Treatment strategy for upper gastrointestinal rebleeding after devascularization operation in portal hypertension patients:a report of 56 cases / 中国普通外科杂志

ABSTRACT

Objective To explore the causes of upper gastrointestinal rebleeding after devascularization operation for portal hypertension and the therapeutic effect of shunt operation.Methods The clinical data of 56 cases of upper gastrointestinal rebleeding after devascularization operation for portal hypertension in our hospital from 1996 to 2006 were retrospectively analyzed.Shunt operation was done in 54 ceses including emergency operation shunt in 5 cases,and elective operation in 49 cases.C-type Mesocaval shunt was done in 45 cases,inferior mesenteric vein-cava shunt in 4 cases,H-type and portacaval in 5 cases.Results Chylorrhea occurred in 13 cases after operation and all recovered;hepatic encephalopathy occurred in 5 cases,and 4 cases recovered,1 died;and 1 case died of liver function failure on the third day after operation.Fifty-two cases were followed-up from 6 months to 9 years,and none had recurrence of upper gastrointestinal bleeding,but 7 died(2 cases died of primary hepatic carcinoma,3 cases died of liver function failure and hepatic encephalopathy,and 2 cases died of non-correlated disease).Conclusions Patients with upper gastrointestinal rebleeding after devascularization operation for portal hypertension should undergo non-operative treatment at first,and elective surgery is done later.If aggressive non-operative treatment for 48h is not successful,then emergency operation should be performed.In elective cases,the operation of first choice is mesocaval interposition synthetic graft shunt,which is particularly applicable in patients with portal vein thrombosis or portal hypertensive gastropathy.