Effects of modified splenocaval shunt plus devascularization on esophagogastric variceal bleeding: a comparative study of this treatment and devascularization only in cirrhotic portal hypertension
Corresponding Author
Lixue Du
- [email protected]
- +86-29-852513312064 | Fax: +86-29-852513312064
Department of Hepatobiliary Surgery, The Third Affiliated Hospital of the Medical College of Xi';an Jiaotong University (Shaanxi Provincial People's Hospital), No. 256, Youyi West Road, Xi'an, 710068 China
Department of Hepatobiliary Surgery, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, 710061 China
Search for more papers by this authorWujun Wu
Department of Hepatobiliary Surgery, The Third Affiliated Hospital of the Medical College of Xi';an Jiaotong University (Shaanxi Provincial People's Hospital), No. 256, Youyi West Road, Xi'an, 710068 China
Search for more papers by this authorYu Zhang
Department of Hepatobiliary Surgery, The Third Affiliated Hospital of the Medical College of Xi';an Jiaotong University (Shaanxi Provincial People's Hospital), No. 256, Youyi West Road, Xi'an, 710068 China
Search for more papers by this authorZhongjie Sun
Department of Hepatobiliary Surgery, The Third Affiliated Hospital of the Medical College of Xi';an Jiaotong University (Shaanxi Provincial People's Hospital), No. 256, Youyi West Road, Xi'an, 710068 China
Search for more papers by this authorHaitian Hu
Department of Hepatobiliary Surgery, The Third Affiliated Hospital of the Medical College of Xi';an Jiaotong University (Shaanxi Provincial People's Hospital), No. 256, Youyi West Road, Xi'an, 710068 China
Search for more papers by this authorXiaogang Liu
Department of Hepatobiliary Surgery, The Third Affiliated Hospital of the Medical College of Xi';an Jiaotong University (Shaanxi Provincial People's Hospital), No. 256, Youyi West Road, Xi'an, 710068 China
Search for more papers by this authorQingguang Liu
Department of Hepatobiliary Surgery, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, 710061 China
Search for more papers by this authorCorresponding Author
Lixue Du
- [email protected]
- +86-29-852513312064 | Fax: +86-29-852513312064
Department of Hepatobiliary Surgery, The Third Affiliated Hospital of the Medical College of Xi';an Jiaotong University (Shaanxi Provincial People's Hospital), No. 256, Youyi West Road, Xi'an, 710068 China
Department of Hepatobiliary Surgery, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, 710061 China
Search for more papers by this authorWujun Wu
Department of Hepatobiliary Surgery, The Third Affiliated Hospital of the Medical College of Xi';an Jiaotong University (Shaanxi Provincial People's Hospital), No. 256, Youyi West Road, Xi'an, 710068 China
Search for more papers by this authorYu Zhang
Department of Hepatobiliary Surgery, The Third Affiliated Hospital of the Medical College of Xi';an Jiaotong University (Shaanxi Provincial People's Hospital), No. 256, Youyi West Road, Xi'an, 710068 China
Search for more papers by this authorZhongjie Sun
Department of Hepatobiliary Surgery, The Third Affiliated Hospital of the Medical College of Xi';an Jiaotong University (Shaanxi Provincial People's Hospital), No. 256, Youyi West Road, Xi'an, 710068 China
Search for more papers by this authorHaitian Hu
Department of Hepatobiliary Surgery, The Third Affiliated Hospital of the Medical College of Xi';an Jiaotong University (Shaanxi Provincial People's Hospital), No. 256, Youyi West Road, Xi'an, 710068 China
Search for more papers by this authorXiaogang Liu
Department of Hepatobiliary Surgery, The Third Affiliated Hospital of the Medical College of Xi';an Jiaotong University (Shaanxi Provincial People's Hospital), No. 256, Youyi West Road, Xi'an, 710068 China
Search for more papers by this authorQingguang Liu
Department of Hepatobiliary Surgery, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, 710061 China
Search for more papers by this authorAbstract
Background
Pericardial devascularization (PCDV) and portosystemic shunt were reported to have favorable results for the management of portal hypertension in cirrhotic patients in China and the West, respectively. This study was undertaken to investigate the effects of a modified proximal splenocaval shunt plus PCDV on variceal bleeding in patients with portal hypertension.
Methods
From January 1997 to December 2007, 168 patients with portal hypertension of cirrhotic origin received an operation for gastroesophageal variceal bleeding. Of these, 90 patients received a splenocaval shunt plus a PCDV procedure (Combined Group) and the other 78 patients received a PCDV procedure only (PCDV Group). The procedure-related morbidity and mortality, rebleeding, encephalopathy, and survival rates were analyzed.
Results
Postoperative mortality was 3.3% in the combined group and 5.1% in the PCDV group (p > 0.05). Overall morbidity was 13.3% in the combined group and 15.4% in the PCDV group (p > 0.05). The rate for rebleeding, including variceal bleeding and gastropathy, was 5.1% in the combined group, which was significantly lower than that in the PCDV group, at 16.7% (p < 0.05). The incidence of encephalopathy was 6.63% in the combined group and 6.67% in the PCDV group (p > 0.05). The 1-, 3-, 5- and 10-year survival rates were 97.4, 91.7, 80.0, and 60.0% in the combined group and 96.7, 83.3, 73.3, and 53.3% in the PCDV group (p > 0.05).
Conclusions
The modified splenocaval shunt plus PCDV is a safe and effective procedure for the long-term control of variceal bleeding; the procedure may not only maintain the portal flow to the liver, but may also protect the liver function in cirrhotic patients. The better clinical outcome means that the procedure may be one of the best choices for treating portal hypertension of cirrhotic origin.
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