Chinese Medical Journal

eet

PORTAL HYPERTENSION 45

portal pressure in all the above 6 cases was definitely higher than this normal average. 3. We measured the epiploic, splenic and portal vein pressures in 1 case during operation and found them 258, 290 and 310 mm blood column respectively. This showed that the pressure readings can be different when the basal line is put at different levels. Thus when the epiploic pressure is determined after the omentum is laid down over the abdominal wall, the pressure reading can be lower than the actual portal pressure.

In correlating the portal pressure with the clinical manifestations of esophageal varices, hematemesis and ascites we found that the incidence of esophageal varices was roughly in proportion to the height of the portal pressure (Fig. 2). Also, the curves for the incidences of esophageal varices and hematemesis were closely parallel, and the incidence of ascites had some relation to the height of portal pressure.

100 o----o Esophageal varices

cf »——x Ascites

One ~@ Hematemesis

80 70 60 50

40

Percentage

50

20

10

0 Portal pressure less 150- 200- 300- 400

mm in blood than column 150 199 229) so on mone

Fig. 2. The relationship between portal pressure and the occurrence of esophageal yarices, hematemesis and ascites.

TREATMENT

The various types of operative treatment in our 65 cases are listed in Table 13. Splenectomy was carried out in most of the cases; splenorenal shunt has been done in this hospital only since April 1953. Endotracheal ether or continuous spinal anesthesia (in the more recent cases) was employed.