[Function of portal pressure during operation on the choice of surgical approaches in portal hypertension].
OBJECTIVE
To investigate the relationship between perioperative free portal pressure (FPP) after devascularization or spleno-renal shunt operation added devascularization and rebleeding or encephalopathy in patients with portal hypertension, and evaluate the relationship between dynamic changes of FPP and surgical approaches.


METHODS
The clinical data of 170 patients with portal hypertension receiving devascularization or devascularization with spleno-renal shunt operation (combination group) from January 2001 to December 2007 were retrospectively analyzed. All patients were divided into three groups: low pressure group [L group, after devascularization FPP <or= 22 mm Hg (1 mm Hg = 0.133 kPa), n = 43], high pressure group (H group, FPP > 22 mm Hg, n = 60) and combination group (C group, n = 47). There was no significant difference in preoperative Child-Pugh score and pre-operation FPP (P > 0.05) among the three groups. Perioperative FPP, morbidity of rebleeding and encephalopathy were compared with each other.


RESULTS
The values of postoperative FPP were (27.1 +/- 1.9) mm Hg, (20.8 +/- 1.8) mm Hg and (21.5 +/- 2.2) mm Hg among the H group, L group and C group respectively. The rebleeding rates were 21.7%, 4.6% and 4.5% among the three groups respectively. All the values in H group were higher than those in L group and C group remarkably. The encephalopathy rate in C group (10.4%) was higher than that in L group (7.0%) or H group (3.3%), but there were no statistical significance (P > 0.05).


CONCLUSIONS
FPP after splenectomy and devascularization may be a basis of choice of surgical approaches in portal hypertension. The spleno-renal shunt operation should be performed in the patients when FPP is over 22 mm Hg after devascularization.
Chen
Wei
W
Department of General Surgery, Renji Hospital, Shanghai Jiaotong University School of Medcine, Shanghai 200127, China.
Luo
Meng
M
Sun
Yong-wei
YW
Xu
Qing
Q
Zhao
Gang
G
Hua
Rong
R
Liu
Wei
W
Jiang
Chun-hui
CH
Shi
Chang-ying
CY
Wu
Zhi-yong
ZY
D000328:Adult; D000368:Aged; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D017082:Portal Pressure / Q000502:physiology*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies