Liver function reserve in surgical treatment of patients with portal hypertension: report of 146 cases

摘要

Objective: To evaluate the significance of intraopera-tive reassessment of liver function reserve in the se-lection of surgical procedures to optimize therapeuticresults in the treatment of portal hypertension.Methods: The data of 146 patients with portal hyper-tension treated in the past 10 years were retrospec-tively reviewed. Posthepatitis cirrhosis was found in118 patients, schistosomial cirrhosis in 6, alcoholiccirrhosis in 1, mixed cirrhosis in 5, and other disea-ses in 16. According to Child’s criteria, 45 patientswere classified into class A, 92 class B, and 9 classC. At operation, 33 patients were reclassified intoclass A, 78 class B, and 35 class C. Disconnectionprocedure was performed in 89 patients (61. 0%)and shunt procedure in 57 (39. 0 %). These opera-tions included prophylactic operations in 27 patients(18. 5 %) and emergency disconnection operations in2 (1. 4%).Results: One patient (0. 7 %) died of upper gastroin-testinal bleeding during operation. Early rebleedingfollowing operation occurred in 9 patients (6. 1%)(disconnection in 5 patients and shunt in 4). Earlyencephalopathy after operation occurred in 2 patients(1. 4 %) (disconnection in 1 patient and shunt in 1).A total of 98 patients (67. 6%) (disconnection in 61patients and shunt in 37) were followed up (6months to 9 years). Bleeding occurred again in 12patients (12. 2 %) (disconnection in 9 patients andshunt in 3) 17 months after operation (4 to 41months). Late encephalopathy occurred in 6 shuntpatients at 19 months (3-40 months). The late re-bleeding rates of shunt patients and disconnection pa-tients were 8.1% (3/37 patients) and 14. 9 % (9/61) (P0. 05) respectively. The late encephalopathyrates of shunt patients and disconnection patientswere 16. 2% (6/37) and 0% (0/61) respectively (P0. 01). Eight patients (5. 5 %) died of upper gas-trointestinal bleeding (2), hepatic failure (3), livercancer (2), and rectal cancer (1) in the period offollow-up.Conclusions: The success and effectiveness of surgicalprocedures for portal hypertension are closely relatedto the status of patient’s liver function reserve. In-tra-operative reassessment of hepatic function reserveis crucial. Selection of procedures based on patient’shepatic function reserve, local anatomical conditionsand surgeon’s experience would optimize therapeuticresults.