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Year 2014 Vol. 22 No 4
GENERAL AND SPECIAL SURGERY
L.P. KOTELNIKOVA1,2, I.S. MUKHAMADEEV1,2, I.G. BURNISHEV2, R.A. STEPANOV1,2, N.N. FEDACHUK1,2
THE RESULTS OF SURGICAL TREATMENT FOR THE COMPLICATIONS OF PORTAL HYPERTENSION
SBEE HPE “Perm State Medical Academy named after E.A.Vagner”1,
SBME “Perm Regional Clinical Hospital” of Perm order “Badge of Honor” region 2,
The Russian Federation
Objectives. To evaluate the early postoperative period and long-term results in the patients with portal hypertension operated for ongoing bleeding from the varicose dilated esophageal veins (VDEV) as well as its primary and secondary prophylaxis.
Methods. The analysis of short- and long-term surgical treatment results of patients (n=69) with portal hypertension syndrome complicated by VDEV have been performed: shunt operations (n=18), modified Sugiura-Futagawa operation (n=51).
Results. Splenorenal anastomosis has been performed to the patients with Child-Pugh Class A and B hepatic dysfunction (n=18). Postoperative complications developed in 4 (22,2%) patients. Mortality rate made up 5,5% (n=1). The modified Sugiura-Futagawa operation has been carried out in 51 patients: Child-Pugh class A hepatic insufficiency was diagnosed in 4 (7,8%) cases, class B – in 17 (33,3%), class C – in 24 (47,1%), and extrahepatic portal hypertension – in 6 (11,8%) patients in the case of conservative treatment and endoscopic procedures have failed. Postoperative complications developed in 25 patients (49%), specific – in 18 (35,3%) cases. Mortality rate made up 31,4% (n=16). Within a year no recurrences of bleeding after both operations have been observed, survival rate has been 100% after shunt surgeries and 88% – after modified Sugiura-Futagawa operations.
Conclusions. Postoperative period and outcomes of both shunt and disconnection operations at portal hypertension complicated by gastrointestinal bleeding depend upon the class of initial hepatic impairment (Child-Pugh Classification). In the case of inability of shunting, shunt thrombosis and ongoing bleeding it seems to be advisable to perform azigoportal disconnection surgery (a modified Sugiura-Futagawa operation), available to provide the reliable hemostasis even in severe patients with satisfactory short- and long-term results.
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614000, Rossiyskaya Federatsiya, g. Perm, ul. Petropavlovskaya, d. 26, GBOU VPO «Permskaya gosudarstvennaya meditsinskaya akademiya im. ak. E.A. Vagnera», kafedra khirurgii FPK i PPS,
Stepanov Ruslan Alekseevich
Kotelnikova L.P. MD, professor, a head of the surgery chair of the advanced training faculty and retraining of the staff of SBEE HPE “Perm State Medical Academy named after E.A.Vagner”, a surgeon of SBME “Perm Regional Clinical Hospital” of Perm order “Badge of Honor” region.
Mukhamadeev I.S. MD, an associate professor of the surgery chair of the advanced training faculty and retraining of the staff of SBEE HPE “Perm State Medical Academy named after E.A.Vagner”, a head of the vascular surgery department of SBME “Perm Regional Clinical Hospital” of Perm order “Badge of Honor” region.
Burnishev I.G. PhD, a head of the 2nd surgical department of SBME “Perm Regional Clinical Hospital” of Perm order “Badge of Honor” region.
Stepanov P.A. PhD, an assistant of the surgery chair of the advanced training faculty and retraining of the staff of SBEE HPE “Perm State Medical Academy named after E.A.Vagner”, a physician of the vascular surgery department of SBME of SBME “Perm Regional Clinical Hospital” of Perm order “Badge of Honor” region.
Fedachuk N.N. An extramural post-graduate student of the surgery chair of the advanced training faculty and retraining of the staff of SBEE HPE “Perm State Medical Academy named after E.A.Vagner”, a surgeon of SBME of SBME “Perm Regional Clinical Hospital” of Perm order “Badge of Honor” region.