Brief description of the case ***, male, 63 years old, hospitalization number 173394. Diagnosis: 1) ruptured esophagogastric fundic varices bleeding; 2) cirrhotic portal hypertension with portal vein thrombosis; 3) hypersplenism; 4) postoperative primary hepatocellular carcinoma;
5) after multiple percutaneous liver puncture portal vein embolization and thrombolytic therapy; 6) after TIPS treatment; Medical history: 1) right partial hepatectomy for hepatocellular carcinoma in September 2001, AFP has been normal since then; 2) first upper gastrointestinal bleeding in June 2008, after conservative treatment confirmed by gastroscopy as esophageal and gastric fundic severe varices; 3) first percutaneous gastric left vein embolization in August 2008 In December 2008, the second percutaneous hepatic puncture was performed to embolize the left and short gastric veins and thrombolysis of the portal vein, and the bleeding was repeatedly repeated after three months; 5) in April 2009, TIPS treatment was performed, and the bleeding was repeated six months later, and the frequency and volume increased, basically bleeding when eating; preoperative manifestations: repeated vomiting of blood, black stool The liver function test was basically normal and there was no ascites. Question: What is the best treatment option? The most feasible? Results: Selective combined dissection + splenectomy was performed on March 12, 2010. Intraoperatively, a small amount of blood stool was still seen in the intestine, nodule-like changes in the liver, splenomegaly, a small amount of ascites, opening of the portal choroidal traffic branch, formation of multiple gastric branches, esophageal branches, high esophageal branches, severe paraesophageal adhesions, multiple intravascular chemical glue emboli were seen, postoperative FPP was elevated by 2 CMH2O, and recovery was smooth after surgery. Follow-up: No rebleeding and ascites until December 2013, and liver function was basically normal.