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Transabdominal gastroesophageal devascularization without transection for bleeding varices: results and indicators of prognosis 总被引:3,自引:0,他引:3
Goyal N Singhal D Gupta S Soin AS Nundy S 《Journal of gastroenterology and hepatology》2007,22(1):47-50
BACKGROUND: Esophagogastric devascularization is an operation that can be performed for endoscopically uncontrolled variceal bleeding in hospitals having only basic surgical instruments and is therefore an appropriate procedure for small hospitals in developing countries. The aim of this study was to analyze one hospital's experience of this operation in consecutive patients with variceal bleeding. METHODS: Between 1996 and 2003, 45 patients (30 male, 15 female) who had a mean age of 40 years (range 7-78 years) underwent devascularization procedures. Of the 45, 23 had cirrhosis and 22 had non-cirrhotic portal hypertension (11 extrahepatic portal venous obstruction, 11 non-cirrhotic portal fibrosis), and 18 patients had emergency procedures and 27 were elective. Mortality, morbidity, rebleeding rates and the prognostic factors for death were assessed. RESULTS: Elective and emergency mortality was one (3.7%) and 11 (61%) patients, respectively. There was no rebleeding in hospital. At follow up (mean 48 months, range 3-92 months) overall survival in patients with cirrhosis was 7 out of 20 and in patients with non-cirrhotic portal hypertension was 19 of 21. Five (17%) had recurrent variceal hemorrhage, of whom three, all cirrhotic patients, died. Preoperative prognostic indicators for death were emergency surgery, a Child-Pugh score >or=10, preoperative blood transfusion >or=20 units and renal failure. CONCLUSIONS: Gastroesophageal devascularization effectively controls variceal bleeding especially in non-cirrhotic patients with portal hypertension. In the elective situation it carries a low mortality and rebleed rate. In emergencies the prognosis is poor with advanced cirrhosis, following large quantities of blood transfusion and deranged renal function. It is suggested that this operation be offered especially to non-cirrhotic patients in hospitals in developing countries where facilities for more sophisticated procedures are not available. 相似文献
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G. Nagabhusan S. K. Acharya Y. K. Joshi S. Nundy B. N. Tandon M.D. 《Journal of gastroenterology》1989,24(4):442-445
The accuracy of ultrasonography (US) in delineating the portal vascular anatomy was assessed clinically by the clinician in
30 cases of portal hypertension due to noncirrhotic portal fibrosis and extra hepatic portal venous obstruction. Ultrasonography
detected portal vein block in 19 and in 11 patients it was found to be patent. These ultrasonic diagnoses were confirmed by
spleno-portovenography (SPV) in all, except in 2 cases due to technical failure. Ultrasononic assessment of the splenic vein
was found to be accurate in 93.3% (28/30) of cases. SPV also had similar accuracy of splenic vein assessment when compared
with the surgical findings. In one patient, intraperitoneal haemorrhage was encounted following SPV, necessitating emergency
surgery. Thus, US was found to be as accurate as splenoportovenography in the assessment of portal vascular anatomy. The imaging
technique is cheap, easy, safe, and can be repeated as often as necessary. It should be the procedure of choice in assessing
the anatomy of portal vascular system. 相似文献
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Sanjiv Saigal Nabeen C. Nayak Deepali Jain Vinay Kumaran Ravi Mohanka Neeraj Saraf Amit Rastogi Naimesh Mehta Samiran Nundy Arvinder Soin 《Hepatology International》2011,5(4):882-889