Clinical efficacy of selective venous shunts of gastrosplenic area for portal hypertension

Objective:To investigate the clinical efficacy of selective venous shunts of gastrosplenic area for portal hypertension.
Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 68 patients with portal hypertension who were admitted to the People′s Hospital of Ning Xia Autonomous Region from Semptember 2016 to August 2019 were collected. There were 46 males and 22 females, aged from 26 to 71 years, with a median age of 48 years. Selective venous shunts of gastrosplenic area were performed according to evaluation results on preoperative vessel course around gastroesophageal varices by computed tomography (CT) and on intraoperative portal hemodynamics. Observation indicatores: (1) surgical and postoperative situations; (2) follow.up. Follow.up was performed by outpatient examination or telephone interview up to February 2020. Gastroscopy and portal vein CT examinations were performed within postoperative 3 to 6 months, and liver function, alpha fetoprotein and hepatobiliary B ultrasound were reexamined once every 6 months thereafter on patients to detect platelet count, coagulation and gastroesophageal varices. Measurement data with skewed distribution were expressed as M (range). Count data were described as absolute numbers or percentages.
Results:(1) Surgical and postoperative situations: of the 68 patients, 30 underwent selective shunts, including 16 cases of splenectomy combined with coronary renal shunt, 7 cases of splenectomy combined with coronary caval shunt, 5 cases of distal splenorenal shunt, 1 case of inferior mesenteric vein renal shunt and 1 case of right gastroepiploic vein caval shunt. Selective gastric vein shunt was performed in 38 cases by rerouting the spontaneous porto.systemic shunt, including 33 cases by rerouting the spontaneous gastric.renal shunt, 3 cases by rerouting the spontaneous splenorenal shunt and splenectomy, 2 cases by rerouting the spontaneous splenorenal shunt only. Of 68 patients, no operative death was found. There was 1 case of intraperitoneal hemorrhage requiring reoperation for hemostasis, 1 case of intraperitoneal infection, 1 case of mild hepatic encephalopathy and 1 case of mild pulmonary embolism. (2) Follow.up: 68 patients were followed up for 18 months (range, 6-36 months). The liver function and the degree of ascites were improved obviously after operation. Portal vein thrombosis occurred in 5 patients, which were all in the group of selective gastric venous shunt via spontaneous gastric.renal shunt, with an incidence of 15.2%(5/33). Postoperative gastroscopy and CT portography showed the disappearance of gastrioesophageal varices in 31 cases, mild residue in 34 cases, recurrence in 3 cases including 1 case of rupture and rebleeding. Rebleeding was caused by anastomotic stenosis after right gastroepiploic vein caval shunt and the patient was cured after reoperation. Primary liver cancer occurred in 3 cases.
Conclusion:Selective shunt procedures based on the portal hemodynamic features on patients can effectively prevent and cure gastroesophageal variceal bleeding, which can also improve liver function.