Chinese Medical Journal

Denes atm

PORTAL HYPERTENSION 49

cases (Table 15). The reduction is most marked in the extrahepatic group. We believe that in cases of extrahepatic obstruction splenectomy alone can effect a satisfactory reduction of the portal pressure and that shunting is usually unnecessary.

Table 15. The effect of operation on portal pressure

Average reduction of

roce f . Procedure portal pressure in mm

Ligation of the

: splenic artery : 36.6 HaielNS eee Splenectomy 55.4 Splenorenal shunt 774 Ligation of splenic Extrahepatic artery : 47.5

Splenectomy 108.0

In 5 cases in which the portal pressure was not too high (all below 250 mm blood column) we found that after splenectomy there was a rise of the portal pressure instead of a fall. The possible explanations for this are: 1. The perisplenic collaterals were divided while the spleen was freed. 2. Since the spleen functions as a blood reservoir, its gradual enlargement tends to make it a buffer to the elevation of the portal pressure. This effect may be more marked in a soft spleen than a fibrotic one. The above cases presented low portal pressure either because of the existence of rich collaterals or a distensible spleen. Thus, although the arterial inflow to the portal system was reduced by approximately 40 per cent after splenectomy, the resultant portal pressure became higher than before operation.

c. Changes in blood picture. With the exception of 2 cases of mediastinotomy, 1 case in which only ligation of the splenic and hepatic arteries was done and 2 operative deaths, the blood picture in nearly all the other cases showed marked improvement immediately after splenectomy (Fig 3). In the case in which only ligation of the splenic and hepatic arteries was done, the white count increased from 4,300 to a maximum of 7,600 and platelets increased from 100,000 to 150,000, while there was no change in the red count or hemoglobin. It is apparent that this procedure is far less effective than splenectomy in relieving hypersplenism. In the majority of the cases there was moderate leukocytosis immediately after splenectomy. The white count usually returned to normal in one to two months. In 15 eases, followed up from one to two months, the white count was below 5,000 in 2 cases, between 5,000 and 10,000 in 11 cases, between 10,000 and 15,000 in 1 case and above 15,000 in 1 case.

d. Changes in liver function. Whether splenectomy or shunt operation has any influence on the course of liver cirrhosis is worth serious study. It is known that chronic passive congestion of the liver resulting