Patient: Patient male 32 years old, 09 August to the onset of hospitalization to normal liver function after discharge; 2010 January 2, the first major bleeding, examination, fundic esophageal varices (severe) hemostasis after discharge, July and then bleeding, has two major bleeding, three small bleeding, 11 years no bleeding, examination of normal liver function; DNA normal; splenomegaly, hypersplenism, 12 years February April bleeding twice, low platelets and low white blood cells. Has been hospitalized in Shenzhen, Shangluo, Xi’an and other hospitals, each hospital recommended surgery. Now the spirit is improving. Examination shows: normal liver function; normal DNA; large spleen; hypersplenism; low platelets and white blood cells; severe anemia. 1.If surgery is done, what kind of effect is good? 2.What is the effect of splenectomy, dissection and shunt, and is there any way to treat future bleeding? 3.How much does the surgery cost and how long does it take to rest? Tian Mingguo, Department of Hepatobiliary Surgery, People’s Hospital of Ningxia Hui Autonomous Region Tian Mingguo, Department of Hepatobiliary Surgery, People’s Hospital of Ningxia Autonomous Region: According to your description, surgery should be performed. Surgery is broadly divided into two types, namely, dissection and bypass. First, flow dissection: it is a dissection and ligation of the blood vessels around the bleeding-prone parts of the fundus and lower esophagus, along with the removal of the spleen. This method is effective in stopping bleeding and preventing rebleeding, but there is a certain recurrence rate after the operation because of the elevated portal vein pressure in some patients after the operation, now the operation has been improved in China, that is, “selective dissection + in situ splenectomy”, so that the portal vein pressure can be reduced after the operation. Shunt: The blood from the portal vein is shunted to the inferior vena cava, which effectively reduces the portal vein pressure and prevents bleeding. However, it is detrimental to the liver itself because the nutrient blood from the portal vein is shunted and cannot enter the liver thus affecting the nutrient supply to the liver, and also detoxifying the liver. Currently, there is a more reasonable shunt in China, namely “distal splenorenal shunt”, which only shunts blood from the bleeding-prone part of the lower esophagus of the fundus, thus effectively preventing bleeding while not affecting the blood supply to the liver. It is the best procedure among shunts. As to whether bypass or dissection is better, it depends on the establishment of collateral circulation in the patient’s body and the portal vein pressure. Therefore, CT examination is needed to see the vascular condition and sometimes intraoperative measurement of portal vein pressure is required to determine this. The above is a brief introduction, and you can contact again if you are not sure. As for the cost and time of treatment, it depends on the patient’s liver function status, which normally takes about 40,000 Yuan in Yinchuan, Ningxia. The rest time after surgery depends on the respective physical condition.