Abstract: Objective:To investigate the clinical efficacy of remodified Sugiura procedure for the treatment of portal hypertension.
Methods:The retrospective cohort study was adopted. The clinical data of 119 patients with portal hypertension who were admitted to Second People′s Hospital of Yichang from June 2006 to October 2014 were collected. Seventytwo patients who underwent pericardial devascularization were allocated into the Hassab group, and the other 47 patients who underwent the remodified Sugiura procedure were allocated into the RM Sugiura group. All the patients firstly underwent splenectomy. The patients of the Hassab group received the classical surgery of pericardial devascularization, and the operation in the RM Sugiura group was improved on the modified Sugiura procedure in several aspects: (1) the cardia was transected obliquely. (2) Paraesophageal vessels were preserved by selective pericardial devascularization. (3) The pedicled omentum covered the anterior anastomosis and was sutured to the posterior abdominal wall. Observed indices included (1) intraoperative and postoperative situations: operation time, volume of intraoperative blood loss, postoperative anal exhaust time and duration of postoperative hospital stay. (2) Postoperative complications: postoperative pleural effusion, perioperative digestive tract rebleeding, difficult swallowing, portal vein thrombosis and gastric dynamic dysfunction. (3) Situation of followup. The followup was performed by telephone interview and outpatient examination to observe the grading of the esophageal varices at postoperative month 6 and 18 using gastroscope till February 2016. Measurement data with normal distribution were presented as ±s, and comparison between groups was done by the t test. Count data were analyzed by the chisquare test. Ranked data were analyzed by Wilcoxon rank test.
Results:(1) Intraoperative and postoperative situations: operation time of the Hassab group and the RM Sugiura group was (201±27)minutes and (255±32)minutes, respectively, with a statistically significant difference between the 2 groups (t=9.67, P<0.05). The volume of intraoperative blood loss, postoperative anal exhaust time and duration of postoperative hospital stay were (380±86)mL, (2.7±0.7)days, (14.2±2.4)days in the Hassab group and (401±72)mL, (3.0±1.7)days, (15.1±2.7)days in the RM Sugiura group, respectively, showing no statistically significant difference (t= 1.35, 1.26, 1.86, P>0.05). (2) Postoperative complications: dysphagia was detected in 3 patients of the Hassab group and in 10 patients of the RM Sugiura group at the postoperative day 10, with a statistically significant difference between the 2 groups (χ²=0.86, P<0.05). However, dysphagia was detected in 1 patient of the Hassab group and in 4 patients of the RM Sugiura group at the postoperative day 20, showing no statistically significant difference between the 2 groups (χ²=2.03, P> 0.05). The number of postoperative pleural effusion, perioperative digestive tract rebleeding, portal vein thrombosis and gastric dynamic dysfunction of the Hassab group and the RM Sugiura group were 23, 6, 10, 8 cases and 20, 1, 6, 6 cases, respectively, showing no statistically significant difference (χ²=1.39, 1.02, 0.03, 0.08, P>0.05). (3) Situation of followup: all the patients were reexamined using gastroscope to observe the grading of esophageal varices. There were 0, 7, 56, 9 patients of G0, GⅠ, GⅡ, GⅢ grading of varices in the Hassab group and 35, 12, 0, 0 patients in the RM Sugiura group at postoperative month 6, showing a statistically significant difference between the 2 groups (Z=-9.64, P<0.05). There were 0, 0, 48, 24 patients of G0, GⅠ, GⅡ, GⅢ grading of varices in the Hassab group and 24, 20, 3, 0 patients in the RM Sugiura group at postoperative month 18, showing a statistically significant difference between the 2 groups (Z=-9.28, P<0.05).
Conclusion:The remodified Sugiura procedure is more effective than the Hassab operation in curing portal hypertension, and it could also reduce the rate of rehemorrhage and improve the shortterm and longterm prognosis.