Abstract
Variceal bleeding remains an important complication in extrahepatic portal vein thrombosis (EPVT). As for portal hypertension due to other etiologies, an elective treatment to decrease the risk of subsequent rebleeding is warranted. The results of the Sugiura-Futagawa procedure (SP) in 38 patients with variceal bleeding secondary to EPVT are reported: 20 women and 18 men, with a mean age of 28±2 years (SEM). Thirty-seven patients were classified as Child-Pugh class A, and one patient as class B. In terms of diagnosis, 45% of patients had idiopathic EPVT, and 18% had associated hypercoagulability disorders; 52% of patients had associated splenic vein thrombosis. The SP was completed in two surgical stages in 18 patients and in one surgical stage in 14; 6 patients had only the abdominal stage. One patient had mild postoperative encephalopathy, and three patients rebled at long-term follow-up study. There were two operative deaths. Actuarial survival was 70% at 64 months. It is concluded that the SP is an excellent alternative for patients with variceal bleeding secondary to EPVT.
Résumé
L'hémorragie par varices oesophagiennes est une complication importante de la thrombose porte extrahépatique (TPEH). Comme dans d'autres étiologies d'hypertension portale, un traitement électif, dans le but de prévenir la récidive hémorragique est souhaitable. Les résultats de l'intervention de Sugiura-Futagawa (SF) sont rapportés chez 38 patients ayant saigné en raison d'une TPEH. Il y avait 20 femmes, et 18 hommes dont l'âge moyen était de 28±2 ans (Erreur de la moyenne). Parmi eux, 37 était de grade Child-Pugh A, et 1, de grade Child-Pugh B. Quarante-cinq p. cent des patients avaient une TPEH idiopathique, associée dans 18% des cas à une hypercoagulabilité. Une thrombose de la veine splénque a été retroyvée chez 52% des patients. L'intervention de SF a été réalisée chez 18 patients en deux temps et chez 14 patients en un temps. Le temps abdominal n'a été réalisé que chez six patients. Il y a eu deux décès peropératoires, un cas d'encéphalopathie modérée et trois patients ont eu une récidive hémorragique. La survie actuarielle était de 70% à 64 mois. On conclue que l'intervention de SF est une excellente alternative chez le patient ayant présenté une hémorragie par rupture de varices oesophagiennes secondaire à une TPEH.
Resumen
La trombosis portal extrahepática sin patologia hepática asociada (TPEH) constituye alrededor del 7% de los casos de hipertensión portal en adultos, y es la causa más frecuente en el paciente pediátrico. Como en otros tipos de hipertensión portal, una de las más importantes complicaciones en pacientes con TPEH es la hemorragia varicosa, la cual requiere algún tipo de tratamiento electivo. Se informan los resultados de nuestra experiencia con el procedimiento de Sugiura-Futagawa (PSP) en 38 pacientes con hemorragia varicosa secundaria a TPEH. El grupo consiste en 20 mujeres y 18 hombres con edad promedio de 28±2 años; 37 pacientes fueron clasificados como Child-Pugh A y uno como B. Se diagnosticó TPEH en 40% de los casos y 18% presentaban alteraciones asociadas de hipercoagulabilidad; 40% presentó trombosis esplénica concomitante. El PSP fue realizado en dos etapas en 18 pacientes y en una en 14; en 6 pacientes se realizó la etapa abdominal solamente. Se registraron dos muertes operatorias. Una paciente presentó encefalopatía postoperatoria leve y tres pacientes desarrollaron sangrado en el seguimiento a largo plazo. La tasa actuarial de sobrevida fue de 70% a los 64 meses.
Nuestra conclusión es que el PSP es una excelente alternativa para pacientes con hemorragia varicosa debida a TPEH.
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Orozco, H., Takahashi, T., Mercado, M.A. et al. Surgical management of extrahepatic portal hypertension and variceal bleeding. World J. Surg. 18, 246–250 (1994). https://doi.org/10.1007/BF00294409
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DOI: https://doi.org/10.1007/BF00294409