Clinical Research of Gastrointestinal Rebleeding after Operation on Portal Hypertension Patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Hongfeng , LI Xiaoyi , LIU Yuewu , GAO Weisheng.

Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;

Corresponding author：

Keywords：

Portal hypertension; Gastrointestinal rebleeding; Lienectomy; Shunt operation

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Objective To explore the causes and treatment of rebleeding after operation on portal hypertension patients. Methods The clinical data of 41 rebleeding cases underwent the operational between January 2000 and December 2009 in Peking Union Medical College Hospital were retrospectively analyzed.
Results All 13 cases who got rebleeding after shunt operation received lienectomy, but for those who got rebleeding after lienectomy, 23 patients received Phemister or modified Phemister or expanded lienectomy and 5 patients received shunt operation. Surgical related complications occurred in 7 cases (17.1%) at 2 weeks after operation, including abdominal bleeding (3 cases), gastrointestinal bleeding (2 cases), and intractable ascites (2 cases). After the follow-up of 3-60 months (mean 39 months), all patients were still alive. During the follow-up, 3 cases of recurrent esophageal varices were observed and one of them got rebleeding.
Conclusion The majority of rebleeding after lienectomy tend to be ascribed to the wrong operations chose, while bad operation skill often contribute to the rebleeding after shunt operation, suggesting ideal therapeutic effect for rebleeding can benefit from appropriate operation choose.

Citation： LIU Hongfeng,LI Xiaoyi,LIU Yuewu,GAO Weisheng.. Clinical Research of Gastrointestinal Rebleeding after Operation on Portal Hypertension Patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(8): 820-823. doi: Copy

1.	高维生, 刘跃武, 赵玉沛, 等. 门静脉高压症术后再出血手术方式及其疗效的探讨 [J]. 中华普通外科杂志, 2001; 16(7): 392394.
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3.	黄莚庭. 正确认识门静脉高压症手术的个体化问题 [J]. 中华普通外科杂志, 2006; 21(5): 313314.
4.	高维生, 刘洪沨, 刘跃武, 等. 食管下段胃近端切除术治疗门静脉高压症上消化道出血136例分析 [J]. 中华外科杂志, 2006; 44(19): 13301332.
5.	da Silva L C, Strauss E, Gayotto LC, et al. A randomized trial for the study of the elective surgical treatment of portal hypertension in mansonic schistosomiasis [J]. Ann Surg, 1986; 204(2): 148153.
6.	Orozco H, Mercado MA, Chan C, et al. Current role of surgery for the treatment of portal hypertension [J]. Ann Hepatol, 2002; 1(4): 175178.
7.	姜洪池. 肝硬变门静脉高压症外科治疗的今日思考 [J]. 中国普外基础与临床杂志, 2008; 15(12): 871872.
8.	GarcíaPagán JC, Villanueva C, Albillos A, et al. Nadolol plus isosorbide mononitrate alone or associated with band ligation in the prevention of recurrent bleeding: a multicentre randomised controlled trial [J]. Gut, 2009; 58(8): 11441150.
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10.	Groszmann RJ, GarciaTsao G, Bosch J, et al. βblockers to prevent gastroesophageal varices in patients with cirrhosis [J]. N Engl J Med, 2005; 353(21): 22542261.
11.	Thalheimer U, Mela M, Patch D, et al. Monitoring target reduction in hepatic venous pressure gradient during pharmacological therapy of portal hypertension: a close look at the evidence [J]. Gut, 2004; 53(1): 143148.
12.	李震, 贾如冰, 汪忠镐, 等. 附脐静脉在门静脉高压分流术中的应用 [J]. 中国普外基础与临床杂志, 2010; 17(2): 180181.
13.	Mandell MS, Durham J, Kumpe D, et al. The effects of desflurane and propofol on portosystemic pressure in patients with portal hypertension [J]. Anesth Analg, 2003; 97(6): 15731577.
14.	Villanueva C, Miana J, Ortiz J, et al. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding [J]. N Engl J Med, 2001; 345(9): 647655.
15.	李震, 吴继东, 汪忠镐, 等. 肝前型门静脉高压症的诊治 [J]. 中国普外基础与临床杂志, 2009; 16(12): 10051009.
16.	Sharara AI, Rockey DC. Gastroesophageal variceal hemorrhage [J]. N Engl J Med, 2001; 345(9): 669681.
17.	PomierLayrargues G, Villeneuve JP, Deschênes M, et al. Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial [J]. Gut, 2001; 48(3): 390396.
18.	任辉, 李志伟, 肖朝辉, 等. 门静脉高压症断流术后上消化道再出血诊治体会 [J]. 中国普外基础与临床杂志, 2008; 15(6): 448449.
19.	Jalan R, Hayes PC. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. British Society of Gastroenterology [J]. Gut, 2000; 46 Suppl 34: Ⅲ1Ⅲ15.
20.	Abraldes JG, Tarantino I, Turnes J, et al. Hemodynamic response to pharmacological treatment of portal hypertension and longterm prognosis of cirrhosis [J]. Hepatology, 2003; 37(4): 902908.
21.	Villeneuve JP, PomierLayrargues G, InfanteRivard C, et al. Propranolol for the prevention of recurrent variceal hemorrhage: a controlled trial [J]. Hepatology, 1986; 6(6):12391243.
22.	Boyer TD, Henderson JM, Heerey AM, et al. Cost of preventing variceal rebleeding with transjugular intrahepatic portal systemic shunt and distal splenorenal shunt [J]. J Hepatol, 2008; 48(3): 407414.
23.	GarciaPagan JC, De Gottardi A, Bosch J. Review article: the modern management of portal hypertensionprimary and secondary prophylaxis of variceal bleeding in cirrhotic patients [J]. Aliment Pharmacol Ther, 2008; 28(2): 178186.
24.	Lebrec D. Review: pharmacotherapeutic agents in the treatment of portal hypertension [J]. J Gastroenterol Hepatol, 1997; 12(2): 159166.

1. 高维生, 刘跃武, 赵玉沛, 等. 门静脉高压症术后再出血手术方式及其疗效的探讨 [J]. 中华普通外科杂志, 2001; 16(7): 392394.
2. 黄莚庭. 重视对门静脉高压症术后再出血的临床诊治 [J]. 中华实用外科杂志, 2001; 21(3): 129130.
3. 黄莚庭. 正确认识门静脉高压症手术的个体化问题 [J]. 中华普通外科杂志, 2006; 21(5): 313314.
4. 高维生, 刘洪沨, 刘跃武, 等. 食管下段胃近端切除术治疗门静脉高压症上消化道出血136例分析 [J]. 中华外科杂志, 2006; 44(19): 13301332.
5. da Silva L C, Strauss E, Gayotto LC, et al. A randomized trial for the study of the elective surgical treatment of portal hypertension in mansonic schistosomiasis [J]. Ann Surg, 1986; 204(2): 148153.
6. Orozco H, Mercado MA, Chan C, et al. Current role of surgery for the treatment of portal hypertension [J]. Ann Hepatol, 2002; 1(4): 175178.
7. 姜洪池. 肝硬变门静脉高压症外科治疗的今日思考 [J]. 中国普外基础与临床杂志, 2008; 15(12): 871872.
8. GarcíaPagán JC, Villanueva C, Albillos A, et al. Nadolol plus isosorbide mononitrate alone or associated with band ligation in the prevention of recurrent bleeding: a multicentre randomised controlled trial [J]. Gut, 2009; 58(8): 11441150.
9. Zipprich A, LoureiroSilva MR, D’Silva I, et al. The role of hepatic arterial flow on portal venous and hepatic venous wedged pressure in the isolated perfused CCl4cirrhotic liver [J]. Am J Physiol Gastrointest Liver Physiol, 2008; 295(1): G197G202.
10. Groszmann RJ, GarciaTsao G, Bosch J, et al. βblockers to prevent gastroesophageal varices in patients with cirrhosis [J]. N Engl J Med, 2005; 353(21): 22542261.
11. Thalheimer U, Mela M, Patch D, et al. Monitoring target reduction in hepatic venous pressure gradient during pharmacological therapy of portal hypertension: a close look at the evidence [J]. Gut, 2004; 53(1): 143148.
12. 李震, 贾如冰, 汪忠镐, 等. 附脐静脉在门静脉高压分流术中的应用 [J]. 中国普外基础与临床杂志, 2010; 17(2): 180181.
13. Mandell MS, Durham J, Kumpe D, et al. The effects of desflurane and propofol on portosystemic pressure in patients with portal hypertension [J]. Anesth Analg, 2003; 97(6): 15731577.
14. Villanueva C, Miana J, Ortiz J, et al. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding [J]. N Engl J Med, 2001; 345(9): 647655.
15. 李震, 吴继东, 汪忠镐, 等. 肝前型门静脉高压症的诊治 [J]. 中国普外基础与临床杂志, 2009; 16(12): 10051009.
16. Sharara AI, Rockey DC. Gastroesophageal variceal hemorrhage [J]. N Engl J Med, 2001; 345(9): 669681.
17. PomierLayrargues G, Villeneuve JP, Deschênes M, et al. Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial [J]. Gut, 2001; 48(3): 390396.
18. 任辉, 李志伟, 肖朝辉, 等. 门静脉高压症断流术后上消化道再出血诊治体会 [J]. 中国普外基础与临床杂志, 2008; 15(6): 448449.
19. Jalan R, Hayes PC. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. British Society of Gastroenterology [J]. Gut, 2000; 46 Suppl 34: Ⅲ1Ⅲ15.
20. Abraldes JG, Tarantino I, Turnes J, et al. Hemodynamic response to pharmacological treatment of portal hypertension and longterm prognosis of cirrhosis [J]. Hepatology, 2003; 37(4): 902908.
21. Villeneuve JP, PomierLayrargues G, InfanteRivard C, et al. Propranolol for the prevention of recurrent variceal hemorrhage: a controlled trial [J]. Hepatology, 1986; 6(6):12391243.
22. Boyer TD, Henderson JM, Heerey AM, et al. Cost of preventing variceal rebleeding with transjugular intrahepatic portal systemic shunt and distal splenorenal shunt [J]. J Hepatol, 2008; 48(3): 407414.
23. GarciaPagan JC, De Gottardi A, Bosch J. Review article: the modern management of portal hypertensionprimary and secondary prophylaxis of variceal bleeding in cirrhotic patients [J]. Aliment Pharmacol Ther, 2008; 28(2): 178186.
24. Lebrec D. Review: pharmacotherapeutic agents in the treatment of portal hypertension [J]. J Gastroenterol Hepatol, 1997; 12(2): 159166.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Research of Gastrointestinal Rebleeding after Operation on Portal Hypertension Patients

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