[Portacaval shunt with H-grafts of small diameter in treating cirrhotic patients with portal hypertension].
OBJECTIVE
To evaluate the effectiveness of portacaval shunt with H-grafts of small diameter in the treatment of cirrhotic patients with portal hypertension.


METHODS
48 patients cirrhotic with portal hypertension were randomized into three groups: portacaval shunt with H-grafts of 8 mm diameter with external ring reinforced (20 patients), proximal splenorenal shunt (17), and side-to-side portacaval shunt (11). The preoperative liver function in Child's grade and the history of variceal bleeding were the same in the three groups.


RESULTS
The postoperative decrease in portal pressure was comparable in the three groups (0.83 +/- 0.31 kPa, 0.81 +/- 0.50 kPa, and 1.02 +/- 0.45 kPa, P > 0.05). There was no significant difference in postoperative rebleeding rate during the follow-up for 15-28 months, and in hospital mortality between the three groups. However, postoperative encephalopathy developed much less in patients undergoing portacaval shunt with H-grafts than those receiving side-to-side portacaval shunt (5.0% vs. 36.4%, P < 0.05). Postoperative transfemoral portography performed within one month showed shunt patency in 95% of the 20 patients undergoing H-graft shunting. B-mode ultrasonography follow-up of up to 15 months also showed shunt patency in all 19 survivals receiving H-graft shunt.


CONCLUSIONS
This procedure shows less trauma, lower postoperative encephalopathy rate, while as effective in preventing recurrent variceal bleeding as the traditional portosystemic shunt.
Leng
X
X
Department of Surgery, People's Hospital, Beijing Medical University, Beijing 100044.
Zhu
J
J
Du
R
R
D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D013164:Splenorenal Shunt, Surgical