Changes in portal blood flow consequent to partial hepatectomy: Doppler estimation.

Hemodynamic changes in portal blood flow were investigated in 56 patients with hepatic tumors who underwent partial hepatectomy. Portal flow was measured with a Doppler ultrasound system before, during, and after surgery. The portal flow of patients who underwent massive hepatectomy decreased intraoperatively. The portal flow per unit of cardiac output decreased in patients who underwent massive or major hepatectomy, patients with a cirrhotic liver, and patients who had a satisfactory postoperative course. Postoperatively, the portal flow in patients with a poor clinical outcome (multiple organ failure, hepatic failure, and cardiorespiratory failure) decreased significantly. Monitoring portal hemodynamic values appears to be useful in providing an index of "hepatic functional reserve." Adequate portal flow is essential for postoperative hepatic regeneration; changes in portal hemodynamic values may be directly related to the patient's ability to survive surgery and to regain or maintain normal liver function.