Abstract:

Objective  To compare  the clinical effects of extensive devascularization around the cardia plus cerclage on gastric fundus and extensive devascularization around the cardia  plus    application of staplers  on  esophagus transection for treatment of the  upper gastrointestinal hemorrhage of portal hypertension.Methods The clinical data  of 151 cases of upper gastrointestinal hemorrhage of portal hypertension with treatment of  portal azygous di
sconnection  were retrospectively analyzed,including 122 patients with extensive devascularization around
the cardia plus cerclage on gastric fundus  (gastric fundus cerclage group) and 29 patients with extensive devascularization around the cardia  plus    application of staplers  on  esophagus transection  (esophageal transection group).The  preoperative and    postoperative  liver function,ascites, hepaticencephalopathy,  astrointestinal bleeding,abdominal hemorrhage,gastrointestinal fistula rate of perioperative complications and long-term recurrent upper gastrointestinal bleeding rate of the patients in two groups were compared.
Results Compared with gastric fundus cerclage group,the more significant impact on patients with liver function and nutritional status,long hospital stay,the high incidence of postoperative gastrointestinal fistula were found in esophageal transection group.In comparative analysis of long-term postoperative bleeding, long-term rebleeding rate of the patients in esophageal transection group(variceal bleeding and  gastric mucosal lesions rebleeding) was 30.0% (15.0%,15.0%) which was higher than that in gastric fundus cerclage group (8.5%) (4.9%,3.6%).
Conclusion Compared with extensive devascularization around the cardia  plus    application of staplers  on  esophagus transection,extensive devascularization around the cardia plus cerclage on gastric fundus has the advantages on liver function,smaller and fewer complications,shorter hospital stay,and can effectively control
the long-term incidence of rebleeding.The operation is simple and easy to grasp.

Key words: portal azygous disconnection;hypertension,portal vein;gastric fundus purse string suture;upper gastrointestinal bleeding