Clinical and portal hemodynamic features in cirrhotic patients having a large spontaneous spleno- and gastrorenal shunt.

概要

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Clinical and portal hemodynamic features in 28 cirrhotic subjects with a large spontaneous spleno- and/or gastrorenal shunts were studied in comparison with 30 control cirrhotic cases without such collaterals. Forty-six percent of cirrhotic subjects with these collaterals had chronic hepatic encephalopathy, but none of cirrhotic subjects without collaterals did. Eleven percent of the former and 30 percent of the latter had the history of variceal bleeding, although the difference was not statistically significant. Large-sized esophageal varices were significantly less frequent in patients with large collaterals than in patients without (39% vs 77%, p<0.025). All cases of chronic hepatic encephalopathy had hepatofugal flow of part of superior mesenteric venous blood into these collaterals, but the same did not occur in patients without such colleaterals. In patients with encephalopathy, portal venous flow was less than one half of that in patients without these collaterals, and the portion of superior mesenteric venous blood that was flowing hepatofugally seemed equal to or greater than the portal venous flow.