Role of ultrasound doppler examination in choice of surgical tactics in portal hypertension

Abstract

Introduction: Сhoice of surgical tactics in complicated portal hypertension (PH) is actual.More than 400 examinations of hepatic blood flow in patients with complicated PH, including 16 patients, operated by the method of liver tunneling, were fulfilled. Methods: One hundred protocols were chosen randomly. Comparison of distribution indices revealed different occurrence frequency of ultrasound symptoms of PH, having different etiology. Seventy patients with viral etiology of PH prevailed. Varix dilatation of cardia is revealed in 47% of patients. Splenorenal venous shunt (SRVS) is visualized in 43%, recanalization of umbilical vein - in 23% of patients. All types of anhepatic portosystemic shunts are visualized in majority of patients with cirrhosis of ethanol etiology. Liver is always enlarged in fatty hepatosis. In spite of low linear blood flow velocity in PV, its compensatory dilatation is not typical. Damage of PV architectonics is revealed in patients with subhepatic PH, enlargement of PV diameter is naturally absent, splenorenal venous shunt is always observed. Results: Ultrasound Doppler examination is the method of early diagnosis of PH type, its stage and prognosis of bleeding risk. It permits to choose optimal treatment method and evaluate its efficiency by comparison of indices before and after treatment. Conclusion: Indications to application of splenorenal venous anastomosis are doubtful due to natural formation of shunt in 43% of patients with viral hepatitis and 62% - with ethanol liver cirrhosis. Formation of SRVS in anhepatic PH is a compensatory mechanism. In this situation splenectomy or application of splenorenal venous anastomosis can be fatal.