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Effects of combined procedure and devascularization alone on hyperdynamics of the portal venous system in patients with portal hypertension

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Abstract

Shunts and devascularizations have totally different effects on the hemodynamics of the portal venous system. The actual results of pericardial devascularization (PCDV) alone and conventional splenorenal shunt combined with pericardial devascularization (combined procedure, CP) should be determined by more clinical observations. This study aimed to evaluate effects on hemodynamics in the portal venous system after CP and PCDV only. In 20 patients who received CP and 18 who received PCDV, hemodynamic parameters of the portal venous system were studied by magnetic resonance angiography 1 week before and 2 weeks after operation. Free portal pressure (FPP) was continuously detected by a transducer during the operations. Compared to the preoperative data, a decreased flow in the portal vein (PVF) [(563.12 ± 206.42) mL/min vs (1080.63 ± 352.85) mL/min, P < 0.05], a decreased portal vein diameter (PVD) [(1.20 ± 0.11) cm vs (1.30 ± 0.16) cm, P < 0.01], a decreased FPP [(21.50 ± 2.67) mmHg vs (29.88 ± 2.30) mmHg, P < 0.01] and an increased flow in the superior mesenteric vein (SMVF) [(1105.45 ± 309.03) mL/min vs (569.13 ± 178.46) mL/min, P < 0.05] were found in the CP group after operation; a decreased PVD [(1.27 ± 0.16) cm vs (1.40 ± 0.23) cm, P < 0.05], a decreased PVF [(684.60 ± 165.73) mL/min vs (1175.64 ± 415.09) mL/min, P < 0.05], a decreased FPP [(24.40 ± 3.78) mmHg vs (28.80 ± 3.56) mmHg, P < 0.05] and an increased SMVF [(697.91 ± 121.83) mL/min vs (521.30 ± 115.82) mL/min, P < 0.05] were observed in the PCDV group. After operation, PVF in the CP group [(563.12 ± 206.42) mL/min vs (684.60 ± 165.73) mL/min, P > 0.05] had no significant decrease, while FPP [(21.50 ± 2.67) mmHg vs (24.40 ± 3.78) mmHg, P < 0.01] had a significant decrease as compared with that in the PCDV group. PVF and FPP could be decreased by both surgical procedures, but the effect of decreasing FPP was much better in the combined procedure than in PCDV alone. Further, there was no significant difference in PVF between the two groups. It is suggested that the combined surgical procedure could integrate the advantages of shunting with those of devascularization, as well as maintaining the normal anatomic structure of hepatic portal system, thus it should be one of the best choices for patients with portal hypertension when surgical interventions are considered.

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References

  1. Chen Z P, Wu Z Y. Selection of operative procedures in portal hypertension. Waike Lilun Yu Shijian Zazhi, 1999, 4(1): 71–72 (in Chinese)

    Google Scholar 

  2. Wu Z Y. Splenectomy and spleno-renal shunt combined percardial devascularization should be the first choice of surgical procedures for hemorrhage caused by portal hypertension. Zhongguo Shiyong Waike Zazhi, 2002, 22(1): 60–62 (in Chinese)

    Google Scholar 

  3. Okumura A, Watanabe Y, Donke M, Ishimori T, Amoh Y, Oda K, Dodo Y. Contrast-enhanced three-dimensional MR portography. Radiographics, 1999, 19(4): 973–987

    PubMed  CAS  Google Scholar 

  4. Kopa L, Rodenwaldt J, Vosshenrich R, Fischer U, Renner B, Lorf T, Graessner J, Ringe B, Grabbe E. Hepatic blood supply: comparison of optimized dual phase contrast-enhanced three-dimensional MR angiography and digital subtraction angiography. Radiology, 1999, 211(1): 51–58

    Google Scholar 

  5. Wang Y. Surgical treatment of portal hypertension. Hepatobiliary Pancreat Dis Int, 2002, 1(2): 211–214

    PubMed  Google Scholar 

  6. Liu H, Chen Z P, Wu Z Y, Chen K M, Ding X L. The role of MRA in evaluation the effects of operation in patients with portal hypertension. Waike Lilun Yu Shijian Zazhi, 2001, 6(2): 159–162 (in Chinese)

    Google Scholar 

  7. Rauws E A. Prevention of recurrent variceal bleeding. Scand J Gastroenterol, 1999, 230(Suppl): 71–74

    Article  CAS  Google Scholar 

  8. Shah V. Cellular and molecular basis of portal hypertension. Clin Liver Dis, 2001, 5(3): 629–644

    Article  PubMed  CAS  Google Scholar 

  9. Ma Y G, Li X S, Zhao J, Chen H, Wu M C. Modified Sugiura procedure for the management of 160 cirrhotc patients with portal hypertension. Hepatobiliary Pancreat Dis Int, 2004, 3(3): 399–401

    PubMed  Google Scholar 

  10. Ma Y G, Chen H, Wu M C. Evaluation of modified Sugiura procedure treating for portal hypertension. Zhonghua Putong Waike Zazhi, 2002, 17(2): 135–136 (in Chinese)

    Google Scholar 

  11. Nevens F, Bustami R, Scheys I, Scheys I, Lesaffre E, Fevery J. Varceal pressure is a factor predicting the risk of a first variceal bleeding: a prospective cohort study in a cirrhotic patients. Hepatology, 1998, 27(1): 15–19

    Article  PubMed  CAS  Google Scholar 

  12. Yin X Y, Lu M D, Huang J F, Liang L J. Effects of splenectomy and portal-azygous disconnection on portal hemodynamics. Zhonghua Putong Waike Zazhi, 2000, 12(7): 728–730 (in Chinese)

    Google Scholar 

  13. Král V, Klein J, Havlík R, Aujeský R, Utíkal P. Esophagogastric devascularization as the last option in the management of variceal bleeding. Hepatogastroenterology, 2002, 49(43): 244–246

    PubMed  Google Scholar 

  14. Ekataksin W, Kneada K. Liver microvascular architecture: an insight into the pathophysiology of portal hypertension. Semin Liver Dis, 1999, 19(4): 359–382

    Article  PubMed  CAS  Google Scholar 

  15. Rockey D C. Cellular pathophysiology of portal hypertension and prospects for management with gene therapy. Clin Liver Dis, 2001, 5(3): 851–856

    Article  PubMed  CAS  Google Scholar 

  16. Somlyo A P, Somlyo A V. Signal transduction by G-proteins, rho-kinase and protein phosphatase to smooth muscle and non-muscle myosin II. J Physiol, 2000, 522(pt2): 177–185

    Article  PubMed  CAS  Google Scholar 

  17. Hino S, Kakutani H, Ikeda K, Uchiyama Y, Sumiyama K, Kuramochi A, Kitamura Y, Matsuda K, Arakawa H, Kawamura M, Masuda K, Suzuki H. Hemodynamic assessment of the left gastric vein in patients with esophageal varices with color Doppler EUS: factors affecting development of esophageal varices. Gastrointest Endosc, 2002, 55(4): 512–517

    Article  PubMed  Google Scholar 

  18. Zhou G W, Tao Z Y, Peng C H, Li H W. Reasonable choice of surgical procedures for patients with portal hypertension. Hepatobiliary Pancreat Dis Int, 2003, 2(3): 330–333

    PubMed  Google Scholar 

  19. Xu H, Wang Q, Xin M J, Guo H G. Effects of splenorenal shunt combined disconnection on portal hemodynamics. Gandan Waike Zazhi, 2003, 11(2): 126–128 (in Chinese)

    Google Scholar 

  20. Zhang S G, Ruan C L, Yu Z H, Li G X, Xu C E, Li L, Liu A L. Clinical study on change of hemodynamics in the portal venous system after spleno-renal shunt and pericardial devascularization. Waike Lilun Yu Shijian Zazhi, 2002, 7(4): 276–279 (in Chinese)

    Google Scholar 

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  1. Department of General Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China

    Rong Hua, Yongwei Sun & Zhiyong Wu

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  1. Rong Hua
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  2. Yongwei Sun
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Hua, R., Sun, Y. & Wu, Z. Effects of combined procedure and devascularization alone on hyperdynamics of the portal venous system in patients with portal hypertension. Front. Med. China 2, 244–247 (2008). https://doi.org/10.1007/s11684-008-0046-6

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  • DOI: https://doi.org/10.1007/s11684-008-0046-6

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