Paulo Danilo Nagib Salomão, Paulo Isabel Cristina Andreatta Lemos, Kalil Mitre, Vargas Paulo Merçon, Silva Alcino Lázaro da, Baptista João Florêncio de Abreu, Guerra Alvino Jorge
Laboratory of the Division of Surgical Principles, Department of Surgery, School of Science, Santa Casa de Misericórdia, Vitória Espírito Santo (EMESCAM), Rua Santa Rita de Cássia 777, 29052-270 Vitória (ES), Brazil.
Acta Cir Bras. 2006 Sep-Oct;21(5):321-7.
To assess the possibility of preserving the lower pole of the spleen, supplied by the inferior lobar vessels and segmental vessels, or by vessels of the gastrosplenic ligament, in subtotal splenectomy; to study the viability and function of the lower pole of the spleen.
Thirty-six male Wistar rats were used in this study. Said animals weighed 273-390 g ( 355.2 +/- 30.5 g ), and were randomly distributed into three groups. Group 1 comprised ten animals which were submitted to exploratory laparotomy with spleen manipulation (sham operation). Group 2 comprised 16 animals which were submitted to total splenectomy. Group 3 comprised ten animals which were submitted to subtotal splenectomy, preserving the lower pole of the spleen. Blood was collected from all animals before and 90 days after surgery to measure the levels of cholesterol and triglycerides. The animals were sacrificed 90 days after surgery. Spleens and remaining spleens were removed for macroscopic and microscopic examination.
Surgery was performed with no complications in all groups. Six animals died in group 2. Spleens of groups 1 and 2, and lower poles of group 3 were macroscopically viable. Apparent white pulp hyperplasia was observed in group 1. In group 3, slight inflammation and capsular fibrosis were observed at the incision site, as well as diffuse hemosiderosis in the red pulp. Average mass of remaining spleen was 35.84% +/- 4.31%. No significant difference was observed between preoperative and late postoperative lipid levels in groups 1 and 3 (p > 0.05). Late postoperative lipid levels significantly increased in group 2.
Preservation of the lower pole of the spleen (supplied by gastrosplenic vessels or inferior lobar vessels and segmental vessels) was possible with subtotal splenectomy. The lower pole was macroscopically and microscopically viable in all cases. Subtotal splenectomy preserving the lower pole prevented changes in lipid levels, which were observed in rats submitted to total splenectomy. Plasma lipid levels in rats submitted to subtotal splenectomy were similar to those observed in sham operated rats.
评估在脾次全切除术中保留由下叶血管、节段血管或胃脾韧带血管供血的脾下极的可能性;研究脾下极的活力和功能。
本研究使用36只雄性Wistar大鼠。这些动物体重为273 - 390克(355.2±30.5克),随机分为三组。第1组包括10只动物,接受了探查性剖腹术并对脾脏进行操作(假手术)。第2组包括16只动物,接受了全脾切除术。第3组包括10只动物,接受了脾次全切除术,保留脾下极。在所有动物手术前及术后90天采集血液,测量胆固醇和甘油三酯水平。术后90天处死动物。取出脾脏和剩余脾脏进行宏观和微观检查。
所有组手术均无并发症。第2组有6只动物死亡。第1组和第2组的脾脏以及第3组的脾下极在宏观上均存活。第1组观察到明显的白髓增生。第3组在切口部位观察到轻微炎症和包膜纤维化,红髓中存在弥漫性含铁血黄素沉着。剩余脾脏的平均质量为35.84%±4.31%。第1组和第3组术前和术后晚期血脂水平无显著差异(p>0.05)。第2组术后晚期血脂水平显著升高。
脾次全切除术有可能保留由胃脾血管或下叶血管及节段血管供血的脾下极。在所有病例中,脾下极在宏观和微观上均存活。保留脾下极的脾次全切除术可防止血脂水平变化,而全脾切除的大鼠则出现这种变化。接受脾次全切除术的大鼠血浆脂质水平与假手术大鼠相似。