Risk factors and management strategy of intraperitoneal hemorrhage following surgical treatment of portal hypertension   XU Wei, LI Jing-dong, TIAN Yun-hong,et al. Department of General Surgery, Institute of  Hepatobiliary-
pancreatic-intestinal Diseases, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
Corresponding author：LI Jing-dong，E-mail: lijingdong358@126.com
Abstract    Objective    To explore the risk factors of postoperative intraperitoneal hemorrhage (PITH) following surgical treatment of portal hypertension (PH) and study management strategy. Methods    The clinical data of 259 cases of PH treated surgically from January 2004 to January 2011 in the Affiliated Hospital of North Sichuan Medical College were analyzed retrospectively. Clinical factors were explored for their possible association with occurrence of PITH in univariate and multivariate analysis using Logistic regression model. Receiver operating characteristics (ROC) analysis with calculation of the area under the curve (AUC), sensitivity and specificity were applied to define cutoff values for continuous variables appropriated. Results    Among 259 cases, PITH occurred in 15 cases (5.8%). Among 15 cases, haemostasis was achieved successfully with conservative treatment in 4 cases, while re-laparotomy was performed in the rest 11 cases to confirm possible bleeding sites. Multivariate analysis revealed that INR＞1.500, AFP≥6.245μg/L and portal vein diameter＞1.3cm were independent risk factors predicting occurrence of PITH. Risk stratification showed statistically significant difference of PITH occurrence (73.3%vs.1.6%, P=0.000). Conclusion    PITH, as a not-so-often complication following PH surgical management, can not be simply attributed to poor liver function and deserves attention because of possible life-threatening outcome, especially under concomitant liver cirrhosis. Patients in higher risk for developing PITH should be monitored carefully or offered prophylactic treatment.