Artigos Nacionais - Resumo

Trombose de veia porta após desconexão ázigo-portal e esplenectomia em pacientes esquistossomóticos. Qual a real importância?
Autores: Makdissi FF , Herman P, Machado MA, Pugliese V, D'Albuquerque LA
Arq Gastroenterol 2009; 46(1):50-56.

 

 

RESUMO - Contexto - A complicação mais frequente após a desconexão ázigo-portal e esplenectomia em doentes com esquistossomose mansônica hepatoesplênica é a trombose da veia porta. Objetivos - Avaliar a incidência, os fatores preditivos dessa complicação, assim como, a evolução clínica, laboratorial, endoscópica e ultrassonográfica desses pacientes. Métodos - Foram analisados retrospectivamente os prontuários de 155 doentes esquistossomóticos submetidos a desconexão ázigo-portal e esplenectomia. Resultados - Trombose de veia porta foi observada em 52,3% dos pacientes, sendo 6,5% de trombose total e 45,8% de trombose parcial. Os pacientes que evoluíram com trombose de veia porta apresentaram mais frequentemente diarreia no pós-operatório. Febre foi evento habitual que ocorreu em 70% dos casos, mais frequente, entretanto, nos doentes com trombose total da veia porta (100%). Trombose de veia mesentérica superior ocorreu em quatro doentes (2,6%), sendo mais frequente entre os com trombose total da veia porta. Não se encontrou diferença estatística quanto aos parâmetros clínicos, laboratoriais, endoscópicos e recidiva hemorrágica no pós-operatório tardio, quando comparados os pacientes com e sem trombose portal. Conclusões - A trombose de veia porta no pós-operatório da desconexão ázigo-portal e esplenectomia é evento frequente, sem nenhum fator preditivo para sua ocorrência; na maioria dos casos a trombose é parcial e apresenta evolução benigna, com baixa morbidade; trombose total da veia porta está mais frequentemente associada à trombose da veia mesentérica superior, com elevada morbidade; a trombose da veia porta, parcial ou total, não acarretou complicações no período pós-operatório tardio.

 
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