Reasonable choice of surgical procedures for patients with portal hypertension

摘要

OBJECTIVE: To assess individualized therapeutic protocol for patients with portal hypertension on thebasis of accumulated knowledge about the mechanism of portal hypertension.DATA SOURCES: Patients data on shunt and other surgical procedures from Ruijin Hospital, Shanghai,China and the published papers.RESULTS: The direction of blood flow of the collateral vessels in the gastro-splenic region is animportant factor in deciding surgical strategy because there is a close relationship between surgical riskand the classification of liver function. Clinically it is confirmed that each patient needs an individualizedsurgical procedure and that prophylactic operation is suitable for patients with splenomegaly, splenismassociated with serious esophageal varices and hemorrhagic tendency under endoscopy but acceptableliver function. The shunt diameter (SD) (SD=0.67×PVD) is determined in our patients according toindividualized hemodynamics. The rehemorrhagic rate after shunt being higher than that in others may berelated to lesioned gastric mucosa caused by portal hypertension or bleeding and temporary melena. Thisfinding is good for prevention of hepatic encephalopathy. The life quality and labor ability of patients willbe improved because of hepatopetal flow in the portal vein. With strict indications for reoperation,selective operation is performed as soon as possible when hemorrhage is controlled conservatively andliver function improved. Once the patient with cirrhosis associated with portal hypertension is scheduledfor liver transplantation, treatment of hemorrhage should aim to keep the patient in good condition and toavoid the protocol that may be disadvantageous to liver transplantation in the future.CONCLUSION: Surgical procedures for patients with portal hypertension should follow the principle ofindividualization. To obtain the best outcome, the choice of reasonable surgical procedure is expected.