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Avaliação da sobrevivência comparada em animais com shunt portossistémico após tratamento médico ou cirúrgico
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Os shunts portossistémicos (SPS) são anomalias vasculares que permitem a comunicação entre a circulação venosa portal e a sistémica, resultando na consequente perda de função hepática com acumulação de toxinas no organismo e aparecimento de sinais clínicos. Existem duas possibilidades de tratamento: cirúrgico e/ou médico. O presente estudo teve como objetivo a caracterização de uma série de casos clínicos com diagnóstico de SPS de forma a comparar o prognóstico dos animais submetidos a tratamento cirúrgico com o dos animais mantidos apenas com tratamento médico. Para tal foi realizado um inquérito a médicos veterinários para recolha de informação sobre casos clínicos com SPS. A sua participação resultou na inclusão de 31 casos clínicos. Nos casos estudados, o Yorkshire terrier foi a raça mais representada (32,3%). A correção cirúrgica foi realizada em 17 casos (54,8%) e em 14 (45,2%) tratamento médico. Dos métodos cirúrgicos utilizados, o mais comum foi a ligadura de celofane (76,5%) e a aplicação do constritor ameroide (17,6%). O tratamento médico incluiu a administração de laxante (92,9%), antibiótico (100%), antioxidantes e protetores hepáticos (14,3%) e dieta hipoalergénica (25%) ou hepática (75%). Após correção cirúrgica, 88,2% dos animais resolveram os sinais clínicos em menos de um mês e nos animais com tratamento médico 64,3% demonstraram resolução dos sinais clínicos no mesmo período. Foram registadas 5 mortes, todas dentro do grupo dos animais com tratamento médico, correspondendo a uma taxa de mortalidade neste grupo de 35,7%. Foi encontrada uma associação significativa entre a não realização de cirurgia e a ocorrência de morte (p=0,012), sugerindo um benefício na correção cirúrgica dos SPS. Adicionalmente, foi demonstrada uma longevidade significativamente superior no grupo dos animais submetidos a correção cirúrgica (p=0,04). Apesar do reduzido número de casos, os resultados obtidos mostram uma tendência. Estudos adicionais, incluindo uma amostra maior, poderão contribuir para evidenciar as diferenças no prognóstico entre estas duas formas terapêuticas
ABSTRACT - Evaluation of comparative survival in animals with portosystemic shunt after medical or surgical treatment - Portosystemic shunts (PSS) are vascular anomalies that allow communication between the portal and systemic venous circulation, resulting in the consequent loss of liver function with accumulation of toxins in the body and the onset of clinical signs. There are two options for treatment: surgical and/or medical. The objective of this study was to characterize a series of clinical cases diagnosed with PSS in order to compare the prognosis of animals submitted to surgical treatment with the animals maintained only with medical treatment. To this end, a questionnaire was carried out with veterinarians to collect information on clinical cases with SPS. Their participation resulted in the inclusion of 31 clinical cases. In this study, Yorkshire terrier (32.3%) was the most represented breed. Surgical correction was performed in 17 cases (54.8%) and medical treatment was initiated in 14 (45.2%). Of the surgical methods used, the most common was cellophane banding (76.5%) and ameroid constrictor (17.6%). Medical treatment included the administration of laxatives (92.9%), antibiotics (100%), antioxidants and liver protectors (14.3%) and hypoallergenic (25%) or liver (75%) diets. After surgical correction, 88.2% of the animals solved the clinical signs in less than a month while in the animals with medical treatment, only 64.3% showed resolution of the clinical signs in the same time. Five deaths were registered, all within the group of animals with medical treatment, representing a mortality rate in this group of 35.7%. A significant association was found between not having surgery and the occurrence of death (p=0.012), suggesting a benefit in surgical correction of PSS. Additionally, a significantly higher longevity was demonstrated in the group of animals submitted to surgical correction (p=0.04). Despite the reduced number of cases, the results obtained show a trend. Additional studies, including a larger sample, may contribute to highlight the differences in prognosis between these two therapeutic forms
ABSTRACT - Evaluation of comparative survival in animals with portosystemic shunt after medical or surgical treatment - Portosystemic shunts (PSS) are vascular anomalies that allow communication between the portal and systemic venous circulation, resulting in the consequent loss of liver function with accumulation of toxins in the body and the onset of clinical signs. There are two options for treatment: surgical and/or medical. The objective of this study was to characterize a series of clinical cases diagnosed with PSS in order to compare the prognosis of animals submitted to surgical treatment with the animals maintained only with medical treatment. To this end, a questionnaire was carried out with veterinarians to collect information on clinical cases with SPS. Their participation resulted in the inclusion of 31 clinical cases. In this study, Yorkshire terrier (32.3%) was the most represented breed. Surgical correction was performed in 17 cases (54.8%) and medical treatment was initiated in 14 (45.2%). Of the surgical methods used, the most common was cellophane banding (76.5%) and ameroid constrictor (17.6%). Medical treatment included the administration of laxatives (92.9%), antibiotics (100%), antioxidants and liver protectors (14.3%) and hypoallergenic (25%) or liver (75%) diets. After surgical correction, 88.2% of the animals solved the clinical signs in less than a month while in the animals with medical treatment, only 64.3% showed resolution of the clinical signs in the same time. Five deaths were registered, all within the group of animals with medical treatment, representing a mortality rate in this group of 35.7%. A significant association was found between not having surgery and the occurrence of death (p=0.012), suggesting a benefit in surgical correction of PSS. Additionally, a significantly higher longevity was demonstrated in the group of animals submitted to surgical correction (p=0.04). Despite the reduced number of cases, the results obtained show a trend. Additional studies, including a larger sample, may contribute to highlight the differences in prognosis between these two therapeutic forms
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária, na área científica de Clínica
Palavras-chave
Cão Shunt portossistémico Tratamento Cirurgia Sobrevivência Dog Portosystemic shunt Treatment Surgery Survival
Contexto Educativo
Citação
Tavares IR. 2023. Avaliação da sobrevivência comparada em animais com shunt portossistémico após tratamento médico ou cirúrgico [dissertação de mestrado]. Lisboa: FMV-Universidade de Lisboa
Editora
Universidade de Lisboa, Faculdade de Medicina Veterinária