Posterior gastric vein. Portal hipertension
Alcino Lázaro da Silva, TCBC-MGI; Túlio 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
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.
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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
Aceito para publicação em 9/8/99
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