J.Jpn. Surg. Soc.. 56(9): 1169-1194, 1955
STUDIES ON THE PATHOHISTOLOGICAL CHANGES OF THE LIVER AND THE SPLEEN IN PORTAL VEIN SURGERY
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2nd Surgical Department, Tokyo University School of Medicine (Director: Prof. KIMOTO) Junpei MIYAO |
Portacaval anastomosis (Eck's fistula) was performed on dogs. PathohistoIogical, studies were done on the liver and spleen between 9-685 days after operation. Up to about 30 days post-operative parenchymal damage of the liver was seen but after that gradual recovery was noted. No progressive liver atrophy such as seen in reports made by Bollman and Mann were observed.
As arterialization of portal vein, end-to-side anastomosis between renal artery and portal vein, side-to-side anastomosis between mesenteric artery and portal vein, and as complete arterialization of portal vein, Eck's operation in combination with end-to-end anastomosis between renal artery and portal vein, Eck's operation in combination with side-to-end anastomosis between the aorta and portal vein was performed, but severe liver damage was seen in those other than when renal artery was used.
After arterialization of portal vein, dilatation of portal venous radicles in the livere and a long term thickening of the vascular wall were the characteristic changes obserrved.
Although the liver damage recovers certain period of time after Eck's operation as anticipated, further liver damage and Eck fistula syndrome can be prevented if arterialization of portal vein is also combined.
2. Cornments of the clinical cases.
Laparotomies were performed on 56 cases of portal hypertension and the pathohistological findings of the liver specimen and the portal vein pressure were compared. No relation between the pathohistological extent of Iiver cirrhosis and the portal vein pressure was found, but there was a interrelationship between the edema, cell infiltration, thickening of the vascular wall of portal venous radicles in the liver and the portal vein pressure. Henceforth, it is important to note that portal scIerosis is the cause of portal hypertension more than liver cirrhosis itself.
Laparotomies were performed again on 4 cases of Eck's operation and 3 cases of arterialization of porlal vein. From the findings of the liver and results of the operation, Eck's operation was more successful in decreasing the portal vein pressure but there was more post-operative liver damage. On the other hand, when arterialization of the portal vein was combined, prevention of liver damage and occurrence of Eck fistula syndrome could be anticipated.
(author's abstract)
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