Clinical Efficacy Comparison Of LSPD And TIPS Combined With GCVE In The Treatment Of Portal Hypertension And Upper Gastrointestinal Hemorrhage

Objective:1、To investigate the postoperative effect between Laparoscopic Splenectomy plus pericardial Devascularizationthe and TIPS plus Varicose vein Embolization;2、To discuss it’s advantages and disadvantages for treatment of portal hypertension.Methods:The object of study was the clinical data of portal hypertension and upper gastrointestinal hemorrhage in the second affiliated hospital of kunming medical university from October 2013 to October 2016: Laparoscopic Splenectomy plus pericardial Devascularization (group LS) ,30patients;and at the same time ,the TIPS plus Varicose vein Embolization (group TIPS) in 35 patients.Operation method for LS.TIPS two groups respectively to collect preoperative, intraoperative and postoperative data lines of group LS and group TIPS line of comparative research. Student t-test, Chi-square test were used for statistical analysis based on data type respectively in SpSS 17.0.Results:preoperative:Group LS(Laparoscopic Splenectomy plus pericardial Devascularizationthe),group TIPS(TIPS plus Varicose vein Embolization)of patients with preoperative basic information including age, gender and grade of the child of hepatic function, the degree of esophageal gastric varices,total bilirubin levels, albumin concentration ,alamine aminotransferase,plateletcount,white blood cell,red blood cell and prothrombin time and the case to complete statistical processing.The results was no statistical differences, (p >0.05).That means the preoperative data was comparable.Intraoperative:The operation time group TIPS was shorter than group LS; the hemorrhage group TIPS was less than group LS;(p<0.05), with statistical significance.postoperative:The hospitalization time group TIPS shorter than group LS, (p<0.05), with statistical significance.Group TIPS haven’t put stomach tube.But the total hospitalization expenses of group TIPS was higher than that of group LS,(p<0.05),with statistical significance.Group LS compared with group TIPS: postoperative 1week、1 months、3 months、 6 months hepatic function, postoperative three day、1 week、1 months、3 months、6 months total bilirubin level significantly less than group TIPS、(p<0.05),with statistical significance ; postoperative three day、 week albumin concentration significantly higher than group TIPS, (p<0.05),with statistical significance, postoperative three day、1 week、1 months、3 months、6 months total bilirubin level significantly less than group TIPS、(p<0.05),with statistical significance; postoperative three day、1 week、1 months、3 months、6 months plateletcount、 white blood cell significantly higher than group TIPS, (p<0.05),with statistical significance; postoperative 1 week、1 months、3 months、6 months red blood cell significantly higher than group TIPS, (p<0.05),with statistical significance;postoperative three day、1 week、1 months、3 months、6 months prothrombin time significantly less than group TIPS, (p<0.05),with statistical significance; postoperative 1 week、3 months blood ammonia significantly less than group TIPS,(p<0.05),with statistical significance ; the incidence of rebleeding.postoperative hepatic encephalopathy and secondary surgery significantly less than group TIPS, (p<0.05),with statistical significance; postoperative 1 year、2 year survival rate higher than group TIPS, (p<0.05),with statistical significance.there’s statistically significant differences compared hepatic function tests main index change after group LS one month, three month and six month with preoperation.there’s statistically significant differences compared plateletcount、white blood cell change after group LS three day,one week, one month, three month and six month with preoperation.there’s statistically significant differences compared red blood cell、prothrombin time change after group LS three month and six month with preoperation.The hepatic function after surgery on the three day and after one week was significant difference with preoperation(p < 0.05).The plateletcount after surgery on the three day was significant difference with preoperation(p<0.05).The red blood cel after surgery on the 6 month was significant difference with preoperation(p<0.05).The prothrombin time after surgery on the three day, one week, three month and six month was significant difference with preoperation(p<0.05).The rest was no difference with preoperation(p>0.05).Conclusion:1.LSPD needs lower hospital costs compare with TIPS plus GCVE, but it needs longer operation time and hospital stay.2.The postoperative hepatic function n blood cell and prothrombin time of LSPD can improve significantly compare with preoperative,but TIPS plus GCVE was no difference with preoperation.3.The postoperative blood ammonia、postoperative hepatic encephalopathy rate、rebleeding rate and secondary surgery rate of LSPD significantly less than TIPS plus GCVE, and the postoperative 1 year、 2 year survival rate of group LS higher than group TIPS.