[Portacaval shunt with H-grafts of small diameter in treating cirrhotic patients with portal hypertension].

OBJECTIVE: To evaluate the effectiveness of portacaval shunt with H-grafts of small diameter in the treatment of cirrhotic patients with portal hypertension. METHOD: 48 patients cirrhotic with portal hypertension were randomized into three groups: portacaval shunt with H-grafts of 8 mm diameter with external ring reinforced (20 patients), proximal splenorenal shunt (17), and side-to-side portacaval shunt (11). The preoperative liver function in Child's grade and the history of variceal bleeding were the same in the three groups. RESULT: The postoperative decrease in portal pressure was comparable in the three groups (0.83 +/- 0.31 kPa, 0.81 +/- 0.50 kPa, and 1.02 +/- 0.45 kPa, P > 0.05). There was no significant difference in postoperative rebleeding rate during the follow-up for 15-28 months, and in hospital mortality between the three groups. However, postoperative encephalopathy developed much less in patients undergoing portacaval shunt with H-grafts than those receiving side-to-side portacaval shunt (5.0% vs. 36.4%, P < 0.05). Postoperative transfemoral portography performed within one month showed shunt patency in 95% of the 20 patients undergoing H-graft shunting. B-mode ultrasonography follow-up of up to 15 months also showed shunt patency in all 19 survivals receiving H-graft shunt. CONCLUSION: This procedure shows less trauma, lower postoperative encephalopathy rate, while as effective in preventing recurrent variceal bleeding as the traditional portosystemic shunt.