Assessment of splanchnic hemodynamics in patients with cirrhosis after splenectomy in comparison with non-operated patients at the decompensated stage

Authors

  • Алий Саитович Тугушев Zaporizhzhia State Medical University, 3 Sedova str., Zaporozhye, Ukraine, 69035, Ukraine
  • Наталья Валерьевна Туманская Zaporizhzhia State Medical University, 3 Sedova str., Zaporozhye, Ukraine, 69035, Ukraine
  • Сергей Николаевич Гулевский Educational and scientific medical center "University Clinic" 83 Kirov str., Zaporizhia, Ukraine, 69063, Ukraine
  • Ольга Степановна Черковская Zaporozhye state medical university 3 Sedova str., Zaporozhye, Ukraine, 69035, Ukraine
  • Александр Михайлович Киосов Educational and scientific medical center "University Clinic" Center of endoscopic diagnostics and treatment 83 Kirov str., Zaporizhia, Ukraine, 69063, Ukraine
  • Арнольд Анатольевич Тулупов Municipal management «City clinical hospital emergency and emergency medical service» 80 Pobedy str., Zaporozhye, 69005, Ukraine

DOI:

https://doi.org/10.15587/2313-8416.2015.51691

Keywords:

cirrhosis, portal hypertension, splanchnic blood flow, splenectomy, ultrasound scanning, dopplerography

Abstract

Splenectomy in patients with cirrhosis presupposes an increase of blood inflow into portal system to decrease the portal pressure. At the same time there are different opinions about splenectomy. So it is actual to study the character of changes of blood flow in vessels of abdominal cavity in pre- and postsurgical periods and assessment of an influence of these changes on the clinical course of cirrhosis.

Aim of research: To assess an influence of splenectomy on the character of changes of splanchnic hemodynamics in patients with cirrhosis comparing to non-operated patients with compensated and decompensated clinical course.

Materials and methods: There were examined 190 patients with cirrhosis: gastrointestinal bleeding from oesophagus varicose veins took place in 133 patients, diuretic resistant ascites – in 57 ones. 19 patients underwent splenectomy: 7 – in association with sewing of the left gastric vein and artery, 6 – with “skeletonization” of the lesser curvature of stomach with Nessen’s operation, 2 – with Patsiora’s operation, 2 – with application of selective porto-caval shunt between the low mesenteric vein and the left vein of an ovary. 84 patients died during observation. The duration of observation was from 0.5 to 3.5 years. All patients underwent fibrogastroscopy every 3–4 month. Hemodynamics was assessed on the base of repeated ultrasound of abdominal cavity. There were assessed diameter of hepatic and splenic vessels; qualitative and quantitative characteristics of blood flow in hepatic and splenic arteries, portal and splenic veins.

Results of research: Changes of hemodynamics in patients after splenectomy as opposed to non-operative patients are characterized with the decrease of diameter of portal vein at almost stable speed of the linear blood flow in it. The result is some decrease of the volume of portal blood and index of portal blood congestion that indirectly indicates the decrease of portal pressure after splenectomy. At the same time arterial hepatic blood flow stays without essential changes.

At fibrogastroscopy there was noticed a decrease of esophageal varicose veins dilatation, its tension, elimination of «red signs” that is a prognostic marker of the menace of bleeding. There were noticed no one relapse of bleeding and the sign of refractory ascites during the period of observation.

Conclusio: The changes of splanchnic hemodynamics after splenectomy are characterized with decrease of the volume of splanchnic blood. The result is a decrease of portal pressure that is proved with decrease of congestion index in portal vein, decrease of tension of varicose veins, elimination of “red signs” and consequently elimination of the menace of relapse of bleeding and development of resistant ascites. At the same time splectomy can be done in patients with decompensated clinical course of cirrhosis that is proved with an absence of lethality in postsurgical period

Author Biographies

Алий Саитович Тугушев, Zaporizhzhia State Medical University, 3 Sedova str., Zaporozhye, Ukraine, 69035

Candidate of Medical Science, Assistant

Department of faculty surgery

Наталья Валерьевна Туманская, Zaporizhzhia State Medical University, 3 Sedova str., Zaporozhye, Ukraine, 69035

Candidate of sciences medichnih, assistant professor

Department of Urology and Radiology

Сергей Николаевич Гулевский, Educational and scientific medical center "University Clinic" 83 Kirov str., Zaporizhia, Ukraine, 69063

Manager endoscopy office

Center of endoscopic diagnostics and treatment

Ольга Степановна Черковская, Zaporozhye state medical university 3 Sedova str., Zaporozhye, Ukraine, 69035

Candidate of medical science, assistant

Department of surgery

Александр Михайлович Киосов, Educational and scientific medical center "University Clinic" Center of endoscopic diagnostics and treatment 83 Kirov str., Zaporizhia, Ukraine, 69063

Assistant, endoscopist

Department of faculty surgery

Арнольд Анатольевич Тулупов, Municipal management «City clinical hospital emergency and emergency medical service» 80 Pobedy str., Zaporozhye, 69005

Endoscopist

Endoscopic department

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Published

2015-10-25

Issue

Section

Medical Science. Part 1