Year 2015 Vol. 23 No 3

REVIEWS

E.V. MAHILIAVETS

CORRECTION OF HYPERSPLENISM IN PATIENTS WITH SURGICAL COMPLICATIONS OF PORTAL HYPERTENSION

"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
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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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