Manejo de la obstrucción del flujo venoso hepático de salida
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1Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi.
Lancet (London, England)
|September 18, 1993
Resumen
El manejo de la obstrucción del flujo venoso hepático (HVOO) mejoró con intervenciones específicas. Las derivaciones portocavales lado a lado para problemas de venas hepáticas y la angioplastia con globo para el bloqueo de la vena cava inferior ofrecen un tratamiento efectivo, lo que lleva a un alivio de los síntomas en muchos pacientes.
Área de la Ciencia:
- Hepatología Hepatología.
- Cirugía vascular Cirugía vascular.
- Radiología intervencionista Radiología intervencionista.
Sus antecedentes:
- La obstrucción del flujo venoso hepático (HVOO) es una causa rara de hipertensión portal.
- Los tratamientos conservadores para HVOO son generalmente ineficaces, lo que requiere estrategias de manejo activo.
Objetivo del estudio:
- Diseñar y evaluar un protocolo de manejo para la obstrucción del flujo venoso venoso hepático.
- Para evaluar la eficacia de diferentes procedimientos quirúrgicos e intervencionistas para HVOO basado en el sitio de obstrucción.
Principales métodos:
- Estudio prospectivo de 75 pacientes con HVOO entre 1978 y 1992.
- Categoría de HVOO en obstrucción de la vena hepática (24 pacientes), obstrucción de la vena cava inferior (IVC) (44 pacientes) y obstrucción combinada (7 pacientes).
- Evaluación de los tratamientos que incluyen derivaciones espleno-renales proximales, dilatación del globo, derivación portocaval de lado a lado y angioplastia con globo.
Principales resultados:
- La derivación portocaval de lado a lado mostró una promesa para la obstrucción de la vena hepática (4/6 vivos y bien).
- La angioplastia con globo fue muy exitosa para la obstrucción del VCI (28/30 exitosos, 4 restenosis).
- En total, 44 de 75 pacientes no presentaban síntomas, con 22 muertes y 7 tratamientos incompletos.
Conclusiones:
- Se recomienda el manejo activo de HVOO.
- La derivación portocaval de lado a lado se sugiere para la obstrucción de la vena hepática.
- La angioplastia con globo es el tratamiento preferido para la obstrucción de la vena cava inferior.
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