Evaluation of surgical procedure selection based on intraoperative free portal pressure measurement in patients with portal hypertension.
BACKGROUND
Various surgical procedures can be used to treat liver cirrhosis and portal hypertension. How to select the most appropriate procedure for patients with portal hypertension has become a difficult problem. This study aimed to analyze the relationship between the value of intraoperative free portal pressure (FPP) and postoperative complications, and to explore the significance of intraoperative FPP measurement with respect to surgical procedure selection.


METHODS
The clinical data of 187 patients with portal hypertension who received pericardial devascularization and proximal splenorenal shunt combined with devascularization (combined operation) at the Department of General Surgery in our hospital from January 2001 to September 2008 were retrospectively analyzed. Among the patients who received pericardial devascularization, those with a postoperative FPP >or=22 mmHg were included in a high-pressure group (n=68), and those with FPP <22 mmHg were in a low-pressure group (n=49). Seventy patients who received the combined operation comprised a combined group. The intraoperative FPP measurement changes at different times, and the incidence of postoperative complications in the three groups of patients were compared.


RESULTS
The postoperative FPP value in the high-pressure group was 27.5+/-2.3 mmHg, which was significantly higher than that of the low-pressure (20.9+/-1.8 mmHg) or combined groups (21.7+/-2.5 mmHg). The rebleeding rate in the high-pressure group was significantly higher than that in the low-pressure and combined groups. The incidence rates of postoperative hepatic encephalopathy and liver failure were not statistically different among the three groups. The mortality due to rebleeding in the low-pressure and combined groups (0.84%) was significantly lower than that of the high-pressure group.


CONCLUSIONS
The study demonstrates that FPP is a critical measurement for surgical procedure selection in patients with portal hypertension. A FPP value >or=22 mmHg after splenectomy and devascularization alone is an important indicator that an additional proximal splenorenal shunt needs to be performed.
Department of General Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Yong-Wei
YW
Sun
Wei
W
Chen
Meng
M
Luo
Rong
R
Hua
Wei
W
Liu
Yan-Miao
YM
Huo
Zhi-Yong
ZY
Wu
Hui
H
Cao
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007430:Intraoperative Care; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017082:Portal Pressure; D011182:Postoperative Care; D012189:Retrospective Studies; D013164:Splenorenal Shunt, Surgical / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects