nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”10.23934/2223-9022-2021-10-3-589-597nmp-1224Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL OBSERVATIONSПервый клинический опыт венозной реконструкции аутологичным сосудистым протезом из серповидной связки печени при парциальном портосистемном шунтированииFirst Clinical Experience of Venous Reconstruction With Autologous Vascular Prosthesis From the Sickle Ligament of the Liver With Partial Portosystemic Bypass Surgeryhttps://orcid.org/0000-0003-4156-434XАнисимовА. Ю.AnisimovA. Yu.

доктор медицинских наук, профессор, заведующий кафедрой неотложной медицинской помощи и симуляционной медицины Института фундаментальной медицины и биологии, Главный внештатный специалист хирург Министерства здравоохранения Республики Татарстан

 Российская Федерация, 420008, Казань, ул. Кремлевская, д. 18 

Doctor of Medical Sciences, Professor, Head of the Department of Emergency Medicine and Simulation Medicine, Institute of Fundamental Medicine and Biology. Chief External Specialist, Surgeon of the Ministry of Health of the Republic of Tatarstan

 18, Kremlyovskaya St., Kazan 420008, Russian Federation 

aanisimovbsmp@yandex.ruhttps://orcid.org/0000-0002-5323-7226АнисимовА. А.AnisimovA. A.

преподаватель кафедры неотложной медицинской помощи и симуляционной медицины Института фундаментальной медицины и биологии 

 Российская Федерация, 420008, Казань, ул. Кремлевская, д. 18 

Lecturer of the Department of Emergency Medicine and Simulation Medicine of the Institute of Fundamental Medicine and Biology

 18, Kremlyovskaya St., Kazan 420008, Russian Federation 

aa_anisimov@bk.ruАндреевА. И.AndreevA. I.

заведующий отделением хирургии № 4 ГАУЗ ГКБ № 7

 Российская Федерация, 420103, Казань, ул. Чуйкова, д. 54 

Head of the Department of Surgery No. 4

 54, Chuikov St., Kazan 420103, Russian Federation 

aandreyi@yandex.ruhttps://orcid.org/0000-0003-0788-9845ИбрагимовР. А.IbragimovR. A.

врач-хирург отделения хирургии № 4

 Российская Федерация, 420103, Казань, ул. Чуйкова, д. 54 

Surgeon of the Department of Surgery No. 4

 54, Chuikov St., Kazan 420103, Russian Federation 

rinatibr@mail.ruhttps://orcid.org/0000-0002-6152-5033ГараевА. Т.GaraevA. T.

преподаватель кафедры неотложной медицинской помощи и симуляционной медицины Института фундаментальной медицины и биологии 

 Российская Федерация, 420008, Казань, ул. Кремлевская, д. 18 

Lecturer of the Department of Emergency Medicine and Simulation Medicine of the Institute of Fundamental Medicine and Biology

 18, Kremlyovskaya St., Kazan 420008, Russian Federation 

micro116@mail.ruФГАОУ ВО «Казанский (Приволжский) федеральный университет»РоссияKazan (Privolzhsky) Federal UniversityRussian FederationГАУЗ «Городская клиническая больница № 7»РоссияMunicipal Clinical Hospital № 7Russian Federation202119112021103589597Copyright © Анисимов А.Ю., Анисимов А.А., Андреев А.И., Ибрагимов Р.А., Гараев А.Т., 20212021Анисимов А.Ю., Анисимов А.А., Андреев А.И., Ибрагимов Р.А., Гараев А.Т.Anisimov A.Y., Anisimov A.A., Andreev A.I., Ibragimov R.A., Garaev A.T.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/1224Цель

Цель. Представление собственного первого клинического опыта венозной реконструкции при портосистемном шунтировании с использованием в качестве возможной замены аутологичных сосудистых протезов серповидной связкой печени в спленоренальной позиции у пациента с синдромом портальной гипертензии в исходе цирроза печени вирусной этиологии.

Материал и методы

Материал и методы. Представлено клиническое наблюдение пациента 1978 года рождения с диагнозом: «Цирроз печени вирусной этиологии (HCV), класс А по Child–Pugh (6). MELD 10 баллов. Неактивная фаза. Синдром внутрипеченочной портальной гипертензии. Варикозные вены пищевода III степени по А.Г. Шерцингеру, желудка — I тип (GOV1) по Sarin. Состояние после неоднократных рецидивирующих пищеводно-желудочных кровотечений». Данному пациенту в связи с высоким риском развития очередного кровотечения в качестве вторичной профилактики пищеводно-желудочного кровотечения была выполнена операция парциального спленоренального анастомоза «Н»-типа путем замены аутологичного сосудистого протеза серповидной связкой печени в спленоренальной позиции.

Результаты

Результаты. Из серповидной связки печени пациента был вырезан лоскут размерами 60,0х20,0 мм. Из последнего после подгонки размеров трансплантата под индивидуальные особенности пациента был сформирован аутологичный кондуит. Он был использован в качестве вставки при формировании спленоренального анастомоза «Н»-типа с наложением двух анастомозов по типу «конец в бок» между селезеночной веной и одним концом кондуита и между левой почечной веной и другим концом кондуита. Проходимость анастомоза была проверена с помощью интраоперационной сонографии. В удовлетворительном состоянии пациент был выписан на амбулаторное долечивание по месту жительства. На момент написания статьи срок наблюдения составил 8 месяцев. Кровотечения не повторялись. На контрольных эндоскопических исследованиях варикозных вен в пищеводе и желудке не найдено. Проходимость спленоренального шунта подтверждена данными ультразвуковой допплерографии.

Заключение

Заключение. Первый клинический опыт венозной реконструкции при портосистемном шунтировании с использованием серповидной связки печени в спленоренальной позиции в лечении синдрома портальной гипертензии дает надежду на возможность дальнейшей успешной апробации этого способа спленоренального шунтирования для снижения риска кровотечения из варикозных вен.

Aim of study. Presentation of our own first clinical experience of venous reconstruction in portosystemic bypass surgery with the use of autologous vascular prostheses of the falciform ligament of the liver in the splenorenal position in a patient with portal hypertension syndrome in the outcome of liver cirrhosis of viral etiology.Material and methods. Clinical observation of a patient born in 1978 with a diagnosis of cirrhosis of the liver of viral etiology (HCV) Child-Pugh A (6). MELD 10 points. Inactive phase. Intrahepatic portal hypertension syndrome. Esophageal varices grade III according to A. G. Scherzinger, gastric varices type I (GOV1) according to Sarin. Condition after repeated recurrent esophageal-gastric bleeding. Due to the high risk of another bleeding, as a secondary prevention of esophageal-gastric bleeding, partial splenorenal anastomosis of “H” - type was performed with the use of an autologous vascular prosthesis of the falciform ligament of the liver in the splenorenal position.Results. A flap measuring 60.0x20.0 mm was cut from the falciform ligament of the patient’s liver. From the latter, after adjusting the size of the graft to the individual needs of the patient, an autologous conduit was formed. It was used as an insert in the formation of an “H” - type splenorenal anastomosis with the imposition of two end-to-side anastomoses between the splenic vein and one end of the conduit and between the left renal vein and the other end of the conduit. The patency of the anastomosis was checked using intraoperative sonography. In a satisfactory condition, the patient was discharged for outpatient follow-up treatment at the place of residence. At the moment of writing the article, the follow-up period was 8 months. The bleeding did not recur. No varicose veins were found in the esophagus and stomach during control endoscopic examinations. The patency of the splenorenal shunt was confirmed by ultrasound dopplerography.Conclusion. The first clinical experience of venous reconstruction with portosystemic bypass surgery using as a possible replacement of autologous vascular prostheses of the falciform ligament of the liver in the splenorenal position in a patient with portal hypertension syndrome in the outcome of cirrhosis of the liver of viral etiology gives hope for the possibility of further successful testing of this method of splenorenal bypass surgery to reduce the risk of bleeding from varicose veins.

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The authors declare that there are no conflicts of interest present.