Liver function reserve in surgical treatment of patients with portal hypertension: report of 146 cases

作     者：Da-Yong Gu Wei-Gang Xu Zhi-Pin Lin Zhe Luo Hai-Fu Wu the Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China 

作者机构：Department of General Surgery Zhongshan Hospital Fudan University Shanghai 200032 China. dayongg@*** 

出 版 物：《Hepatobiliary & Pancreatic Diseases International》 (国际肝胆胰疾病杂志（英文版）)

年 卷 期：2002年第1卷第4期

页      面：515-518页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：portal hypertension surgery shunt disconnection 

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) (P0. 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. C