MORPHOLOGY OF THE LIVER IN PROGNOSTIC ASPECT AND EVALUATION RESULTS OF PORTOSISTEM SHUNTING IN PATIENTS WITH LIVER CIRRHOSIS

F.G.NAZIROV, R.A. IBADOV, I.M. BAIBEKOV

Republican Specialized Centre of Surgery named after acad. V. Vakhidov, Tashkent,

UZBEKISTAN

Objective: elaborate the criteria of the morphological estimation liver and install intercoupling between structured status liver and probability of survival after portosistem shunting (PSSH).

Material and methods: analyses 41 biopsies liver beside patients with cirrhosis liver handled in RSCS name akad. V.Vakhidov for period 1979 - 2005 years. Patients be divided on the following 3 groups: with probability of survival before 1 year (1 group) - 12, before 5 years (2 group) - 14 and before 10 and more years (3 group) - 10 patients. Beside all bioptates got during operative interference. Beside 8 patients are organized repeated aiming thin needle to biopsies under checking spiral computer tomography (5 events) and ultrasonic sonography (3 events). Of them beside 3-h after 3 years, beside 3-h after 5 years and beside 2-h after 10 years after PSSH.

Results: The most structured change liver noted in 1 group patient, in which prevail mixed multilobular forms of the liver cirrhosis.

In the second group prevail small node forms of the liver cirrhosis. The septes between nodes rather broad. Existed the local concourse lymphocites that is indicative of rather high level to activities of the process. In nodule of the hutch polymorphic with light citoplasm and polymorphic nucleus. In spite of polymorphic nucleus and heterogen hepatocytes, these change denominated to a lesser extent, than in the first group. The typical particularity liver in this group is an expansion sinusoid capillary under good safety hepatocytes at heart organ, as well as presence of the significant number bilious channel different calibre in layer to connective tissue.

In the third group bridgefigurative necrosises and formed septet met basically, in subcapsular area. Herewith, in spite of area, rather broad zones bridgefigurative necrosis, is noted satisfactory safety of the most hepatocytes.

The morphological studies of liver bioptates at remote periods after PSSH have shown the expressed reduction of the changes in liver tissue, having place before operation in 2 and in 3 groups patient that was expressed in absence bridgefigurative and multigraded a necrosis of hepatocytes. The capsule remains thickened, however under her is not defined area of the haemorrhages and infiltration lymphocytes.

Conclusion: The degree to efficiency PSSH is defined by three-dementional share struck hepatocytes, degree their necrobiotic change and necrosis and correlation morphological modified hepatocytes to struck. The structured base, defining good results to correction portal hypertension, are a following morphological signs: proliferation of bilious channel, neovasculogenesis by fine layer to connective tissue, as well as expressed domination masses unaltered hepatocytes. The group patients with given morphological status liver has outlived 10-year border after PSSH.

PECULIARITIES OF ANGIOARCHITECTONICS AND HISTOSTRUCTURE OF VESSELS OF SPLENAL AND LEFT RENAL BASINS IN PATIENTS WITH PORTAL HYPERTENSION

F.G. NAZYROV, A.V. DEVYATOV, I.M. BAIBEKOV,

A.H. BABAJANOV, S.A SULTANOV

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

Introduction: In vascular surgery of portal hypertension (PH), special importance is attached to the variant anatomy of vessels of splenoportal and left renal basins which are of fundamental importance in terms of the possibility of applying of different types of bypass operations. Was conducted the analysis of these changes and their impact on the possibility of using of second-order veins, in particular of suprarenal vessel in the planning of central decompression of the portal system - splenosuprarenal anasthomosis.

Materials and methods: Morphological analysis of peculiarities of histostructure of veins of portal and left renal basins was carried out in 47 patients with liver cirrhosis (LC) and PH. The corresponding veins, collected during autopsies of patients without signs of pathology of hepatobiliary system and gastrointestinal tract served as a control.

Results: Lumen of blood vessels in PH was significantly (P <0,05) larger than in the control group. The only exception was vena jugularis interna, in which both the length and the width of the lumen indices did not differ from the control group. In turn, both vessels of the portal basin and left renal vein with its tributaries underwent changes. As in the norm, the part of the splenic vein, adjacent to pancreas was also slightly thicker than its free site, but these changes were more pronounced in PH. The wall thickness of the left renal vein both in control and PH had no significant difference that is apparently a ssociated with a large lumen of the vessel and the primary characteristic changes only in the length and the width of the vein. In turn, the left renal vein tributaries, which have a smaller macroscopic diameter, in conditions of PH feel a heavy pressure, which is reflected in significant differences in wall thickness of adrenal and genital veins as compared to the control.

Conclusion: Morphometric analysis of peculiarities of histostructuref of veins of portal and left renal basins has shown that in LC the impact of PH is not limited with the vascular wall of the portolienal basin. Due to the increased compensative functional activity of natural collateral portocaval anasthomoses , PH increases the hemodynamic load on other systems, associated with portal bed, particulary on the channel of the left renal vein. It is proved by the established significant difference of lumen and wall thickness of adrenal and genital veins in compare with the control , as well as by absence of these changes in vena cava superior.

Date: 2014-12-28; view: 1005