Clinical analysis of surgical treatment of portal hypertension.
OBJECTIVE
To review the experience in surgery for 508 patients with portal hypertension and to explore the selection of reasonable operation under different conditions.


METHODS
The data of 508 patients with portal hypertension treated surgically in 1991-2001 in our centers were analyzed. Of the 508 patients, 256 were treated with portaazygous devascularization (PAD), 167 with portasystemic shunt (PSS), 62 with selective shunt (SS), 11 with combined portasystemic shunt and portaazygous devascularization (PSS+PAD), 9 with liver transplantation (LT), 3 with union operation for hepatic carcinoma and portal hypertension (HCC+PH).


RESULTS
In the 167 patients treated with PSS, free portal pressure (FPP) was significantly higher in the patients with a longer diameter of the anastomotic stoma than in those with a shorter diameter before the operation (P < 0.01). After the operation, FPP in the former patients markedly decreased compared to the latter ones (P < 0.01). The incidence rate of hemorrhage in patients treated with PAD, PSS, SS, PSS+PAD, and HCC+PH was 21.09% (54/256), 13.77 (23/167), 11.29 (7/62), 36.36% (4/11), and 100% (3/3), respectively. The incidence rate of hepatic encephalopathy was 3.91% (10/256), 9.58% (16/167), 4.84% (3/62), 9.09% (1/11), and 100% (3/3), respectively while the operative mortality was 5.49% (15/256), 4.22% (7/167), 4.84% (3/62), 9.09% (1/11), and 66.67% (2/3) respectively. The operative mortality of liver transplantation was 22.22% (2/9).


CONCLUSIONS
Five kinds of operation in surgical treatment of portal hypertension have their advantages and disadvantages. Therefore, the selection of operation should be based on the actual needs of the patients.
Xu
Xin-Bao
XB
Department of Hepatobiliary Surgery, People's Hospital, Peking University, Beijing 100044, China. x_xb@163.net
Cai
Jing-Xiu
JX
Leng
Xi-Sheng
XS
Dong
Jia-Hong
JH
Zhu
Ji-Ye
JY
He
Zhen-Ping
ZP
Wang
Fu-Shun
FS
Peng
Ji-Run
JR
Han
Ben-Li
BL
Du
Ru-Yu
RY
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006470:Hemorrhage / Q000401:mortality / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000401:mortality* / Q000601:surgery*; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies