Can portal hypertension be cured?

Many people don't know much about portal hypertension, which is a common disease in general surgery. When portal hypertension occurs, it often leads to spleen enlargement, gastrointestinal bleeding, and ascites. It is very harmful to patients. When this happens, timely treatment is needed to correct hypovolemia and avoid shock. Sometimes blood transfusion is needed in time.

Can portal hypertension be restored? 1. When non-surgical treatment is used for ruptured bleeding of esophageal and gastric varicose veins, the first thing to do is to correct hypovolemia and perform anti-shock treatment. Appropriate amounts of fresh blood and plasma should be transfused. Give hemostatic drugs and intravenous infusion of vasopressin (use with caution in patients with severe liver damage). Somatostatin such as strontium or sandostatin can also be used as intravenous infusion. A double-balloon three-lumen catheter is used for compression and hemostasis, or a sclerosant is injected through a fiberoptic endoscope to stop bleeding. 2. Surgical treatment Shunt surgery: It is to anastomose the main trunk of the portal vein system and its main branches with the vena cava and its main branches, so that the higher pressure portal vein blood can be shunted into the vena cava. Since it can effectively reduce the portal vein pressure, it is an ideal method for preventing and treating massive bleeding. Disconnection surgery: generally includes intracavitary esophageal and gastric vein ligation, pericardial vascular disconnection, and coronary vein ligation. In recent years, fiber endoscopes have been used to inject sclerosing agents directly into varicose veins.

Emergency treatment of massive upper gastrointestinal bleeding: (1) Non-surgical treatment: ① replenish blood volume in time and correct shock; ② use hemostatic drugs (reptilase, cycloheximide, cycloheximide, sodium heparin); ③ three-lumen tube compression hemostasis: (2) Surgical treatment: after non-surgical treatment, if blood pressure and pulse cannot return to normal, blood is drawn from the three-lumen gastric tube, or even blood pressure continues to drop, emergency surgical treatment should be considered. (1) Indications: ① Patients with a history of esophageal varicose bleeding or bleeding crisis; ② Patients with acute bleeding who cannot control bleeding after non-surgical treatment; ③ Patients with splenomegaly and obvious hypersplenism that affects their quality of life. (2) Surgical conditions: Patients who undergo elective surgery should generally be in good general condition, free of serious heart, lung, kidney and other diseases, and have good liver function compensation. Patients with Child's liver function classification (Table 13-2-4) grade I or II are generally selected, while patients with grade III are usually not considered for surgery. In cases of emergency surgery, emergency surgery should be performed after hypovolemia has been corrected as much as possible or under the premise of effective anti-shock treatment.

3. Choice of surgical method Emergency surgery generally includes devascularization, such as pericardial vascularization, gastric fundus transection, or resection of the lower esophagus, cardia, and gastric fundus. Patients with better conditions can also undergo emergency shunt surgery. There are two types of shunt surgeries: selective shunt and non-selective shunt, including proximal splenorenal shunt, distal splenorenal shunt, gastrocoronary vein-inferior vena cava shunt, superior mesenteric vein-inferior vena cava shunt, splenic cavity, and portal vein shunt. Patients who are undergoing elective surgery and have severe varicose veins of the esophagus and gastric fundus and are at risk of bleeding or have already ruptured and bled should choose an appropriate shunt technique, and if conditions permit, a splenorenal venous shunt should be performed as much as possible. For patients with severe hypersplenism and mild varicose veins, simple splenectomy and omental splenic fossa packing can be considered.

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