Surgical Treatment of Complications of Portal Hypertension Using Splenorenal Anastomosis

Бибалаев, М. Х.; Dydykin, S.S.; Shcherbiuk, A N

doi:10.24884/0042-4625-2018-177-1-100-103

Cited by 4 publications

(2 citation statements)

References 13 publications

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“…Дистальный спленоренальный анастомоз -это хирургическая операция соединения проксимального участка селезеночной вены (СВ) (часть портальной венозной системы) с левой почечной веной (ЛПВ) (часть кавальной венозной системы) [12]. Одним из недостатков такого варианта портокавального шунтирования считают технические трудности выполнения мобилизации вен селезеночноворотного и левого почечного бассейнов, связанные с вариантной топографической анатомией и ее зависимостью от антропометрических показателей пациента [13,14]. Мобилизация СВ при ее глубоком расположении за поджелудочной железой или в толще последней таит в себе высокий риск во время хирургических манипуляций непреднамеренного интраоперационного повреждения как самого сосуда, так и поджелудочной железы -основных причин интраоперационного кровотечения и послеоперационного панкреатита, тромбоза шунта, рецидива кровотечения из варикозных вен и, в конечном итоге, -смертельного исхода.…”

Section: Introductionunclassified

Clinical and Anatomical Substantiation of Access to the Splenic and Left Renal Veins in the Operation of Distal Splenorenal Anastomosis

Anisimov¹,

Андреев

Ибрагимов

et al. 2021

Neotložnaâ med. pomoŝʹ

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Aim of study. Development in an anatomical experiment of a technique for operative access to the splenic and left renal veins during distal splenorenal bypass surgery with justification of the possibility of its successful application in clinical conditions.Material and methods. In the conditions of an anatomical experiment on 40 unfixed corpses of adults of both genders, objective volumetric and spatial indicators in surgical wounds were studied in two variants of exposure of retroperitoneal space vessels, as the first stage of distal splenorenal anastomosis. In clinical conditions in 40 patients with portal hypertension of various genesis, during the operation of distal splenorenal anastomosis, the wide exposure of the anterior surface of the pancreas, spleen, left renal veins and most of their branches was performed using the original method of partial left — sided medial visceral rotation, followed by an objective assessment of the volume-spatial parameters of access. Measurements were performed using a medical goniometer in relation to the mobilized areas of the left renal and splenic veins. Statistical processing of the study results was carried out using the method of variation statistics. To identify statistically significant differences, the Student’s t-test was used for disjoint samples.Results. An original method of operative access to the splenic and left renal veins was developed during the operation of distal splenorenal bypass by lifting the internal organs of the left flank of the abdominal cavity from the posterior abdominal wall and diverting them to the right. In the anatomical experiment in the original method of partial left-sided medial visceral rotation, all indicators were better (depth of the wound is less and the angles of operative activity and the inclination of the axis of operative activity — larger) than with a classic approach of intraoperative intraperitoneal access via transverse incision in the mesentery of the transverse colon. Despite the various variants of vascular architectonics and various anthropometric indicators of patients, there were no any forced refusal of distal splenorenal bypass surgery or unintentional damage to both the vessels themselves and the pancreas, specific complications associated with the implementation of the proposed operative approach to the vessels of the left retroperitoneal space, including damage to the spleen and ischemia of the descending colon, in any of 40 clinical cases.Conclusion. The suggested option of operative access to the splenic, left renal veins and their branches at the first stage of performing distal splenorenal anastomosis in patients with portal hypertension of various genesis provides convenient spatial relations in the operating wound; creates comfortable conditions for performing the main surgical technique — applying vascular anastomosis; has a minimal risk of developing specific complications associated with the approach to the vessels of the left retroperitoneal space.

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Section: Introductionunclassified

Clinical and Anatomical Substantiation of Access to the Splenic and Left Renal Veins in the Operation of Distal Splenorenal Anastomosis

Anisimov¹,

Андреев

Ибрагимов

et al. 2021

Neotložnaâ med. pomoŝʹ

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“…Одним из факторов, обуславливающих клиническую значимость хронических гепатитов и исхода в фиброз и цирроз печени, является развитие синдрома портальной гипертензии на фоне системной эндотоксемии. Среди осложнений портальной гипертензии самым частым и грозным является кровотечение из варикозно расширенных вен пищевода, нередко приводящее к смерти пациента [1]. Этому осложнению могут предшествовать такие синдромы, как анемия, коагулопатия, тромбоцитопения.…”

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Pathophysiological aspects of blood transfusion for patients with liver cirrhosis

Lazareva

Колосков

2019

VESTNIK KHIRURGII IMENI I.I.GREKOVA

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To date, there are no clear indications and reasons for transfusion therapy in patients with cirrhosis. The article discus ses the basic pathophysiological changes in the patient's body during the formation of the liver cirrhosis as the outcome of hepatitis of different etiology. Particular attention is given to a component of donor plasma fibronectin, the lack of which, including in patients with liver cirrhosis, causes progressing endotoxemia.

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Surgeon’s view: portal vein system’s vessels angioarchitecture in portal hypertension

Khoronko¹,

Sapronova²,

Косовцев³

et al. 2023

Oper. khir.

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Surgical Treatment of Complications of Portal Hypertension Using Splenorenal Anastomosis

Cited by 4 publications

References 13 publications

Clinical and Anatomical Substantiation of Access to the Splenic and Left Renal Veins in the Operation of Distal Splenorenal Anastomosis

Clinical and Anatomical Substantiation of Access to the Splenic and Left Renal Veins in the Operation of Distal Splenorenal Anastomosis

Pathophysiological aspects of blood transfusion for patients with liver cirrhosis

Surgeon’s view: portal vein system’s vessels angioarchitecture in portal hypertension

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