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The journal «ONCOSURGERY» 2013, Vol.5, No 4

Organ-sparing surgeries for spleen injury and dynamics of serum cytolytic enzymes

Musatov OV, Zurnadjan SA, Kokhanov AV

Astrakhan State Medical Academy, Department of Operative surgery with Section anatomy, Department of General hygiene, Astrakhan, Russia
Contact: Мusatov ОV, e-mail:

The rate of iatrogenic injuries of spleen during surgery on gastrointestinal tract for malignant tumors is from 0.24% to 3.1%. Considering the possibility for sparing the spleen in this situa-tion comparative analysis of autograft organ-sparing surgery impact on the dynamics of serum cytolytic enzymes was performed in the study on 72 rabbits.

Material and methods. Premodeled wound in lower pole of the spleen was repaired by seromuscular pedicled flap from greater curvature of the stomach in 45 rabbits under general anesthesia, by greater omentum – in, the control group included 10 intact animals. The follow-up period was from 1 to 360 days.

Results. In the group of gastric spleen reconstruction alanine aminotransferase, aspar-tate aminotransferase and hepatic lactate dehydrogenase tended to lower levels with earlier terms of recovery comparing with group of omental spleen reconstruction. Only gamma glu-tamine transferase had reverse dynamics: its levels after reconstruction by gastric autoflap higher than for omental reconstruction, its recovery occurred at day 60, that is later than in the group of omental reconstruction for 1 month.

Application of results. For spleen injury and if use of greater omentum is impossible one can use seromuscular pedicled flap from the stomach to perform organ-sparing surgery on this parenchymal organ.

Conclusion. Use of different autoflaps for repair of spleen wound has differential im-pact on dynamics of serum cytolytic enzymes. The dynamics of alanine aminotransferase, as-partate aminotransferase and hepatic lactate dehydrogenase reflects pattern of inflammatory and reparative processes in the spleen wound. Dynamics of gamma glutamine transferase re-flects extent of surgical injury for autoreconstruction of spleen wound.

KEY WORDS: Spleen, wound, stomach, flap, omentum.

References

  1. Maslyakov VV, Dmitriev NV, Barsukov VG. Surgical tactics for iatrogenic injuries of spleen. Vestnik khirurgii im. I.I. Grekova, 2010; 169(2): 90-91.
  2. Langevin JM, Rothenberger DA, Goldberg SM. Accidental splenic injury during surgical treatment of the colon and rectum. Surg Gynecol Obstet, 1984; 159(2):139-44
  3. Malek MM, Greenstein AJ, Chin EH, Nguyen SQ, Sandler AL, Wong RK, Byrn JC, Katz LB, Divino CM. Comparison of iatrogenic splenectomy during open and laparoscopic colon resection. Surg Laparosc Endosc Percutan Tech, 2007; 17(5): 385-7.
  4. Wakeman CJ, Dobbs BR, Frizelle FA, Bissett IP, Dennett ER, Hill AG, Thompson-Fawcett MW. The impact of splenectomy on outcome after resection for colorectal cancer: a multicenter, nested, paired cohort study. Dis Colon Rectum, 2008; 51(2): 213-7.
  5. Holubar SD, Wang JK, Wolff BG, Nagorney DM, Dozois EJ, Cima RR, O’Byrne MM, Qin R, Larson DW. Splenic salvage after intraoperative splenic injury during colectomy. Arch Surg, 2009; 144(11): 1040-5.
  6. Mettke R, Schmidt A, Wolff S, Koch A, Ptok H, Lippert H, Gastinger I. Milzver-letzungen im Rahmen kolorektaler Karzinomchirurgie. Einfluss auf das fruhpostoperative Ergebnis Chirurg, 2012; 83(9): 809-14.
  7. Gaugin EE, Rutkovskiy VV. Infectious complications in patients with blood disease after splenectomy. Klin med, 1985; (5): 95-98.
  8. Kataev SI, Chernenko NV. Characteristics of liver microvasculature in rats after splenectomy based on correlation analysis. Astrakhan Medical Journal, 2007; 2 (2): 89.
  9. Ricchi P, Ammirabile M, Costantini S, Di Matola T, Spasiano A, Genna M.L, Cinque P, Prossomariti L. Splenectomy is a risk factor for developing hyperuricemia and nephrolithiasis in patients with thalassemia intermedia: a retrospective study. Blood Cells Mol Dis. 2012; 49(3-4): 133-5.
  10. Struchko GJu, Merkulova LM, Stomenskaya IS, Zakhid M, Nikiforova NV, Soloviova IA. Accidental thymus involution after splenectomy ( immunohistological study). Morphologiya, 2001; 120 (5): 65-71.
  11. Nechai VV. Late morphological changes of intestine after splenectomy in mice BALB/C. Russian medical biological vestnik im. I.P. Pavlova, 2012; (1): 35-40.
  12. Atlas of oncological surgeries. Edited by BE Peterson, VI Chissov, AI Paches. М: Medicina, 1987; 536.
  13. Valter VG, Prolisko SV. Use of seromuscular flap from the stomach for revascularization of kidney. Vestnik khirurgii im. I.I. Grekova, 1969; 102(4): 34−37.
  14. Zurnadjyants VA, Chernikin GP, Vasilkov VN. Repair of wound surface of parenchymal organs by seromuscular flap from greater curvature of stomach. Klin khir, 1979. (1): 56-57.
  15. Chissov VI, Reshetov IV. Microsurgical transplantation of orgqns and tissues in cancer patients. Khirurgiya, 1999; 8-11.
  16. Bayles SW, Hayden RE. Gastroomental free flap reconstruction of the head and neck. Arch Facial Plast Surg, 2008; 10(4): 255-9.
  17. Musatov OV, Zurnadgan SA, Bogatyreva OE. Morphometric estimation of wound necrosis in liver, spleen and kidney depending on type of wound closure in the experimental study. Bul experim biol and med, 2008; 146 (11): 591-593.
  18. Zurnadzhyants VA, Nazarochkin YuV. Autotransplantation of spleen after splenectomy. Vestnik khirurgii im. I.I. Grekova, 1995; 154 (3): 45-49.

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