Because approximately 85 to 90% of portal hypertension is caused by cirrhosis, the basic treatment remains medical. The main surgical treatment is the treatment or prevention of ruptured bleeding from varices in the lower esophagus and the treatment of hypersplenism. Most patients require elective surgery after proper preparation, and sometimes emergency hemostatic surgery is performed when hemorrhage cannot be controlled with non-surgical treatment. The mortality rate and prognosis of surgical treatment are closely related to the degree of hepatic impairment, so the liver reserve must be correctly determined and the indications for surgery must be carefully chosen. Surgical treatment is generally divided into two categories, one is to reduce portal vein pressure through various shunts. The other type is to block the paradoxical blood flow in the portal vein, so as to achieve the purpose of preventing and controlling bleeding. 1.Bypass surgery: It is to use the main trunk of portal vein system and its main branches to anastomose with the vena cava and its main branches, so that the higher pressure portal blood can be shunted into the vena cava, because it can effectively reduce the pressure of portal vein, it is a more ideal method to prevent and control the hemorrhage, currently there are six kinds of surgical methods that are widely used: (1) Portal-ventricular shunt: the portal vein is directly anastomosed with the inferior vena cava laterally, the shunt (1) Portal vein shunt: the portal vein is directly anastomosed laterally with the inferior vena cava, and the shunt has a significant antihypertensive effect and good hemostasis, but the incidence of hepatic encephalopathy is high. (2) Lateral bypass of superior mesenteric vein and inferior vena cava. (3) Superior mesenteric vein and inferior vena cava “bridge” shunt (usually taken from the right internal jugular vein graft), the above shunt is effective, especially in patients who have undergone splenectomy and have hemorrhage and portal vein adhesions, embolism and other reasons can not perform portal shunt. (4) Splenorenal vein end-lateral shunt: After splenectomy, the splenic vein is laterally anastomosed with the left renal vein, and the shunt is less effective in lowering the pressure. It is better to choose the caliber of splenic vein above 1 cm. (5) Splenic vena cava shunt: after splenectomy, the severed end of splenic vein is anastomosed with the lateral aspect of the inferior vena cava. (6) Distal splenorenal vein shunt: anastomosis of the distal severed end of the splenic vein with the lateral side of the renal vein or the proximal severed end of the renal vein, through the splenic vein, the short gastric vein, and drainage to reduce the pressure of the varices of the esophagogastric fundus, so as to improve splenomegaly and hypersplenism without reducing the portal vein pressure. Maintaining the perfusion of portal blood to the liver is conducive to the improvement of hepatocyte function, while also maintaining the immune function of the spleen, giving a better outcome. 2, portal odd dissection: generally includes intraluminal esophagogastric fundic vein ligation. Peripancreatic vascular dissection, coronary vein ligation. Peripancreatic vascular dissection: that is, splenectomy, while completely ligating and cutting off the coronary veins of the stomach, including the high esophageal branches, posterior gastric branches and the vessels around the cardia, this operation is more accurate to prevent hemorrhage, easier to operate, and does not affect the perfusion of the portal vein, less burden on the patient, and better prognosis (see Figure 2-80, 81). Moreover, splenectomy can reduce the amount of blood from the splenic vein in the portal system by 20-40% and can also correct the symptoms caused by hypersplenism at the same time. In recent years, fiberoptic endoscopy has been used to inject sclerosing agents directly into the varicose veins. In the lower part of the esophagus, starting at 5 ml above the cardia, 2 to 3 levels of circumferential injection in the direction of the cardia, each injection point injected 1 to 3 ml, the total amount of 30 to 50 ml; the injection can be repeated every week. Although the recent efficacy is good, but the re-bleeding rate is high, up to 45%, 3, upper gastrointestinal haemorrhage emergency treatment: upper gastrointestinal haemorrhage is a very serious complication of portal hypertension. Only 40% of patients with hepatic sclerosis have esophagogastric fundic varices, while about 50-60% of patients with esophagogastric fundic varices can be complicated by hemorrhage. After hemorrhage, the patient may not only suffer from shock due to acute hemorrhage, but also the possibility of hepatic coma, so the resuscitation measures are as follows: (1) Non-surgical treatment: ① timely replenishment of blood volume, correction of shock; ② the use of hemostatic drugs, such as Anloha, vitamin K, if the bleeding still does not stop, the use of posterior pituitary 20 units into 5% glucose 200 ml of slow intravenous drip, if necessary, repeat after 4 hours Repeat the injection after 4 hours if necessary. (iii) Three-lumen tube for hemostasis by compression: The principle is to compress the varices in the fundus of the stomach and the lower esophagus respectively by using an inflatable balloon to stop bleeding. The tube has three chambers, one through the round air sac, which is inflated to compress the gastric fundus; one through the oval air sac, which is inflated to compress the lower esophagus; and one through the gastric lumen, through which suction, flushing and injection of hemostatic drugs are feasible. (2) Surgical treatment: After non-surgical treatment, if the blood pressure pulse cannot return to normal, fresh blood is drawn from the three-lumen tube in the gastric tube, and even the blood pressure continues to drop, emergency surgical treatment should be considered. Surgical methods are usually fundoplication, fundoplication transection, splenectomy and gastric cerclage with peripancreatic vascular dissection. For patients with good liver function and general condition, early emergency bypass can be pursued. For patients with poor liver function, mild jaundice and small amount of ascites, simple hemostatic surgery, such as splenectomy with peripancreatic vascular dissection of the gastric fundus, is appropriate. The surgical method is simple and easy to master, and the hemostatic effect is generally good.