식도정맥류에 대한 수술요법

Abstract

We studies 83 cases of esophageal varices with portal hypertension treated by Sugiura procedure (esophageal transection with paraesophagogastric devascularization) in one or two stages, or by Kobayashi procedure (transabdominal esophageal transection) and Yamamoto procedure (TEPG, terminal esophagoproximal gastrectomy), depending on the patient's condition, at the Department of Surgery, Keimyung University School of Medicine, from January 1979 to February 1985.

The results of the operative procedures can be summarized as follows:

1) The ages of the patient ranged from IX years to 62 years.

Among 83 patients, 52 were male and 21 were female and the ratio of male and female was about 2. 5： 1, the age incidence were most prevalent in the 4th and 5th decades.

2) The procedures were prophyactic measure in 13 cases(15.7%), elective surgery in 59(71.1%)， and emergency in 11(13.2%)

3) Twenty-six patients were in Child's classification group A (31.3%), forty-one in group B (49.4%) and sixteen in group C (19.3%).

4) The Sugiura procedure was performed at 73 cases as one stage-two procedures in 39 cases, two stages-one procedure In 25 (6 thoracic procedure only and 19 abdominal procedure only), and two stages-two procedures in 9.

The Kobayashi procedure was performed at 6 cases and the Yamamoto procedure at 4 cases.

5) The portal pressures measured intraoperatively ranged from approximately 130 to 450mm. saline in 60 cases. Among them, 57 cases (95.0%) were above 200mm. saline and 3 cases (5.0%) were normal portal pressure.

The intraoperative liver wedge biopsy was performed at 62 cases.

The results were cirrhosis of liver in 55 cases, chronic mflammation in 3, portal fibrosis 1 and normal 3.

6) postoperative complications occurred in 43 cases.

The significant complications were hepatic failure in 6 cases, esophageal leakage accompanied with rebleeding in 2, rebleeding only in 3, esophageal leakage only in 3, esophageal stenosis in 3. Alkaline reflux esophagitis was occurred in 1 case of Yamamoto procedure.

No postoperative encephalopathy was noted.

7) The overall mortality within one month after surgery was 13 cases (15.7%), among them, 1(7.7%) in 13 prophylactic cases, 6(10.2%) in 59 elective cases and 6 (54.5%) in 11 emergency cases.

And the operative mortality according to the Child's classification, 1 (3.8%) in 26 group A, 8 (19. 5%) in 41 group B and 4 (25.0%) in 16 group C.

8) The postoperative esophagography was performed at 39 cases and revealed disappearance of esophageal varices in 17 cases (44.7%), marked improvement in 19(50.0%) and stationary in (5.3%).

9) 60 cases were followed up from 3 months to 6 years period. Among them, 7 cases were expired due to rebleeding in 3 cases, hepatic failure in 3 cases and metastatic hepatoma in X cases. The remaining 53 cases were relatively well without rebleeding.