Liver function reserve in surgical treatment of patients with portal hypertension: report of 146 cases.
OBJECTIVE
To evaluate the significance of intraoperative reassessment of liver function reserve in the selection of surgical procedures to optimize therapeutic results in the treatment of portal hypertension.


METHODS
The data of 146 patients with portal hypertension treated in the past 10 years were retrospectively reviewed. Posthepatitis cirrhosis was found in 118 patients, schistosomial cirrhosis in 6, alcoholic cirrhosis in 1, mixed cirrhosis in 5, and other diseases in 16. According to Child's criteria, 45 patients were classified into class A, 92 class B, and 9 class C. At operation, 33 patients were reclassified into class A, 78 class B, and 35 class C. Disconnection procedure was performed in 89 patients (61.0%) and shunt procedure in 57 (39.0%). These operations included prophylactic operations in 27 patients (18.5%) and emergency disconnection operations in 2 (1.4%).


RESULTS
One patient (0.7%) died of upper gastrointestinal bleeding during operation. Early rebleeding following operation occurred in 9 patients (6.1%) (disconnection in 5 patients and shunt in 4). Early encephalopathy 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 61 patients and shunt in 37) were followed up (6 months to 9 years). Bleeding occurred again in 12 patients (12.2%) (disconnection in 9 patients and shunt in 3) 17 months after operation (4 to 41 months). Late encephalopathy occurred in 6 shunt patients at 19 months (3-40 months). The late rebleeding rates of shunt patients and disconnection patients were 8.1% (3/37 patients) and 14.9% (9/61) (P>0.05) respectively. The late encephalopathy rates of shunt patients and disconnection patients were 16.2% (6/37) and 0% (0/61) respectively (P<0.01). Eight patients (5.5%) died of upper gastrointestinal bleeding (2), hepatic failure (3), liver cancer (2), and rectal cancer (1) in the period of follow-up.


CONCLUSIONS
The success and effectiveness of surgical procedures for portal hypertension are closely related to the status of patient's liver function reserve. Intra-operative reassessment of hepatic function reserve is crucial. Selection of procedures based on patient's hepatic function reserve, local anatomical conditions and surgeon's experience would optimize therapeutic results.
Gu
Da-Yong
DY
Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China. dayongg@citiz.net
Xu
Wei-Gang
WG
Lin
Zhi-Pin
ZP
Luo
Zhe
Z
Wu
Hai-Fu
HF
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000601:surgery; D006501:Hepatic Encephalopathy / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D015994:Incidence; D008099:Liver / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome