The improvement of diagnostics and surgical treatment of patients with portal hypertension

Abstract

Aims: To improve results of patient treatment with portal hypertension by implementation of new diagnostic technologies and differentiated approach to operations. Methods: Watched 71 (89,9%) patients with liver cirrhosis(LC) and 8 (10.1%) – with extrahepatic portal hypertension(EPH). Routinely 51 (64,6%) patients with high risk of bleeding were operated. 29 (56,9%) LC patients and 8 (15,6%) EPH of all cases had surgical shunting. The flashing the esophagus and stomach veins by Paziora method was performed on 14 (27,5%) patients. In emergency 28 (35.4%) of LC patients with esophageal gastric bleeding were operated. 23 LC patients had 3D ultrasound investigation of the esophagus and stomach veins, and in 30 cases thermography of the anterior abdominal wall was used. Results: Advisable to use 3Dultrasound and thermography of the anterior abdominal wall in the diagnosis of portal hypertension. After flashing the esophagus and stomach veins by Paciora method-bleeding complications occurred in 57.1% of cases and postoperative mortality was 35,7%. After the planned surgical shunting- complications occurred in 27.3% of cases and postoperative mortality was 4.5%. After the planned flashing the esophagus and stomach veins by Paziora method, complications occurred in 33.3% of cases, and deaths were absent. Conclusions: Advisable to perform mesenterica-caval anastamosis on patients with EPH. In case of compensated LC («A»), in its inactive or low-active phase, also when volumetric blood flow in the portal vein more than 1000 ml/min, it is advisable to perform the distal splenorenal anastomosis. In case of subcompensated LC («B»), in its inactive or low-active phase, also when volumetric blood flow in the portal vein less than 1000 ml/min, it is advisable to perform Paciora method – the flashing of the esophagus and stomach varicose veins. In case of decompensated LC(«C»), in its moderately active or high-coactive phase, it is advisable to abstain from active surgical tactics.