Differentiated Surgical Treatment of Portal Hypertension and its Complications in Patients with Liver Cirrhosis Part I. Assessment of Diseases Severity and Choice of Surgical Intervention

Aim. To develop the system assessing degree of disease compensation and the algorithm for selection of method of surgical treatment. Material and Methods. Main parameters of nutritionally – metabolic status, central hemodynamics, porto-hepatic circula tion, oxygen regime of tissues and major clinical syndromes (ascites, jaundice, hepatic encephalopathy) depending on severity and degree of disease compensation were studied in 166 patients with liver cirrhosis and portal hypertension. Results. Intensity of catabolism and amino-acid disorganization amplifies accordingly to increased severity of disease in groups A, B and C by Child. It is accompanied by increased protein deficit in somatic and visceral protein parts of body and formation of moderate and severe malnutrition. In parallel with these changes there are compensatory changes in central hemodynamics including transition from normorkinetic type of circulation in the group A to hyperkinetic circulation in group B, “breaking” of compensation with formation of hypokinetic circulation in group C. It is accompanied by changes in porto-hepatic circulation and reflected on functional state of liver. The hypothesis of liver failure progression with formation of five functional classes is suggested. Violations of “trophic homeokinesis” supporting “vicious circle” play important role in pathogenesis of liver failure. Based on obtained data additional groups characterizing the transition from one class to another are determined. We presented quantitative objectification of changes of main parameters which characterize the severity of disease. It allows to modify the system assessing reserve potential in patients with liver cirrhosis and portal hypertension. Based on this classification the algorithm for selection of surgical treatment in these patients is poposed. Conclusion. The suggested classification assessing degree of disease compensation in patients with liver cirrhosis and portal hypertension is not an alternative to popular forecasting Child’s system but complements it in clinical situations which are difficult to assess the reserve potential and to choose surgical treatment. The classification will allow to compare obtained results in evaluation of effectiveness of different treatment strategies.