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Khirurgii

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Year 2015 Vol. 23 No 3

REVIEWS

E.V. MAHILIAVETS

CORRECTION OF HYPERSPLENISM IN PATIENTS WITH SURGICAL COMPLICATIONS OF PORTAL HYPERTENSION

ÅÅ "Grodno State Medical University",
The Republic of Belarus

In some cases in surgical the clinical situation is aggravated by the development of the hypersplenism syndrome in patients with complications of portal hypertension the departments of surgery. It negatively affects the overall disease course and the results of treatment. Substitution therapy with appropriate drugs is used in case of concomitant deficit of cyanocobalamin or folic acid as a conservative therapy of thrombocytopenia.
Platelet transfusion prior invasive procedures is performed at the level of platelets less than 40×109/L. Among the available arsenal methods to correct immune-mediated reduction of the platelet the intravenous immunoglobulin forms are used.
The cytokine thrombopoietin stimulates the production of megakaryocytes and separation from them of platelets, promotes to a long-term functioning and division of hematopoietic stem cells. Splenectomy is considered to be a profitable method of treatment in the conservative correction of hypersplenism, X-ray endovascular embolization of the spleen artery and other minimally invasive methods of the platelets inhibition destruction in the spleen.
The absence of effect of the conservative therapy (3-6 months), uncontrolled or recurrent bleeding in case of the reduction of corticosteroids dose, platelet level 10×109/l and less without bleeding, inefficiency of the correction of thrombocytopenia at the level of platelet counts less than 30×109/l within three months are considered as the indications for the spleen removal. Development of preoperative preparation methods contributing to the increase concentration of cellular elements in the peripheral blood is considered to be topical to improve operation tolerability, correcting complications of portal hypertension.

Keywords: hypersplenism, thrombocytopenia, embolization of the sleen artery, splenectomy, liver cirrhosis, bleeding, platelet counts, portal hypertension
p. 332-338 of the original issue
References
  1. Kedia S, Goyal R, Mangla V, Kumar A, S S, Das P, Pal S, Sahni P, Acharya SK. Splenectomy in cirrhosis with hypersplenism: improvement in cytopenias, Child's status and institution of specific treatment for hepatitis C with success. Ann Hepatol. 2012 Nov-Dec;11(6):921-29.
  2. Tutchenko NI, Rudyk DV. Taktika lecheniia bol'nykh tsirrozom pecheni s krovotecheniem iz varikozno-rasshirennykh ven pishchevoda, zheludka v sochetanii s drugimi oslozhneniiami portal'noi gipertenzii s ispol'zovaniem laparoskopicheskoi tekhniki [Tactics of treatment of patients with liver cirrhosis and bleeding varices of the esophagus, stomach, combined with other complications of portal hypertension using the laparoscopic technique]. Ukr Zhurn Khirurgii. 2012;(18)3:15-20.
  3. Kujovich JL. Hemostatic defects in end stage liver disease. 2005 Jul;21(3):563-87.
  4. Peck-Radosavljevic M. Thrombocytopenia in liver disease. Can J Gastroenterol. 2000 Nov;14 Suppl D:60D-66D.
  5. Stasi R. How to approach thrombocytopenia. Hematology Am Soc Hematol Educ Program. 2012;2012:191-7. doi: 10.1182/asheducation-2012.1.191.
  6. Warkentin TE. Heparin-induced thrombocytopenia and the anesthesiologist. 2002 Jun-Jul;49(6):S36-49.
  7. Eramishantsev AK. Razvitie problemy khirurgicheskogo lecheniia krovotechenii iz varikozno rasshirennykh ven pishchevoda i zheludka [The development issues of surgical treatment of esophageal and gastric varices bleeding]. Annaly Khirurg Gepatol. 2007;(12)2:8-15.
  8. Zabolotskikh IB, Sin'kov SV. Osnovy gemostaziologii (spravochnik) [Fundamentals of Hemostasis (A Handbook)]. Krasnodar, RF: Izd-vo Kub Gos Med Akademii. 2002. 200 p.
  9. Reinhartz O, Farrar DJ, Hershon JH, Avery GJ Jr, Haeusslein EA, Hill JD. Importance of preoperative liver function as a predictor of survival in patients supported with Thoratec ventricular assist devices as a bridge to transplantation. J Thorac Cardiovasc Surg. 1998 Oct;116(4):633-40.
  10. Martin TG 3rd, Somberg KA, Meng YG, Cohen RL, Heid CA, de Sauvage FJ, Shuman MA. Thrombopoietin levels in patients with cirrhosis before and after orthotopic liver transplantation. 1997 Aug 15;127(4):285-88.
  11. Masevich TsG. Terapiia khronicheskikh gepatitov i tsirrozov pecheni [Treatment of chronic hepatitis and liver cirrhosis]. Novosti Farmakoterapii. 1997;(3-4):56-60.
  12. Jeker R. [Hypersplenism]. [Article in German] Ther Umsch. 2013 Mar;70(3):152-6. doi: 10.1024/0040-5930/a000383.
  13. Lejniece S. Trombotsitopeniia [Thrombocytopenia]. Vnutr Meditsina. 2009;(5)6:17-18.
  14. Djordjević J, Svorcan P, Vrinić D, Dapcević B. [Splenomegaly and thrombocytopenia in patients with liver cirrhosis]. [Article in Serbian] Vojnosanit Pregl. 2010 Feb;67(2):166-69.
  15. Radević B, Jesić R, Sagić D, Perisić V, Nenezić D, Popov P, Ilijevski N, Dugalić V, Gajin P, Vucurević G, Radak Dj, Trebjesanin Z, Babić D, Kastratović D, Matić P. Partial resection of the spleen and spleno-renal shunt in the treatment of portal hypertension with splenomegaly and hypersplenism. [Article in Croatian] Acta Chir Iugosl. 2002;(49)6:93-98.
  16. Bolognesi M, Merkel C, Sacerdoti D, Nava V, Gatta A. Role of spleen enlargement in cirrhosis with portal hypertension. Dig Liver Dis. 2002 Feb;34(2):144-50.
  17. Shah SH, Hayes PC, Allan PL, Nicoll J, Finlayson ND. Measurement of spleen size and its relation to hypersplenism and portal hemodynamics in portal hypertension due to hepatic cirrhosis. Am J Gastroenterol. 1996 Dec;91(12):2580-83.
  18. Shi BM, Wang XY, Mu QL, Wu TH, Xu J.Value of portal hemodynamics and hypersplenism in cirrhosis staging. World J Gastroenterol. 2005 Feb 7;11(5):708-11.
  19. Borisov AE, Kashchenko VA. Tsirroz pecheni i portal'naia gipertenziia [Liver cirrhosis and portal hypertension]. Saint-Petersburg, RF: 2009. 112 p.
  20. Peck-Radosavljevic M. Hypersplenism. Eur J Gastroenterol Hepatol. 2001 Apr;13(4):317-23.
  21. Sin'kov SV, Zabolotskikh IB, Shaposhnikov SA. Priobretennye koagulopatii: sovremennye podkhody k differentsial'noi diagnostike i intensivnoi terapii s pozitsii dokazatel'noi meditsiny [Acquired coagulopathy: current approaches to differential diagnosis and intensive care from the point of evidence-based medicine]. Obshch Reanimatologiia. 2007;(3)5-6:192-98.
  22. Fujimura K. [Pathogenesis and management of immune thrombocytopenia]. [Article in Japanese] Rinsho Ketsueki. 2014 Jan;55(1):83-92.
  23. Godeau B. [Immune thrombocytopenias: pathophysiology and treatment]. [Article in French]. Bull Acad Natl Med. 2013 Feb;197(2):407-17.
  24. McHutchison JG, Dusheiko G, Shiffman ML, Rodriguez-Torres M, Sigal S, Bourliere M, Berg T, Gordon SC, Campbell FM, Theodore D, Blackman N, Jenkins J, Afdhal NH; TPL102357 Study Group. Eltrombopag for thrombocytopenia in patients with cirrhosis associated with hepatitis C. N Engl J Med. 2007 Nov 29;357(22):2227-36.
  25. Kuter DJ.Thrombopoietin and thrombopoietin mimetics in the treatment of thrombocytopenia. Annu Rev Med. 2009;(60):193-206.
  26. Shih A, Nazi I, Kelton JG, Arnold DM. Novel treatments for immune thrombocytopenia. 2014 Apr;43(4 Pt 2):e87-95. doi: 10.1016/j.lpm.2014.02.006.
  27. Panzer S. Eltrombopag in chronic idiopathic thrombocytopenic purpura and HCV-related thrombocytopenia. Drugs Today (Barc). 2009 Feb;45(2):93-9. doi: 10.1358/dot.2009.45.2.1322479.
  28. Nomura Y, Kage M, Ogata T, Kondou R, Kinoshita H, Ohshima K, Yano H. Influence of splenectomy in patients with liver cirrhosis and hypersplenism. Hepatol Res. 2014 Oct;44(10):E100-9. doi: 10.1111/hepr.12234.
  29. Aref S, Ibrahem L, El Menshawy N, Bassam A.Effect of splenectomy on platelets associated antibodies in hepatitis C patients with thrombocytopenia. Hematology. 2012 Mar;17(2):118-21. doi: 10.1179/102453312X13221316477705.
  30. Vidmane-Ozola I, Boka V, Tsunskis E, Leinietse S, Rivkina A, Kalnin'sh I. Laparoskopicheskaia splenektomiia u gematologicheskikh bol'nykh s gipersplenizmom, vyzvannym tsirrozom pecheni [Laparoscopic splenectomy of hematological patients with hypersplenism caused by cirrhosis of the liver]. Khirurgiia. Zhurn im NI Pirogova 2012;6:13-18.
  31. Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot JF, Leandros E, Lechner K, Rhodes M, Silecchia G, Szold A, Targarona E, Torelli P, Neugebauer E. Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2008 Apr;22(4):821-48. doi: 10.1007/s00464-007-9735-5.
  32. Zhu JH, Wang YD, Ye ZY, Zhao T, Zhu YW, Xie ZJ, Liu JM. Laparoscopic versus open splenectomy for hypersplenism secondary to liver cirrhosis. Surg Laparosc Endosc Percutan Tech. 2009 Jun;19(3):258-62. doi: 10.1097/SLE.0b013e3181a6ec7c.
  33. Murata K, Ito K, Yoneda K, Shiraki K, Sakurai H, Ito M. Splenectomy improves liver function in patients with liver cirrhosis. Hepatogastroenterology. 2008;(55)85:1407-11.
  34. Gol'dshtein AV. Vaktsinoprofilaktika pnevmokokkovoi infektsii. Vaktsinatsiia: [Vaccines for pneumococcal disease prevention. Vaccination]. Novosti Vaktsinoprofilaktiki. 2004;(32)2:10-11.
  35. Kozlov RS. Sovremennye vozmozhnosti spetsificheskoi profilaktiki pnevmokokkovykh infektsii [Current possibilities of specific prevention of pneumococcal infections]. Klin Mikrobiol i Antimikrob Khimioterapiia. 2002;(4)1:61-69.
  36. Watanabe Y, Horiuchi A, Yoshida M, Yamamoto Y, Sugishita H, Kumagi T, Hiasa Y, Kawachi K. Significance of laparoscopic splenectomy in patients with hypersplenism. World J Surg. 2007 Mar;31(3):549-55.
  37. Batvinkov NI, Garelik PV. Diagnostika i lechenie zabolevanii i travm selezenki [Diagnosis and treatment of diseases and injuries of the spleen]. Vestn Khirurgii. 1989;(10):131-33.
  38. Sukhov MN, Drozdov AV, Isaeva MV, Seniakovich NB, Myzin AV, Mosin AV, Nazhimov VP, Nasibulin MD. Partsial'naia rezektsiia selezenki u bol'nykh tsirrozom pecheni: pervyi opyt [Partial resection of the spleen in patients with cirrhosis of the liver: the first experience]. Tikhookean Med Zhurn. 2004;(3):64-65.
  39. Gajin P, Radević B, Nenezić D, Ilijevski N, Jesić-Vukićević R, Radak D. Distal splenorenal shunt with partial spleen resection. [Article in Serbian] Srp Arh Celok Lek. 2007 May-Jun;135(5-6):293-97.
  40. Boiko VV, Klimova EM, Avdos'ev IuV, Grechikhin GV. Novyi podkhod k vyboru metoda khirurgicheskogo lecheniia gipersplenizma u bol'nykh tsirrozom pecheni [A new approach to the choice of method of surgical treatment of hypersplenism in patients with liver cirrhosis]. Khark³v Kh³rurg Shkola. 2011;(2):130-32.
  41. Sockrider CS, Boykin KN, Green J, Marsala A, Mladenka M, McMillan R, Zibari GB.Partial splenic embolization for hypersplenism before and after liver transplantation. Clin Transplant. 2002;16 Suppl 7:59-61.
  42. Omer S, Zara O2, Iacobescu C3, Dina I4.Partial splenic embolization for hypersplenism in cirrhotic patients. A case series. J Gastrointestin Liver Dis. 2014 Jun;23(2):215-18.
  43. Amin MA, el-Gendy MM, Dawoud IE, Shoma A, Negm AM, Amer TA.Partial splenic embolization versus splenectomy for the management of hypersplenism in cirrhotic patients. 2009 Aug;33(8):1702-10. doi: 10.1007/s00268-009-0095-2.
  44. Elmonem SA, Tantawy HI, Ragheb AS, Matar NE, Tantawi I. The outcome of partial splenic embolization for hypersplenism in the cirrhotic patients. Egypt J of Radiol & Nuclear Medicine 03/2011; 42(1):35–42.
  45. Liu QD, Ma KS, He ZP, Ding J, Huang XQ, Dong JH. Experimental study on the feasibility and safety of radiofrequency ablation for secondary splenomagely and hypersplenism. World J Gastroenterol. 2003 Apr;9(4):813-7.
  46. Liu QD, Ma KS, He ZP, Ding J, Huang XQ, Dong JH. The feasibility and safety of radiofrequency ablation for secondary splenomegaly and hypersplenism in dogs. Zhonghua Wai Ke Za Zhi. 2003 Apr;41(4):299-302. [Article in Chinese].
  47. Pursnani KG, Sillin LF, Kaplan DS.Effect of transjugular intrahepatic portosystemic shunt on secondary hypersplenism. Am J Surg. 1997 Mar;173(3):169-73.
  48. Barney EJ, Little EC, Gerkin RD, Ramos AX, Kahn J, Wong M, Kolli G, Manch R. Coated transjugular intrahepatic portosystemic shunt does not improve thrombocytopenia in patients with liver cirrhosis. Dig Dis Sci. 2012 Sep;57(9):2430-7. doi: 10.1007/s10620-012-2162-z.
  49. Papp M., Mezei G., Udvardy M., Altorjay I. Changes in hematologic and hemostatic parameters after transjugular intrahepatic portosystemic shunt (TIPS) implantation. Orv Hetil. 2003;(144)27:1341-45.
Address for correspondence:
230023, ul. Gorkogo, 80, g.
Grodno, UO "Grodnenskiy gosudarstvennyiy
meditsinskiy universitet",
1-ya kafedra khirurgicheskih bolezney,
tel.mob.: 375 29 586 16 00,
e-mail: emogilevec@yandex.ru
Mogilevets Eduard Vladislavovich
Information about the authors:
Mahiliavets E.V. PhD, an associate professor of the 1st chair of surgical diseases of EE "Grodno State Medical University".
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