[Changes in portal circulation after esophageal transection].

UNLABELLED

104 patients with hepatic cirrhosis and esophageal varices were treated between 1979 and 1996 using the modified Sugiura (Hirashima) procedure. In 60 cases (18 F, 42 M) portal hemodynamics (portal blood velocity (PBV) and portal blood flow (PBF)) were investigated using Doppler-USG method. In 40 cases a prospective study before operation, 2 weeks, 3 months after operation and then in 6-month intervals was completed. In 20 patients the study was done 18 months to 7 years after operation only. The control group comprised 20 healthy volunteers. Mean PBV before operation was 17.5 +/- 1.2 cm/s, 2 weeks after surgery-14.2 +/- 1.0 and 3 months after operation 15.1 +/- 0.9 cm/s, mean PBF: 1211 +/- 124 ccm/min, 987 +/- 97 ccm/min and 1179 +/- 92 ccm/min respectively. The observed decrease of PBV and PBF was not significant. In the late postoperative period mean PBV was 14.0 +/- 1.2 cm/s and PBF 1077 +/- 99 ccm/min. We observed portal vein thrombosis in 4 cases before the operation and 7 new cases after operation. In 3 of them the recanalization of portal vein trunk was noted in further investigations.

CONCLUSION

Extended gastroesophageal devascularization, splenectomy and esophageal transection (Hirashima procedure) does not result in significant decrease of portal blood velocity and portal blood flow. The hemodynamic effect of this operation is stabile in the observation period 1.5 to 7 years.