ObjectiveTo analyze the effect and incidence rate of major postoperative complications of pericardial devascularization in treatment of portal hypertension. MethodsEnglish and Chinese literatures about pericardial deva-scularization in treatment of portal hypertension were searched through Medline, Elsevier, PubMed, CNKI, and WanFang database, and meta analysis was taken in the process by using R-2.15 software. ResultsIn total of 671 literatures were searched and 23 were selected finally according to inclusion criteria and exclusion criteria.The results of meta analysis showed that, the effect of pericardial devascularization in treatment of portal hypertension were as follows:the incidence rate of rebleeding was 21%(95% CI: 0.18-0.24), the incidence rate of hepatic encephalopathy was 4%(95% CI: 0.02-0.06), the incidence rate of ascites was 29%(95% CI: 0.14-0.47), mortality of operation was 3%(95% CI: 0.02-0.04), mortality was 23%(95% CI: 0.15-0.33). ConclusionsThere is a certain incidence rate of complications of pericardial devascularization, of which the most common complication is rebleeding.So, it is necessary to do further improvement and development of pericardial devascularization.
Objective To explore the causes and treatment of rebleeding after operation on portal hypertension patients. Methods The clinical data of 41 rebleeding cases underwent the operational between January 2000 and December 2009 in Peking Union Medical College Hospital were retrospectively analyzed. Results All 13 cases who got rebleeding after shunt operation received lienectomy, but for those who got rebleeding after lienectomy, 23 patients received Phemister or modified Phemister or expanded lienectomy and 5 patients received shunt operation. Surgical related complications occurred in 7 cases (17.1%) at 2 weeks after operation, including abdominal bleeding (3 cases), gastrointestinal bleeding (2 cases), and intractable ascites (2 cases). After the follow-up of 3-60 months (mean 39 months), all patients were still alive. During the follow-up, 3 cases of recurrent esophageal varices were observed and one of them got rebleeding.Conclusion The majority of rebleeding after lienectomy tend to be ascribed to the wrong operations chose, while bad operation skill often contribute to the rebleeding after shunt operation, suggesting ideal therapeutic effect for rebleeding can benefit from appropriate operation choose.
目的 探讨血吸虫病性肝硬变行脾切除术后再发大出血的外科治疗方法。 方法 回顾性分析1987年4月至1999年12月期间我院收治的经左胸行贲门周围血管离断术治疗脾切除术后再发大出血11例患者的临床资料。结果 急诊手术4例，2例死亡，其中1例手术后30 d死于肝功能衰竭，另1例于出院后2个月再发大出血而死亡。余2例及择期手术7例均无手术并发症和死亡率，随访6~8年，无出血再发。结论 对脾切除术后再发大出血病例行断流术，经左胸入路是一种可取的治疗方法。
门静脉高压症是慢性肝病的主要合并症之一，它所导致的食管胃底静脉曲张破裂出血死亡率可达30%～50%，是肝硬变患者的主要死亡原因。1概述自1945年Whipple等人倡导门体分流手术治疗门静脉高压症以来，各国学者作出了不懈努力，探求对这种顽症的治疗手段。最近20～30年在治疗方法上出现了许多革新，如内窥镜下曲张静脉硬化剂注射、曲张静脉套扎、门体静脉选择性分流（远端脾肾分流）等。应用β受体阻滞剂心得安来预防或治疗门静脉高压症引起的上消化道出血取得了肯定的疗效。小口径人工血管门静脉下腔静脉搭桥分流减少了门体分流手术后脑病的发生率，而复发出血率几乎可与传统门腔分流术相比。经颈内静脉肝内门体分流术（TIPSS）治疗急性上消化道出血的疗效十分肯定，尤其适用于手术风险大、肝功能差者。肝脏移植作为治疗终末期不可逆性肝病的成熟手段，近年来也越来越多地应用于肝硬变门静脉高压症的治疗，与其它各种治疗手段相比，肝移植可算是对门静脉高压症治疗的一种革命性的变化，一个成功的肝移植一劳永逸地解决了门静脉高压症产生的根源，使门静脉高压症得到根治。
OBJECTIVE The purpose of this study was to study the effect of splenopneumopexy for patients with portal hypertension in children. METHODS From March 1993 to April 1998, splenopneumopexy was performed on six children with portal hypertension. Doppler ultrasound and radionuclide were used to demonstrate the portopulmonary shunt after operation. RESULTS The bleeding from the esophageal varices was controlled and the esophageal varices were eliminated gradually. The symptoms pertaining to hypertension were disappeared. The patency of the shunt was maintained without the formation of thrombosis. No pulmonary complication was observed. CONCLUSION The results indicated that splenopneumopexy was a safe and effective procedure for patients with portal hypertension in children.
ObjectiveTo summarize the recent development of surgical treatment for portal hypertension with hypersplenism. MethodsThe related literatures on various operation treatment of hypertension with hypersplenism at home and abroad in recent years were collected and reviewed. ResultsThere are many operation treatment methods of hypertension with hypersplenism, includes the pericardial devascularization, subtotal splenectomy, partial splenic embolization, spleen radiofrequency ablation, splenic artery ligation, distal splenorenal shunt, and so on. The different operation methods each has its advantages and disadvantages, but there are a certain percentage of the incidence of complications. At the same time, due to the limited understanding of the function of the spleen in portal hypertension, the treatment of "resecting" or "reserving" spleen has always been the hot spot of the academic dispute. ConclusionFor what kind of operation method is the most suitable for the treatment of hypertension with hypersplenism is no fixed conclusion.
ObjectiveTo summarize research progress of vascular physiological function of epoxyeicosatrienoic acid and its impact on pathogenesis of cirrhotic portal hypertension. MethodLiteratures about recent studies on epoxyeicosatrienoic acid in different organs and different animal models including cirrhotic portal hypertension were reviewed according to the results searched from PubMed and Wanfang databases. ResultsEpoxyeicosatrienoic acid in the different organs and the different animal models showed the complex functions, and it might affect the development of cirrhosis portal hypertension disease through its vascular physiological function. ConclusionIncreasing or decreasing epoxyeicosatrienoic acid might affect development of cirrhosis portal hypertension disease, which could provide a new method for treatment of cirrhosis portal hypertension.
Objective To summarize the effect of the splenectomy in patients with portal hypertension on the occurrence and recurrence of hepatocellular carcinoma. Methods The related literatures about the splenectomy in patients with hepatocirrhosis combined with portal hypertension or patients with hepatocellular carcinoma combined with portal hypertension in recent years were reviewed. Results At present, most academics considered that, for patients with hepatocirrhosis combined with portal hypertension, splenectomy could reduce the occurrence of hepatocellular carcinoma. For patients with hepatocellular carcinoma combined with portal hypertension, splenectomy+hepatectomy didn’t increase the perioperative mortality, and it could reduce the recurrence rate of hepatocellular carcinoma. Conclusion Splenectomy for patients with portal hypertension is safe, and it can inhibit the occurrence and progress of hepatocellular carcinoma, however, the specific mechanism remain needs further study.