Abstract
Background. Doppler ultrasonography assesses hepatic hemodynamics noninvasively. This study uses
hepatic hemodynamic parameters to predict posthepatectomy complications. Methods. Sixty-three consecutive patients scheduled for liver resection (23 with cirrhosis,
12 with chronic hepatitis, and 28 with no diffuse liver disease) were enrolled. We
measured the right portal venous peak velocity (PVPV; cm/s), right hepatic arterial
peak systolic velocity (cm/s), hepatic arterial pulsatility index, and the splenic
arterial pulsatility index (SAPI). Results. Prolonged ascites developed in 12 patients overall and in 7 patients who underwent
limited hepatectomy. In both instances, the SAPI was higher in patients with prolonged
ascites than in those without prolonged ascites (P <.0001 and P <.02, respectively). The sensitivity, specificity, and accuracy of a high SAPI (defined
as SAPI ≥ 1.0) in predicting prolonged ascites were 100%, 81%, and 84%, respectively.
Hyperbilirubinemia (serum total bilirubin concentration ≥ 2.0 mg/dL) occurred in 27
patients overall and in 11 patients who underwent limited hepatectomy. In both instances,
the PVPV was lower in patients with hyperbilirubinemia than in those without hyperbilirubinemia
(P =.003 and P <.002, respectively). The sensitivity, specificity, and accuracy of a low PVPV (defined
as PVPV < 15 cm/s) in predicting hyperbilirubinemia were 48%, 92%, and 73%, respectively.
Conclusions. A high SAPI predicts prolonged postoperative ascites and decreased PVPV is a risk
factor for postoperative hyperbilirubinemia. (Surgery 2002;132:431-40.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Ultrasonically guided subsegmentectomy.Surg Gynecol Obstet. 1985; 161: 346-350
- Extended hepatectomy for hepatocellular carcinoma.Br J Surg. 1990; 77: 1247-1250
- Criteria for safe hepatic resection.Am J Surg. 1995; 169: 589-594
- Surgery and portal hypertension.in: The liver and portal hypertension. : WB Saunders, Philadelphia1964: 50-51
- Transection of the esophagus for bleeding esophageal varices.Br J Surg. 1973; 60: 646-649
- Blood loss and ICG clearance as best prognostic marker of post-hepatectomy liver failure.Hepatogastroenterology. 1999; 46: 1669-1672
- Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy.Br J Surg. 1997; 84: 1255-1259
- A comparative study of postoperative complications after hepatectomy in patients with and without chronic liver disease.Surgery. 1999; 126: 484-491
- Doppler analysis of hepatic blood flow predicts liver dysfunction after major hepatectomy.World J Surg. 1994; 18: 143-149
- Acute portal hypertension associated with liver resection.Arch Surg. 1985; 120: 1303-1305
- Reduction of intrahepatic vascular space in the pathogenesis of portal hypertension.Gastroenterology. 1987; 93: 157-161
- Hepatic regeneration in the absence of portal viscera.Surgery. 1975; 77: 419-426
- Liver blood flow after partial hepatectomy in pig.J Surg Res. 1984; 37: 290-294
- Portal venous hemodynamics in chronic liver disease: effect of posture change and exercise.Radiology. 1985; 155: 757-761
- Clinical application of an ultrasonic duplex system in quantitative measurement of portal blood flow.J Clin Ultrasound. 1986; 14: 579-588
- Effect of meal on portal hemodynamics in healthy humans and in patients with chronic liver disease.Hepatology. 1989; 9: 815-819
- Hepatic arterial pulsatility index in cirrhosis: correlation with portal pressure.J Hepatol. 1999; 30: 876-881
- Splenic Doppler impedance indices: influence of different portal hemodynamic conditions.Hepatology. 1996; 23: 1035-1040
- Inter-observer and inter-equipment variability of echo-Doppler examination of the portal vein: effect of a co-operative training program.Hepatology. 1995; 21: 428-433
- Interobserver and interequipment variability of hepatic, splenic, and renal arterial Doppler resistance indices in normal subjects and patients with cirrhosis.J Hepatol. 1997; 27: 986-992
- Doppler ultrasound. I. Basic principles, instrumentation and pitfalls.Radiology. 1990; 174: 297-307
- Hepatic arterial resistance in cirrhosis with and without portal vein thrombosis: relationship with portal hemodynamics.Gastroenterology. 1995; 108: 1152-1158
- Doppler study of mesenteric, hepatic, and portal circulation in alcoholic cirrhosis: relationship between quantitative Doppler measurements and the severity of portal hypertension and hepatic failure.Hepatology. 1998; 28: 932-936
- Prognostic usefulness of hepatic vein catheterization in patients with cirrhosis and esophageal varices.Gastroenterology. 1992; 102: 973-979
- Echo-Doppler measurement of splanchnic blood flow in control and cirrhotic subjects.J Clin Ultrasound. 1986; 14: 429-435
- Value of measurement of mean portal flow velocity by Doppler flowmetry in the diagnosis of portal hypertension.J Hepatol. 1992; 16: 298-303
- Relationship between peripheral portal blood flow and liver function in patients with liver cirrhosis.Scand J Gastroenterol. 1994; 29: 859-864
- Value of Doppler ultrasound parameters of portal vein and hepatic artery in the diagnosis of cirrhosis and portal hypertension.Am J Gastroenterol. 1997; 92: 1012-1017
- Changes in portal blood flow consequent to partial hepatectomy: Doppler estimation.Radiology. 1991; 180: 373-377
- Hepatic arterial resistive index: correlation with the severity of cirrhosis.Abdom Imaging. 1993; 18: 61-65
- Hepatic artery hemodynamic responsiveness to altered portal blood flow in normal and cirrhotic livers.Radiology. 1996; 200: 793-798
- Value of splanchnic Doppler ultrasound in the diagnosis of portal hypertension.Ultrasound Med Biol. 2001; 27: 893-899
- Noninvasive grading of the sensitivity of portal hypertension in cirrhotic patients by echo-color-Doppler.Ultrasound Med Biol. 2001; 27: 901-907
- Surgical resection of hepatocellular carcinoma in cirrhotic patients. Prognostic value of preoperative portal pressure.Gastroenterology. 1996; 111: 1018-1022
- Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation.Hepatology. 1999; 30: 1434-1440
- Splenic impedance indices: a useful method to monitor patients after liver transplantation?.Hepatology. 1998; 27: 674-678
- Mechanism and role of intrinsic regulation of hepatic arterial blood flow: hepatic arterial buffer response.Am J Physiol. 1985; 249: G549-G556
- Effect of hyperdynamic circulatory support on hepatic hemodynammics, oxygen supply and demand after massive hepatectomy.Surgery. 1991; 109: 277-283
- Effects of portal-systemic shunt following 90% partial hepatectomy in rats.J Surg Res. 2000; 89: 126-131
- Correlative classification of clinical and hemodynamic function after acute myocardial infarction.Am J Cardiol. 1977; 39: 137-145
- Indocyanine green disappearance enhanced by prostaglandin E1 in patients with hepatic resection.J Surg Res. 1996; 66: 64-68
Article info
Publication history
Accepted:
April 15,
2002
Footnotes
*Reprint requests: Hiroyuki Sugimoto, Department of Surgery II, Nagoya University School of Medicine, Tsurumai-cho 65, Showa-ku, Nagoya 466-8550, Japan.
Identification
Copyright
© 2002 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
