Veia gástrica posterior: hipertensão porta

Silva, Alcino Lázaro da; Navarro, Túlio Pinho; Oliveira, Sérgio Caporali de; Faion, Ailton Gomes; Ferreira, Lincoln Warley

doi:10.1590/S0100-69911999000500004

Resumos

A veia gástrica posterior não é muito citada nos livros de anatomia e nos trabalhos sobre hipertensão porta. Estudou-se sua anatomia, freqüência e desembocadura. Ela foi encontrada em 54% dos casos e, em 100%, desembocava na veia esplênica. Discute-se a vantagem ou não de sua ligadura ou preservação no tratamento cirúrgico da hipertensão porta.

Hipertensão porta; Varizes; Veia gástrica posterior

The posterior gastric vein has not been mentioned very often neither in anatomy textbooks nor in portal hypertension papers. The authors studied the anatomy, frequency and confluence of this vein because is a huge variety in the presentation of esophageal varices. Twenty-six adult preserved corpses (twenty females and six males) had a wide abdominal incision allowing the dissection of the portal system, identifying the frequency and confluence of its tributaries, notably the posterior gastric vein. The portal vein, in all cases, was formed by the confluence of the superior mesenteric vein with the splenic vein and had a mean length of 6.4 cm. The splenic vein had a mean length of 6.5 cm. The left gastric vein was tributary of the portal vein in 50% of the cases and in 30% of the cases in the splenic vein. The right gastric vein had it's confluence to portal vein in 30 % of the cases and to the splenic vein in 4 %. The inferior mesenteric vein was tributary of the splenic vein in 54% of the cases and in the superior mesenteric vein in 46%. The left gastro-omental vein had its confluence to the splenic vein in 50% of the cases and to the inferior polar vein in 34 %. The middle colic vein had its confluence to superior mesenteric vein in 42% of the cases, to inferior mesenteric vein in 12% and to splenic vein in 8%. The posterior gastric vein was found in 54% of the corpses, and in all cases it was a tributary of the splenic vein, in retropancreatic position, coming from the esophageal-gastric junction. These findings agree with previous papers describing a prevalence of 60% of posterior gastric vein in patients submitted to surgery in portal hypertension, and in all cases, this vein was tributary of the splenic vein. The identification of this vein may influence the treatment, because if left untied during cases of portal-azigos disconnection, they may predispose to postoperative bleeding, but in cases of splenorenal anastomosis may preserve its patency in cases of anastomosis occlusion, or can lead again to postoperative bleeding feeding the esophageal varices. To ligate or not this vein will depends on the surgeon 's experience and common sense. Regarding to previous papers and to this data presented here, the authors believe that the prevalence of this vein is between 50 and 60% in the population.

Portal hypertension; Varices; Posterior gastric vein

ARTIGOS ORIGINAIS

Veia gástrica posterior. Hipertensão porta

Posterior gastric vein. Portal hipertension

Alcino Lázaro da Silva, TCBC-MG^I; Túlio Pinho Navarro^II; Sérgio Caporali de Oliveira^II; Ailton Gomes Faion^III; Lincoln Warley Ferreira^III

^IProfessor Titular de Cirurgia do Aparelho Digestivo da Faculdade de Medicina da UFMG

^IICirurgião Vascular do Departamento de Cirurgia da Faculdade de Medicina da UFMG

^IIICirurgião Geral do Departamento de Cirurgia da Faculdade de Medicina da UFMG

^{Endereço para correspondência} Endereço para correspondência: Alcino Lázaro da Silva Rua Guaratinga, 151 30315-430 - Belo Horizonte - MG

RESUMO

A veia gástrica posterior não é muito citada nos livros de anatomia e nos trabalhos sobre hipertensão porta. Estudou-se sua anatomia, freqüência e desembocadura. Ela foi encontrada em 54% dos casos e, em 100%, desembocava na veia esplênica. Discute-se a vantagem ou não de sua ligadura ou preservação no tratamento cirúrgico da hipertensão porta.

Unitermos: Hipertensão porta; Varizes; Veia gástrica posterior.

ABSTRACT

The posterior gastric vein has not been mentioned very often neither in anatomy textbooks nor in portal hypertension papers. The authors studied the anatomy, frequency and confluence of this vein because is a huge variety in the presentation of esophageal varices. Twenty-six adult preserved corpses (twenty females and six males) had a wide abdominal incision allowing the dissection of the portal system, identifying the frequency and confluence of its tributaries, notably the posterior gastric vein. The portal vein, in all cases, was formed by the confluence of the superior mesenteric vein with the splenic vein and had a mean length of 6.4 cm. The splenic vein had a mean length of 6.5 cm. The left gastric vein was tributary of the portal vein in 50% of the cases and in 30% of the cases in the splenic vein. The right gastric vein had it's confluence to portal vein in 30 % of the cases and to the splenic vein in 4 %. The inferior mesenteric vein was tributary of the splenic vein in 54% of the cases and in the superior mesenteric vein in 46%. The left gastro-omental vein had its confluence to the splenic vein in 50% of the cases and to the inferior polar vein in 34 %. The middle colic vein had its confluence to superior mesenteric vein in 42% of the cases, to inferior mesenteric vein in 12% and to splenic vein in 8%. The posterior gastric vein was found in 54% of the corpses, and in all cases it was a tributary of the splenic vein, in retropancreatic position, coming from the esophageal-gastric junction. These findings agree with previous papers describing a prevalence of 60% of posterior gastric vein in patients submitted to surgery in portal hypertension, and in all cases, this vein was tributary of the splenic vein. The identification of this vein may influence the treatment, because if left untied during cases of portal-azigos disconnection, they may predispose to postoperative bleeding, but in cases of splenorenal anastomosis may preserve its patency in cases of anastomosis occlusion, or can lead again to postoperative bleeding feeding the esophageal varices. To ligate or not this vein will depends on the surgeon 's experience and common sense. Regarding to previous papers and to this data presented here, the authors believe that the prevalence of this vein is between 50 and 60% in the population.

Key words: Portal hypertension; Varices; Posterior gastric vein.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido em 5/3/99

Aceito para publicação em 9/8/99

Trabalho realizado no Departamento de Cirurgia da Faculdade de Medicina da Universidade Federal de Minas Gerais - UFMG.

1. Abdalla P. Formaçăo do Sistema Porta, in Anais do XI Congresso de Anatomia e 11 Congresso Luso-Brasileiro de Anatomia-Julho 1976 - Vol. l.
2. Kelner S. Veia mesentérica superior: contribuiçăo anatômica ŕs anastomoses cirúrgicas com o sistema cava superior. 1953. Tese (Livre-Docęncia em Técnica Operatória e Cirurgia Experimental) - Universidade do Recife.
3. Pitanga LC.Cirurgia da Hipertensăo Portal Esquistossomótica. Livro Médico Editora Ltda., Rio de Janeiro, 1980, pág. 20.
4. Vieira ET. Veia gástrica posterior. Revista da Associaçăo Médica Brasileira 1968; 10: 265-266.
5. Kimura K, Ohtio M, Matsutani S, et al. Relative frequencies of portosystemic pathways and renal shunt formation through the "posterior" gastric vein: portographic study in 460 patients. Hepatology 1990;12:725-728.
6. SaIam AA, Warren WD. Anatomic basis of the surgical treatment of portal hypertension. Surg Clin N Am 1974;54:1.247-57.
7. Lázaro da Silva A, Nunes TA. Estudo radiológico da anastomose espleno-renal proximal através da veia gastro-omental direita em pacientes portadores de hipertensăo porta esquistossomótica. Rev Goiana Med 1991;37:23-28.
8. Nunes TA. Estudo radiológico da anastomose espleno-renal proximaI através da veia gastro-omentaI direita em pacientes portadores de hipertensăo porta esquistossomótica. Tese de Doutoramento. Fac. Med. UFMG, 1992.
9. Katoh H, Shimozawa E, Kojima T, et al. Modified splenorenal shunt with splenopancreatic disconnection. Surgery 1989;5:920-924.
10. Lacombe M, Vaysse J. Arguments in favour of splenorenal anastomosis. J Cardiov Surg 1967;8:142-148.
11. Langer B, Taylor BR, Greig PD. Selective or total shunts for variceal bleeding. Am J Surg 1990;160:75-79.
12. Leite Sobrinho GB, Pardini R, Silva AL. Síndrome de hipertensăo porta por esquistossomose mansoni. Rev Bras Med 1992;49: 639- 646.
13. Warren WF, Fomon JJ, Zeppa R. Further evaluation of selective decompression of varices by splenorenaI shunt. Arlna/s of Surgery 1969;169:652-660.
14. Warren WD, Millikan WJ Jr., Henderson JM, et al. Splenopancreatic disconnection; improved selectivity of distal splenorenal shunt. Anna/s of Surgery 1986;204:346-355.

Endereço para correspondência:

Alcino Lázaro da Silva

Rua Guaratinga, 151

30315-430 - Belo Horizonte - MG

Datas de Publicação

Publicação nesta coleção
24 Nov 2009
Data do Fascículo
Out 1999

Histórico

Aceito
09 Ago 1999
Recebido
05 Mar 1999

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Abdalla P. Formaçăo do Sistema Porta, in Anais do XI Congresso de Anatomia e 11 Congresso Luso-Brasileiro de Anatomia-Julho 1976 - Vol. l.

[2] 2. Kelner S. Veia mesentérica superior: contribuiçăo anatômica ŕs anastomoses cirúrgicas com o sistema cava superior. 1953. Tese (Livre-Docęncia em Técnica Operatória e Cirurgia Experimental) - Universidade do Recife.

[3] 3. Pitanga LC.Cirurgia da Hipertensăo Portal Esquistossomótica. Livro Médico Editora Ltda., Rio de Janeiro, 1980, pág. 20.

[4] 4. Vieira ET. Veia gástrica posterior. Revista da Associaçăo Médica Brasileira 1968; 10: 265-266.

[5] 5. Kimura K, Ohtio M, Matsutani S, et al. Relative frequencies of portosystemic pathways and renal shunt formation through the "posterior" gastric vein: portographic study in 460 patients. Hepatology 1990;12:725-728.

[6] 6. SaIam AA, Warren WD. Anatomic basis of the surgical treatment of portal hypertension. Surg Clin N Am 1974;54:1.247-57.

[7] 7. Lázaro da Silva A, Nunes TA. Estudo radiológico da anastomose espleno-renal proximal através da veia gastro-omental direita em pacientes portadores de hipertensăo porta esquistossomótica. Rev Goiana Med 1991;37:23-28.

[8] 8. Nunes TA. Estudo radiológico da anastomose espleno-renal proximaI através da veia gastro-omentaI direita em pacientes portadores de hipertensăo porta esquistossomótica. Tese de Doutoramento. Fac. Med. UFMG, 1992.

[9] 9. Katoh H, Shimozawa E, Kojima T, et al. Modified splenorenal shunt with splenopancreatic disconnection. Surgery 1989;5:920-924.

[10] 10. Lacombe M, Vaysse J. Arguments in favour of splenorenal anastomosis. J Cardiov Surg 1967;8:142-148.

[11] 11. Langer B, Taylor BR, Greig PD. Selective or total shunts for variceal bleeding. Am J Surg 1990;160:75-79.

[12] 12. Leite Sobrinho GB, Pardini R, Silva AL. Síndrome de hipertensăo porta por esquistossomose mansoni. Rev Bras Med 1992;49: 639- 646.

[13] 13. Warren WF, Fomon JJ, Zeppa R. Further evaluation of selective decompression of varices by splenorenaI shunt. Arlna/s of Surgery 1969;169:652-660.

[14] 14. Warren WD, Millikan WJ Jr., Henderson JM, et al. Splenopancreatic disconnection; improved selectivity of distal splenorenal shunt. Anna/s of Surgery 1986;204:346-355.

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