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Martins AL, Parreira ABS, Grossi MLFJ, Benevides RDA, da Motta LL, Pimassoni LHS, Borjaili ASD, Paulo MSL, Paulo DNS. Study of the upper pole after subtotal splenectomy in rats. Acta Cir Bras 2023; 37:e371103. [PMID: 36629530 PMCID: PMC9829190 DOI: 10.1590/acb371103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/15/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To evaluate macro/microscopic viability of the upper pole (UP) in rats after 80 days of subtotal splenectomy preserving the upper pole (SSPUP). METHODS Twenty-five male Wistar rats were submitted to SSPUP. After 80 days, the rats were euthanized, and the remaining UP was evaluated macroscopically regarding appearance, color, consistency, length, width, thickness, and presence of fibrosis/necrosis; and microscopically regarding presence of red and white pulp, fibrosis/necrosis. RESULTS Two rats died during surgery and were removed from the statistical analysis. There was statistically significant increase in length and width between the pre and postoperative in the experimental group, with no significant difference in thickness. In the manipulation group, the macroscopic appearance of the spleen was normal in pre and postoperative, with viability preserved. In the experimental group, two UP of the spleen were not found during the second surgery. Macroscopically, it was observed absence of fibrosis and necrosis in all cases. Microscopically, the white and red pulp were intact in both groups. Two spleens of rats in the manipulation group presented areas with fibrosis and necrosis focus, which were not enough to be considered inviable. CONCLUSIONS The UP of the spleen remained viable in 91.3% of the cases.
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Affiliation(s)
- Amanda Lessa Martins
- Graduate student. Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória – School of Medicine – Vitória (ES), Brazil
| | - Anna Bárbara Scárdua Parreira
- Graduate student. Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória – School of Medicine – Vitória (ES), Brazil
| | - Maria Luiza Font Juliá Grossi
- Graduate student. Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória – School of Medicine – Vitória (ES), Brazil
| | | | - Luciene Lage da Motta
- PhD, full professor. Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória – Department of Pathology – School of Medicine – Vitória (ES), Brazil
| | - Lucia Helena Sagrillo Pimassoni
- PhD, Full Professor. Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória – Department of Statistics – School of Medicine – Vitória (ES), Brazil
| | | | - Marcela Souza Lima Paulo
- PhD, associate professor. Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória – School of Medicine – Vitória (ES), Brazil.,Corresponding author:
- (55 27) 981499283
| | - Danilo Nagib Salomão Paulo
- PhD, full professor. Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória – Department of Surgery – School of Medicine – Vitória (ES), Brazil
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Petroianu A. The left gastro-omental vessels are able to maintain the entire spleen blood supply. J Vasc Bras 2022; 21:e20210191. [PMID: 35571522 PMCID: PMC9083538 DOI: 10.1590/1677-5449.20210178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/21/2022] [Indexed: 11/24/2022] Open
Abstract
The spleen is supplied by blood flow through the splenic artery and vein. The purpose of this communication is to report an ectopic spleen supplied only by reverse flow through the left gastro-omental vessels. A 14-year-old boy presented with pelvic splenomegaly supplied only by the left gastro-omental artery and veins connected to the inferior polar vessels, which were the only vessels communicating with the spleen. After detorsion of the spleen and splenopexy, the spleen returned to normal dimensions. The patient had uneventful follow-up. In conclusion, the left gastroepiploic vessels are able to maintain the entire spleen blood supply.
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Paulo LNL, Alexander DR, Vallandro EID, Benevides RDA, Motta LLD, Paulo MSL, Paulo DNS. Macro and microscopic comparison of the upper pole of the spleen with the lower pole in partial splenectomy. Acta Cir Bras 2020; 35:e202000902. [PMID: 33084734 PMCID: PMC7584296 DOI: 10.1590/s0102-865020200090000002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate the viability of the upper (UP) and lower pole (LP) of the spleen from a macro and microscopic point of view, after subtotal splenectomy with preservation (SSP) of the UP and the LP. Methods Seventeen male Wistar rats, two months old, were submitted to SSPUP and SSPLP and 5 to simulated operation (SG). After 80 days, the rats were euthanized, and the remaining LP and UP and intact spleens were evaluated macroscopically and microscopically. Results Two rats died during the operation. Macroscopic analysis showed that in 15 LP, one of them was not viable and in 15 UP and in 5 spleens in the SG, all were viable. In the statistical analysis, there was no difference in relation to viability. The LP and UP analyzed showed variation. As for the length, the UP increased significantly; however, in relation to the width, there was a significant increase in the LP in relation to the UP. In addition, the weight of the UP was significantly greater than that of the LP. Microscopic analysis attested viability of the splenic remnants. Conclusion There was no significant difference regarding the viability of UP and LP, in macroscopy and microscopy.
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Lee HR, You NK, Seo SJ, Choi MS. Concurrent Surgery of Craniectomy and Splenectomy as Initial Treatment in Severe Traumatic Head Injury: A Case Report. Korean J Neurotrauma 2017; 13:141-143. [PMID: 29201849 PMCID: PMC5702750 DOI: 10.13004/kjnt.2017.13.2.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 12/05/2022] Open
Abstract
It is not a common case for neurosurgery department and the other departments to perform joint operation at the same time. Patients with severe head injury are a condition in which vital signs are unstable due to severe brain swelling and increased intracranial pressure, and emergency surgery is required. A 44-year-old man visited the trauma center with a motorcycle accident. The Glasgow Coma Scale score at the time of emergency department was 3 points, and the pupil was fixed at 6 mm on both sides. His medical history was unknown. His vital signs including blood pressure (BP), heart rate, respiratory rate and oxygen saturation were stable. Associated injuries included multiple fractures of whole body. Brain computed tomography revealed subarachnoid hemorrhage, intraventricular hemorrhage and severe cerebral edema. During the preparation of the craniectomy, abdominal ultrasonography performed because of decreased BP resulted in a large amount of hemoperitoneum. The bi-coronal craniectomy and splenectomy were performed simultaneously for about 4 hours. After fifty days of treatment, he was discharged with Glasgow Outcome Scale-extended 4 points and is undergoing rehabilitation. In severe polytrauma patients, active concurrent surgery is a good method to save their lives.
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Affiliation(s)
- Hyeong Rae Lee
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Nam Kyu You
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Sook Jin Seo
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Mi Sun Choi
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
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Spijkerman R, Teuben MPJ, Hoosain F, Taylor LP, Hardcastle TC, Blokhuis TJ, Warren BL, Leenen LPH. Non-operative management for penetrating splenic trauma: how far can we go to save splenic function? World J Emerg Surg 2017; 12:33. [PMID: 28769999 PMCID: PMC5526240 DOI: 10.1186/s13017-017-0144-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Selective non-operative management (NOM) for the treatment of blunt splenic trauma is safe. Currently, the feasibility of selective NOM for penetrating splenic injury (PSI) is unclear. Unfortunately, little is known about the success rate of spleen-preserving surgical procedures. The aim of this study was to investigate the outcome of selective NOM for penetrating splenic injuries. METHODS A dual-centre study is performed in two level-one trauma centres. All identified patients treated for PSI were identified. Patients were grouped based on the treatment they received. Group one consisted of splenectomised patients, the second group included patients treated by a spleen-preserving surgical intervention, and group three included those patients who were treated by NOM. RESULTS A total of 118 patients with a median age of 27 and a median ISS of 25 (interquartile range (IQR) 16-34) were included. Ninety-six patients required operative intervention, of whom 45 underwent a total splenectomy and 51 underwent spleen-preserving surgical procedures. Furthermore, 22 patients (12 stab wounds and 10 gunshot wounds) were treated by NOM. There were several anticipated significant differences in the baseline encountered. The median hospitalization time was 8 (5-12) days, with no significant differences between the groups. The splenectomy group had significantly more intensive care unit (ICU) days (2(0-6) vs. 0(0-1)) and ventilation days (1(0-3) vs. 0(0-0)) compared to the NOM group. Mortality was only noted in the splenectomy group. CONCLUSIONS Spleen-preserving surgical therapy for PSI is a feasible treatment modality and is not associated with increased mortality. Moreover, a select group of patients can be treated without any surgical intervention at all.
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Affiliation(s)
- Roy Spijkerman
- Department of Trauma, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Michel Paul Johan Teuben
- Department of Trauma, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Fatima Hoosain
- Department of Trauma, Tygerberg Hospital (University of Stellenbosch), Francie van Zijl Avenue, Cape Town, 7505 South Africa
| | - Liezel Phyllis Taylor
- Department of Trauma, Tygerberg Hospital (University of Stellenbosch), Francie van Zijl Avenue, Cape Town, 7505 South Africa
| | - Timothy Craig Hardcastle
- Department of Trauma, Inkosi Albert Luthuli Central Hospital (University of Kwazulu-Natal), 800 Bellair Road, Durban, 4091 South Africa
| | - Taco Johan Blokhuis
- Department of Trauma, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Brian Leigh Warren
- Department of Trauma, Tygerberg Hospital (University of Stellenbosch), Francie van Zijl Avenue, Cape Town, 7505 South Africa
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Petroianu A. Subtotal splenectomy preserving the inferior splenic pole for the treatment of Hodgkin's lymphoma. Int J Surg Case Rep 2017; 36:1-3. [PMID: 28486174 PMCID: PMC5423331 DOI: 10.1016/j.ijscr.2017.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/12/2017] [Accepted: 04/12/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Splenectomy is helpful in the management of selected patients with Hodgkin's lymphoma (HL), but in some cases this procedure is accompanied by a greater morbidity and mortality mainly due to sepsis. This is the first published case of subtotal splenectomy preserving the inferior splenic pole without the maintenance of the splenic vascular pedicle. PRESENTATION OF CASE A 53-year-old man with HL refractory to chemo and radiotherapy associated to a very large spleen was successfully treated with subtotal splenectomy, preserving the inferior splenic pole supplied only by the left gastroepiploic and inferior splenic pole vessels. After an eleven year uneventful postoperative follow-up, the dimensions and function of the spleen are still preserved, and the disease is under control with chemo- and radiotherapy. CONCLUSION Subtotal splenectomy is efficacious to preserve the splenic functions and to prevent adverse effects of a large spleen on the treatment of Hodgkin's lymphoma confined to superior pole and producing significant abdominal symptoms and hematological effects.
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Affiliation(s)
- Andy Petroianu
- Department of Surgery of the Medical School of the Federal University of Minas Gerais, Brazil.
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Mendonça FA, Carmo FPTD, Paris LG, Pagotte MD, Pereira FLA, Vidigal PVT, Paulo DNS, Nunes TA. Effects of inferior splenic lobe pole fixation and gastrosplenic peritoneal membrane section on the vitality of the remanent of subtotal splenectomy in rats. Acta Cir Bras 2016; 30:461-9. [PMID: 26270137 DOI: 10.1590/s0102-865020150070000003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 06/15/2015] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate the vitality of the spleen lower pole after subtotal splenectomy with suture to the stomach and after posterior peritoneal gastro-splenic membrane section, using macro and microscopic evaluations. METHODS Sixty Wistar rats were used in this study and were randomly distributed in the three groups: Group 1: (n=20), subtotal splenectomy with lower pole preservation, Group 2: (n=20) subtotal splenectomy with lower pole preservation and suture to the stomach, Group 3: subtotal splenectomy with lower pole preservation and posterior peritoneal gastrosplenic ligament section. The animals were sacrificed 45 days after the surgery and the spleen lower poles were removed for macroscopic and microscopic examination. RESULTS All animals in this series survived. No macroscopic differences were encountered between the groups. Microscopic evaluation observed statistic difference concerning fibrosis between group 1 and 3 (p ≤ 0.05), but the analysis for necrosis and inflammation presented no differences. CONCLUSION Vitality of the spleen lower pole after subtotal splenectomy is minimally modified when it is fixed to the stomach or when the posterior peritoneal gastrosplenic ligament is resected.
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Cirugía preservadora de órgano tras traumatismo esplénico cerrado con implicación hiliar. CIR CIR 2015; 83:516-21. [DOI: 10.1016/j.circir.2015.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 10/03/2014] [Indexed: 11/17/2022]
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Khripun AI, Alimov AN, Pryamikov AD, Alimov VA. [Immunological aspects in spleen ruptures surgery due to closed abdominal trauma]. Khirurgiia (Mosk) 2015:76-80. [PMID: 26031956 DOI: 10.17116/hirurgia2015376-80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The remote results of immunity investigation in 30 patients after organ-preserving surgery and in 30 patients after splenectomy forspleen rupture are presented in the article. Indexes of cellular and humoral immunity were normal and life quality did not differ from that in healthy individuals after organ-preserving operations with splenic artery ligation. Splenectomy leads to deterioration of life quality and disorders in cellular immunity including decrease of T-helpers/inductors cells (CD4), immunoregulatory index (CD3/CD4) and general number of T-lymphocytes (CD3) in some cases on background of compensatory increase of normal killers (CD16). It was observed significant decrease of IgG and IgM levels. Values of IgA and cytokines IL-1, IL-2, IL-6 and TNF remained normal. Level of immunosuppression is reduced due to development of splenosis.
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Affiliation(s)
- A I Khripun
- Chair of Surgery and Endoscopy, Faculty of Advanced Medical, N.I. Pirogov Russian Research Medical University, Moscow
| | - A N Alimov
- Chair of Surgery and Endoscopy, Faculty of Advanced Medical, N.I. Pirogov Russian Research Medical University, Moscow
| | - A D Pryamikov
- Chair of Surgery and Endoscopy, Faculty of Advanced Medical, N.I. Pirogov Russian Research Medical University, Moscow
| | - V A Alimov
- Chair of Surgery and Endoscopy, Faculty of Advanced Medical, N.I. Pirogov Russian Research Medical University, Moscow
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da Silva AL. Splenic inferior pole. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 28:86. [PMID: 25861078 PMCID: PMC4739241 DOI: 10.1590/s0102-67202015000100021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 12/09/2014] [Indexed: 11/24/2022]
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Female
- Follow-Up Studies
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/surgery
- Male
- Middle Aged
- Splenectomy/methods
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Affiliation(s)
- A Petroianu
- Department of Surgery, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil
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Paulo MSL, Paulo ICAL, Nunes TA, Silva ALD, Cintra LC, Paulo DNS. Effect of hyperbaric oxygen therapy in rats with subtotal splenectomy preserving the inferior pole. Acta Cir Bras 2011; 26:156-64. [DOI: 10.1590/s0102-86502011000300002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 02/16/2011] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To evaluate the effect of hyperbaric oxygen therapy on the survival and weight of rats submitted to subtotal splenectomy and on the viability and growth of the inferior pole. METHODS: Forty Wistar rats underwent subtotal splenectomy with preservation of the inferior pole and distributed into two groups: Group A (n=20) - not treated with hyperbaric oxygen, Group B (n=20) - treated with hyperbaric oxygen. These groups were divided into two subgroups of 10 animals each, according to the time of euthanasia, 15th and 45th days. The survival and weight of the animals were recorded. The inferior pole was measured, weighed and morphologically analyzed. RESULTS: All animals survived. The weight of the animals increased in all subgroups, but decreased on the 10th day in the subgroups treated with hyperbaric oxygen (p<0.001). The viability of the inferior pole was more evident in animals treated on the 15th day, but did not differ on the 45th day. The growth of the inferior pole has not occurred on the 15th day but on the 45th day after surgery in untreated animals (p<0.01) and treated animals (p<0.05). Vascular and cellular increase in treated animals was significantly higher than in untreated ones. CONCLUSION: Hyperbaric oxygen therapy did not affect the survival of animals but reduced their weight. It improved the viability of the inferior splenic pole, but did not interfere with their growth.
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Costamagna D, Rizzi S, Zampogna A, Alonzo A. Open partial splenectomy for trauma using GIA-Stapler and FloSeal matrix haemostatic agent. BMJ Case Rep 2010; 2010:2010/aug06_1/bcr0120102601. [PMID: 22767672 DOI: 10.1136/bcr.01.2010.2601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A ruptured spleen caused by blunt abdominal injury is often treated by splenectomy. In view of the gravity of the 'postsplenectomy syndrome,' a conservative approach has been increasingly used. We present the case of a 29-year-old man with a Grade III splenic lesion for a blunt abdominal trauma after a car accident. We performed a partial splenectomy of the upper pole using GIA-Stapler. A supplemental haemostasis of the stapled line was successfully achieved by the application of FloSeal matrix haemostatic agent. The splenic remnant was fixed into the left-upper quadrant using human fibrin glue.
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Affiliation(s)
- Daniela Costamagna
- Department of General and Emergency Surgery, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy.
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Petroianu A, da Silva RG, Nascimento Cardoso V, Alberti LR, da Silva MG. Effect of spleen surgeries on Escherichia coli distribution on the mononuclear phagocytic system. Int J Surg 2009; 8:48-51. [PMID: 19854304 DOI: 10.1016/j.ijsu.2009.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 10/16/2009] [Accepted: 10/16/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To avoid asplenic state, many approaches preserving the spleen have been proposed in the literature: splenorraphy, partial splenectomy with or without preservation of hilar vessels and splenic tissue auto-implants. Subtotal splenectomy, preserving the upper spleen pole nourished only by splenogastric vessels is an alternative when the splenic pedicle must be ligated. The purpose of this study was to evaluate the influence of partial, subtotal and total splenectomies on the distribution of Escherichia coli in the mononuclear phagocytic system. METHOD Thirty-two rats divided into four groups were studied: sham operation (total spleen preservation), partial splenectomy, subtotal splenectomy and total splenectomy. Five weeks after surgeries, an aliquot of E. coli marked with tecnetium-99m was injected intravenously. The animals were killed 20min later and the spleen, lungs and liver were removed in order to determine the distribution of labeled bacteria. RESULTS The amount of E. coli in the splenic tissue was greater in the intact spleen group than in the partial or subtotal splenectomy groups. Phagocytosis through the spleen did not differ between the partial and subtotal splenectomy groups. The amount of bacteria in the lungs was greater in the partial than in the subtotal splenectomy group. The distribution of labeled bacteria was greater in the liver of animals submitted to subtotal splenectomy than in the other groups. CONCLUSION The upper splenic pole, supplied only by splenogastric vessels, has the ability to remove live bacteria from the blood stream, showing that effective blood clearance occurs even without vascularization through the splenic pedicle. Thus, the distribution of E. coli through the mononuclear phagocytic system shows different behavior depending on the type of splenectomy to which the animals are submitted.
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Affiliation(s)
- Andy Petroianu
- Department of Surgery, Medical School of the Federal University of Minas Gerais, Brazil.
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Gauer JM, Gerber-Paulet S, Seiler C, Schweizer WP. Twenty Years of Splenic Preservation in Trauma: Lower Early Infection Rate Than in Splenectomy. World J Surg 2008; 32:2730-5. [DOI: 10.1007/s00268-008-9733-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Petroianu A, Rezende Neto JB. Tratamento de hemorragia intestinal grave decorrente de hipertensão porta, por meio de esplenectomia subtotal e anastomose esplenorrenal proximal. Rev Col Bras Cir 2008. [DOI: 10.1590/s0100-69912008000400010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Um dos maiores desafios no tratamento da hipertensão porta é o sangramento de varizes intestinais. O objetivo deste artigo é apresentar um novo tratamento para hemorragia entérica grave provocada por hipertensão porta cirrótica, utilizando a esplenectomia subtotal combinada com derivação esplenorrenal proximal. TÉCNICA: Uma paciente de 64 anos apresentou sangramento intenso proveniente de varizes em alça jejunal em Y de Roux, para derivação biliodigestiva, após lesão coledociana, complicada com cirrose hepática. O procedimento consistiu em esplenectomia subtotal, preservando o pólo superior do baço, suprido apenas pelos vasos esplenogástricos, e anastomose término-lateral da veia esplênica, em sua extremidade proximal, à veia renal esquerda. RESULTADOS: Esse procedimento foi seguro, sem sangramento maior, dificuldade técnica ou complicação. No acompanhamento de 30 meses, a paciente não teve novos episódios de sangramento, a cirrose não avançou e, atualmente, encontra-se bem, sob controle. CONCLUSÃO: A esplenectomia subtotal combinada com derivação esplenorrenal proximal é uma boa alternativa operatória para tratar hemorragia proveniente de varizes intestinais, decorrentes de hipertensão porta.
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Abstract
Apesar de a esplenectomia ser eficaz na abordagem terapêutica de pacientes com hemangioma esplênico, esse procedimento é acompanhado de elevada morbidade e até mortalidade, principalmente devido à sepse, quando realizado em crianças e adolescentes com sistema imunitário ainda imaturo. Para prevenir os efeitos adversos da asplenia, propõe-se neste artigo a esplenectomia parcial, com a retirada apenas da região do hemangioma, mantendo o restante do baço e preservando suas importantes funções.
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Rezende-Neto JB, Petroianu A, Santana SK. Subtotal splenectomy and central splenorenal shunt for treatment of bleeding from Roux en Y jejunal loop varices secondary to portal hypertension. Dig Dis Sci 2008; 53:539-43. [PMID: 17597406 DOI: 10.1007/s10620-007-9878-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2007] [Accepted: 05/14/2007] [Indexed: 12/09/2022]
Abstract
PURPOSE To present subtotal splenectomy and splenorenal shunt as a surgical option to treat severe bleeding from a Roux en Y jejunal loop varices secondary to portal hypertension. METHOD A 64-year-old white woman presented severe episodes of bleeding from varices inside a Roux en Y jejunal loop secondary to portal hypertension due to cirrhosis. Subtotal splenectomy was performed with preservation of the upper splenic pole supplied by the splenogastric vessels. This procedure was combined with a central splenorenal shunt to divert part of portal blood to systemic flow. RESULTS This procedure was safely performed with no complications. A 2-year post-operative follow-up of the patient has been uneventful. No re-bleeding occurred during this period and she returned to her normal life. CONCLUSION Subtotal splenectomy combined with central splenorenal shunt seems to be a safe procedure useful for the treatment of enteral bleedings due to portal hypertension.
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Affiliation(s)
- João Baptista Rezende-Neto
- Department of Surgery, Medical School of the Federal University of Minas Gerais, Avenida Afonso Pena, 1626-apto. 1901, Belo Horizonte, Minas Gerais, 30130-005, Brazil
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Petroianu A, Cabezas-Andrade MA, Berindoague Neto R. Operações laparoscópicas conservadoras do baço para tratar dor esplênica por isquemia. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2007. [DOI: 10.1590/s0102-67202007000100004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
RACIONAL: Desde 1979 este grupo de autores executa esplenectomia conservadora através de esplenectomia sub-total e autotransplante esplênico. Estes procedimentos foram realizados em mais de 300 pacientes para tratar diferentes condições patológicas. OBJETIVO: Apresentar proposta original e inédita em seres humanos de esplenectomia subtotal, preservando apenas o pólo superior do baço por via laparoscópica e esplenectomia total complementada por implante autógeno de tecido esplênico, também pela via laparoscópica, como nova forma de tratamento da dor severa devida à isquemia do baço. MÉTODOS: Três pacientes com intensa dor no hipocôndrio esquerdo foram submetidos a grande número de exames para concluir que sua dor era provocada por isquemia de parte do baço. A dor era resistente a todos os métodos conservadores utilizados. Decidiu-se, então, pelo tratamento cirúrgico por meio da esplenectomia subtotal, preservando o pólo superior do baço suprido pelos vasos esplenogástricos em dois casos, e esplenectomia total complementada por implante no omento maior de 20 fragmentos retirados desse baço, no terceiro caso. As três operações foram realizadas por via laparoscópica. Os três doentes foram acompanhados com exames hematológicos, imunológicos, tomográficos e cintilográficos. RESULTADOS: Esses procedimentos foram conduzidos sem risco para os paciente e com sangramento mínimo. Não houve dificuldade técnica nem complicações per ou pós-operatórias. No seguimento, não foram constatadas anormalidades, comprovando-se a vitalidade e a função dos remanescentes esplênicos. A dor esplênica desapareceu desde o dia da operação e não retornou durante o período de acompanhamento. CONCLUSÃO: A esplenectomia subtotal e os auto-implantes esplênicos são factíveis por via laparoscópica, de maneira segura para os doentes e devem deve ser considerados no tratamento da dor de origem isquêmica do baço.
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Abstract
OBJETIVO: O objetivo deste trabalho foi determinar a exeqüibilidade, reprodutibilidade e segurança da esplenectomia subtotal por via laparoscópica e suas repercussões morfológicas, hematológicas, imunitárias e de depuração sangüínea, comparando esses dados com os obtidos na esplenectomia laparotómica. MÉTODO: Este estudo experimental foi conduzido de acordo com os princípios éticos de pesquisa experimental, propostos pelo Comitê de Ética em Experimentação Animal da UFMG. Quatorze cães adultos mestiços de ambos os sexos foram distribuídos em dois grupos (n = 7): Grupo 1 - Esplenectomia subtotal laparoscópica, preservando o polo superior suprido exclusivamente pelos vasos esplenogástricos; a secção esplênica e hemostasia foram realizadas utilizando um grampeador linear cortante laparoscópico com carga de 45 mm de extensão. Grupo 2 - Esplenectomia total, realizada por meio de laparotomia mediana. Depois de três meses, foram analisadas as alterações nos exames hematológico, imunitário e cintilográfico em todos os animais. Secções dos remanescentes esplênicos, fígado e linfonodos foram avaliadas histologicamente. RESULTADOS: Todos os procedimentos transcorreram sem complicações, não havendo morte operatória e com perda sangüínea mínima. Todos os animais sobreviveram à operação durante os três meses de acompanhamento. Após esse período, houve redução da contagem de plaquetas (p < 0,05) no Grupo 1. O restante dos exames hematológicos permaneceu normal. Os remanescentes esplênicos apresentaram arquitetura semelhante ao baço normal. Não houve alterações histológicas nos linfonodos e fragmentos hepáticos. CONCLUSÕES: É possível e segura a realização da esplenectomia subtotal por via laparoscópica no cão.
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Petroianu A, Resende V, Da Silva RG. Late follow-up of patients submitted to subtotal splenectomy. Int J Surg 2006; 4:172-8. [PMID: 17462342 DOI: 10.1016/j.ijsu.2005.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Revised: 12/28/2005] [Accepted: 12/29/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND Over the past 21years, we have performed more than 200 subtotal splenectomies, in which the upper splenic pole vascularized only by the gastrosplenic pole vascularized only by the gastrosplenic vessels is preserved, to treat different pathologic conditions. A meticulous follow-up of the postoperative results of this procedure is of fundamental importance. METHODS All patients undergoing subtotal splenectomy were invited to be reviewed. A total of 86 patients who had undergone surgery 1-20years ago were gathered; the surgical procedure was performed for one of the following conditions: portal hypertension due to schistosomiasis (n=43), trauma (n=31), Gaucher's disease (n=4), myeloid hepatosplenomegaly due to myelofibrosis (n=3), splenomegalic retarded growth and sexual development (n=2), severe pain due to splenic ischemia (n=2) and pancreatic cystadenoma (n=1). Patients underwent a hematological examination, an immunological assessment, abdominal ultrasonography, computed tomography, scintigraphy and endoscopy. RESULTS Increased white blood cell count and platelets were the only hematological abnormalities. No immunological deficit was found. Esophageal varices were still present in patients who underwent surgery because of portal hypertension although without rebleeding. The ultrasound, tomography and scintigraphy examinations confirmed the presence of functional splenic remnants without significant size alteration. CONCLUSIONS Subtotal splenectomy seems to be a safe procedure that can be useful in treating conditions involving the spleen. The functions of the splenic remnants are preserved during long periods of time.
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Affiliation(s)
- Andy Petroianu
- Alfa Institute of Gastroenterology, Hospital of Clinics, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Petroianu A, Resende V, Silva RGD. Late postoperative follow-up of patients undergoing subtotal splenectomy. Clinics (Sao Paulo) 2005; 60:473-8. [PMID: 16358137 DOI: 10.1590/s1807-59322005000600008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Over the past 21 years, we have performed more than 200 subtotal splenectomies, in which the upper splenic pole vascularized only by the gastrosplenic pole vascularized only by the gastrosplenic vessels is preserved, to treat different pathologic conditions. A meticulous follow-up of the postoperative results of this procedure is of fundamental importance. METHODS All patients undergoing subtotal splenectomy were invited to be reviewed. A total of 86 patients who had undergone surgery 1 to 20 years ago were gathered; the surgical procedure was performed for one of the following conditions: portal hypertension due to schistosomiasis (n = 43), trauma (n = 31), Gaucher's disease (n = 4), myeloid hepatosplenomegaly due to myelofibrosis (n = 3), splenomegalic retarded growth and sexual development (n = 2), severe pain due to splenic ischemia (n = 2) and pancreatic cystadenoma (n = 1). Patients underwent a hematologic exam, an immunologic assessment, abdominal ultrasonography, computed tomography, scintigraphy and endoscopy. RESULTS Increased white blood cell count and platelets were the only hematological abnormalities. No immunologic deficit was found. Esophageal varices were still present in patients who underwent surgery because of portal hypertension although without rebleeding. The ultrasound, tomography and scintigraphy exams confirmed the presence of functional splenic remnants without significant size alteration. CONCLUSIONS Subtotal splenectomy seems to be a safe procedure that can be useful in treating conditions involving the spleen. The functions of the splenic remnants are preserved during long periods of time.
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Affiliation(s)
- Andy Petroianu
- Afla Institute of Gastroenterology, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
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Petroianu A, De Oliveira AE, Alberti LR. Hypersplenism in Schistosomatic Portal Hypertension. Arch Med Res 2005; 36:496-501. [PMID: 16099328 DOI: 10.1016/j.arcmed.2005.04.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2004] [Accepted: 03/18/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND For many years, the hematologic changes occurring in hepatosplenic Manson's schistosomiasis have been defined as hypersplenism. Initially, the belief was that removal of the spleen would normalize the hematologic values. However, hematimetric normalization was observed in surgeries for the treatment of portal hypertension in which the spleen was preserved. In view of these findings, it is necessary to verify the clinical and laboratory profile of these patients in order to define the real presence of hypersplenism. METHODS This study was conducted on 51 patients with schistosomatic portal hypertension divided into five groups: group 1, non-operated patients under clinical control; group 2, patients submitted to distal splenorenal shunt; group 3, patients with subtotal splenectomy and central splenorenal shunt; group 4, patients with total splenectomy and central splenorenal shunt; and group 5, patients with total splenectomy and portal-variceal disconnection. Clinical signs of hypersplenism were assessed in all patients. Hematologic values of the pre- and postoperative period were compared. Immunoglobulin counts of the patients were verified in the late postoperative period. RESULTS In all operated groups, hematimetric values, leukocyte counts, platelet number and prothrombin time were higher during the postoperative period. With respect to the immunoglobulins, the postoperative values of IgM, IgG and IgA were normal. CONCLUSIONS Patients with schistosomatic portal hypertension and peripheral cytopenia cannot be classified as having hypersplenism but rather as having pancytopenia due to splenomegaly caused by difficulty on portal blood drainage.
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Affiliation(s)
- Andy Petroianu
- Alfa Institut of Gastroenterology, Hospital of Clinics of the Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Haghighi KS, Steinke K, Hazratwala K, Kam PCA, Daniel S, Morris DL. Controlled study of in-line ovine spleen transection assisted by radiofrequency ablation. ACTA ACUST UNITED AC 2005; 58:841-4. [PMID: 15824666 DOI: 10.1097/01.ta.0000161495.29886.24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trauma to the spleen or tumors of the spleen often require total splenectomy for control of hemorrhage. Partial splenectomy is the preferred technique because of the short- and long-term sepsis problems in asplenic patients. Multiple techniques for partial splenectomy have been tried in the past with limited success. The authors designed the in-line radiofrequency ablation (ILRFA) probe for liver surgery. It uses radiofrequency energy to make a linear coagulative plane that allows the parenchyma of solid vascular organs to be divided. In this study, for the first time, the efficiency of ILRFA was tested with the ovine spleen. METHODS Seven sheep were used for this study. With the sheep under general anesthesia, a laparotomy was performed. The first sheep was used for a pilot study. Eight partial splenectomies were made in the remaining six sheep using ILRFA. For a control, a matching partial splenectomy was made in each sheep using diathermy and sutures. Blood loss was measured by determining the difference in the weights of dry sponges and blood-stained sponges after resection. A paired t test was used to compare the bleeding between the control and the ILRFA techniques. RESULTS The mean blood loss was 33.14 +/- 17 g using ILRFA and 123.43 +/- 72 g in the control group. The bleeding was significantly reduced in the ILRFA group (p = 0.0056). The time required to apply ILRFA was 12 minutes. CONCLUSION Partial splenectomy was achieved in the ovine spleen using radiofrequency energy with minimal blood loss.
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Affiliation(s)
- Koroush S Haghighi
- Department of Surgery, St George Hospital, University of New South Wales, Sydney, Australia
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Brandt CT, Leite CRC, de-Castro CMMB, Manhães-de-Castro R, Brandt Filho C. Esquitossomose mansônica hepatoesplênica humana: produção de TNF-alfa em monócitos. Rev Col Bras Cir 2003. [DOI: 10.1590/s0100-69912003000600008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Investigar os níveis de liberação de TNF-alfa?em cultura de monócitos em portadores humanos da forma hepatoesplênica de esquistossomose mansônica. MÉTODO: Foram incluídos aleatoriamente, no estudo, 39 voluntários de idades variando entre 15 e 31 anos, 19 homens e 20 mulheres, divididos em três grupos. Grupo 1 (GC) 12 indivíduos sadios, sem esquistossomose. Grupo 2 (AI) 18 indivíduos portadores de esquistossomose mansônica na forma hepatoesplênica, que tinham se submetido a esplenectomia, ligadura da veia gástrica esquerda e auto-implante de tecido esplênico no omento maior, quando tinham idades entre 7 e 16 anos. Esses pacientes receberam oxaminiquine na dose de 20mg/kg 30 dias antes do procedimento cirúrgico. O seguimento médio atual é de cerca de 8 anos. Grupo 3 - pacientes esplenectomizados sem auto-implante esplênico (ESAI) constituído de nove adultos jovens que tinham se submetido à esplenectomia sem auto-implante esplênico e desconexão ázigo-porta. Os pacientes esquistossomóticos dos grupos 2 e 3 tiveram confirmação dessa doença pela presença de fibrose de Symmers nas biópsias hepáticas realizadas durante o ato cirúrgico. Foram colhidos 6 ml de sangue periférico de cada um dos voluntários incluídos no presente estudo, cujos monócitos foram separados por centrifugação e cultivados no meio de cultura CultilabÒ). Amostras de 100ml do sobrenadante da cultura de monócitos (10(6) células/ml), de cada indivíduo dos três grupos, eram colhidos para determinação das concentrações de TNF-alfa. Essa concentração era mensurada pelo estudo colorimétrico de ELISA para citocinas (QuanticininasTM - Sistema R&D), após 4 horas de estimulação com PMA e incubação, em uma atmosfera úmida com 5% de CO² a 37ºC. RESULTADOS: As concentrações de TNF-alfa? não diferiram significantemente nos três grupos estudados [(GC 135,0 ± 51,6 pg/ml; AI 97,0 ± 25,4 pg/ml e ESAI 107,0 ±. 52,1 pg/ml) - ANOVA, F = 0,210; p = 0,813]. CONCLUSÃO: Os achados contribuem para hipótese de que após esplenectomia com ou sem auto-implante esplênico a função dos monócitos, com relação a produção de TNF-alfa, mantém-se preservada.
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Resende V, Tavares Júnior WC, Kanson MJM, Abrantes WL, Drumond DAF. Tratamento não-operatório e operatório de lesões esplênicas em crianças. Rev Col Bras Cir 2003. [DOI: 10.1590/s0100-69912003000500007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Comparar dois grupos de pacientes pediátricos com lesões esplênicas sendo um tratado conservadoramente e outro com cirurgia. MÉTODO: Foram avaliadas prospectivamente 32 crianças com lesões esplênicas. Os pacientes foram divididos em dois grupos, Grupo I (tratamento não-operatório, n=16) e Grupo II (tratamento operatório, n=16). O critério para inclusão no tratamento não-operatório foi estabilidade hemodinâmica, escala de coma de Glasgow maior que 12, ausência de lesões associadas de vísceras ôcas. Na avaliação clínica foram verificadas a necessidade de hemotransfusão e de tratamento em Unidade de Terapia Intensiva (UTI). As complicações, tempo de permanência hospitalar,o índice de trauma (RTS, ISS e TRISS) foram analisados. Os exames complementares por imagem foram a ultra-sonografia abdominal seguida de tomografia computadorizada. RESULTADOS: As lesões grau II e III predominaram no Grupo I enquanto as de grau IV e V no Grupo II. As lesões associadas mais freqüentes foram o TCE seguido pelo trauma de extremidades. Com os critérios adotados se obteve total sucesso no tratamento não operatório. CONCLUSÕES: O tratamento não-operatório é uma opção segura para o trauma abdominal fechado com lesão esplênica, desde que seja indicado mediante critérios técnicos explicitados. O tratamento não-operatório da lesão esplênica só pode ser feito em serviços que estejam adequadamente equipados com recursos materiais ( ultra-sonografia e tomografia computadorizada) e com equipe cirúrgica em tempo integral para avaliação continuada dos pacientes.
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Marques RG, Petroianu A. Distribuição de Escherichia coli nos órgãos do sistema mononuclear fagocitário após esplenectomia total isolada ou combinada com auto-implante esplênico em rato. Rev Col Bras Cir 2003. [DOI: 10.1590/s0100-69912003000500002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: O auto-implante esplênico parece constituir a única alternativa para preservação de tecido esplênico, após esplenectomia total. O objetivo deste trabalho foi analisar a depuração de Escherichia coli pelos órgãos do sistema mononuclear fagocitário (SMF) após esplenectomia total e auto-implante esplênico. MÉTODO: Utilizou-se um modelo experimental com ratos Wistar jovens e adultos, de ambos os sexos, submetidos a esplenectomia total e auto-implante esplênico. O método de avaliação foi a inoculação intravenosa de suspensão de Escherichia coli marcada com tecnécio - 99m. Analisou-se a captação desta bactéria pelos órgãos do SMF e o remanescente bacteriano na corrente sangüínea. RESULTADOS: Dentro de cada grupo, não foi encontrado diferença entre animais jovens e adultos no que se refere à captação de bactérias pelos órgãos do SMF. Na comparação entre os grupos verificou-se que o percentual médio de captação pelo baço e pelo fígado de animais do Grupo-Controle foi maior que o dos auto-implantes. Embora a captação de bactérias pelo baço de animais do Grupo-Controle tenha sido maior que o dos auto-implantes esplênicos, o remanescente bacteriano no sangue não foi diferente. Animais submetidos a esplenectomia total isolada apresentam maior remanescente de bactérias na corrente sangüínea que animais do Grupo-Controle ou do grupo submetido a esplenectomia total combinada com auto-implante esplênico. CONCLUSÃO: Nossos resultados indicam que o auto-implante esplênico é eficaz na depuração de bactérias, em rato, mediante a fagocitose por seus macrófagos, e não interfere na função de remoção bacteriana do fígado e do pulmão.
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Resende V, Petroianu A. Functions of the splenic remnant after subtotal splenectomy for treatment of severe splenic injuries. Am J Surg 2003; 185:311-5. [PMID: 12657380 DOI: 10.1016/s0002-9610(02)01407-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND To evaluate the clinical and laboratory characteristics of patients submitted to subtotal splenectomy during the immediate and late postoperative period. METHODS The study was conducted on 34 patients, 25 of whom were submitted to subtotal splenectomy (group I), and 9 to total splenectomy without preservation of splenic tissue (group II), and on 22 patients with intact spleens (group III, control). The immediate and late postoperative complications were investigated. Hematological examinations were performed during the late postoperative period (red cell count, hemoglobin, platelets, total and segmented leukocytes, lymphocytes, and Howell-Jolly bodies). Immunoglobulins (IgA, IgM, and IgG) and total T lymphocytes (TTL), active T lymphocytes (ATL), and B lymphocytes were also determined. Splenic scintigraphy with (99m)Tc colloidal sulfur was performed. RESULTS Groups I and III did not presented abnormal blood bodies and their hematological and immunological pattern were normal. None of the groups showed leukocytosis or thrombocytosis. Howell-Jolly bodies were observed only in group II, which also showed reduced IgM levels. Scintigraphy showed filtering splenic tissue in group I. CONCLUSIONS We conclude that subtotal splenectomy is a good surgical alternative for serious distal spleen lesion or when the main splenic pedicle is injured.
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Affiliation(s)
- Vivian Resende
- Federal University of Minas Gerais and Hospital João XXIII, Rua Sergipe, no 67, Apto 2401, Bairro Funcionários, Belo Horizonte, MG 30130-170, Brazil.
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Abstract
RACIONAL: A esplenectomia, em qualquer faixa etária e por qualquer indicação, aumenta o risco de morte por infecção fulminante. OBJETIVO: Avaliar a definição, a etiologia, a incidência, os fatores de risco e a profilaxia da infeção fulminante pós-esplenectomia, bem como os métodos existentes para preservação de tecido esplênico quando a esplenectomia total faz-se necessária. MÉTODO: Revisão bibliográfica. RESULTADOS: Os agentes etiológicos mais freqüentemente encontrados nesse quadro séptico são Streptococcus pneumoniae, Haemophilus influenza e tipo B, e Neisseria meningitidis. Outras bactérias, como Escherichia coli, Streptococcus b-hemolítico, Staphylococcus aureus e Pseudomonas sp, também representam risco significativo. Similarmente, grande variedade de agentes, incluindo outros microrganismos entéricos Gram-negativos e patógenos não-bacterianos, também é relatada esporadicamente. A profilaxia situa-se em três categorias principais: educação dos pacientes, imunoprofilaxia e quimioprofilaxia. Contudo, essas medidas não são suficientes para debelar o grande risco de desenvolvimento dessa enfermidade. Quando a esplenectomia total for necessária, o auto-implante esplênico heterotópico parece constituir a única alternativa para preservação de tecido esplênico. Estudos clínicos e experimentais têm mostrado que, após um período de regeneração, desenvolve-se tecido esplênico viável, com características estruturais similares a um baço normal e com preservação da função imune esplênica. CONCLUSÕES: Com a caracterização mais detalhada da infecção fulminante pós-esplenectomia, a indicação para esplenectomia total, tanto no trauma, como em diversas enfermidades, vem nitidamente decrescendo. Métodos profiláticos foram desenvolvidos visando à minimização dos efeitos dessa grave enfermidade. Muitas pesquisas vêm tentando determinar o grau de imunocompetência que o enxerto esplênico autógeno pode prover ao hospedeiro, em resposta à invasão bacteriana.
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Affiliation(s)
- Ruy Garcia Marques
- Departamento de Cirurgia Geral, Faculdade de Ciências Médicas, Universidade Estadual do Rio de Janeiro RJ, Brasil.
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Silva RGD, Petroianu A, Silva MGD, Diniz SOF, Cardoso VN. Influência das operações sobre o baço na distribuição da escherichia coli no sistema mononuclear fagocitário. Rev Col Bras Cir 2003. [DOI: 10.1590/s0100-69912003000100011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVOS: Para se evitar o estado asplênico, muitas medidas preservadoras do baço têm sido propostas na literatura, como a esplenorrafia, a esplenectomia parcial com preservação dos vasos hilares e o auto-implante de tecido esplênico. A esplenectomia subtotal, com conservação do pólo superior do baço, nutrido apenas pelos vasos esplenogástricos é uma alternativa quando o pedículo esplênico precisa ser ligado. O objetivo deste estudo foi avaliar a influência das esplenectomias parcial, subtotal e total na distribuição da Escherichia coli no sistema mononuclear fagocitário. MÉTODO: Foram estudados 32 ratos divididos em 4 grupos: operação simulada (mantendo todo o baço), esplenectomia parcial, esplenectomia subtotal e esplenectomia total. Após cinco semanas da operação, uma alíquota de Escherichia coli marcada com 99m-tecnécio foi injetada por via venosa. Após 20 minutos, os animais foram mortos, e o baço, os pulmões e o fígado foram retirados para se verificar a distribuição das bactérias marcadas. RESULTADOS: A quantidade de Escherichia coli no tecido esplênico foi maior no grupo com o baço íntegro em comparação com os grupos esplenectomia parcial e subtotal. A distribuição da bactéria marcada pelo baço não diferiu nos grupos com esplenectomia parcial ou subtotal. A quantidade de bactérias no pulmão foi maior no grupo esplenectomia parcial do que a do grupo com esplenectomia subtotal. Após esplenectomia subtotal, a distribuição da bactéria marcada foi maior no fígado em comparação com a captação desse órgão nos demais grupos. CONCLUSÕES: O pólo superior do baço, suprido apenas pelos vasos esplenogástricos, tem capacidade de remover da circulação bactérias vivas, mostrando que, mesmo sem a vascularização pelo pedículo esplênico, há uma eficiente depuração sangüínea. A distribuição da Escherichia coli pelo sistema mononuclear fagocitário apresenta comportamentos diferentes, dependendo do tipo de esplenectomia a que o animal é submetido.
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Marques RG, Petroianu A, de Oliveira MBN, Bernardo-Filho M, Boasquevisque EM, Portela MC. Bacterial clearance after total splenectomy and splenic autotransplantation in rats. Appl Radiat Isot 2002; 57:767-71. [PMID: 12406614 DOI: 10.1016/s0969-8043(02)00135-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Wistar rats submitted to isolated total splenectomy or total splenectomy combined with splenic autotransplantation were inoculated with 99mtechnetium-labeled Escherichia coli. Measurement of isotope uptake in the organs of the mononuclear phagocytic system showed a greater bacterial bloodstream clearance in rats with splenic autotransplantation. Although uptake of bacteria in the spleen was higher in the control group, the number of bacteria remaining in the bloodstream did not differ between groups. These results indicate that splenic autotransplantation preserves the phagocytic function of the spleen.
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Affiliation(s)
- Ruy Garcia Marques
- Department of General Surgery, Rio de Janeiro State University, Rua Clovis Salgado 280/104 Recreio, 22795-230, Rio de Janeiro, RJ, Brazil.
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Petroianu A, Silva KDDA. Esplenectomia subtotal para tratamento do hipodesenvolvimento somático e sexual secundário a esplenomegalia. Rev Col Bras Cir 2002. [DOI: 10.1590/s0100-69912002000400005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: "Nanismo esplênico" é condição clínica decorrente de processo imunitário relacionado ao baço e tem como tratamento preconizado a esplenectomia total. Seguindo uma linha de pesquisa voltada ao estudo da esplenectomia subtotal em diferentes afecções, o objetivo do presente trabalho foi avaliar o crescimento somático de pacientes portadores deste hipodesenvolvimento esplenomegálico, submetidos à esplenectomia subtotal com preservação do pólo superior esplênico irrigado apenas pelos vasos esplenogástricos. MÉTODO: Quatro pacientes masculinos (14, 14, 16 e 17 anos) com esplenomegalia (três de etiologia esquistossomática e um com cirrose auto-imune) e retardo do desenvolvimento somático e sexual foram submetidos à esplenectomia subtotal. As indicações para cirurgia foram sangramento de varizes do esôfago e pancitopenia. RESULTADOS: Em todos os casos houve retomada do crescimento e após um ano eles já se encontravam dentro da faixa de desenvolvimento somático e sexual compatível com a idade. CONCLUSÃO: O hipodesenvolvimento esplenomegálico não é decorrente da presença do baço, mas de seu crescimento; a esplenectomia subtotal é um procedimento adequado para tratar o retardo de desenvolvimento somático e sexual por esplenomegalia.
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Resende V, Petroianu A. Estudo funcional tardio do auto-implante esplênico após trauma complexo do baço humano. Rev Col Bras Cir 2001. [DOI: 10.1590/s0100-69912001000300003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar as repercussões clínicas e laboratoriais em pacientes submetidos a auto-implantes esplênicos. MÉTODOS: Foram estudados 29 pacientes com lesões graves do baço, 20 que receberam auto-implantes esplênicos (grupo I), nove a esplenectomia total sem preservação de tecido esplênico (grupo II) e 22 pacientes com baços íntegros constituíram o grupo controle (grupo III). Investigaram-se as complicações pós-operatórias imediatas e tardias. No pós-operatório tardio realizaram-se exames hematológicos (hematimetria, hemoglobina, hematócrito, plaquetas, leucócitos globais e segmentados, linfócitos e corpúsculos de Howell Jolly). Dosaram-se as imunoglobulinas (IgA, IgM e IgG) e linfócitos T totais (LTT), linfócitos T ativos (LTA) e linfócitos B. Realizou-se cintilografia esplênica com enxofre coloidal marcado com o 99mTc. RESULTADOS: Em nenhum dos grupos verificou-se leucocitose ou trombocitose. Os corpúsculos de Howell-Jolly foram observados no grupo II e neste grupo a IgM esteve reduzida. A cintilografia mostrou tecido esplênico captante no grupo I. CONCLUSÃO: O auto-implante é uma boa alternativa quando a esplenectomia total for necessária.
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Torres OJM, Macedo EL, Picciani ÉRG, Nunes PMS, Costa JVG, Carvalho AB, Lobato Junior PDS. Estudo histológico da regeneração esplênica de ratos submetidos a esplenectomia subtotal. Acta Cir Bras 2000. [DOI: 10.1590/s0102-86502000000200006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Um aumento da susceptibilidade à infecção severa é uma complicação reconhecida da esplenectomia. Um grande número de alternativas tem sido propostas que poderiam impedir esta complicação do estado asplênico. O presente estudo analisa a regeneração histológica do tecido esplênico em ratos submetidos a esplenectomia subtotal. Foram utilizados trinta ratos machos da linhagem Wistar, adultos, pesando entre 160 e 210g. Os animais foram submetidos a esplenectomia subtotal e divididos em três grupos contendo dez ratos cada onde foram estudados após 15, 30 e 45 dias. Após este período de observação o tecido esplênico foi recuperado e submetido a exame histológico. A estrutura tecidual esplênica no 15º dia se apresentava irregular, porém sem necrose. Após 30 dias , a cápsula se apresentava histologicamente espessada e com maior desenvolvimento. Em 45 dias foi observado semelhança considerável entre o tecido esplênico remanescente e o baço normal. O presente estudo mostra que o baço submetido a esplenectomia subtotal se regenera completamente em um período de 45 dias.
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