Z Yang1, F Qiu. 1. Department of Surgery, Tongji Hospital, Tongji Medical University, Wuhan, China.
Abstract
OBJECTIVE: To review our experiences in and evaluate the efficacy of pericardial devascularization with splenectomy for the treatment of portal hypertension. METHODS: From May 1972 to October 1999, 508 patients with portal hypertension were treated with this operation. 319 of them had posthepatitic cirrhosis, and 141 late stage schistosomiasis or accompanied chronic viral hepatitis. RESULTS: The bleeding control rate was 94.1%, and the overall operative mortality rate was 4.5%. The major causes of death were upper gastrointestinal bleeding, intraabdominal hemorrhage, hepatic failure and hepatorenal syndrome. The mean follow-up time was 3.8 years. The 5-year survival rate was 94.1%, and the 10-year survival 70.7%. The 5-year recurrent bleeding rate was 6.2%. The 10-year recurrent bleeding rate was 13.3%. The rate of postoperative hepatic encephalopathy was 2.5% at 5 years, and 4.1% at 10 years. CONCLUSIONS: Pericardial devascularization with splenectomy was the first choice for the treatment of portal hypertension, especially for posthepatitic cirrhosis. The following were our experience: (1) thorough porto-azygos disconnection; (2) performing the operation in according to pericardial anatomy with correct surgical techniques; (3) selection of operative candidates and opportunity; (4) emphasizing perioperative management and preventing complications.
OBJECTIVE: To review our experiences in and evaluate the efficacy of pericardial devascularization with splenectomy for the treatment of portal hypertension. METHODS: From May 1972 to October 1999, 508 patients with portal hypertension were treated with this operation. 319 of them had posthepatitic cirrhosis, and 141 late stage schistosomiasis or accompanied chronic viral hepatitis. RESULTS: The bleeding control rate was 94.1%, and the overall operative mortality rate was 4.5%. The major causes of death were upper gastrointestinal bleeding, intraabdominal hemorrhage, hepatic failure and hepatorenal syndrome. The mean follow-up time was 3.8 years. The 5-year survival rate was 94.1%, and the 10-year survival 70.7%. The 5-year recurrent bleeding rate was 6.2%. The 10-year recurrent bleeding rate was 13.3%. The rate of postoperative hepatic encephalopathy was 2.5% at 5 years, and 4.1% at 10 years. CONCLUSIONS: Pericardial devascularization with splenectomy was the first choice for the treatment of portal hypertension, especially for posthepatitic cirrhosis. The following were our experience: (1) thorough porto-azygos disconnection; (2) performing the operation in according to pericardial anatomy with correct surgical techniques; (3) selection of operative candidates and opportunity; (4) emphasizing perioperative management and preventing complications.