Efeitos da esplenectomia, ligadura da veia gÃstrica esquerda e desvascularizaÃÃo da grande curvatura gÃstrica na colopatia da hipertensÃo portal esquistossomÃtica: AnÃlise endoscÃpica, histolÃgica e histomorfomÃtrica

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

The aim of this study was to analyse the alterations of portal congestive colopathy previously and six to 12 months after splenectomy, ligature of the left gastric vein and devascularization of the greater curvature of the stomach. Twelve patients with hepatosplenic schistosomiasis who had had upper gastrointestinal bleeding were studied prospectively. Patients underwent colonoscopies with mucosal biopsies of rectum, sigmoid and ascending colon for histopathologic and histomorphometric analysis. It was analysed the occurency and intensity of lesions (erythemas, telangiectasias, angiodysplasias, rectal varices), the grade of portal colopathy, the intensity of histopathologic alterations (edema, hyperemia, capillary ectasia, inflammatory infiltrate) and the measurement of areas and diameters of colonic mucosal vessels through histomorphometric study before and after sugery. It was used a control group due to lack of normal pattern of the histomorphometric measures of rectum and colon vessels in individuals without portal hypertension. The categoric variables frequency was evaluated by McNemar or Stuart-Maxwell tests. There were compared the median of the values obtained before and after surgery using the Wilcoxon test for samples and controls. The critical level of significance adopted in all tests was of a maximum probability error of 5% (p<0, 05). No significant statistical difference between the severity of schistosomiasis portal colopathy and the intensity of histopathologic mucosal alterations in the rectum and colon was observed before and after surgery. There was a significant statistical decrease in the areas and diameters of the small vessels analysed through histomorphometric study in the colon and rectum mucosa before and after surgery. The histomorfometric measures of rectum and colon vessels after surgery compared to controlâs presented increased values, statistically significant. On the basis of these results, it can be concluded that the short time of follow up was insufficient for detecting regression of the vascular mucosal alterations by colonoscopy and histopathology, but statistically significant regression was found on histomorfometric analysis. It was not observed normalization of the histomorfometric vessels measures, but only decreasing values, after portal hypertension surgical treatment

ASSUNTO(S)

portal hypertension hipertensÃo portal esquistossomose mansÃnica cirurgia esplenectomia histomorfometric splenectomy colopatia portal histomorfomÃtrica portal colopathy schistosomiasis mansoni

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