Document Detail


Evaluation of surgical procedure selection based on intraoperative free portal pressure measurement in patients with portal hypertension.
MedLine Citation:
PMID:  20525554     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Yong-Wei Sun; Wei Chen; Meng Luo; Rong Hua; Wei Liu; Yan-Miao Huo; Zhi-Yong Wu; Hui Cao
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Hepatobiliary & pancreatic diseases international : HBPD INT     Volume:  9     ISSN:  1499-3872     ISO Abbreviation:  HBPD INT     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-07     Completed Date:  2010-09-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101151457     Medline TA:  Hepatobiliary Pancreat Dis Int     Country:  China    
Other Details:
Languages:  eng     Pagination:  269-74     Citation Subset:  IM    
Affiliation:
Department of General Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Chi-Square Distribution
Female
Humans
Hypertension, Portal / etiology,  physiopathology,  surgery*
Intraoperative Care
Liver Cirrhosis / complications,  physiopathology,  surgery*
Liver Function Tests
Male
Middle Aged
Patient Selection*
Portal Pressure*
Postoperative Care
Retrospective Studies
Splenorenal Shunt, Surgical* / adverse effects
Time Factors
Treatment Outcome
Vascular Surgical Procedures* / adverse effects

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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