Widman Azzo, Oliveira Ilka Regina Souza de, Speranzini Manlio Bas lio, Cerri Giovanni Guido, Saad William Abr o, Gama-Rodrigues Joaquim
Grupo de Cirurgia do Fígado e Hepertensão Portal da Divisão de Clínicas Cirúrgica II do Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, RS, Brasil.
Arq Gastroenterol. 2002 Oct-Dec;39(4):217-21. doi: 10.1590/s0004-28032002000400003. Epub 2003 Jul 16.
The distal splenorenal anastomosis (Warren's operation) has been indicated for the treatment of high digestive bleeding caused by esophagic varices because it would ideally reduce the venous pressure in the cardiotuberositary territory without changing the mesenteric-portal venous flow. However, the changes it produce in the splenic territory have not been fully understood.
To appraise the late morphologic and hemodynamic changes in the splenic territory produced by the distal splenorenal anastomosis in patients with portal hypertension due to mansoni's hepatosplenic schistosomiasis complicated by esophagic bleeding.
Ultrasonography-Doppler study of the splenic region of 52 patients with portal hypertension due to mansoni's schistosomiasis and previous bleeding by esophagic varices. They were divided in two groups: 40 non operated upon and 12 with a distal splenorerenal anastomosis. The following parameters and indices were compared between the two groups: a) morphometric parameters (splenic artery and vein's diameter, splenic diameters (longitudinal, transversal and antero-posterior); b) velocimetric parameters of the splenic vessels (systolic peak velocity in the splenic artery, mean flow velocity in the splenic vein; c) biometric index of the spleen (longitudinal x transversal); volumetric index of the spleen (longitudinal x transversal x antero-posterior x 0,523); hemodynamic indices of the splenic artery's impedance: pulsatility and resistivity.
The patients with distal splenorenal anastomosis showed: a) reduction in splenic indices: volumetric (non operated 903,83 +/- 452, 77 cm / distal splenorenal anastomosis 482,32 +/- 208,02 cm (46,64%)) and biometric (non operated 138,14 +/- 51,89 cm /distal splenorenal anastomosis 94,83 +/- 39,83 cm (33,35%)); b) no change: splenic artery's diameter (non operated 0,57 +/- 0,16 cm/distal splenorenal anastomosis 0,57 +/- 0,23 cm); velocity in the splenic artery non operated 107 +/- 42,02 cm/seg/distal splenorenal anastomosis 89,81 +/- 41,20 cm/seg), resistivity (non operated 0,58 +/- 0,008/distal splenorenal anastomosis 0,56 +/- 0,06) and pulsatility (non operated 0,91 +/- 0,19/distal splenorenal anastomosis 0,86 +/- 0,15, splenic vein (non operated 1,10 +/- 0,30 cm/distal splenorenal anastomosis 1,19 +/- 0,29 cm); c) increase: mean flow velocity in the splenic vein (non operated 20,54 +/- 8,45 cm/seg/distal splenorenal anastomosis 27,83 +/- 9,29 cm/seg).
The comparison of the ultrasonography Doppler results of the two groups of patient (non operated and distal splenorenal anastomosis) showed that in patients with distal splenorenal anastomosis there was a decrease of the volume of spleen; increase in the mean flow velocity in the splenic vein; no changes in the morphologic and hemodinamyc parameters of the splenic artery neither in its velocimetric indices.
远端脾肾吻合术（沃伦手术）已被用于治疗由食管静脉曲张引起的严重消化性出血，因为它理论上可以降低贲门结节区域的静脉压力，而不改变肠系膜-门静脉血流。然而，它在脾脏区域所产生的变化尚未被完全理解。
评估曼氏肝脾血吸虫病合并食管出血所致门静脉高压患者行远端脾肾吻合术后脾脏区域的晚期形态学和血流动力学变化。
对52例曼氏血吸虫病所致门静脉高压且既往有食管静脉曲张出血的患者的脾脏区域进行超声多普勒研究。他们被分为两组：40例未手术组和12例行远端脾肾吻合术组。比较两组之间的以下参数和指标：a）形态学参数（脾动脉和静脉直径、脾脏直径（纵径、横径和前后径））；b）脾血管的流速参数（脾动脉收缩期峰值流速、脾静脉平均流速）；c）脾脏的生物测量指数（纵径×横径）；脾脏体积指数（纵径×横径×前后径×0.523）；脾动脉阻抗的血流动力学指数：搏动性和阻力。
行远端脾肾吻合术的患者表现为：a）脾脏指数降低：体积（未手术组903.83±452.77cm³/远端脾肾吻合术组482.32±208.02cm³（46.64%））和生物测量指数（未手术组138.14±51.89cm²/远端脾肾吻合术组94.83±39.83cm²（33.35%））；b）无变化：脾动脉直径（未手术组0.57±0.16cm/远端脾肾吻合术组0.57±0.23cm）；脾动脉流速（未手术组107±42.02cm/秒/远端脾肾吻合术组89.81±41.20cm/秒）、阻力（未手术组0.58±0.008/远端脾肾吻合术组0.56±0.06）和搏动性（未手术组0.91±0.19/远端脾肾吻合术组0.86±0.15），脾静脉（未手术组1.10±0.30cm/远端脾肾吻合术组1.19±0.29cm）；c）增加：脾静脉平均流速（未手术组20.54±8.45cm/秒/远端脾肾吻合术组27.83±9.29cm/秒）。
两组患者（未手术组和远端脾肾吻合术组）的超声多普勒结果比较显示，行远端脾肾吻合术的患者脾脏体积减小；脾静脉平均流速增加；脾动脉的形态学和血流动力学参数及其流速指标均无变化。
