[An analysis of prognostic examination in cirrhotic portal hypertension and hepatoma]

Abstract

With an increasing number of patients with advanced liver cirrhosis, the discrepancy between the preoperative examination and results of surgery for bleeding varices is widening. To correct this discrepancy, additional prognostic examinations to Child's criteria and routine hepatic laboratory tests were studied in our 246 cirrhotic patients with esophageal varices. These included wedged hepatic vein pressure, clearance and maximal removal rate of indocyanine green, and hepaplastin test. We performed the endoscope assisted terminal esophagoproximal gastrectomy with the EEA stapler gun with devascularization and splenectomy. No operative death and complications developed when the results of following 4 preoperative examinations were: wedged hepatic vein pressure below 400 mm of saline, peripheral disappearance rate (K) of indocyanine green above 0.04 min-1, maximal removal rate (Rmax) of the dye above 0.3mg/kg/min and hepaplastin test more than 40%. It is necessary for these indicators to be satisfied simultaneously prior to performing this surgery. In addition, these values should be changed a little in their critical limits when these cirrhotic patients also had hepatoma and were candidates for hepatectomy.