Improvement of the Diagnosis and Surgical Treatment of Patients with Portal Hypertension

Abstract

Aim. To improve the results of treatment of patients with different forms of portal hypertension syndrome (PH) based on introduction of the new diagnostic technologies and differentiated approach to the choice of surgical treatment in clinical practice. Material and Methods. Treatment of 65 patients with PH for the period from 2006 to 2013 was analyzed. 57 patients (87.7%) had liver cirrhosis, 8 patients (12.3%) – extrahepatic portal hypertension. 37 and 28 patients were operated routinely and urgently respectively. In 28 patients with diffuse parenchymal lesion features of the vascular bed architectonics were studied angiographically. 3D ultrasound investigation of the esophagus and stomach veins was made in 23 patients. 30 patients had the thermography of anterior abdominal wall. Results. Vascular architectonics of the liver allows to evaluate the level of vascular compensation and, thus, to predict the chance of gastro-esophageal bleeding. 3D ultrasonography allows noninvasive patient’s monitoring in the postoperative period, and the thermography gives the objective information about the development of collateral blood flow through the vessels of anterior abdominal wall. Conclusion. After portocaval bypass surgery performed routinely complications occurred in 27.3% of cases and postoperative mortality was 4.5%. After esophageal and gastric varices ligation complications occurred in 33.3% of cases, deaths were not observed. In case of emergency surgery complications were diagnosed in 57.1% of cases, postoperative mortality was 35.7%.