摘要
Objective: To evaluate the significance of intraopera- tive reassessment of liver function reserve in the se- lection of surgical procedures to optimize therapeutic results in the treatment of portal hypertension. Methods: The data of 146 patients with portal hyper- tension treated in the past 10 years were retrospec- tively reviewed. Posthepatitis cirrhosis was found in 118 patients, schistosomial cirrhosis in 6, alcoholic cirrhosis in 1, mixed cirrhosis in 5, and other disea- ses in 16. According to Child's criteria, 45 patients were classified into class A, 92 class B, and 9 class C. At operation, 33 patients were reclassified into class A, 78 class B, and 35 class C. Disconnection procedure was performed in 89 patients (61. 0%) and shunt procedure in 57 (39. 0 %). These opera- tions included prophylactic operations in 27 patients (18. 5 %) and emergency disconnection operations in 2 (1. 4%). Results: One patient (0. 7 %) died of upper gastroin- testinal bleeding during operation. Early rebleeding following operation occurred in 9 patients (6. 1%) (disconnection in 5 patients and shunt in 4). Early encephalopathy after operation occurred in 2 patients (1. 4 %) (disconnection in 1 patient and shunt in 1). A total of 98 patients (67. 6%) (disconnection in 61 patients and shunt in 37) were followed up (6 months to 9 years). Bleeding occurred again in 12 patients (12. 2 %) (disconnection in 9 patients and shunt in 3) 17 months after operation (4 to 41 months). Late encephalopathy occurred in 6 shunt patients at 19 months (3-40 months). The late re- bleeding rates of shunt patients and disconnection pa- tients were 8.1% (3/37 patients) and 14. 9 % (9/ 61) (P>0. 05) respectively. The late encephalopathy rates of shunt patients and disconnection patients were 16. 2% (6/37) and 0% (0/61) respectively (P <0. 01). Eight patients (5. 5 %) died of upper gas- trointestinal bleeding (2), hepatic failure (3), liver cancer (2), and rectal cancer (1) in the period of follow-up. Conclusions: The success and effectiveness of surgical procedures for portal hypertension are closely related to the status of patient's liver function reserve. In- tra-operative reassessment of hepatic function reserve is crucial. Selection of procedures based on patient's hepatic function reserve, local anatomical conditions and surgeon's experience would optimize therapeutic results.
Objective: To evaluate the significance of intraopera- tive reassessment of liver function reserve in the se- lection of surgical procedures to optimize therapeutic results in the treatment of portal hypertension. Methods: The data of 146 patients with portal hyper- tension treated in the past 10 years were retrospec- tively reviewed. Posthepatitis cirrhosis was found in 118 patients, schistosomial cirrhosis in 6, alcoholic cirrhosis in 1, mixed cirrhosis in 5, and other disea- ses in 16. According to Child's criteria, 45 patients were classified into class A, 92 class B, and 9 class C. At operation, 33 patients were reclassified into class A, 78 class B, and 35 class C. Disconnection procedure was performed in 89 patients (61. 0%) and shunt procedure in 57 (39. 0 %). These opera- tions included prophylactic operations in 27 patients (18. 5 %) and emergency disconnection operations in 2 (1. 4%). Results: One patient (0. 7 %) died of upper gastroin- testinal bleeding during operation. Early rebleeding following operation occurred in 9 patients (6. 1%) (disconnection in 5 patients and shunt in 4). Early encephalopathy after operation occurred in 2 patients (1. 4 %) (disconnection in 1 patient and shunt in 1). A total of 98 patients (67. 6%) (disconnection in 61 patients and shunt in 37) were followed up (6 months to 9 years). Bleeding occurred again in 12 patients (12. 2 %) (disconnection in 9 patients and shunt in 3) 17 months after operation (4 to 41 months). Late encephalopathy occurred in 6 shunt patients at 19 months (3-40 months). The late re- bleeding rates of shunt patients and disconnection pa- tients were 8.1% (3/37 patients) and 14. 9 % (9/ 61) (P>0. 05) respectively. The late encephalopathy rates of shunt patients and disconnection patients were 16. 2% (6/37) and 0% (0/61) respectively (P <0. 01). Eight patients (5. 5 %) died of upper gas- trointestinal bleeding (2), hepatic failure (3), liver cancer (2), and rectal cancer (1) in the period of follow-up. Conclusions: The success and effectiveness of surgical procedures for portal hypertension are closely related to the status of patient's liver function reserve. In- tra-operative reassessment of hepatic function reserve is crucial. Selection of procedures based on patient's hepatic function reserve, local anatomical conditions and surgeon's experience would optimize therapeutic results.
