milmedВоенная медицинаMilitary Medicine2074-5044Белорусский государственный медицинский университет10.51922/2074-5044.2021.2.56milmed-929Research ArticleОРИГИНАЛЬНЫЕ НАУЧНЫЕ ПУБЛИКАЦИИ. Лечебно-профилактические вопросыORIGINAL SCIENTIFIC PUBLICATIONS. Medical and preventive questionsЭмболизация селезеночной артерии в собственной модификации у пациентов с кровотечением из варикозно расширенных вен дна желудка вследствие сегментарной портальной гипертензииSplenic artery embolization in our own modification in patients with segmental portal hypertension and bleeding from varices of the gastric fundusМогилевецЭ. В.MahiliavetsE. V.ГареликП. В.HarelikP. V.ВасильчукЛ. Ф.VasilchukL. F.ЧернийА. В.CherniyA. V.УО «Гродненский государственный медицинский университет»BelarusУЗ «Гродненская университетская клиника»Belarus202130102026025663Copyright © Могилевец Э.В., Гарелик П.В., Васильчук Л.Ф., Черний А.В., 20262026Могилевец Э.В., Гарелик П.В., Васильчук Л.Ф., Черний А.В.Mahiliavets E.V., Harelik P.V., Vasilchuk L.F., Cherniy A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://milmed.ejournal.by/jour/article/view/929

По прежнему нет единой точки зрения относительно выбора наиболее эффективного метода лечения левосторонней портальной гипертензии, вследствие сложностей в организации набора групп пациентов для контролируемых исследований по данной тематике.

Цель

Цель. Предварительный анализ результатов выполнения рентгенэндоваскулярной эмболизации селезеночной артерии в собственной модификации у пациентов с левосторонней портальной гипертензией.

Материалы и методы

Материалы и методы. Рентгенэндоваскулярная эмболизация селезеночной артерии в собственной модификации выполнена троим пациентам (все мужского пола) в возрасте от 46 до 59 лет после очередного повторного эпизода кровотечения из варикозно расширенных вен дна желудка (от 2 до 3 рецидивов) вследствие левосторонней портальной гипертензии на фоне хронического рецидивирующего панкреатита. Отличительным моментом нашей модификации рентгенэндоваскулярную парциальную эмболизацию проксимального сегмента селезеночной артерии являлось, то, что критерием прекращения процесса редукции кровотока по селезеночной артерии являлась эндоскопическя констатация факта достижения надежного гемостаза.

Результаты и обсуждение

Результаты и обсуждение. Все пациенты успешно перенесли операцию. Двое пациентов были переведены после операции в отделение хирургической панкреатологии, гепатологии и трансплантации. В одном наблюдении потребовалось нахождение после операции в отделении реанимации в течение четырех суток вследствие тяжести дооперационной кровопотери. Время пребывания в стационаре в послеоперационном периоде составило (Me [min; max]) – 7 [6; 7] суток. В течение послеоперационного наблюдения за указанными пациентами за период от 22 до 60 месяцев рецидивов кровотечений из ВРВЖ отмечено не было. У всех пациентов при эндоскопическом исследовании через год отмечена регрессия степени расширения ВРВЖ.

Выводы

Выводы. Представленный в статье способ РЭСА позволяет эффективно достигнуть надежного гемостаза при кровотечении из варикозно расширенных вен дна желудка у пациентов с левосторонней портальной гипертензией при сохранении кровотока по селезеночной артерии, достаточного для минимизации риска развития тотального некроза и абсцесса селезенки, некротических изменений дна желудка и хвоста поджелудочной железы. Следует отметить технологичность и воспроизводимость оперативного вмешательства, его эффективность и безопасность. Целесообразным является дальнейшее проведение исследований эффективности методики в рандомизированных контролируемых исследованиях.

There is still no single point of view regarding the choice of the most effective method for treating leftsided portal hypertension, due to the difficulties in organizing the recruitment of patient groups for controlled studies on this topic.

Aim

Aim. Preliminary analysis of the results of performing endovascular embolization of the splenic artery in our own modification in patients with left-sided portal hypertension.

Materials and methods

Materials and methods. Endovascular embolization of the splenic artery in our own modification was performed in three patients with chronic recurrent pancreatitis and left-sided portal hypertension (all males) aged 46 to 59 years after a repeated episode of bleeding from varices of the gastric fundus (2 to 3 relapses). A distinctive feature of our modification of X-ray endovascular partial embolization of the proximal segment of the splenic artery was that the criterion for stopping the process of reducing blood flow through the splenic artery was endoscopic confirmation of the fact of achieving reliable hemostasis.

Results and discussion

Results and discussion. All patients underwent successful surgery. Two patients were transferred after surgery to the Department of Surgical Pancreatology, Hepatology and Transplantation. In one case, it was required to stay in the intensive care unit for four days after surgery due to the severity of preoperative blood loss. The time spent in hospital in the postoperative period was (Me [min; max]) – 7 [6; 7] days. During the postoperative observation of these patients for the period from 22 to 60 months, no recurrence of bleeding from gastric varices was noted. In all patients, endoscopic examination after a year showed regression of the degree of expansion of gastric varices.

Сonclusions

Сonclusions. The method of endovascular embolization of the splenic artery presented in the article makes it possible to effectively achieve reliable hemostasis in bleeding from varices of the fundus of the stomach in patients with left-sided portal hypertension while maintaining blood flow through the splenic artery sufficient to minimize the risk of developing total necrosis and abscess of the spleen, necrotic changes in the fundus of the stomach and pancreas.

The reproducibility of the surgical intervention, its effectiveness and safety should be noted. It is advisable carry out further studies of the effectiveness of the technique in randomized controlled trials.

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The authors declare that there are no conflicts of interest present.