To explore the application value of individualized surgical treatment based on the CT portal venograpy (CTPV) classification in cirrhotic portal hypertension.

One hundred and fifty-six patients with cirrhotic portal hypertension who received surgical treatment in Anhui Province Hospital between June 2010 and December 2014 were enrolled in this prospective study. According to different surgical procedures, the patients were divided into two groups: the individualized surgery based on CTPV classification group (classification group) and traditional surgery group (traditional group). Among the 84 patients in the classification group, 56 were males and 28 were females with the age ranging from 19 to 67 years old and the median of 45 years old. Among the 72 patients in the traditional group, 47 were males and 25 were females with the age ranging from 23 to 62 years old and the median of 43 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients in the classification group underwent individualized surgery according to the pre-operative CTPV classification, while the patients in the traditional group underwent splenectomy + pericardial devascularization. The effects of two surgical procedures on the portal hypertension, intraoperative and postoperative conditions and postoperative survival rate of the patients were observed. The observation indexes of two groups were compared using t test and survival analysis was conducted using Kaplan-Meier method and Log-rank test.

The postoperative free portal pressure (FPP) in the classification group was (27±3) cmH₂O (1 cmH₂O=0.098 kPa), significantly lower than (33±8) cmH₂O in the traditional group (t=-3.355, P<0.05). The FPP decrease range before and after surgery in the classification group was (13±6) cmH₂O, significantly higher than (9±5) cmH₂O in the traditional group (t=3.016, P<0.05). The length of surgery and intraoperative blood loss in the classification group were respectively (188±84) min and (378±49) ml, significantly less than (240±76) min and (463±57) ml in the traditional group (t=-2.687, -3.015; P<0.05). The postoperative length of stay and hospitalization expense in the classification group were respectively (12±4) d and (31 000 ± 15 000) yuan, significantly lower than (15±5) d and (36 000±15 000) yuan in the traditional group (t=-2.061, -2.104; P<0.05). The 1, 3-year accumulative survival rate were respectively 94.05% and 85.71% in the classification group, and were respectively 87.50% and 68.05% in the traditional group. The overall survival rate in the classification group was significantly higher than that in the traditional group (χ²=7.000, P<0.05).

Pre-operative CTPV classification and individualized surgical treatment for patients with cirrhotic portal hypertension can effectively reduce the portal vein pressure and has the advantages of smaller injury and better prognosis.