CORRECTION OF HEMATOLOGICAL INDICATORS IN PATIENTS WITH PORTAL HYPERTENSION
DOI:
https://doi.org/10.11603/1811-2471.2023.v.i3.14087Keywords:
liver cirrhosis, portal hypertension, hypersplenism, porto-azygos disconnection, splenectomyAbstract
SUMMARY. The aim – to evaluate surgical tactics to improve the survival prognosis of patients with PH complicated by bleeding from esophageal varices, and to identify hematological changes in the early postoperative period as a compensatory indicator of PH.
Material and Methods. The clinical material of 34 patients with PG was analyzed (average age – 49.09±1.65 years; 16 men, 18 women). The patients were divided into two groups: the first group – 23 patients, the source of bleeding was eliminated by laparoscopic assisted devascularization of the proximal part of the stomach, abdominal part of the esophagus with its subsequent transection in the epicardial area; the second group – 11 patients additionally performed splenectomy.
Results. In the postoperative period, changes in the dynamics of hematological parameters between the studied groups were detected. In the first group, an increase in the level of erythrocytes on the first day after surgery by 15.61 % compared to the initial values, a decrease by 11.25 % on the third day compared to the first day, and a slight increase by 0.72 % on the eleventh day compared to the third around the clock Whereas, accordingly, in the second group, there was an increase of 18.65 % on the first day, a decrease of 1.31 % on the third day, and a slight decrease of 1 % by the eleventh day.
The dynamics of leukocytosis had a wave-like character: on the first day of the postoperative period, the level of leukocytes increased by 63.39 % in the first group and by 80.56 % in the second group compared to the initial indicators, on the third day there was a decrease of 13.34 % in the first and on 6.37 % in the second group compared to the first day, on the eleventh day a significant decrease in leukocytosis was found by 46.67 % and 45.41 %, respectively.
The dynamics of platelet level changes showed a linear upward trend in both groups. In the first group, the increase was not significant: on the first day by 3.1 %, on the third day by 10.11 %, on the eleventh day by 2.49 %. In the second group, a significant increase was recorded: 165.94 % on the first day, 466.15 % on the third day compared to the first day and 177.76 % on the eleventh day compared to the third day, and compared to the initial level by 1374.95 %, i.e. more than 13.5 times. In the period of 9–12 months, 32 patients were examined, one patient died, 2 patients of the first group had recurrences of bleeding without the need for blood transfusions and resuscitation measures.
Conclusions. 1. Portal hypertension leads not only to significant disturbances in hemodynamic indicators, in the form of venous dilatation, but also in hematological ones, which are due to functional disorders of the liver and pronounced hypersplenism. 2. Performing splenectomy in combination with devascularization of the cardiac part of the stomach and the abdominal part of the esophagus and its hardware transection significantly improves hematological indicators and, as a result, reduces the number of complications and mortality.
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