A Study of Changes in Intraoperative Portal Venous Pressure Following Hepatectomy

Abstract

We measured portal venous pressure during hepatectomy in 51 patients, and studied the relationship among the degrees of fibrosis of the resected liver, the growth rate of the remnant liver after hepatectomy, and pre-and postoperative changes in ICG. The portal venous presure before hepatectomy (PVB) became significantly higher as liver fibrosis increased. The portal venous pressure after hepatectomy (PVA) increased, or did not change, in all patients, but it also did not decrease. The portal pressure after hepatectomy increased according to the increase in the volume of resected liver. When the rate of change in portal pressure before and after hepatectomy was regarded as (1/ PVA-1/ PVB) / 1/ PVB, and the rate of change in ICGK before and after hepatectomy was regarded as (postoperative ICGKpreoperative ICGK) /preoperative ICGK, the rate of change in portal pressure tended to increase according to the increase in liver fibrosis and was positively correlated with rate of change in ICGK, but not with the growth rate. The portal pressure, when clamping the portal vein (Pringle maneuver), tended to be lower when the preoperative ICGR15 was higher. Such changes in portal pressure can be measured before hepatectomy by clamping Glisson's sheath of the segment which will be removed, and ICGK levels can be estimated by calculating the rate of change in portal pressure. Based on the above, intraoperative measurement of the portal pressure was considered to be useful for assessing hepatic function.