Novosti
|
This journal is indexed in Scopus |
|---|
Year 2012 Vol. 20 No 4
GENERAL AND SPECIAL SURGERY
P.K. KHOLMATOV, U.A. KURBANOV, N.U. USMANOV
RESULTS OF PORTOSYSTEMIC SHUNTING AT PORTAL HYPERTENSION
Tajik Abu Ali Ibn Sino State Medical University ,
The Republic of Tajikistan
Objectives. To study the immediate results of portosystemic shunting in patients with the portal hypertension.
Methods. The treatment results of 41 patients with the portal hypertension (PH) were studied: 17 patients with A class, 24 patients with B class according to the classification of Child – Pugh. Splenorenal anastomosis was made side by side in 14 patients, the distal splenorenal shunting – in 11, the splenorenal anastomosis with the upper interlobar vein of the left kidney with splenectomy – in 2, the splenorenal anastomosis and splenectomy - in 10 cases and the mesocaval anastomosis – in 4 cases.
Results. Esophageal varicosity of the I grade was revealed in 6 (14,6%), of the II grade – in 14 (34,29%) and of the III grade – in 21 (51,2%) patients. Patients with the liver cirrhosis (functional class A) having an initial degree of esophageal varicosity revealed the expansion of the splenic vein (VESV) up to 0,86±0,21 cm and a moderate enlargement of the spleen up to 12,9±2,5 cm. The high-speed parameters in the portal system veins in this group is appeared to reduce. In patients with the liver cirrhosis (functional class B) and marked VESV one registered the following: a more pronounced expansion of the splenic vein 0,98±0,17 cm, splenomegaly, in 14 (58,3%) patients the blood flow was registered in the periomphalic vein. In the early postoperative period after the splenorenal anastomosis performance combined with splenectomy gastro-esophageal bleeding has developed in 3 patients. The portosystemic shunt was successful in 38 patients.
Conclusions. Surgical correction with the performance of various portosystemic anastomoses in A and B class patients according to the classification of Child – Pugh at esophageal varicosity of the II-III grades is considered to be an effective method of prevention and treatment of the gastro-esophageal bleeding.
1. Khazanov AI. Alkogol'nye i virusnye tsirrozy pecheni u statsionarnykh bol'nykh (1996–2005 gg.): rasprostranennost' i iskhody [Alcoholic and viral cirrhosis of the liver in outpatients (1996-2005 yrs.): Prevalence and outcomes]. Ros Zhurn Gastroenterol Gepatol Koloproktol.. 2007;(2):19–27.
2. Nazyrov FG, Akilov KhA, Deviatov AV. Khirurgiia portal'noi gipertenzii u bol'nykh tsirrozom pecheni v Tsentral'no Aziatskom regione [Surgery of portal hypertension in patients with liver cirrhosis in the Central Asian region]. Annaly Khirurg Gepatologii. 2003;8(1):19–28.
3. Zatevakhin II. Trans"iuguliarnoe vnutripechenochnoe portosistemnoe shuntirovanie - endovaskuliarnyi metod sozdaniia portokaval'nogo anastomoza [Transjugular intrahepatic portosystemic shunt - endovascular method of a portocaval anastomosis creation]. Flebologiia. 2008;(4):10–16.
4. Henderson JM. Role of distal splenorenal shunt for long-term management of variceal bleeding. World J Surg. 1994 Mar-Apr;18(2):205–10.
5. Hillert C, Fischer L, Broering DC, Rogiers X. Liver transplantation in patients with liver cirrhosis and esophageal bleeding. Langenbecks Arch Surg. 2003;388:150–54.
6. Qazi SA, Khalid K, Hameed AM, Al-Wahabi K, Galul R, Al-Salamah SM.Al-Salamah Transabdominal gastro-esophageal devascularization and esophageal transection for bleeding esophageal varices after failed injection sclerotherapy: long-term follow-up report. World J Surg. 2006 Jul;30:1329–37.
7. Wolff M, Hirner A. Current state of portosystemic shunt surgery. Langenbecks Arch Surg. 2003 Jul;388:141–49.
8. Rossle M. When endoscopic therapy or pharmacotherapy fails to control variceal bleeding: what should be done? Immediate control of bleeding by TIPS? Langenbecks Arch Surg. 2003 Jul;388(3):155–62.
9. Wright AS, Rikkers LF. Current management of portal hypertension. J Gastrointest Surg. 2005 Sep-Oct;9(7):992–1005.
10. Yamamoto S, Sato Y, Nakatsuka H, Oya H, Kobayashi T, Hatakeyama K. Bene?cial effect of partial portal decompression using the inferior mesenteric vein for intractable gastroesophageal variceal bleeding in patients with liver cirrhosis. World J Surg. 2007 Jun;31(6):1264–69.
11. Moon SB, Jung SE, Ha JW, Park KW, Seo JK, Kim WK. The usefulness of distal splenorenal shunt in children with portal hypertension for the treatment of severe thrombocytopenia and leucopenia. World J Surg. 2008 Mar;32(3):483–37.
12. Makuuchi M, Miller CM, Olthoff K, Schwartz M. Adult–adult living donor liver transplantation. J Gastrointest Surgery. 2004 Mar-Apr;8(3):303–12.
13. Nazyrov FG. Vybor khirurgicheskoi taktiki u bol'nykh s tsirrozom pecheni s izolirovannoi splenektomiei v anamneze [The choice of surgical treatment in patients with liver cirrhosis and isolated splenectomy in history]. Annaly Khirurgii. 2008(2):46–49.
14. Terblanche J. Portal hypertension: A surgical hepatologist's view of current management. J Gastrointest Surg. 1997 Jan-Feb;1(1):4–12.
15. Ferreira FG, Ribeiro MA, de Fatima Santos M, Assef JC, Szutan LA. Doppler ultrasound could predict varices progression and rebleeding after portal hypertension surgery: lessons from 146 EGDS and 10 years of follow-up. World J Surg. 2009 Oct;33(10):2136–43.
734003, Respublika Tadzhikistan,Dushanbe, prospekt Rudaki, d. 139,Tadzhikskiy gosudarstvennyiy meditsinskiyuniversitet im. Abuali ibni Sino,kafedra hirurgicheskih bolezney №1
e-mail: egan0428@mail.ru,
Holmatov Pulat Kadyirovich
Kholmatov P.K., Candidate of Medical Sciences, Associate Professor of the Surgical Diseases Chair №1 of Tajik Abu Ali Ibn Sino State Medical University
Kurbanov U.A., Doctor of Medical Sciences, Professor, Rector of Tajik Abu Ali Ibn Sino State Medical University
Usmanov N.U., Academician of the Academy of Sciences of Tajikistan, Professor of The Surgical Diseases Chair №2 of Tajik Abu Ali Ibn Sino State Medical University.
Article in the .pdf format
