[Significance of liver volume for the early survival of patients with liver cirrhosis operated on porta-caval anastomosis: Clinical data and relation to pathophysiological implications (author's transl)].
It is thought that the early outcome of patients with liver cirrhosis after end-to-side porta-caval anastomosis not only depends on their clinical situation but also on the postoperative haemodynamic state of the liver. The postoperative haemodynamics can be estimated if the relation of liver volume and the predicted hepatic arterial perfusion is focused. The maximum of arterial liver perfusion seems to be 1200 ml/min in the absence of a portal liver blood supply. Thus, a postoperative perfusionindex between 0.8-1.2 like in normal subjects seems to be the best situation to prevent postoperative hepatic underperfusion. 25 patients were investigated, in which the clinical situation was classified as recommended by Child, and liver volume was estimated by means of ultrasonography. Those patients having liver volumes between 1000 and 1500 ml providing a postoperative PI between 0.8-12 survived in 100%. The early mortality rate of those, having liver volumes more or less these thresholds died in 69%. It was concluded that hepatomegaly or extreme liver atrophy are situations not to be recommended for classical porta-caval anastomosis. Other procedures are dissussed which "seem to be some good news" by clinical data and by means of experimental results. The techniques discussed consist in procedures preventing the pancreatic venous blood to shunt away from the liver.