Functional Hepatic Flow Can Predict the Hepatic Reserve Function in Surgical Cirrhotic Patients

Abstract

Aim: To evaluate hepatic reserve function by monitoring functional hepatic flow in cirrhotic patients admitted for surgical treatments. Methods: Thirty-seven biopsy-proved cirrhotic patients with portal hypertension and 10 healthy volunteers entered the study. Eleven were Child-Pugh class A, 18 class B, and 8 class C. Eight patients undergone Transjugular intrahepatic portosystemic shunt (TIPS), 10 were submitted to the combination of TIPS and portal-azygous disconnection, 10 were treated with surgical portal-azygous disconnection, and 9 were treated with the combination of portal-azygous disconnection and spleno-renal shunt. The functional hepatic flow (FHF) and total hepatic flow (THF) were determined by means of modified hepatic clearance of D-sorbitol combined with duplex Doppler color sonography. Portal pressure was measured directly by portal vein catheterization. Results: Portal blood flow, hepatic artery flow, and THF significantly increased in cirrhotic patients compared to the controls, while FHF was significantly reduced. Both portal pressure and FHF decreased in cirrhotic patients submitted to TIPS, the combination of TIPS and portal-azygous disconnection, or the combination of portal-azygous disconnection and spleno-renal shunt (p <.05). FHF decreased significantly in patients treated with TIPS compared to other patients (p <.01). The portal pressure decreased in patients treated with portal-azygous disconnection while FHF maintained no changes (p >.05). Conclusions: Monitor of FHF in cirrhotic patients is valuable to predict different hepatic reserve function in patients receiving different surgical operations.

Keywords:

• Hypertension
• Surgery
• Shunt
• TIPS
• Functional Hepatic Flow
• Liver cirrhosis