Comparative Clinical Study Of Pericardial Devascularization By Preserving Vagus Trunks Versus Traditional Surgery

Background：Esophageal varices bleeding serious complications of portal hypertension, afterWilliam Mayo in the removal of a significant enlargement of congestion of the spleen in1910,patients with upper gastrointestinal bleeding were well controlled. In1929William Mayo foundthat splenectomy can improve the blood flow of the portal vein, and then the world’s attention tothe surgical treatment of portal hypertension. In the early20th century, surgeons began to use theportacaval shunts treatment of portal hypertension, into the medium after, pericardial veindisarticulation, varices suture, lower esophageal transaction, lower esophagus gastric resectionand joint esophageal and gastric vein disarticulation came out one after another. In1943, LesterDragstedt in the treatment of peptic ulcer patients cut vagus nerve trunk and cause significantcomplications（P＜0.05）, which showed that the vagus nerve was very important in the digestivesystem. The vagus nerve can cause gastrointestinal smooth muscle contraction, glandularsecretion, gastrointestinal sphincter relaxation, and promote the body’s absorption of nutrients andenergy. Reserving the vagus nerve trunk is better to maintain the body’s anatomy institutions andphysiological functions, and improve the quality of life of patients. The test through clinicalstudies to explore the advantages, disadvantages and postoperative effects of pericardialdevascularization by preserving vagus trunks and traditional surgery.Objective: To explore the advantages, disadvantages and postoperative effects of pericardialdevascularization by preserving vagus trunks and traditional surgery.Methods:70patients with portal hypertension randomly divided into two groups: A groupwas PDPVT group, B group was PD group, Throught statistical principles, analysis serumalbumin, total bilirubin, aspartate amino transferase, alanine aminotransferase, prothrombin timechanges for preoperative, postoperative day1,5days,9days. Explore the advantages,disadvantages and postoperative effects of pericardial devascularization by preserving vagus trunks and traditional surgery through operative time, blood loss, portal pressure, postoperativegastrointestinal recovery time, and complications(postprandial fullness, gastrointestinal reflux,diarrhea, bleeding, postoperative mortality and other).Results:①A group: postoperative aspartate aminotransferase, alanine aminotransferasecompared with the preoperative slightly elevated, serum albumin, total bilirubin, prothrombintime were no significant changes; B group: one day after surgery aspartate aminotransferase,alanine aminotransferase increased, serum albumin decreased, prothrombin time prolonged, andtotal bilirubin change is particularly evident after three days surgery.②The mean operative timeof A group was172.8±21.3min; The mean operative time of B group was157.0±18.3min（P＞0.05）.③The postoperative portal pressure lower than the preoperative of the two group（P＜0.05）.④A group postoperative gastrointestinal function recovery time is shorter than that in Bgroup.⑤Blood loss of A group was1160.6±166.8ml; Blood loss of B group was1062.5±175.5ml（P＞0.05）.⑥Agroup of postoperative complications is less than that in group B（P＜0.05）.Conclusions: PDPVT could achieve the purpose of hemostasis and reserves the vagus nervetrunk, which maintained the anatomical agencies and physiological function of the body as muchas possible, postoperative complications were significantly reduced, and improved the quality oflife of patients. PDPVT was significantly better than PD.