FUNCTIONAL AND ANATOMICAL CONDITIONS FOR THE PORTO SYSTEMIC SHUNT IN PATIENTS WITH ASCITES

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Aim. The aim of the study was to identify functional and anatomical conditions for the portosystemic shunt surgery in patients with ascites. Material and Methods. 14 patients with liver cirrhosis and refractory ascites underwent a portosystemic bypass surgery. Quality of life was assessed by SF-36 at admission and after 1 and 3 years of surgical treatment. There were 2 groups of patients: 7 with absolutely refractory ascites (no effect of 400 mg of spironolactone and 160 mg of furosemide); and 7 with relatively refractory ascites (prescription of the maximum doses of diuretic drugs was restricted by side effects (encephalopathy, exacerbation of gout, collapse, etc.). Results and Discussion. Patients with absolutely refractory ascites showed improvement of life quality after 1 year but significant decrease in 3 years: in 70% of cases (p<0.002) liver transplantation was required. Patients with relatively refractory as cites needed transplantation in 10% of cases, the quality of life significantly improved after 1 and 3 years (p<0.0001). In one year after surgery patients with relative refractory as cites changed the severity of cirrhosis with Child-Pugh score to B and A (p<0.001). The values of SF improved. Conclusions. Venous system of liver gives anatomical possibilities for the surgical treatment in people with decompensates cirrhosis. According to the obtained data 90% of patients with relatively refractory ascites can delay liver transplantation for 3 years after porto-systemic shunt surgery.