Keywords
portal vein thrombosis
portal hypertension
variceal bleeding
porto-azygos disconnection
How to Cite
Abstract
Aim. To determine the impact of porto-azygos dissection procedures with splenic artery ligation/splenectomy in patients with bleeding from esophageal varices against the background of liver cirrhosis on the development of thrombotic complications with a view to preventing them.
Materials and methods. The results of treatment of 59 patients from 2012 to 2024 were retrospectively analyzed. A sample of patients who underwent surgical correction of bleeding from esophageal-gastric phlebectases was formed. Operative intervention involved portoazygous dissection, supplemented by splenic artery ligation to reduce splenic blood flow in n=17 (28.8%) or splenectomy in n=42 (71.7%) patients.
Results. In all 59 (100%) patients, splenomegaly (171±25 mm), with a determined spleen volume index (1604±821 mm3) and hypersplenism with a platelet count of 63±21×109/l, were detected, respectively.
In the first group, there was a slight increase in the number of PLT (158±6 × 109/l), a direct correlation of the average power (rP=0.39) with the indicator of the spleen volume index. In the second study group, a more than 10-fold increase in the PLT index (806.0±38 × 109/l) was noted, which showed a direct correlation of weak force (rP=0.28). The total frequency of thromboembolic complications in 59 operated patients was 5 (8.5%), namely, in the first experimental group – in 2 out of 17 (11.7%) patients, in the second experimental group – in 3 out of 42 (7.1%) of patients. Thrombotic complications occurred between the 6th and 11th day of the postoperative period. During anticoagulant therapy from 1.5 to 6 months (105 ±58,9 days) in the operated patients, no recurrence of upper gastroesophageal bleeding was observed.
Conclusions. Postsplenectomy thrombocytosis should be considered a predictor of thrombotic complications in patients with cirrhosis of the liver, varices bleeding, and severe hypersplenism. Splenomegaly in patients with cirrhosis of the liver, bleeding esophageal varices and moderate manifestations of hypersplenism justifies indications for additional reduction of splenic blood flow, at the same time, no data were obtained regarding the reduction of the risk of thrombotic complications in the veins of the portal and caval systems in the postoperative period with the described volume of surgical treatment. Anticoagulant therapy can help prevent thrombotic complications. Convincing data have been obtained regarding the effectiveness of prescribing long-term anticoagulant therapy for 3-6 months to prevent the development of portal/caval vein thrombosis.
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