Comparison of the long-term therapeutic effect between spleno-renal shunt combined with pericardial devascularization and simple pericardial devascularization

Objective To evaluate the clinical effects of pericardial devascularization(PCDV) and proximal spleno-renal shunt(PSRS) combined with PCDV.Methods A retrospective analysis was carried out in 384 cases with portal hypertension treated with PCDV(PCFV group) or PSRS plus PCDV(combination group).The incidence of rebleeding,post-operative hepatic encephalopathy and hepatic function failure were summarized.The diameter,blood flow velocity and blood flow of portal vein,splenic vein and superior mesenteric vein were measured with magnetic resonance angiograph at 1 week preoperatively and at 2 weeks postoperatively.Free portal pressure(FPP) was dynamically determined during operation.Results The post-operative rebleeding rate in combination group was obviously lower than that in the pericardial devascularization group,but there was no statistical difference in the liver function and the incidence of hepatic encephalopathy in both groups(P0.01).The difference of the decreasing of the blood flow volume of the portal vein before and after the operation had statistical significance in the combination group.There was no significant difference on decreasing of blood flow of the portal vein,but very significant difference on decreasing of FPP between combination group and PCDV group(P0.01).Conclusion PSRS plus PCDV should be the first choice for the treatment of the portal hypertension combined with hemorrhage because it integrates advantages of shunt and devascularization,significantly decreases incidence of rebleeing and avoids increasing of hepatic encephalopathy.