肝硬化并发食管静脉曲张出血、脑病、腹水的综合治疗

V. Rusyn, Konstantin E. Rumiantsev, Andriy A. Rusyn, O. Balazh
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摘要

目的:探讨食道静脉曲张出血伴失代偿性肝硬化的综合治疗方法。材料与方法:2015-2020年食管静脉曲张出血患者。在喀尔巴阡地区临床医院的诊所A. Novak根据child - turcote - pugh标准检查并治疗了64例c级肝硬化患者。结果:17例患者采用体外超滤腹水后静脉再输注腹水。在39例接受有效硬化治疗的患者亚组中,死亡率为23.1%。在25例ES无效且使用Blackmore管的患者亚组中,死亡率为32%。腹腔镜穿刺术并发腹水排出患者20例,死亡8例(40%)。体外超滤腹水后静脉再输注2例(11.8%)。在应用白蛋白腹膜透析的亚组中,有7例患者死亡(25.9%)。结论:失代偿期肝硬化患者食道静脉曲张出血致死性结局的预后因素为:内镜下硬化治疗作为原发性止血手段无效,前5天出血复发。采用分阶段体外治疗方法可显著提高治疗效果,降低死亡率。
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COMPREHENSIVE TREATMENT OF COMPLICATED COURSE OF LIVER CIRRHOSIS IN CASE OF BLEEDING FROM THE VARICOS VEINS OF ESOPHAGUS, ENCEPHALOPATHY AND ASCITES
Aim: To develop a complex treatment for patients with decompensated cirrhosis in case of bleeding from the varicose veins of the esophagus. Material and methods: With bleeding from varicose veins of the esophagus for the period 2015–2020. in the clinic of the Transcarpathian Regional Clinical Hospital. A. Novak examined and treated 64 patients with C-class liver cirrhosis according to the Child-Turcotte-Pugh criteria. Results: In 17 patients they used extracorporeal ultrafiltration of ascitic fluid with it’s subsequent intravenous reinfusion. In the subgroup of 39 patients with effective sclerotherapy the mortality rate was 23.1%. In the subgroup of 25 patients where the ES was ineffective and the Blackmore tube was applied, the mortality rate was 32%. Among the 20 patients after laparocentesis with ascitic fluid evacuation 8 (40%) died. In the 17 patients after extracorporeal ultrafiltration of ascitic fluid with its subsequent intravenous reinfusion 2 (11.8%). In the subgroup where albumin peritoneal dialysis was applied 7 patients died (25.9%). Conclusions: The prognostic factors for the lethal outcome of bleeding from varicose veins of the esophagus in patients with decompensated liver cirrhosis are: the ineffectiveness of endoscopic sclerotherapy as a means of primary hemostasis, bleeding recurrence in the first 5 days. The use of staged treatment using extracorporeal methods can significantly improve the results of treatment, reduce mortality.
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