hepatoАнналы хирургической гепатологииAnnaly khirurgicheskoy gepatologii = Annals of HPB Surgery1995-54642408-9524НЭИКОН ИСП10.16931/1995-5464.2020127-37hepato-599Research ArticleПЕЧЕНЬLIVERГастрикокавальное шунтирование у больных портальной гипертензией”Left gastric vein to inferior vena cava” bypass in patients with portal hypertensionhttps://orcid.org/0000-0002-0905-8941ЛебезевВ. М.LebezevV. M.

доктор мед. наук, профессор, главный научный сотрудник

119991 Москва, Абрикосовский пер., д. 2, Российская Федерация

Doct. of Sci. (Med.), Professor, Chief Research Fellow

2, Abrikosovskiy lane, Moscow, 119991, Russian Federation

viktorlebezev@yandex.ruhttps://orcid.org/0000-0001-8064-1964МанукьянГ. В.ManukyanG. V.

доктор мед. наук, заведующий

119991 Москва, Абрикосовский пер., д. 2, Российская Федерация

Doct. of Sci. (Med.), Head

2, Abrikosovskiy lane, Moscow, 119991, Russian Federation

drmanukyan@mail.ruhttps://orcid.org/0000-0002-7554-6345ФандеевE. Е.FandeevE. E.

Фандеев Евгений Евгеньевич – канд. мед. наук, старший научный сотрудник

119991 Москва, Абрикосовский пер., д. 2, Российская Федерация

Тел.: +7-916-726-19-83

Evgeniy E. Fandeyev – Cand. of Sci. (Med.), Senior Research Fellow

2, Abrikosovskiy lane, Moscow, 119991, Russian Federation

Phone: +7-916-726-19-83

dr.fan@inbox.ruhttps://orcid.org/0000-0002-8268-3129КиценкоЕ. А.KitsenkoE. A.

доктор мед. наук, ведущий научный сотрудник

119991 Москва, Абрикосовский пер., д. 2, Российская Федерация

Doct. of Sci. (Med.), Leading Research Fellow

2, Abrikosovskiy lane, Moscow, 119991, Russian Federation

kitsenko-surgeon@mail.ruhttps://orcid.org/0000-0002-3380-2224МусинР. А.MusinR. A.

канд. мед. наук, старший научный сотрудник

119991 Москва, Абрикосовский пер., д. 2, Российская Федерация

Cand. of Sci. (Med.), Senior Research Fellow

2, Abrikosovskiy lane, Moscow, 119991, Russian Federation

surgery@mail.ruhttps://orcid.org/0000-0002-4490-4541КосакевичЕ. А.KosakevichE. A.

аспирант

119991 Москва, Абрикосовский пер., д. 2, Российская Федерация

Postgraduate Student

2, Abrikosovskiy lane, Moscow, 119991, Russian Federation

xomich-e@mail.ruhttps://orcid.org/0000-0002-6815-6672РизаеваС. А.RizaevaS. A.

ординатор

119991 Москва, Абрикосовский пер., д. 2, Российская Федерация

Resident

2, Abrikosovskiy lane, Moscow, 119991, Russian Federation

cauduk@yandex.ruhttps://orcid.org/0000-0002-6268-0043БобылеваЯ. С.BobylevaYa. S.

врач-хирург

119991 Москва, Абрикосовский пер., д. 2, Российская Федерация

Surgeon, Resident

2, Abrikosovskiy lane, Moscow, 119991, Russian Federation

iana.bobyleva@gmail.comОтделение экстренной хирургии и портальной гипертензии ФГБНУ “Российский научный центр хирургии им. акад. Б.В. Петровского”РоссияDepartment of Urgent Surgery and Portal Hypertension, Petrovsky Russian Research Center for SurgeryRussian Federation2020170320202512737Copyright © Лебезев В.М., Манукьян Г.В., Фандеев E.Е., Киценко Е.А., Мусин Р.А., Косакевич Е.А., Ризаева С.А., Бобылева Я.С., 20202020Лебезев В.М., Манукьян Г.В., Фандеев E.Е., Киценко Е.А., Мусин Р.А., Косакевич Е.А., Ризаева С.А., Бобылева Я.С.Lebezev V.M., Manukyan G.V., Fandeev E.E., Kitsenko E.A., Musin R.A., Kosakevich E.A., Rizaeva S.A., Bobyleva Y.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://hepato.elpub.ru/jour/article/view/599Цель

Цель. Представить первый в России опыт лечения больных портальной гипертензией различной этиологии созданием селективного портосистемного анастомоза между левой желудочной и нижней полой венами – гастрикокавальное шунтирование.

Материал и методы

Материал и методы. Формирование гастрикокавального венозного анастомоза выполнено 6 пациентам с портальной гипертензией: 4 мужчинам и 2 женщинам (средний возраст 40,4 года). Срок наблюдения составил 10–36 мес.

Результаты

Результаты. У 5 из 6 оперированных пациентов гастрикокавальное шунтирование оказалось эффективным способом лечения портальной гипертензии и связанных с ней осложнений. В отдаленном периоде наблюдения достигнута полная эрадикация варикозно расширенных вен пищевода и желудка, отсутствие пищеводно-желудочных кровотечений. Получены убедительные данные об отсутствии печеночной энцефалопатии и удовлетворительной функции печени. У 1 пациента c тромбофилией и внепеченочной портальной гипертензией (мутация Leiden) отмечен тромбоз шунта и рецидив пищеводно-желудочного кровотечения из варикозно расширенных вен пищевода и желудка через 6 мес после операции на фоне нарушения режима антикоагулянтной терапии.

Заключение

Заключение. Гастрикокавальное шунтирование – эффективный способ лечения, направленный на профилактику (рецидива) гастроэзофагеального кровотечения у больных портальной гипертензией. Ограничение для применения метода – отсутствие у многих пациентов левой желудочной вены достаточного диаметра. Поскольку шунт является высокоселективным, метод имеет определенные патофизиологические преимущества перед другими видами портосистемных анастомозов и должен быть в арсенале оказания хирургической помощи этой категории больных.

Aim

Aim. To present the first Russian experience in the management of portal hypertension of various etiology by creating a selective portosystemic shunt between left gastric vein and inferior vena cava (leftgastric vein caval bypass).

Material and methods

Material and methods. “Left gastric vein to inferior vena cava” bypass was performed in 6 patients with portal hypertension: 4 men and 2 women (mean age 40.4 years). The follow-up period ranged from 10 to 36 months.

Results

Results. “Left gastric vein to inferior vena cava” bypass was effective in the management of portal hypertension and its complications in 5 out of 6 patients. Complete eradication of esophagogastric varices and no variceal bleeding were observed in long-term period. These patients demonstrated no clinical or laboratory signs of hepatic encephalopathy and/or hepatic failure within the follow-up. One patient with thrombophilia and extrahepatic portal vein obstruction (factor V Leiden mutation) had thrombosis of the shunt and recurrent variceal bleeding in 6 months after surgery because of unauthorized abandonment of the anticoagulation.

Conclusion

Conclusion. “Left gastric vein to inferior vena cava” bypass is an effective procedure for prevention of variceal bleeding (or recurrence) in patients with portal hypertension. The limitation of this technique is insufficient diameter of left gastric vein in many patients. This procedure has certain pathophysiological advantages over other types of portosystemic anastomoses due to highly selective nature of the shunt. Thus, this approach should be introduced into surgical treatment of these patients.

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