QIU Fazu and YANG Zhen
Department of Surgery, Tongji
Hospital, Tongji Medical College, Huazhong University of Science
and Technology Wuhan, 430030, P.R. China
Objective: To review our experiences and evaluate the efficacy of pericardial devascularization with slpenectomy for treatment of portal hypertensuon.
Methods: from May 1972 to October 1999, 508 patients with portal hypertension were treated with this operation. 319 of them were posthepatitic cirrhosis, 141 were last stage Schistosomiasis or accompanied the virus chronic hepatitis.
Results: The bleeding control rate was 96.9%, overall operative mortality rate was 4.5%. The major causes of death were upper gastrointestinal bleeding, intraabdominal hemorrhage, hepatic failure and hepatorenal syndrome, postoperative infection and thrombosis of portal vein system. The mean follow-up time was 3.8 years. Actual survival rate was 94.1% at 5 years, and 70.7% at 10 years. Recurrent bleeding rate was 6.2% at 5 years, and 13.3% at 10 years.
Conclusion: The pericardial devascularization with slpenectomy was the first choice for treatment of portal hypertension, especially for posthepatitic cirrhotic patients. Our experiences were: (1) Whole and thorough porto-azygos disconnection of pericardial area is the key of this operation; (2) The operation should be performed in according to the pericardial anatomy with correct surgical techniques; (3) The operation candidates and opportunity have to be selected rationally; (4) It is necessary to emphasize the pericardial management to prevent postoperative complications.
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created 21/12/00
