Alterações angiográficas e pressóricas determinadas pela esplenectomia e ligadura da veia gástrica esquerda em portadores de esquistossomose mansônica

Abstract

-Background:In hepatosplenic schistosomiasis occurs diffuse hepatic fibrosis associated with venous congestion of the portal system resulting in hepatosplenomegaly. It can produce digestive hemorrhage caused by rupture of esophageal and stomach varices or peptic gastroduodenal mucosal lesions. Aim: To study the effects of splenectomy and ligature of the left gastric vein on portohepatic hemodynamics. Method: Twenty-three patients with hepatosplenic schistosomiasis mansoni were studied before and about two weeks after operation through angiographic diameter of the common and proper hepatic artery, splenic artery, superior mesenteric artery, portal vein, superior mesenteric vein and left gastric vein. The pressures of the inferior vena cava and central venous pressure, free hepatic vein, the hepatic sinusoidal and occluded vein were measured. Results: The splenectomy and ligature of the left gastric vein determined low morbidity and null mortality. It determined significant addition to the following variables: diameters of the common and proper hepatic artery; diameter of the superior mesenteric vein. It determined non significant increase on the following measurements: right atrial pressure and diameter of the superior mesenteric artery. It determined non significant decrease to the following variables: inferior vena cava pressure; free hepatic vein pressure; occluded hepatic vein pressure; sinusoidal pressure, diameter of the portal vein. Conclusion: Splenectomy and ligature of the left gastric vein do not determine portal hemodynamic changes capable of breaking the functional hemodinamic balance that characterizes the hepatosplenic mansoni schistosomiasis.RESUMO -Racional: Na esquistossomose mansônica na forma hepatoesplênica ocorre fibrose hepática difusa que associada à congestão venosa do sistema porta resulta em hepatoesplenomegalia. Pode produzir hemorragia digestiva alta por rotura das varizes de esôfago e do estômago ou lesões pépticas da mucosa gastroduodenal. Objetivo: Estudar os efeitos da esplenectomia e ligadura da veia gástrica esquerda sobre a hemodinâmica portohepática. Método: Vinte e três portadores de esquistossomose mansônica na forma hepatoesplênica foram estudados prospectivamente, antes e cerca de duas semanas após a operação, através de estudos angiográficos dos diâmetros da artéria hepática comum e própria, artéria esplênica, artéria mesentérica superior, veia porta, veia mesentérica superior e veia gástrica esquerda. Foram aferidas as pressões da veia cava inferior, venosa central, da veia hepática livre, da veia hepática ocluída e sinusoidal. Resultados: A ligadura da veia gástrica esquerda determinou acréscimo significante nas seguintes variáveis: diâmetros da artéria hepática comum e própria; diâmetro da veia mesentérica superior; o acréscimo não foi significante nas seguintes medidas: pressão venosa central e diâmetro da artéria mesentérica superior. Ela promoveu decréscimo não significante nas variáveis: pressão da veia cava inferior; pressão da veia hepática livre; pressã...

Late Results of Esophagogastric Devascularization and Splenectomy Associated With Endoscopic Treatment in Patients With Schistosomiasis

“…The preferred surgery performed in most groups that deal with presinusoidal portal hypertension 2 3 4 10 , EGDS has the advantage of not triggering postoperative encephalopathy 16 , significant complication after porto-systemic shunts. The major drawback of EGDS is rebleedling that was significantly decreased since the endoscopic treatment (sclerotherapy) was introduced as a routine during follow-up 1 5 19 20 .…”

Disfunções Decorrentes da Esquistossomose

“…Conforme o estudo realizado, as disfunções foram divididas por sistema afetado, os quais foram: renal (BORCH et al, 2009;DUARTE et al, 2014), cardiovascular (ANDRADE, SANTANA, 2010GRAHAM et al, 2010;KOLOSIONEK et al, 2010;TERRA-FILHO et al, 2010;CARVALHO et al, 2011;SAFDAR, BARTOLOME, SUSSMAN, 2012;ARMSTRONG et al, 2013;LAPA et al, 2015;MOCUMBI et al, 2016) e hepatoesplênico (PEREIRA et al, 2013;SINKALA et al, 2016).…”

Hemodynamic Changes in the Intra-Hepatic Circulation of Hepatosplenic Schistosomiasis: the Role of Hepatic Artery

“…Lacerda and Pereira evaluating hemodynamic effects of splenectomy associated with gastroesophageal devascularization and ligation of left gastric vein, respectively, showed an increase in caliber and flow through the hepatic artery, just after surgery, associated with a reduction in the diameter and flow in portal vein accompanied of a slight increase in sinusoidal pressure [34,35] . Lacerda suggests that, in patients with HSS, with large shunts, absence of increased arterial sector is justified by portal blood overflow, which maintain normal liver perfusion, diverting only the blood in excess and dispensable by colateral circulation.…”