Year 2013 Vol. 21 No 1

GENERAL AND SPECIAL SURGERY

V.I. RUSIN1, .. RUMJANTSEV1, I.I. KOPOLOVEC1, I.B. KRAVCHUK 2

IMMEDIATE TREATMENT RESULTS OF BLEEDING FROM ESOPHAGEAL VARICES IN PATIENTS WITH B-CLASS LIVER CIRRHOSIS

SHEE Uzhgorod National Universit1,
Transcarpatian Regional Clinical Hospital named after Andrey Novak2,
The Ukraine

Objectives. To evaluate the effectiveness of the treatment strategy of bleeding from the esophageal varices in patients with B-class liver cirrhosis according to Child-Pugh criteria.
Methods. 67 patients with B-class cirrhosis and bleeding from esophageal varices were included in the study. The endoscopic sclerotherapy was used to stop bleeding and in case of its ineffectiveness the Blakemore tube was applied. Vasoactive therapy with octreotide or terlipressin, volumic resuscitation, antibiotics, solutions of aminoacids, proton pump inhibitors intravenously, menadione intramuscularly, lactulose appeared to be the components of the conservative treatment. Hepatic encephalopathy (I-II degree) was treated conservatively and albumin peritoneal dialysis was performed at III-IV degree.
Results. Endoscopic sclerotherapy stopped bleeding immediately in 53 (79%) of 67 patients. Blakemore tube was applied in the remaining 14 patients (21%). In 13 (26%) patients out of 53 endoscopic sclerotherapy was primary effective, recurrence of bleeding occurred within the first 5 days. In 9 of them it was stopped with the repeated session of endoscopic sclerotherapy, in 4 with Blakemore tube. 5 (9,4%) patients died due to progression of the liver failure. Mortality calculated on the number of recurrences made up 38,5%. Recurrence took place in 8 (57,1%) out of 14 patients with Blakemore tube used initially. In 6 of them bleeding was stopped by the repeated endoscopic sclerotherapy. 8 (57,1%) patients died. Mortality calculated in patients with recurrences composed 100%. Mortality in the subgroup of the conservative treatment of encephalopathy made up 18%, in the case of the application of albumin peritoneal dialysis 23,5%.
Conclusions. Endoscopic sclerotherapy is considered to be an effective method of bleeding treatment (an efficiency of 79% in primary haemorrhage stopping and 71% at recurrence) with a moderate number of recurrences 26% and a low mortality 9,4%. Albumin peritoneal dialysis is considered to be a safe and effective treatment for hepatic encephalopathy of III-IV degree (23,5% mortality), which was not significantly different from that of patients with I-II degree.

Keywords: liver cirrhosis, esophageal varicose veins, bleeding, hepatic encephalopathy, endoscopic sclerotherapy, albumin peritoneal dialysis
p. 36 45 of the original issue
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Address for correspondence:
88018, Ukraina, g. Uzhgorod, ul. Pobedy, d. 22, Zakarpatskaia oblastnaia klinicheskaia bol'nitsa im. A. Novaka, kafedra khirurgicheskikh boleznei meditsinskogo fakul'teta GVUZ Uzhgorodskii natsional'nyi universitet,
e-mail: rusinkafedra@gmail.com,
Rusin Vasilii Ivanovich
Information about the authors:
Rusin V.I. MD, professor, head of the surgical diseases chair of the medical faculty of SHEE Uzhgorod National University.
Rumjantsev K.E. PhD, associate professor of the surgical diseases chair of the medical faculty of SHEE Uzhgorod National University.
Kopolovec I.I. A post-graduate student of the surgical diseases chair of the medical faculty of SHEE Uzhgorod National University.
Kravchuk I.B. Endoscopist of Transcarpatian regional clinical hospital named after Andrey Novak.
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