Silva Neto Walter De Biase da, Tredicci Thiago Miranda, Coelho Fabricio Ferreira, Makdissi Fabio Ferrari, Herman Paulo
Universidade Federal de Goiás, Faculdade de Medicina, Hospital das Clínicas, Departamento de Clínica Cirúrgica.
Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Gastroenterologia, Disciplina de Cirurgia do Aparelho Digestivo.
Arq Gastroenterol. 2018 Apr-Jun;55(2):170-174. doi: 10.1590/S0004-2803.201800000-30.
Schistosomiasis is an endemic health problem affecting about four million people. The hepatosplenic form of the disease is characterized by periportal hepatic fibrosis, pre-sinusoidal portal hypertension and splenomegaly. Liver function is preserved, being varices bleeding the main complication of the disease. The surgical treatment used in the majority of centers for the prevention of rebleeding is esophagogastric devascularization and splenectomy. Most authors reported better results with the association of surgical and postoperative endoscopic treatment.
The aim of this study was to compare the intra operative portal pressure decrease and esophageal varices behavior and rebleeding rates in patients submitted to surgical and postoperative endoscopic treatment after long-term follow-up.
A retrospective study of 36 patients with schistosomiasis with, at least, one previous bleeding from esophageal varices rupture submitted to esophagogastric devascularization and splenectomy, added to endoscopic varices postoperative treatment was performed. Patients were stratified according to the intra operative portal pressure decrease in two groups: reduction below and above 30%. Long-term varices presence, size and bleeding recurrence were evaluated.
Regarding varices behavior, no significant influence was observed in both groups of portal pressure fall. Regarding bleeding recurrence, despite three times more frequent in the group with lower portal pressure fall, no significant difference was observed. All patients were submitted to postoperative endoscopic treatment.
Esophageal varices banding, rather than portal pressure decrease, seems to be the main responsible factor for good results after combination of two therapies (surgery and endoscopy) for patients with portal hypertension due to schistosomiasis; further studies are necessary to confirm this hypothesis.
血吸虫病是一个影响约400万人的地方性健康问题。该疾病的肝脾型以门静脉周围肝纤维化、窦前性门静脉高压和脾肿大为特征。肝功能得以保留，静脉曲张出血是该疾病的主要并发症。大多数中心用于预防再出血的手术治疗是食管胃去血管化和脾切除术。大多数作者报告手术与术后内镜治疗联合使用效果更佳。
本研究的目的是比较接受手术及术后内镜治疗的患者在长期随访后的术中门静脉压力降低情况、食管静脉曲张表现及再出血率。
对36例血吸虫病患者进行回顾性研究，这些患者既往至少有一次食管静脉曲张破裂出血，接受了食管胃去血管化和脾切除术，并在术后接受了内镜下静脉曲张治疗。根据术中门静脉压力降低情况将患者分为两组：降低幅度低于30%和高于30%。评估长期静脉曲张的存在情况、大小及出血复发情况。
关于静脉曲张表现，两组门静脉压力下降均未观察到显著影响。关于出血复发，尽管门静脉压力下降幅度较小的组出血复发频率高出三倍，但未观察到显著差异。所有患者均接受了术后内镜治疗。
对于血吸虫病所致门静脉高压患者，两种治疗方法（手术和内镜）联合治疗后效果良好的主要因素似乎是食管静脉曲张套扎术，而非门静脉压力降低；需要进一步研究来证实这一假设。
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