The Short-term Effect Of The Treatment Of Portal Hypertension By Splenectomy Combined With Esophageal Variceal Ligation

Objective: to explore the short-term effect of the treatment of portalhypertension by splenectomy combined with esophageal variceal ligationMethods: we studied73cases of patients with portal hypertensionwho came to China Japan Union Hospital of Jilin University for treatmentfrom December2010to February2013prospectively. Among them, therewere25cases simply received splenectomy,22cases simply receivedesophageal variceal ligation, and26cases received combination therapy(simple splenectomy+ligation). We used Doppler ultrasound tomeasure the change of portal hemodynamics before and after treatment,and used gastroscopy to count the change of those varicose veins ofesophagus before and after receiving operation. We compared the healingeffect of combination therapy (experimental group) with the other twogroups (control group) by observing the changes of portal hemodynamics,clearance rate of varicose veins within esophagus and the recent liverfunction (ALT, AST, TBIL, DBIL). We also analyzed the51cases whoreceived splenectomy whether there were splenic fever and pancreaticleakage after treatmenResults: we followed up for2months in average, the clearance rateof varicose veins within esophagus of combination therapy was69.2%(18/26), ligation group’s was9.1%(2/22)(P <0.01), andsplenectomy alone group’s was24%(6/25)(P <0.05). There was norecurrent bleeding in combined treatment group. The recurrent bleedingrate of ligation group18.2%(4/22)(P <0.05), which in splenectomyalone group was12%(3/25)(P <0.05). Compared with combinationtreatment group, ligation group’s portal vein blood flow speed, bloodflow and portal vein diameter were significantly increased (P<0.05). In the simple splenectomy group, the portal vein blood flow speed wasslower, the portal vein diameter was narrower and the blood flow was less,comparing with the combination treatment group (P<0.05).7days after theoperation, there was significant difference between the combination groupand ligation group (P<0.05). The incidence of splenic fever and pancreaticleakage after receiving simple splenectomy was6/51and0/51.Conclusion:.1.Compared with simple splenectomy in the Splenectomycombined with esophageal varicose vein ligation group,the change ofportal venous blood flow dynamics is smaller and the clearance rate ofesophageal varicose vein is higher.2.Compared withesophageal varicose vein ligation, in theSplenectomy combined with esophageal varicose vein ligation group,theclearance rate of esophageal varicose vein is higher and the liverfunction could be improved.3.Compared with portoazygos disconnection and esophagealvaricose vein bypass surgery in the Splenectomy combined withesophageal varicose vein ligation group lesspostoperative complications,and esophageal varicose vein ligation can be repeated many times...