Effects of combined splenorenal shunt devascularization and devascularization only on hemodynamics of the portal venous system in patients with portal hypertension.

BACKGROUND: Shunt and devascularization have totally different effects on hemodynamics of the portal venous system, and the actual results of combined shunt and devascularization should be determined by more clinical observations. This study aimed to evaluate effects on hemodynamics of the portal venous system after conventional splenorenal shunt combined with pericardial devascularization and pericardial devascularization only. METHODS: In 20 patients who had received conventional splenorenal shunt combined with pericardial devascularization(CP) and 18 who had received pericardial devascularization and splenectomy(PCDV), hemodynamic parameters of the portal venous system were studied by magnetic resonance angiography 1 week before and 2 weeks after operation. Free portal pressure was detected continuously by a transducer during the operation. RESULTS: Compared to the preoperative data, a decreased flow of the portal vein(PVF) (563.12+/-206.42 ml/min vs. 1080.63+/-352.85 ml/min, P < 0.05), a decreased diameter of the portal vein (PVD) (1.20+/-0.11 cm vs. 1.30+/-0.16 cm, P < 0.01), a decreased free portal pressure(FPP) (21.50+/-2.67 mmHg vs. 29.88+/-2.30 mmHg, P < 0.01) and an increased flow of the superior mesenteric vein (SMVF) (1105.45+/-309.03 ml/min vs. 569.13+/-178.46 ml/min, P < 0.05) were found in the CP group after operation; a decreased PVD (1.27+/-0.16 cm vs. 1.40+/-0.23 cm, P < 0.05), a decreased PVF(684.60+/-165.73 ml/min vs. 1175.64+/-415.09 ml/min, P < 0.05), a decreased FPP (24.40+/-3.78 mmHg vs. 28.80+/-3.56 mmHg, P < 0.05) and an increased SMVF (697.91+/-121.83 ml/min vs. 521.30+/-115.82 ml/min, P < 0.05) were found in the PCDV group. After operation, the PVF of CP group(563.12+/-206.42 ml/min vs. 684.60+/-165.73 ml/min, P > 0.05) was not decreased significantly while FPP (21.50+/-2.67 mmHg vs. 24.40+/-3.78 mmHg, P < 0.01) was decreased significantly as compared with that of the PCDV group. CONCLUSIONS: PVF and FPP could be decreased by both surgical procedures, but the effect of decreasing FPP is much better in the combined procedures than in PCDV. Since there is no significant difference in PVF between the two groups, the combined procedures could integrate advantages of shunt with those of the devascularization, maintaining the normal anatomy structure of the hepatic portal vein, and should be one of the best choices for patients with PHT when surgical interventions are considered.