Summary
From Jan 1, 1982 to Jan 1, 1990 692 patients were admitted because of acute or recurrent hemorrhage from esophagogastric varices. Initial management was endoscopic sclerotherapy. 14 pat. were excluded. In 26 of 311 Child-Pugh C-patients a gastroesophageal disconnection and in 5 because of a portal pressure over 30 mmHg a narrow-lumen mesocaval interposition shunt (NLMCS) were performed because of uncontrollolable hemorrhage. Hospital mortality was 31%. — 182 pat. belonged to Child-Pugh class A and 185 to B. In 194 long-term injection sclerotherapy was successful; 173 were sclerotherapy failures and selected for shunt operation at the end of the selection analysis. 85 refused shunt operation or did not fulfill selection criteria. Thus, 88 pat. were shunted mainly by NLMCS and distal splenorenal shunt. Sclerotherapy and shunt group were comparable. Hospital mortality showed no difference. Five year life-expectancy was significantly higher in shunted patients. Thus, in sclerotherapy failures early a shunt-indication should be discussed.
Zusammenfassung
Vom 1.1. 1982–1. 1. 1990 wurden 692 Patienten mit akuten oder rezidivierenden Ösophagus- und Magenvarizenblutungen behandelt; 14 mußten ausgeschlossen werden. Therapie der 1. Wahl war die Sklerosierungsbehandlung. Von 311 Child-Pugh C-Pat. erhielten 26 eine gastroösophageale Diskonnektion und 5 wegen Pfortaderdruckwerten über 30 mmHg einen mesocavalen Interpositionsshunt (MCA) mit 12 mm Goretex-Prothese wegen unstillbarer Blutung. Die Kliniksterblichkeit betrug 31%. — 182 Pat. gehörten der Child-Pugh-Klassifikation A und 185 der B an. Bei 194 war die Langzeitsklerosierung erfolgreich. 173 Pat. hatten ein oder mehrere Blutungsrezidive; diesen Skierotherapieversagern wurde eine Shuntoperation nach Abschluß einer Selektionsanalyse empfohlen. 85 Pat. verweigerten die Shunt-Operation, 88 erhielten einen MCA oder einen splenoralen Shunt. Die Kliniksterblichkeit in der Sklerosierungs- und Shunt-Gruppe war gleich, die Fünfjahres-Überlebenszeit signifikant höher in der Shunt-Gruppe. Die Indikation zur Shunt-Operation sollte bei Sklerosierungstherapieversagern rechtzeitig gestellt werden.
Dr. H. A. erhielt ein Stipendium von der Ägyptischen Studienmission der Bundesrepublik Deutschland.
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© 1990 Springer-Verlag Berlin Heidelberg
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Paquet, KJ., Lazar, A., Gad, H.A. (1990). Chirurgische Maßnahmen bei Rezidivblutungen aus Ösophagus- und Magenvarizen nach Sklerosierungstherapie — eine prospektive Studie. In: Ungeheuer, E. (eds) Deutsche Gesellschaft für Chirurgie. Langenbecks Archiv für Chirurgie Gegründet 1860 Kongreßorgan der Deutschen Gesellschaft für Chirurgie, vol 1990. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-48163-5_78
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