Anwar Saad, Parasar Kunal, Anand Utpal, Singh Basant, Kant Kislay, Kodali Rohith
Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, India.
Turk J Surg. 2024 Sep 30;40(3):229-239. doi: 10.47717/turkjsurg.2024.6525. eCollection 2024 Sep.
Non-cirrhotic portal hypertension (NCPH) is the most common cause of portal hypertension and upper gastro-intestinal bleeding in children and adolescents in developing nations. It is characterized by features of portal hypertension with preserved liver function. Proximal splenorenal shunt (PSRS) and esophagogastric devascularization are the two most commonly performed surgeries for its management. The present study is aimed at comparison of surgical outcomes between these two procedures.
Between April 2018 and March 2022, prospectively maintained data of consecutive NCPH cases who underwent surgical intervention was reviewed retrospectively. Cases were categorized into two groups- shunt surgery and devascularization. The pre-operative characteristics, peri-operative morbidity and long-term outcomes were compared between the groups.
Of 112 cases who were treated during the study period, 54 cases which underwent surgery were included in the study. Of these, 20 cases underwent PSRS, and splenectomy and devascularization was performed in 34 cases. There was no difference in pre-operative variables between the two groups. Patients undergoing PSRS experienced longer duration of surgery (260 vs. 200 minutes, p <0.001), and those in the devascularization group had significantly greater operative blood loss (350 vs. 455 ml, p <0.001). Post-operative morbidity was comparable between the two groups. Hypersplenism was corrected in all cases and no cases reported rebleeding after median follow-up of 30 months. Three cases in each group developed features of portal biliopathy in follow up period.
Both PSRS and devascularization procedures have comparable efficacy and safety in the management of NCPH.
非肝硬化门静脉高压症（NCPH）是发展中国家儿童和青少年门静脉高压症及上消化道出血的最常见原因。其特征为门静脉高压伴肝功能保留。近端脾肾分流术（PSRS）和食管胃去血管化术是治疗该病最常用的两种手术方式。本研究旨在比较这两种手术的疗效。
回顾性分析2018年4月至2022年3月期间接受手术干预的连续性NCPH病例的前瞻性维护数据。病例分为两组——分流手术组和去血管化手术组。比较两组术前特征、围手术期发病率和长期疗效。
在研究期间接受治疗的112例病例中，54例接受手术的病例纳入研究。其中，20例行PSRS，34例行脾切除术和去血管化术。两组术前变量无差异。接受PSRS的患者手术时间更长（260分钟对200分钟，p<0.001），去血管化组患者术中失血量显著更多（350毫升对455毫升，p<0.001）。两组术后发病率相当。所有病例的脾功能亢进均得到纠正，中位随访30个月后无病例报告再出血。随访期间每组各有3例出现门静脉性肝病特征。
PSRS和去血管化手术在治疗NCPH方面疗效和安全性相当。
