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Khirurgii

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Year 2009 Vol. 17 No 3

GENERAL AND SPECIAL SURGERY

I.I. DZIDZAVA, B.N. KOTIV, D.P. KASHKIN, A.V. SMORODSKY

ЕXPERIENCE OF PORTOCAVAL SHUNTING IN PATIENTS WITH THE LIVER CIRRHOSIS WITH PORTAL HYPERTENSION SYNDROME

The analysis of treatment of 119 patients with the liver cirrhosis complicated by portal hypertension is presented. According to Child-Pugh scale patients were distributed as follows: the class A made up 39 (32,8%), class B – 60 (50,4%) and class C – 20 (16,8%) patients. 56 patients underwent the distal splenorenal shunting (DSRA), 1 – gastrocaval shunting, 62 – different modes of partial shunting (PS). Portocaval anastomosis promoted decrease of portal pressure from 400,3±75,3 to 262,8±61,2 mm H2O (р<0,001). The clinical signs of portosystemic encephalopathy were found in 18,2% cases after the PS, in 15,1% after the distal splenorenal shunt. Thrombosis of the DSRA was diagnosed in 1 (1,8%) cases and of small diameter portocaval anastomosis – in 5 (8,1%) of all observations. There was no the esophageal variceal rebleeding in the long-term period follow-up. One-year survival of patients with portocaval shunts composed 84,4±3,5%, three-, five- and ten-years – 66,6±5,1%, 50,4±5,9% и 25,3,1±6,2%, accordingly. The long-term results of portocaval shunts depend on the degree of hepatocellular insufficiency. The main predictors of survival were less than 10 balls by score of Child-Pugh, retention of ICG < 31%, liver volume > 1200 мл, creatinin < 89 mm/l, volume flow of portal vein > 550 ml/m.

Keywords: liver cirrhosis, portal hypertension, portocaval shunts
p. 31 - 41 of the original issue
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