Sequential laparoscopic splenectomy plus azygoportal disconnection and postoperative endoscopic variceal ligation for portal hypertensive variceal bleeding / 中华普通外科杂志

ABSTRACT

Objective To investigate the clinical safety and value of sequential therapy combining laparoscopic splenectomy and azygoportal disconnection with postoperative endoscopic variceal ligation (EVL) for portal hypertensive variceal bleeding.Methods From February 2012 to March 2016,114 patients underwent sequential laparoscopic splenectomy plus azygoportal disconnection and periodical postoperative endoscopic variceal ligation.Results were compared with those who underwent laparoscopic splenectomy and azygoportal disconnection without postoperative endoscopic variceal ligation in a group of 105 cases.Results Between the two groups oesophageal variceal re-bleeding (EVR) rates during first postoperative 3 months was not significantly different (P ＞ 0.05),however,sequential therapy group was associated with lower EVR rates during the periods ranging from 1 to 12 months,and 4 to 12 months compared with non-sequential therapy group (all P ＜ 0.05).Dynamic changes in the diameter of oesophageal varices and EVL rates in sequential therapy group both decreased gradually and significantly over the 12-month follow-up period (all P ＜0.01).No one in sequential therapy group suffered EVR from 6th month onward.No patient required EVL at the 12th month in sequential therapy group.Conclusion Sequential laparoscopic splenectomy plus azygoportal disconnection and postoperative EVL for portal hypertensive variceal bleeding is safe,feasible and effective in decreasing postoperative EVR rates.