Assessment of splanchnic hemodynamics in patients with cirrhosis after portocaval shunting in comparison with no-operated patients with the compensated and decompensated course of disease

Abstract

Portocaval shunting is recommended for decrease of the portal pressure and regression of the varicose veins in patients with cirrhosis. But the shunting surgery at cirrhosis is limited by the high risk of development of hepatic encephalopathy and the hepatocellular insufficiency in post-surgical period. And the disorder of the hepatic and splanchnic hemodynamics that inevitably appears at different dates after surgery is considered as the main cause of these states.Aim of research. To assess an influence of the shunting surgical interventions on the character of changes of splanchnic hemodynamics in patients with cirrhosis in comparison with no-operated patients with compensated and decompensated course of disease.Material and methods. 190 patients with cirrhosis were examined: 133 had gastrointestinal bleeding, 57 – diuretic-resistant ascites. 18 patients underwent surgery – portocaval shunting. 84 patients died during observation (10 after surgery). The duration of observation was from 2-3 weeks to 2,5-3 years.All patients underwent the repeated ultrasound examination of abdominal cavity. There were defined the diameter of hepatic and splenic vessels; quantitative and qualitative characteristics of the blood flow in hepatic and splenic arteries, in portal and splenic veins. Results of research. At assessment of splanchnic hemodynamics we noticed the differences of parameters depending on time that passed after surgery. The changes of portal blood flow in first 3-6 month were characterized by the moderate widening of portal and splenic veins at little decrease of its mean linear and volume speed so an inflow of the portal blood still stable. Arterial blood flow in hepatic artery was forced at the expense of both widening of diameter and increase of the mean speed of blood flow. The splenic arterial blood flow practically was not changed. The reliable decrease of the volume blood flow in portal vein at the expense of decrease of its linear speed was observed in all patients at later dates. An unfavorable sign was an increase of an index of haemostasia in portal vein and of splenic and hepatic portal index in dynamics that took place in all operated patients and in no-operated ones at the stage of decompensation.Conclusions. The character of changes of splanchnic hemodynamics after portocaval shunting is analogous to the one in no-operated patients at transition from the compensated course of cirrhosis to decompensated one. The compensatory mechanism that preserves the volume of the portal inflow to liver is the widening of the portal vein and preservation of the splenic blood flow. The quality of life in post-surgical period is determined by the duration of compensation of hemodynamic disorders