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

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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