| Co-Investigator(Kenkyū-buntansha) |
SAKAMOTO Hirohiko Faculty of Medicine, University of Tokyo, 医学部外科学一般, 医員 (40196100)
HARIHARA Yasushi Faculty of Medicine, University of Tokyo, 医学部外科学一般, 助手 (10189714)
OHASHI Kazumasa Faculty of Medicine, University of Tokyo, 医学部外科学一般, 助手 (50185352)
KAWASAKI Seiji Faculty of Medicine, University of Tokyo, 医学部外科学一般, 助手 (80177667)
SANJO Kensho Faculty of Medicine, University of Tokyo, 医学部外科学一般, 講師 (90114503)
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| Budget Amount *help |
¥7,000,000 (Direct Cost: ¥7,000,000)
Fiscal Year 1987: ¥3,000,000 (Direct Cost: ¥3,000,000)
Fiscal Year 1986: ¥4,000,000 (Direct Cost: ¥4,000,000)
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| Research Abstract |
Since 1954, non-shunting operations (454 esophageal transection with esophagogastric devascularization, 43 Hassab's operation, 12 others) has been performed in 509 patients with varices (liver cirrhosis 362, idiopathic portal hypertension 102, extrahepatic portal vein obstruction 38, Schistosomiasis 4, others 3). Esophageal transection was performed transthoracically in 125, transabdominally in 42, and thoracoabdominally in 287.
Overall operative mortality of these non-shunting operations was 5.1% (26/509). Operative deaths occurred only in patients with liver cirrhosis (7.1%, 26/362), and higher in emergency cases (23.3%, 14/60) compared to the elective or prophylactic operations (3.8%, 7/138 for elective operations and 4.2%, 5/119 for prophylactic operations). Operative deaths were observed in 4 of the Child B patients and 22 of the Child C patients. Cummulative survival rate at ten yeard after esophageal transection was been satisfactory in patients with idiopathic portal hypertensio
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n and extrahepatic opetalvein obstruction (75.8%,and 90.1% respectively), but 26.9% in cases of liver cirrhosis.
Dissappearance of esophageal varices was most complete with thoracoabdominal approach where the most extensive devascularization of both the esophagus and the stomach was possibble, however this is a large operation and only recommendable in good risk patients (Child A category). The varices dissappeared completely in 80% of the patients in whom transabdominal transection with EEA was performed, and this operation has been well tolarated in most of the Child A and B patients, and hence most widely recommendable. When the dissapearance of the varices is not complete after this operation, the remaining varices may easily be t reated by endoscopic sclerotherapy. In half of the patients treated by transthoracic transection, some of the esophageal varices above the line of transection remained, and bleeding recurred. The use of transthoracic esophageal transection should be limited as an emergency to stop bleeding in good risk patients (Child A and B). Less
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