Современное СоСтояние проблемы кровотечений из варикозно-раСширенных вен пищевода и желудка

Abstract

Modern views on the etiology, pathogenesis, classification, diagnosis and treatment of bleeding from esophageal and gastric varices changed viens for different versions of portal hypertension are presented. Summarized own clinical experience in treating patients with portal hypertension of various origins, complicated by bleeding from esophageal and gastric varices. We made the comparative analysis of modern methods of treatment of patients with portal hypertension of various etiologies. Summarized own clinical experience in treating 115 patients with portal hypertension of various origins, complicated by bleeding from esophageal and gastric varices. In 77 patients (control group) treatment program included a waiting conservative tactics. In this group variceal needling as a «desperate operation» was performed only in 13 (16,9%) patients. In 38 patients (study group) active surgical tactics using M.D. Patsiora operation was applied as much as possible before the onset of early hepatic decompensation. Inclusion the active surgical tactics in the treatment program for compensated (Class A) and subcompensated (Class B) patients with hepatic cirrhosis, complicated by bleeding from esophagealand gastric varices made possible to reduce the total number of complications from 97,4 to 23,0%, including the number of recurrent bleedings — from 31,2 to 6,8%, the incidence of liver failure — from 89,6 to 33,7%, reduced hospital mortality from 76,6 to 32,2%.