| Objective To compare the long-term postoperative efficacy of proximal splenorenal shunt and splenectomy combined with cardia peripheral vascular dissociation in the treatment of portal hypertension with hepatitis B cirrhosis and hypersplenism,providing reference for clinical surgeons in the surgical treatment of portal hypertension with hepatitis B cirrhosis.Methods A retrospective analysis was performed on 109 patients with hepatitis B cirrhosis portal hypertension complicated with hyplenism who were admitted to The Affiliated Hospital of Nantong University from January 2012 to November 2021 and underwent proximal splenorenal shunt or splenectomy combined with cardia peripheral vascular devascularization with complete postoperative follow-up data.Divided into two groups according to different surgical methods: Basic information of each patient was collected in the shunt group(43 cases)and the devascularization group(66 cases),as well as the auxiliary examination results of white blood cell,platelet,transaminase,total bilirubin,albumin and prothrombin time before and one week after surgery,whether there was a history of hematemesis or melena before surgery,operation time and amount of blood loss.Before outpatient and telephone follow-up,patients with esophagogastric fundus varices and veins bleeding were found to have rebleeding after discharge,quality of life(appetite,mental state)and survival.SPSS28.0 was used for statistical analysis to compare whether there were significant differences in preoperative general conditions,intraoperative operative time and blood loss,postoperative auxiliary examination indicators,complication rate,rebleeding rate and survival rate between the two groups,and analyze the predictors of postoperative rebleeding and survival.Results 1.Preoperative gender(P=0.432),age(P=0.863),number of patients with hematemesis(melena)(P=0.069),number of patients with ascites(P=0.364),white blood cells(P=0.601),platelets(P=0.709),aspartate aminotransferase(P=0.166),alanine aminotransferase(P=0).135),total bilirubin(P=0.387),albumin(P=0.779),prothrombin time(P=0.918),portal vein diameter(P=0.783)and Child-pugh grading(P=0.492)had no significant differences.2.The operation time of the shunt group was longer than that of the devascularization group(P=0.004),and there was no difference in intraoperative blood loss(P=0.108);Seven days after surgery,leukocytes in shunt group were lower than those in devascularization group(P=0.038),prothrombin time was longer than that in devascularization group(P=0.036).Platelet(P=0.969),aspartate aminotransferase(P=0.403),alanine aminotransferase(P=0.302),total bilirubin(P=0.194)and albumin(P=0.101)had no significant difference.There was no difference in the incidence of postoperative complications between the two groups(P=0.404).3.Postoperative follow-up showed no significant difference in quality of life between the two groups(P=0.548);The rate of postoperative rebleeding was 5.3% in the shunt group and 27.5% in the devascution group,the difference was statistically significant(P=0.043).Multivariate Logistic regression analysis showed that the surgical method was an independent predictor of rebleeding,and the shunt group significantly reduced the rate of postoperative rebleeding compared with the devascution group.The probability of rebleeding in the shunt group was 0.034 times higher than that in the devascularization group.Kaplan-meier analysis showed that the 1-year,2-year,3-year and 5-year survival rates of the shunt group and the devascularization group were95.3%,94.3%,90.9%,88.0% and 95.5%,87.9%,84.8%,70.0%,respectively,and the comparison between the two groups was statistically significant(P=0.049,Log-rank test),COX regression analysis showed that rebleeding(P=0.015)was an independent risk factor affecting survival rate,and the risk of death in patients with rebleeding after surgery was 3.408 times higher than that in patients without rebleeding.Conclusions 1.Surgical method was an independent predictor of rebleeding,and the prevention effect of rebleeding in the shunt group was better than that in the devascution group.2.Rebleeding is an independent risk factor for survival.3.The long-term survival rate of patients in the shunt group was higher than that in the devascularization group.4.For patients with good basic condition,child-pugh liver function grade A or B,hepatitis B cirrhosis PHT combined with splenomegaly and hyplenism,the postoperative efficacy of proximal splenorenal shunt is better than splenectomy combined with cardia peripheral vascular devascularization. |
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