IN THE SURGERY OF PORTAL HYPERTENSION

F.G. NAZIROV, A.V. DEVYATOV, A.H. BABAJANOV, S.A. SULTANOV

Republican Specialized Center of Surgery after academician Vakhidov, Tashkent, UZBEKISTAN

Introduction: Peculiarities of angioarchitectonics of first-order tributaries of the left renal vein allow to use them in patients with portal hypertension for formation of latero-terminal mezenterial and splenorenal shunts by type of "false" H-shaped "when the inflow of renal vein acts as a communicant between the arteries of portal and caval systems . This variant of shunting was first proposed by A.F Leontev (1979) for formation of suprarenal-mesenterical anastomosis. Tributaries of the left renal vein can also be used in formation of anastomosis with splenic vein.

Materials and methods: In our center first SSRA was carried out in 1992. Until the end of 2010 were imposed 89 SSRA. The average age of patients was 26,9 ± 9,8 years. The review of the frequency of imposition of SSRA, depending on the period of observation, has revealed that its share in all shunt operations (747) made 11.9%, and for the period from its inception (1992-2010 years) composed 14.3%. But considering that the proportion of selective anastomoses in the present period dominates over the central variants of decompression, the share of SSRA composed 25% of all central shunts executed between 1992 and 2010.

Results: Depending on the peculiarities of angioarchitectonics of splenic vein (shape and level according to data of hepatosplenography), the optimal conditions for imposition of SSRA were detected only in 60% of cases with high location of the vain (T-XII) and in 95,2-100% of patients with low variant anatomy ( LI-II). In turn, depending on the diameter of adrenal vein, the probability of imposition of SSRA makes only 64.1%, and the presence of an extended diastasis between anastomized vessels or unsuitability of the thickness of the venous wall reduces this index to 51.3%. Small diameter of adrenal vein is the most common factor of the absence of conditions and was found in 35.9% of cases. Large diastasis between the splenic and renal veins was identified in 8 (10.3%) cases. In 2 (2.6%) patients thin wall of adrenal vein was unsuitable for anastomosis.

Conclusion: Optimal conditions for imposition of SSRA is a combination of the following factors: the diameter of adrenal vein of 8 mm or more; the lack of wide diastasis between adrenal and splenic veins; the absence of an acute angle of incidence of adrenal vein into the left renal vein and of nesessity of considerable transposition of insert with inflection of the inflow for creation of asthamosis with splenic vein; allowable wall thickness of adrenal vein.

Date: 2014-12-28; view: 1073