Clinical effect of spleno-renal shunt combined with pericardial devascularization and its influence on hemodynamics of portal venous system

Objective To investigate the clinical effects of pericardial devascularization (PCDV) and proximal spleno-renal shunt (PSRS) combined with PCDV and evaluate respectively their effects on hemodynamics of portal venous system. Methods A retrospective analysis was carried out in 245 cases with portal hypertension treated with PCDV (PCDV group) or PSRS plus PCDV (combination group). The diameter, blood flow velocity and blood flow of portal vein, splenic vein and superior mesenteric vein were measured by magnetic resonance angiograph at 1 week preoperatively and at 2 week postoperatively. Free portal pressure (FPP) was continuously determined during operation. Results In combination group, the blood flow of portal vein decreased and that of superior mesenteric vein increased (P0.05), but the diameter of portal vein and FPP decreased very significantly (P0.01) compared with the preoperative data. There was no significant difference upon decrease of blood flow of portal vein but very significant difference upon decrease of FPP between combination group and PCDV group (P0.01). Postoperative incidence rate of rebleeding in combination group was significantly lower than that in PCDV group (P0.01). While there was no significant difference upon liver function and incidence rate of postoperative hepatic encephalopathy between both groups. Conclusions PSRS plus PCDV should be the treatment of choice for treatment of portal hypertension combined with hemorrhage because it integrates advantages of shunt and devascularization, significantly decreases incidence rate of rebleeding and avoids increase of hepatic encephalopathy.