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[Pericardial devascularization with splenectomy for the treatment of portal hypertension]
Insights
Pericardial devascularization with splenectomy effectively treats portal hypertension, showing high bleeding control and survival rates. This surgical approach is recommended, particularly for posthepatitic cirrhosis patients.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Clinical Medicine
Context:
- Portal hypertension is a serious complication of liver disease.
- Effective surgical management is crucial for improving patient outcomes.
- Pericardial devascularization with splenectomy is a recognized surgical option.
Purpose:
- To evaluate the efficacy of pericardial devascularization with splenectomy for portal hypertension.
- To review surgical experiences and outcomes in a large patient cohort.
- To identify key factors for successful surgical treatment.
Summary:
- A retrospective review of 508 patients treated between 1972 and 1999.
- Achieved a 94.1% bleeding control rate and a 4.5% operative mortality.
- Reported 5-year survival of 94.1% and 10-year survival of 70.7% with low rebleeding rates.
Impact:
- Establishes pericardial devascularization with splenectomy as a primary treatment for portal hypertension.
- Highlights the importance of surgical technique, patient selection, and perioperative care.
- Provides long-term survival and recurrence data to guide clinical practice.
Objective:
To review our experiences in and evaluate the efficacy of pericardial devascularization with splenectomy for the treatment of portal hypertension.
Methods:
From May 1972 to October 1999, 508 patients with portal hypertension were treated with this operation. 319 of them had posthepatitic cirrhosis, and 141 late stage schistosomiasis or accompanied chronic viral hepatitis.
Results:
The bleeding control rate was 94.1%, and the overall operative mortality rate was 4.5%. The major causes of death were upper gastrointestinal bleeding, intraabdominal hemorrhage, hepatic failure and hepatorenal syndrome. The mean follow-up time was 3.8 years. The 5-year survival rate was 94.1%, and the 10-year survival 70.7%. The 5-year recurrent bleeding rate was 6.2%. The 10-year recurrent bleeding rate was 13.3%. The rate of postoperative hepatic encephalopathy was 2.5% at 5 years, and 4.1% at 10 years.
Conclusions:
Pericardial devascularization with splenectomy was the first choice for the treatment of portal hypertension, especially for posthepatitic cirrhosis. The following were our experience: (1) thorough porto-azygos disconnection; (2) performing the operation in according to pericardial anatomy with correct surgical techniques; (3) selection of operative candidates and opportunity; (4) emphasizing perioperative management and preventing complications.