) and combined TIPS and portal azygous disconnection for the treatment of portal hypertension and variceal bleedings., Methods: Three hundreds and fifty-eight patients with portal hypertension were admitted because of variceal bleeding from July 1993 to May 2008. All patients were divided into 3 groups: 227 cases in group TIPS, 36 cases in TIPS and CVO group, 95 cases in combined TIPS and portal azygous disconnection group. The rates of successful operation, shunt patency, rebleeding, encephalopathy and survival were observed and compared by statistics methods., Results: There were 349 cases (97.5%) underwent successful surgery and 9 cases with failure surgery. The rates of occluded shunts, encephalopathy, rebleeding, and death in early periods were 2.5%, 31.8%, 4.7% and 9.0% respectively. The rate of encephalopathy and death in group with TIPS were higher than in group with combined TIPS and portal azygous disconnection (P < 0.01). The rate of encephalopathy and death were 41.2% and 24.7% in 85 cases with emergency TIPS. During the follow-up 1 - 15 years, the rate of patency shunts in 12 and 24 months after operation was 74.0% and 48.1% respectively. The rate of 1-year patency shunts in group with combined TIPS and portal azygous disconnection was higher than in group with TIPS, TIPS and CVO (P < 0.01 and P < 0.05). The rebleeding in group with TIPS was higher than in group with combined TIPS and portal azygous disconnection (P < 0.01), and the survival rate in group with TIPS was lower than in group with TIPS and CVO, combined TIPS and portal azygous disconnection (P < 0.01 and P < 0.01)., Conclusions: TIPS is an efficient therapy for portal hypertension with CVO, combined TIPS and portal azygous disconnection can improve the results of TIPS for portal hypertension.

Since January 1988 to February 1993, 116 cases of cirrhotic portal hypertension were treated with portazygos disconnection. 37 cases were treated with Hassab's procedure, 36 cases were treated with amplification Hassab's procedure, 33 cases were treated with pericardial devascularization with circular interruption of blood flow of fundus, 10 cases were treated with transthoracic portazygos disconnection. The operative mortality was 6.9%. The hemorrhage rate was 8.6% in one month after the operation. All of 108 patients discharged from the hospital were followed up for 14 months to 75 months. The recurrent hemorrhage rate was 18.5% in the period. The one-year and three-year survival rate after the operation were 94.2% and 81.8%, respectively. The results we have got indicate that amplification Hassab's procedure and transthoracic portazygos disconnection have good effect.

From 1978 to 1990, 35 complications were encountered in 203 cases of portoazygous disconnection in our hospital including intra-abdominal hemorrhage, AHF, ARF, ARDS, and gastric or pancreatic fistulae. The mortality rate was 8% with Hassab's operation, and 38% with Sugiura's, respectively. Emergency operation carried with a mortality of 31.1%, Whereas selective operation only 2.5%. 3.2% of all cases in Child's A group succumbed Postoperatively and 62% in Child's C group. The authors discussed the causes of the complications and ways to prevent them.

Ultrasonic pulsed Doppler duplex system was used to observe the portal hemodynamic changes before and after shunting or nonshunting operations. The results of preoperative measurements revealed significant increases of blood flow volumes of portal and splenic veins in portal hypertension subjects, and a positive correlation was obtained in the subjects with portal hypertension. Postoperative results showed significant reduction of portal blood flow volume more after shunting than the nonshunting operations. The etiology of portal hypertension and the causes of portal hemodynamic changes due to operations were discussed.

In this study, side-to-side mesocaval shunt (MCS-SS), pericardial devascularization (PCDV), and combined operation of the two procedures were performed in 3 groups of thioacetamide induced liver cirrhotic of rats. Portal and hepatic hemodynamics were investigated on a period of six weeks postoperation, and glucagon concentration in portal vein (PV) and inferior vena cava (IVC) was measured before and six weeks after the surgery. It was found that following PCDV, free portal pressure (FPP) was initially elevated without an increase of total hepatic blood flow (THBF) within four weeks, then both FPP and THBF were shown to decrease on the sixth week. After MCS-SS with a stoma diameter of 2.0mm, a 31% decrease of FPP (P less than 0.05) and a 23% decrease of THBF (P less than 0.05) were observed, though the portal blood flow remained hepatopetal and hyperglucagonemia in PV was not changed. After combined procedure there was a greater decrease of FPP and THBF than that after MCS-SS, and the concentration of glucagon in PV was decreased without any change of its content in IVC.

73 cases of cirrhotic portal hypertension treated in 4 years period (1982-1986) were followed by endoscope. Varices showed very little chance to disappear completely, and little difference in results between porto-azygous disconnection and that in combination with lower esophageal transection. The pressure of disconnected coronary vein on stomach side showed considerable elevation than that before and also in combination with lower esophageal transection. Continuous observation of portal pressure changes during and after operation for 4 days showed variations of amplitude suggesting redistribution of portal circulation. Judging from the series of postoperative events in follow-up, particularly rebleeding from recurrence of varices, there was renewed collateral circulation developed in the area of porto-azygous connection irrespective of the means of interruptions.