Esplenectomia e ligadura da veia gÃstrica esquerda na esquistossomose mansÃnica: efeitos sobre pressÃo das varizes do esÃfago, indicadores endoscÃpicos e dopplerfluxometria portal

AUTOR(ES)
DATA DE PUBLICAÇÃO

2003

RESUMO

The effects of splenectomy and gastric vein ligation on the main risk factors of bleeding from esophagogastric varices were studied in 34 patients with the hepatosplenic form of schistosomiasis mansoni and a history of gastrointestinal hemorrhage. The following parameters were investigated: i) esophageal variceal pressure, measured by the endoscopic pneumatic balloon technique; ii) size, fundamental color, extension and red signs of esophageal varices, gastric varices and gastropathy of portal hypertension; iii) diameter, flow velocity and congestion index of portal vein. The evaluations were performed in the preoperative period, immediate postoperative period (between the sixth and eighth postoperative days) and the sixth month of follow-up. The variceal pressure fell from 22.3 Â 2.6mmHg before surgery to 16.0 Â 3.0mmHg in the immediate postoperative period (p <0.001), reaching 13.3 Â 2.6mmHg in the sixth month of follow-up. A significant reduction of the frequency of the parameters associated with a greater risk of hemorrhage was observed between the preoperative period and six-month follow-up when the proportion of large esophageal varices (p <0.05), varices extending to the upper esophagus (p <0.05), bluish varices (p <0.01), varices with red signs (p <0.01) and gastropathy (p <0.05) decreased. The portal vein diameter diminished significantly from 14.0 Â 2.8mm in the preoperative period to 10.8 Â 5.4mm in the sixth month follow-up (p <0.001). The portal vein flow velocity decreased from 29.5 Â 8.9cm/s before surgery to 24.5 Â 8.5cm/s in the immediate postoperative period (p <0.05) and to 24.4 Â 4.7cm/s in the sixth month of follow-up. The congestion index also fell after the surgery but the reduction was not statistically significant. In the immediate postoperative period partial portal vein thrombosis was noted in 57.1% of the cases with no major clinical manifestations. This rate fell significantly to 14.3% during the sixth month of follow-up (p <0.001). No major repercussions of the portal vein thrombosis were observed on esophageal variceal pressure. The proportion of varices with red signs and the portal vein diameter were significantly higher in the patients with portal thrombosis (p <0.05). It was concluded that in patients with hepatosplenic schistosomiasis with a previous history of variceal hemorrhage splenectomy and gastric vein ligation was effective in reducing the main hemorrhagic risk factors until the sixth month of follow-up, indicating a good prospect of achieving the control of bleeding

ASSUNTO(S)

cirurgia veia gÃstrica - ligadura esplenectomia - cirurgia esquistossomose mansÃnica

ACESSO AO ARTIGO

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