ISSN:
1432-1440
Keywords:
Mesocaval shunt
;
Distal splenorenal shunt
;
Liver cirrhosis
;
Quantitative hepatic function
;
Portal hypertension
;
Bleeding esophageal varices
;
Portal pressure
;
Hepatic blood flow
;
Portal systemic encephalopathy
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Summary The effect of the mesocaval interposition shunt (n=12) and the distal splenorenal shunt (n=9) on the wedged hepatic venous pressure, the estimated hepatic blood flow, quantitative hepatic function, and the rate of portal systemic encephalopathy was evaluated in 21 patients who had bled from esophageal varices. After mesocaval shunt the wedged hepatic venous pressure was significantly reduced by 42% (from 26±3 mm Hg to 15±5 mm Hg,P〈0.001) compared to 16% only (from 25±3 mm Hg to 21±2 mm Hg,P〈0.005) after distal splenorenal shunt. The estimated hepatic blood flow also decreased significantly after mesocaval shunt by 61% (from 1.45±0.46 l/min to 0.56±0.25 l/min,P〈0.001) compared to 29% (from 1.29±0.32 l/min to 0.91±0.39 l/min,P〈0.05) after distal splenorenal shunt. Despite significantly different influences of both types of shunt operations on wedged hepatic venous pressure and estimated hepatic blood flow (P〈0.001), postoperative changes of hepatic function were comparable in both groups of patients. The galactose elimination capacity, the initial plasma disappearance rate of Bromsulphalein, and the plasma ratio of valine, leucine, and isoleucine to phenylalanine and tyrosine were reduced by 13%, 26%, and 29%, respectively, after mesocaval shunt, compared to 12%, 25%, and 17% after distal splenorenal shunt. Only two patients of the mesocaval shunt group with the largest decrease in estimated hepatic blood flow developed portal systemic encephalopathy postoperatively, and the distal splenorenal shunt patients with their minor hemodynamic sequelae remained free of portal systemic encephalopathy.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF01733666
Permalink
