In August 2011, a 32-year-old male patient was admitted to the hospital twice for recurrent vomiting of blood. The patient was treated at a local hospital at each episode and the bleeding could be stopped after conservative medical treatment, so he came to our hospital for further treatment. After admission, gastroscopy results showed: severe varices in the lower esophagogastric vein; ultrasound indicated: splenomegaly, cirrhosis; laboratory results showed: hemoglobin 94g/L, platelets 15×109/L (normal value is 100-300×109/L), hepatitis B minor triple-positive. SPD has become a common surgical procedure for the treatment of cirrhotic portal hypertension combined with esophagogastric fundic variceal bleeding and hypersplenism in China, however, because these patients often have different degrees of liver insufficiency, often combined with coagulation, renal function, brain function and nutritional disorders, intraoperative and postoperative hemorrhage is possible, and surgical death also occurs, so the operation is risky. After sufficient preoperative preparation, with rich clinical experience and skillful surgical skills, the medical team successfully completed the operation in the morning of August 31 after two hours of effort, with less than 100 ml of intraoperative bleeding and no intraoperative blood transfusion, and rechecked hemoglobin 102 g/L and platelets 63×109/L on the second day after surgery; rechecked hemoglobin 104 g/L and platelets 129×109/L on the fifth day after surgery. The patient recovered smoothly after surgery through personalized treatment, and no blood transfusion was given during the hospitalization, which saved valuable blood supply in the current situation of tight blood supply nationwide. The patient recovered without any postoperative complications and was discharged from the hospital. The patient has been followed up for 5 months and is in good general condition and has fully resumed normal life. About upper gastrointestinal bleeding Upper gastrointestinal bleeding refers to bleeding caused by lesions in the gastrointestinal tract above the flexural ligament, including the esophagus, stomach, duodenum or pancreas and bile, and bleeding from jejunal lesions after gastrojejunostomy also falls into this range. Massive bleeding is defined as blood loss exceeding 1000 ml or 20% of the circulating blood volume within a few hours, and its clinical manifestation is mainly vomiting blood and/or black stool, often accompanied by acute peripheral circulatory failure due to blood volume reduction. It is a common emergency, with a mortality rate of 8-13.7%. There are many causes of upper gastrointestinal bleeding, the common ones being peptic ulcer, acute gastric mucosal damage, esophagogastric fundic varices and gastric cancer. Vomiting of blood and/or black stool are characteristic manifestations of upper gastrointestinal bleeding. Massive bleeding up to 30-50% of systemic blood volume (about 1500-2500ml) can produce shock, which is manifested by agitation or confusion, pale face, wet and cold extremities, cyanosis of lips, respiratory distress, decrease in blood pressure to undetectable, decrease in pulse pressure difference (less than 3.33-4kpa) and fast and weak pulse rate (pulse rate >120 times/min), etc. If not handled properly, it can lead to death. For patients with upper gastrointestinal hemorrhage, conservative medical treatment is generally used first, and most upper gastrointestinal hemorrhage can be stopped, and then emergency surgery is considered if it is ineffective. Understanding esophagogastric varices In China, esophagogastric varices are mainly caused by post-hepatitis cirrhosis, and the number of patients with hepatitis (including hepatitis B, hepatitis C, alcoholic hepatitis) is more than 10%, and because of the large base of hepatitis patients in China, the hemorrhage caused by esophagogastric varices accounts for about 25% of the hemorrhage, and because such patients can occur repeatedly, each bleeding will damage the liver, causing In the lighter cases, the transaminases will rise, and in the more serious cases, it will lead to severe anemia, hypoproteinemia, ascites, jaundice, hepatic encephalopathy, and even death. Therefore, for patients with upper gastrointestinal bleeding caused by esophagogastric varices, the timing of surgery is an important factor affecting the success or failure of flow dissection, and some data show that the mortality rate of emergency surgery is 12 times that of elective surgery. In view of the fact that once such patients bleed, they are fierce and prone to different degrees of shock in the early stage, which endangers patients’ lives, while surgical treatment can effectively prevent ruptured bleeding from the esophageal vein of the fundus in addition to relieving portal hypertension hypersplenism, while delaying the further decline of liver function and avoiding the occurrence of hepatic encephalopathy, which is an important criterion for measuring the efficacy of surgery. There are many clinical methods used to treat portal hypertension in cirrhosis, and various surgical methods have irreplaceable superiority in treating portal hypertension, but peripancreatic vascular dissection has the advantages of simpler surgical operation, easy promotion in primary units, lower incidence of hepatic encephalopathy compared with bypass, and more satisfactory recent and long-term efficacy. Therefore, for patients with poor hemostatic results from conservative treatment methods, our experience is that for patients whose liver function can tolerate surgery, conservative treatment at the beginning should be used as part of the preparation for emergency surgery, and once the results are less than satisfactory, surgery should be performed decisively to avoid loss of surgery due to deterioration of liver function. For those whose liver function status is not suitable for surgery, treatment to improve liver function should also be actively taken to create surgical conditions for any surgery that may be needed. In view of the above, for patients whose bleeding has stopped after conservative treatment, we recommend surgery for a limited period of time after the condition has stabilized, to avoid losing the opportunity for surgery due to multiple bleeding leading to liver insufficiency or even liver failure.