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terça-feira, 10 de fevereiro de 2015

Veia gástrica posterior. Hipertensão porta



Posterior gastric vein. Portal hipertension


Alcino Lázaro da Silva, TCBC-MGITúlio Pinho NavarroII; Sérgio Caporali de OliveiraII; Ailton Gomes FaionIII; Lincoln Warley FerreiraIII
IProfessor Titular de Cirurgia do Aparelho Digestivo da Faculdade de Medicina da UFMG
IICirurgião Vascular do Departamento de Cirurgia da Faculdade de Medicina da UFMG
IIICirurgião Geral do Departamento de Cirurgia da Faculdade de Medicina da UFMG



RESUMO
A veia gástrica posterior não é muito citada nos livros de anatomia e nos trabalhos sobre hipertensão porta. Estudou-se sua anatomia, freqüência e desembocadura. Ela foi encontrada em 54% dos casos e, em 100%, desembocava na veia esplênica. Discute-se a vantagem ou não de sua ligadura ou preservação no tratamento cirúrgico da hipertensão porta.
Unitermos: Hipertensão porta; Varizes; Veia gástrica posterior.

ABSTRACT
The posterior gastric vein has not been mentioned very often neither in anatomy textbooks nor in portal hypertension papers. The authors studied the anatomy, frequency and confluence of this vein because is a huge variety in the presentation of esophageal varices. Twenty-six adult preserved corpses (twenty females and six males) had a wide abdominal incision allowing the dissection of the portal system, identifying the frequency and confluence of its tributaries, notably the posterior gastric vein. The portal vein, in all cases, was formed by the confluence of the superior mesenteric vein with the splenic vein and had a mean length of 6.4 cm. The splenic vein had a mean length of 6.5 cm. The left gastric vein was tributary of the portal vein in 50% of the cases and in 30% of the cases in the splenic vein. The right gastric vein had it's confluence to portal vein in 30 % of the cases and to the splenic vein in 4 %. The inferior mesenteric vein was tributary of the splenic vein in 54% of the cases and in the superior mesenteric vein in 46%. The left gastro-omental vein had its confluence to the splenic vein in 50% of the cases and to the inferior polar vein in 34 %. The middle colic vein had its confluence to superior mesenteric vein in 42% of the cases, to inferior mesenteric vein in 12% and to splenic vein in 8%. The posterior gastric vein was found in 54% of the corpses, and in all cases it was a tributary of the splenic vein, in retropancreatic position, coming from the esophageal-gastric junction. These findings agree with previous papers describing a prevalence of 60% of posterior gastric vein in patients submitted to surgery in portal hypertension, and in all cases, this vein was tributary of the splenic vein. The identification of this vein may influence the treatment, because if left untied during cases of portal-azigos disconnection, they may predispose to postoperative bleeding, but in cases of splenorenal anastomosis may preserve its patency in cases of anastomosis occlusion, or can lead again to postoperative bleeding feeding the esophageal varices. To ligate or not this vein will depends on the surgeon 's experience and common sense. Regarding to previous papers and to this data presented here, the authors believe that the prevalence of this vein is between 50 and 60% in the population.
Key words: Portal hypertension; Varices; Posterior gastric vein.



Texto completo disponível apenas em PDF.
Full text available only in PDF format.


REFERÊNCIAS
1. Abdalla P. Formação do Sistema Porta, in Anais do XI Congresso de Anatomia e 11 Congresso Luso-Brasileiro de Anatomia-Julho 1976 - Vol. l.         [ Links ]
2. Kelner S. Veia mesentérica superior: contribuição anatômica às anastomoses cirúrgicas com o sistema cava superior. 1953. Tese (Livre-Docência em Técnica Operatória e Cirurgia Experimental) - Universidade do Recife.         [ Links ]
3. Pitanga LC.Cirurgia da Hipertensão Portal Esquistossomótica. Livro Médico Editora Ltda., Rio de Janeiro, 1980, pág. 20.         [ Links ]
4. Vieira ET. Veia gástrica posterior. Revista da Associação Médica Brasileira 1968; 10: 265-266.         [ Links ]
5. Kimura K, Ohtio M, Matsutani S, et al. Relative frequencies of portosystemic pathways and renal shunt formation through the "posterior" gastric vein: portographic study in 460 patients. Hepatology 1990;12:725-728.         [ Links ]
6. SaIam AA, Warren WD. Anatomic basis of the surgical treatment of portal hypertension. Surg Clin N Am1974;54:1.247-57.         [ Links ]
7. Lázaro da Silva A, Nunes TA. Estudo radiológico da anastomose espleno-renal proximal através da veia gastro-omental direita em pacientes portadores de hipertensão porta esquistossomótica. Rev Goiana Med1991;37:23-28.         [ Links ]
8. Nunes TA. Estudo radiológico da anastomose espleno-renal proximaI através da veia gastro-omentaI direita em pacientes portadores de hipertensão porta esquistossomótica. Tese de Doutoramento. Fac. Med. UFMG, 1992.         [ Links ]
9. Katoh H, Shimozawa E, Kojima T, et al. Modified splenorenal shunt with splenopancreatic disconnection.Surgery 1989;5:920-924.         [ Links ]
10. Lacombe M, Vaysse J. Arguments in favour of splenorenal anastomosis. J Cardiov Surg 1967;8:142-148.         [ Links ]
11. Langer B, Taylor BR, Greig PD. Selective or total shunts for variceal bleeding. Am J Surg 1990;160:75-79.         [ Links ]
12. Leite Sobrinho GB, Pardini R, Silva AL. Síndrome de hipertensão porta por esquistossomose mansoni. Rev Bras Med 1992;49: 639- 646.         [ Links ]
13. Warren WF, Fomon JJ, Zeppa R. Further evaluation of selective decompression of varices by splenorenaI shunt. Arlna/s of Surgery 1969;169:652-660.         [ Links ]
14. Warren WD, Millikan WJ Jr., Henderson JM, et al. Splenopancreatic disconnection; improved selectivity of distal splenorenal shunt. Anna/s of Surgery 1986;204:346-355.         [ Links ]


 Endereço para correspondência:
Alcino Lázaro da Silva
Rua Guaratinga, 151
30315-430 - Belo Horizonte - MG
Recebido em 5/3/99
Aceito para publicação em 9/8/99


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