Portal de Periódicos da CAPES

Portal Venous Pressure following Splenectomy in Patients with Portal Hypertension of Differing Etiology

1992; Karger Publishers; Volume: 24; Issue: 6 Linguagem: Inglês

10.1159/000129230

1421-9921

Seishiro Matsubara, Kiyoaki Ouchi, S Matsuno,

Organ Transplantation Techniques and Outcomes

To clarify the effect of splenomegaly on portal hemodynamics in patients with portal hypertension and esophageal varices, manometric studies were carried out before and after splenectomy during an operation for esophageal varices. The 118 patients evaluated retrospectively had underlying liver cirrhosis (LC) (62), idiopathic portal hypertension (IPH) (42), and extrahepatic portal occlusion (EHO) (14). The weight of the spleen did not differ significantly among the three diagnostic groups: 640 ± 473.5 g for LC, 780 ± 414.6 g for IPH, and 683 ± 457.2 g for EHO. Before splenectomy, portal pressure was significantly elevated in the patients with EHO (410 ± 85.2 mm H2O) as compared to either the LC or IPH groups (348 ± 64.1 and 348 ± 73.5 mm H2O). Following splenectomy the reduction of portal pressure was significantly greater in the EHO group (29 ± 15.5 %) than in either the LC (18 ± 17.4%) or IPH (19 ± 17.0%) groups. Each group was subdivided according to severity of splenomegaly: marked (spleen weight ≧ 500 g) or slight (spleen weight < 500 g). Patients with LC and marked splenomegaly showed a reduction in liver function parameters as shown by the prolongation of indocyanine retention rate at 15 min as compared to those with slight splenomegaly. Though it is not statistically significant, the average portal pressure tended to be higher among those with marked splenomegaly. Except for the patients with LC, the reduction of portal pressure following splenectomy in those with marked enlargement was significantly large as compared to those patients with IPH and EHO and only slight splenomegaly (22.0 ± 14.7 vs. 11.6 ± 20.2% and 37.5 ± 14.1 vs. 19.5 ± 11.1%). These observations suggest that in EHO the effect of inflow portal hypertension contributes significantly to the severity of splenomegaly, while in LC the progression of disease may influence the extent of splenomegaly.