The use of quantitative Doppler ultrasonography to predict posthepatectomy complications on the basis of hepatic hemodynamic parameters

Abstract

Background. Doppler ultrasonography assesses hepatic hemodynamics noninvasively. This study uses hepatic hemodynamic parameters to predict posthepatectomy complications. Methods. Sixty-three consecutive patients scheduled for liver resection (23 with cirrhosis, 12 with chronic hepatitis, and 28 with no diffuse liver disease) were enrolled. We measured the right portal venous peak velocity (PVPV; cm/s), right hepatic arterial peak systolic velocity (cm/s), hepatic arterial pulsatility index, and the splenic arterial pulsatility index (SAPI). Results. Prolonged ascites developed in 12 patients overall and in 7 patients who underwent limited hepatectomy. In both instances, the SAPI was higher in patients with prolonged ascites than in those without prolonged ascites (P <.0001 and P <.02, respectively). The sensitivity, specificity, and accuracy of a high SAPI (defined as SAPI ≥ 1.0) in predicting prolonged ascites were 100%, 81%, and 84%, respectively. Hyperbilirubinemia (serum total bilirubin concentration ≥ 2.0 mg/dL) occurred in 27 patients overall and in 11 patients who underwent limited hepatectomy. In both instances, the PVPV was lower in patients with hyperbilirubinemia than in those without hyperbilirubinemia (P =.003 and P <.002, respectively). The sensitivity, specificity, and accuracy of a low PVPV (defined as PVPV < 15 cm/s) in predicting hyperbilirubinemia were 48%, 92%, and 73%, respectively. Conclusions. A high SAPI predicts prolonged postoperative ascites and decreased PVPV is a risk factor for postoperative hyperbilirubinemia. (Surgery 2002;132:431-40.)