Cieľ práce: Overiť správnosť indikácie chirurgickej liečby recidivujúcich krvácaní z pažerákových varixov v dôsledku cirhózy pečene. Metóda: Retrospetívnym študiom záznamov endoskopických vyšetrení a chorobopisov boli revidované kritériá výberu pacientov na operačnú liečbu, typ operácie, pooperačné komplikácie a dlhodobý priebeh. Výsledky: Za šesťročné obdobie bolo vykonaných 7625 gastrofibroskópií. Z nich u 107 mužov a 47 žien sa našli varixy pažeráka. U 76 mužov a 31 žien varixy nekrvácali. U 31 mužov a 16 žien varixy krvácali a boli sklerotizované. Z nich u 24 mužov a 13 žien boli varixy eradikované alebo prešli z Paquet 3–4 na 1–2. U 3 žien a 7 mužov bola sklerotizačná liečba neúčinná a tí krvácali. Päť mužov sa podrobilo operácii a 2 muži a 3 ženy vykrvácali bez operácie. Vykonaná bola 3x Warrenova spojka, 1x Lintonova spojka a 1x resekcia duodenojejunálneho ohybu. Jeden pacient zomrel na zlyhanie pečene. Záver: Sklerotizačná liečba bola neúspešná u 21,3 % pacientov. Z nich polovica vykrvácala. K elektívnej operácii sú indikovaní pacienti vo funkčnom štádiu Child-Pugh A a B pri recidívach krvácaní po sklerotizačnej liečbe, varixoch fundu žalúdka a krvácivej gastropatii. Pri akútnej operácii je na mieste ablatívny výkon.

Aim: The aim of this work was to confirm indications for surgical procedures in cases of relapsing bleeding from oesophageal varices as a consequence of the liver cirrhosis. Methodology: Based on the retrospective study of the endoscopical examinations results and the patient records, the criteria of the patient selection for the surgical procedure, the type of the surgical procedure, the postoperative complications and the long-term assessment, were revised. Results: During the six-year period, 7625 gastrofibroscopies were conducted. In this group, the oesophageal varices were diagnosed in 107 males and 47 females. In 76 males and 31 females the varices did not bleed. In 31 males and 16 females the varices did bleed and were sclerotised. In this subgroup, in 24 males and 13 females the varices were eradicated or moved from the Paquet grade 3–4 to 1–2. In 3 females and 7 males the sclerotherapy was not successful and the patients continued to bleed. Five males underwent surgery and 2 males and 3 females exsanguinated without surgery. The following surgical procedures were completted: 3x Warren anastomoses, 1x Linton anastomosis and 1x resection of the duodenojejunal arcuation. One patient exited due to the liver failure. Conclusion: The sclerotherapy failed in 21.3% patients. Half of them exsanguinated. Only patients in the Child-Pugh A and B functional stage are indicated for the elective surgical procedure in cases of bleeding relapses following the sclerotherapy, varices of the gastric fundus and haemorrhaging gastropathy. Ablation is the method of choice in cases of emergency.

Chirurgické oddelenie nemocnice Trenčín

Cooperation between a surgeon and a gastroenterologist in the management of vascular complications of the liver cirrhosis

Spolupráca chirurga a gastroenterológa pri riešení vaskulárnych komplikácií cirhózy pečene = Cooperation between a surgeon and a gastroenterologist in the management of vascular complications of the liver cirrhosis /

Cooperation between a surgeon and a gastroenterologist in the management of vascular complications of the liver cirrhosis /

Lit. 8