Chinese Medical Journal

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PORTAL HYPERTENSION : 53

incidence is only about one half of that in cases with demonstrable varices.

6. The operative treatment in this series included splenectomy in 52 cases, splenorenal anastomosis in 8, mediastinotomy in 2, ligation of hepatic artery in 2, anastomosis between the splenic vein and a retroperitoneal collateral in 1. The operative mortality was 3.2 per cent.

7. Mediastinotomy and anastomosis of the splenic vein to any collateral branch yielded no beneficial results and were abandoned.

6. Splenectomy relieved hypersplenism and reduced the portal pressure in most of the cases, especially those with the extrahepatic type of portal obstruction. Symptomatic relief and improvement in liver function were observed in the cases followed up postoperatively. The technic is simple, and it is suggested that in early cases of portal hypertension with marked clinical manifestations of hypersplenism and yet with no history of hematemesis, splenectomy should be the operation of choice, especially in the extrahepatic type of cases.

9. Ligation of the hepatic artery in addition to splenectomy may further reduce congestion in the portal system. Clinically, it may have the effect of lessening the occurrence of hematemesis and ascites. In late cases with a history of hematemesis and the presence of ascites in a large amount, ligation of the hepatic artery may be adopted.

10. Splenorenal anastomosis is a more effective procedure in reducing the portal pressure than simple splenectomy. In cases with a history of hematemesis, presence of a moderately enlarged spleen and absence of marked impairment of liver function, splenorenal anastomosis is indicated.

REFERENCES 1. Lan, H. C., Yao, C. W., and Chien, C. E., Surgical management of portal hypertension; a preliminary report, Chinese M. J. 72:118-145, 1954.

2. Hyatt, R. E., and Smith, J. R., The mechanism of ascites; a physiologic appraisal, Am. J. Med. 16:434-448, 1954.

Huang, T. T., Splenorenal anastomosis by the transabdominal approach; a description of technic with report of 9 cases, Chinese M. J. 72:461-471, 1954.