Ischemic-reperfusion hepatic injuries in patients after performance of combined resections on pancreatic gland and portal vein
Objective. Elaboration of the early diagnosis algorithm for thrombosis of the portomesenterial confluens veins in patients after performance of pancreatic resections, соmbined with resection or damage of portal vein and its branches for timely correction of complications developed.
Маterials and methods. Analysis of results of surgical treatment was presented, concerning 269 patients, to whom pancreatic resection of various volume performed, of them in 15 (5.6%) additionally various variants of resection/reconstruction of portal vein with its branches, аnd in 6 (2.2%) patients unintentional damage of the porto-mesenterial confluens veins were noted. Ischemic-reperfusion hepatic damage have been occurred in 17 patients, in 4 patients a portal vein and its branches thrombosis was revealed.
Results. Three degrees of severity of postoperative acute hepatic insufficiency were delineated, basing on estimation of the investigated parameters. Middle and severe degrees of postoperative acute hepatic insufficiency demands essential correction of the intensive therapy conducted. Because of thrombosis of portal vein and its branches 3 of 4 patients died in early postoperative period. Surgical correction of this complication was performed in two patients.
Conclusion. Severe acute hepatic insufficiency may constitute a consequence of thrombosis of a portal vein and its branches, that is why a constant monitoring of passability of the portomesenterial confluens vessels is needed. Revealing of a portal vein thrombosis demands performance of thrombectomy with a portal vein plasty, what gives background to rely on favorable result of treatment.
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