The changes of hepatic hemodynamics and functional hepatic reserve after splenectomy with periesophagogastric devascularization.
OBJECTIVE
The results of much research on the variation of the hepatic hemodynamic and functional hepatic reserve after splenectomy with periesophagogastric devascularization are very different, some are even converse. The purpose of this study is to observe the variation.


METHODS
From July 2006 to August 2007, thirty patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy with periesophagogastric devascularization in our medical group in West China Hospital of Sichuan University. The PVPG (portal venous pressure gradient) was measured by inductor continually during operation. Moreover, the HAF (hepatic artery flow), PVF (portal venous flow) and hepatic arterial RI (resistant index) were measured with Doppler sonography. The EHBF (effective hepatic blood flow) and ICGR15 (indocyanine green retention rate at 15 minutes) were obtained respectively by indocyanine green clearance test before and after the operation. The MELD (model for end stage liver disease) score was calculated at the same time.


RESULTS
The four values of PVPG after laparotomy, ligating the splenic artery, splenectomy and periesophagogastric devascularization showed a tendency to decrease progressively. The PVF decreased and HAF increased in compensation after operation. The EHBF increased, and both the ICGR15 and the MELD score decreased postoperatively.


CONCLUSIONS
After splenectomy with periesophagogastric devascularization, the functional hepatic reserve increases at least in the short term notwithstanding the PVPG and PVF decrease.
Zhang
Yu
Y
Division of Liver Transplantation, West China Hospital, Sichuan University, Chengdu, China.
Wen
Tianfu
T
Yan
Lunan
L
Chen
Zheyu
Z
Yang
Hongji
H
Deng
Xiaofan
X
Liang
Guanling
G
Li
Guo
G
Zhang
Xianhua
X
Ran
Shun
S
Liao
Zhixue
Z
D000328:Adult; D015331:Cohort Studies; D004932:Esophageal and Gastric Varices / Q000503:physiopathology* / Q000601:surgery* / Q000821:virology; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008102:Liver Circulation / Q000502:physiology*; D008103:Liver Cirrhosis / Q000503:physiopathology* / Q000601:surgery / Q000821:virology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000502:physiology; D012189:Retrospective Studies; D013156:Splenectomy; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000502:physiology