Therapeutic effect and safety of selective paraesophagogastric devascularization with or without splenectomy for treatment of esophagogastric variceal hemorrhage
10.3760/cma.j.issn.1007-631X.2018.07.002
- VernacularTitle:保脾断流术与切脾断流术治疗胃底食管曲张静脉破裂出血的疗效及安全性分析
- Author:
Weihua ZHU
1
;
Yijun LIU
;
Zhedong ZHANG
;
Wenyong XIE
;
Dafang ZHANG
;
Shu LI
;
Jiye ZHU
;
Xisheng LENG
Author Information
1. 100044,北京大学人民医院肝胆外科
- Keywords:
Hypertension,portal;
Esophageal and gastric varices;
Splenectomy;
Devascularization
- From:
Chinese Journal of General Surgery
2018;33(7):540-543
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the therapeutic effect or safety of selective paraesophagogastric devascularization with or without splenectomy for treatment of esophagogastric variceal hemorrhage.Methods The clinical data of 70 patients with a history of esophagogastric variceal hemorrhage from 2009 to 2015 were analyzed.29 cases received spleen preserving paraesophagogastric devascularization and 41 were given portoazygous devascularization plus splenectomy.Results Postoperative portal pressure in spleenpreserving group decreased 14％,that in splenectomy group decreased 23％ (t =2.87,P =0.01).The average blood loss in without splenectomy group was (829 ± 720) ml in contrast to (1 400 ± 1 329) ml in splenectomy group (t =2.311,P =0.024).Postoperative WBC and platelet count in without splenectomy group were lower (t =-5.379,t =-4.924,all P ＜0.01).The postoperative complication rate (24％ vs.39％),and portal venous thrombosis (10％ vs.31％) were all in favour of splenectomy free group (x2 =0.036,P ＜0.05).The 1-and 3-year's recurrent bleeding rate were 4％ and 8％ compared with 4％ and 8％ (all P ＞ 0.05).Conclusion Paraesophagogastric devascularization without splenectomy has less blood loss during the surgery,lower rate of PVT and comparable effect against post-op recurrent bleeding in contrast to devascularization plus splenectomy.
