Intra-hepatic Shunt Evaluated by Serum Ammonia Level -Closing of Porto-systemic Shunt-

Takehito Ohtsubo, Ken Takasaki, Masashi Tsugita, Masakazu Yamamoto, Takafumi Suzuki, Syoujiro Miyazaki, Tetsuo Nakagami

Department of Surgery, Insutitute of Gastroenterology, Tokyo Women's Medical College

We investigated the portal blood flow, paticularly intra-hepatic shunt, by measuring the level of ammonia in the portal vein (P) and hepatic vein (H), and the ammonia exclusion ratio (P-H)/P. Twentythree patients were evaluated, 14 had an extra-hepatic shunt, and the others had no shunt. As the liver function deteriorated becouse of fibrosis, the level of ammonia in the hepatic vein increased and the ammonia exclusion ratio decreased. In the patients with no extra-hepatic shunt, there was a highly negative correlation between the ammonia exclusion ratio and ICGR₁₅ (r=-0.85). In the patients with an extra-hepatic shunt, there was a highly negative correlation between the ammonia exclusion ratio and ICGR₁₅ after closing the shunt (r=-0.75) . Consequently, the ammonia exclusion ratio reflected the degree of liver fibrosis and intra-hepatic shunt. The ammonia exclusion ratio is a useful method for determining the closing of the porto-systemic shunt.

Key words
porto-systemic shunt, serum ammonia level, hepatic encephalopathy

Reprint requests
Takehito Ohtsubo Department of Surgery Insutitute of Gastroenterology, Tokyo Women's Medical College
8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162 JAPAN

Accepted
September 11, 1996

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