Colaneri Renata Potonyacz, Coelho Fabrício Ferreira, de Cleva Roberto, Perini Marcos Vinícius, Herman Paulo
Renata Potonyacz Colaneri, Fabrício Ferreira Coelho, Roberto de Cleva, Marcos Vinícius Perini, Paulo Herman, Department of Gastroenterology, University of São Paulo Medical School, São Paulo, SP CEP 05403-000, Brazil.
World J Gastroenterol. 2014 Nov 28;20(44):16734-8. doi: 10.3748/wjg.v20.i44.16734.
To propose a less invasive surgical treatment for schistosomal portal hypertension.
Ten consecutive patients with hepatosplenic schistosomiasis and portal hypertension with a history of upper gastrointestinal hemorrhage from esophageal varices rupture were evaluated in this study. Patients were subjected to a small supraumbilical laparotomy with the ligature of the splenic artery and left gastric vein. During the procedure, direct portal vein pressure before and after the ligatures was measured. Upper gastrointestinal endoscopy was performed at the 30(th) postoperative day, when esophageal varices diameter were measured and band ligature performed. During follow-up, other endoscopic procedures were performed according to endoscopy findings.
There was no intra-operative mortality and all patients had confirmed histologic diagnoses of schistosomal portal hypertension. During the immediate postoperative period, two of the ten patients had complications, one characterized by a splenic infarction, and the other by an incision hematoma. Mean hospitalization time was 4.1 d (range: 2-7 d). Pre- and post-operative liver function tests did not show any significant changes. During endoscopy thirty days after surgery, a decrease in variceal diameters was observed in seven patients. During the follow-up period (57-72 mo), endoscopic therapy was performed and seven patients had their varices eradicated. Considering the late postoperative evaluation, nine patients had a decrease in variceal diameters. A mean of 3.9 endoscopic banding sessions were performed per patient. Two patients presented bleeding recurrence at the late postoperative period, which was controlled with endoscopic banding in one patient due to variceal rupture and presented as secondary to congestive gastropathy in the other patient. Both bleeding episodes were of minor degree with no hemodynamic consequences or need for blood transfusion.
Ligature of the splenic artery and left gastric vein with supraumbilical laparotomy is a promising and less invasive method for treating presinusoidal schistosomiasis portal hypertension.
提出一种治疗血吸虫性门静脉高压症的微创外科治疗方法。
本研究评估了10例连续性肝脾型血吸虫病合并门静脉高压症且有食管静脉曲张破裂所致上消化道出血病史的患者。患者接受经脐上小切口剖腹手术，结扎脾动脉和胃左静脉。术中测量结扎前后的直接门静脉压力。术后第30天进行上消化道内镜检查，测量食管静脉曲张直径并进行套扎。随访期间，根据内镜检查结果进行其他内镜操作。
术中无死亡病例，所有患者均经组织学确诊为血吸虫性门静脉高压症。术后近期，10例患者中有2例出现并发症，1例为脾梗死，另1例为切口血肿。平均住院时间为4.1天（范围：2 - 7天）。术前和术后肝功能检查未显示任何显著变化。术后30天内镜检查时，7例患者的静脉曲张直径减小。随访期间（57 - 72个月），进行了内镜治疗，7例患者的静脉曲张得以根除。考虑到术后晚期评估，9例患者的静脉曲张直径减小。每位患者平均进行3.9次内镜套扎治疗。2例患者在术后晚期出现出血复发，1例因静脉曲张破裂经内镜套扎控制，另1例表现为继发性充血性胃病。两次出血事件程度均较轻，无血流动力学后果，无需输血。
经脐上剖腹手术结扎脾动脉和胃左静脉是治疗窦前性血吸虫病门静脉高压症的一种有前景的微创方法。
