Experience on Emergency Devascularization for Treatment of Upper Gastrointestinal Bleeding due to Portal Hypertension_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XU Yongqing ,  DAI Chaoliu , BU Xianmin , PENG Songlin , XU Feng , JIA Changjun , ZHAO Yang , ZHAO Chuang , ZHAO Liang.

Department of Hepatobiliary and Splenic Surgery， Shengjing Hospital of China Medical University， Shenyang 110004， Liaoning Province， China;

Corresponding author：

DAI Chaoliu, Email: daicl@sj-hospital.org

Keywords：

Portal hypertension; Variceal hemorrhage; Emergency operation; Devascularization; Splenectomy

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To explore and summarize the curative effect and experience of emergency devascularization for treatment of upper gastrointestinal bleeding due to portal hypertension.
Melthods 　The clinical data of 42 patients with upper gastrointestinal bleeding due to portal hypertension， undergoing emergency devascularization from March 2006 to July 2011 in Shengjing Hospital of China Medical University were retrospectively analyzed.
Results　 Of the 42 cases， 29 patients underwent emergency splenectomy plus esophagogastric devascularization， 8 patients underwent emergency spleen artery ligation plus esophagogastric devascularization， and 5 patients only underwent emergency esophagogastric devascularization. The hemostasis rate at 3 hours after emergent disconnection operation was 100%. One patient died of liver failure on 8 days after operation. Three patients supervened with hemorrhage in abdominal cavity on 2 days after operation， and succeeded in hemostasis by conservative treatment. Other patients were successfully
discharged from hospital after postoperative rehabilitation for 2-4 weeks. All cases were followed up regular in 1 year after operation， 5 patients were lost to follow-up. Among the 36 cases followed up， rehaemorrhagia occurred in 1 patient
in 8 months after operation， cured by endoscopic variceal ligation subsequently. A primary liver cancer occurred in 1 patient during physical examination in 7 months after operation， followed by partial hepatectomy. Other patients could complete daily life and work.
Conclusions 　The patients suffering from upper gastrointestinal bleeding due to portal hypertension are likely to benefit from appropriate operations. Decisive emergency devascularization can stop the bleeding rapidly and effectively， and save the lives of those patients.

Citation： XU Yongqing,DAI Chaoliu,BU Xianmin,PENG Songlin,XU Feng,JIA Changjun,ZHAO Yang,ZHAO Chuang,ZHAO Liang.. Experience on Emergency Devascularization for Treatment of Upper Gastrointestinal Bleeding due to Portal Hypertension. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(1): 33-36. doi: Copy

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14.	Collins JC， Sarfeh IJ. Surgical management of portal hypertension[J]. West J Med， 1995， 162(6)：527-535.
15.	Henderson JM. Surgery versus transjugular intrahepatic portal systemic shunt in the treatment of severe variceal bleeding[J]. Clin Liver Dis， 2006， 10(3)： 599-612.
16.	贺勇. 急诊断流术治疗门脉高压症上消化道大出血的临床体会[J]. 中国现代手术学杂志， 2007， 11(6)： 427-429.
17.	杨镇，冷希圣. 门静脉高压症外科治疗策略和手术适应证[J]. 继续医学教育， 2006， 20(9)： 22-25.
18.	裘法祖，杨镇. 外科手术在门静脉高压症治疗中的地位和趋势[J]. 外科理论与实践， 1999， 4(2)：65-66.
19.	戴植本，杨镇. 贲门周围血管离断术临床10年回顾[J]. 中国实用外科杂志， 1990， 10(4)： 199-200.
20.	杨镇. 选择性贲门周围血管离断术的应用解剖[J]. 中国实用外科杂志， 2005， 25(11)：702-704.
21.	杨镇. 选择性贲门周围血管离断术的发展与手术技巧[J]. 中国实用外科杂志， 2009， 29(5)：450-451.
22.	冷希圣. 肝移植时代门静脉高压症治疗策略[J]. 中国实用外科杂志， 2009， 29(5)：373-376.
23.	Orozco H， Mercado MA， Martinez R， et al. Is splenectomy necessary in devascularization procedures for treatment of bleeding portal hypertension?[J]. Arch Surg， 1998， 133(1)：36-38.

1. D’Amico G， De Franchis R；Cooperative Study Group. Upperdigestive bleeding in cirrhosis. Post-therapeutic outcome and progn-ostic indicators[J]. Hepatology， 2003， 38(3)： 599-612.
2. 何振平. 门脉高压症手术治疗的选择[J]. 肝胆外科杂志， 2004， 12(5)： 324-326.
3. García-Pagán JC， Reverter E， Abraldes JG， et al. Acute variceal bleeding[J]. Semin Respir Crit Care Med， 2012， 33(1)：46-54.
4. Kirschniak A， Stierle D， Philipp F， et al. Current management of upper gastrointestinal bleeding[J]. Minerva Chir， 2011， 66(6)： 573-587.
5. Opio CK， Garcia-Tsao G. Managing varices： drugs， bands， and shunts[J]. Gastroenterol Clin North Am， 2011， 40(3)：561-579.
6. Bari K， Garcia-Tsao G. Treatment of portal hypertension[J]. World J Gastroenterol， 2012， 18(11)： 1166-1175.
7. García-Pagán JC， Caca K， Bureau C， et al. Early use of TIPS in patients with cirrhosis and variceal bleeding[J]. N Engl J Med， 2010， 362(25)： 2370-2379.
8. 冷希圣. 如何看待门脉高压症上消化道大出血的急诊手术[J].中国实用外科杂志， 2000， 20(8)： 463-464.
9. 许戈良，胡何节. 门脉高压症上消化道大出血的急诊手术治疗[J]. 肝胆外科杂志， 2006， 14(5)：323-324.
10. Schiano TD. Clinical management of hepatic encephalopathy[J].Pharmacotherapy， 2010， 30(5 Pt 2)： 10S-5S.
11. 裘法祖. 再论断流术治疗门脉高压症并发上消化道大出血[J].中国实用外科杂志， 1990， 10(4)：195-196.
12. 胡虞乾，邓水柱，范平，等. 肝功能Child-Pugh C级的门静脉高压症患者急诊断流术后疗效分析[J]. 医学文选， 2002， 21 (3)：278-280.
13. Orozco H， Mercado MA， Chan C， et al. Current role of surgery for the treatment of portal hypertension[J]. Ann Hepato， 2002， 1(4)：175-178.
14. Collins JC， Sarfeh IJ. Surgical management of portal hypertension[J]. West J Med， 1995， 162(6)：527-535.
15. Henderson JM. Surgery versus transjugular intrahepatic portal systemic shunt in the treatment of severe variceal bleeding[J]. Clin Liver Dis， 2006， 10(3)： 599-612.
16. 贺勇. 急诊断流术治疗门脉高压症上消化道大出血的临床体会[J]. 中国现代手术学杂志， 2007， 11(6)： 427-429.
17. 杨镇，冷希圣. 门静脉高压症外科治疗策略和手术适应证[J]. 继续医学教育， 2006， 20(9)： 22-25.
18. 裘法祖，杨镇. 外科手术在门静脉高压症治疗中的地位和趋势[J]. 外科理论与实践， 1999， 4(2)：65-66.
19. 戴植本，杨镇. 贲门周围血管离断术临床10年回顾[J]. 中国实用外科杂志， 1990， 10(4)： 199-200.
20. 杨镇. 选择性贲门周围血管离断术的应用解剖[J]. 中国实用外科杂志， 2005， 25(11)：702-704.
21. 杨镇. 选择性贲门周围血管离断术的发展与手术技巧[J]. 中国实用外科杂志， 2009， 29(5)：450-451.
22. 冷希圣. 肝移植时代门静脉高压症治疗策略[J]. 中国实用外科杂志， 2009， 29(5)：373-376.
23. Orozco H， Mercado MA， Martinez R， et al. Is splenectomy necessary in devascularization procedures for treatment of bleeding portal hypertension?[J]. Arch Surg， 1998， 133(1)：36-38.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experience on Emergency Devascularization for Treatment of Upper Gastrointestinal Bleeding due to Portal Hypertension

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