The present prospective study was designed to evaluate the effects of
splenectomy and devascularization operation on the hemodynamics of
portal circulation and the reliability of color Doppler ultrasonography as a
non-invasive tool in the assessment of portal h.emodynamics before and
after the operation.
Thirty patients (19 males and 11 females) with clinical diagnosis of
portal hypertension and endoscopic evidence of oesophageal and/or gastric
varices who underwent splenectomy and devascularization were included
in this study. The mean age of the whole group was 32.12+1.8
years (range: 17-52 years). Doppler scanning of the portal vein, before
and after the operation revealed a signficant reduction in the maximum
blood velocity postoperatively (mean 10.59+2.66 cm/sec. versus
12.51+3.16 cm/sec preoperatively), and a signtficant reduction in the volume
blood flow postoperatively (mean 884.3+233.9 ml/ min. versus
1073.8+422.4 ml/mitt., preoperatively). and insignfficant change in the
diameter. Also, the direction of blood flow was hepatopetal in all patients
after operation, while it was bidirectional in one patient and hepatopetal
in 29 patients before operation. The study revealed a significartt positive
correlation between the size of the spleen and the decrease in the blood
velocity and volume blood flow of the portal vein after operation. Also,
there was a positively signficant correlation betweert• the presence of a history of injection sclerotherapy and the diameter and volume blood flow
of the portal vein before the operation. From the present study, it was
concluded that splenectomy and devascularizatiort could be performed
with extremely low mortality in selected elective patients, particularly the
non alcoholic, with virtually no postoperative encephalopathy. This is in
addition to the preservation of the vascular anatomy of the right upper
qund rant for future use in potential liver transplant The operation did not
lead to complete disappearance of oesophageal varices but significant reduction
in their grades and injection sclerotherapy is recommended for
variceal rernenants. Based on the fact that there is a significant positive
con-elation between the size of the spleen and the decrease in the blood
velocity and volume blood flow of portal vein after the operation, it is suggested
that this splenic venous flow contributes, in part, to portal hypertension.
The Doppler scanning is an ideal investigation for portal circulation, as
it is noninvasive, cheap and provides accurate data about the velocity,
volume flow, direction of blood flow and patency of portal circulation. |
