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Bleeding Oesophageal Varices. A Clinical Study of Mesocaval Interposition Shunting and Endoscopic Sclerotherapy

Isaksson, Björn LU (1997)
Abstract (Swedish)
Popular Abstract in Swedish

Blödande åderbråck i matstrupen - en jämförande studie mellan kirurgisk shunt och lokal behandling



Patienter med skrumplever riskerar många komplikationer. Den mest fruktade är blödning från oesofagusvaricer, dvs åderbråck i matstrupen. Fyrtio procent av patienterna avlider om de inte får behandling. Anledningen till att patienter med skrumplever (cirros) utvecklar oesofagusvaricer är att blodflödet från tarmen via portådern hindras vid dess passage genom levern. Trycket stiger i portådern och blodet tvingas ta andra vägar för att komma förbi den cirrotiska levern. I matstrupen upparbetas därför tunnväggiga åderbråck genom vilka tarmblodet passerar förbi levern. En tredjedel av... (More)
Popular Abstract in Swedish

Blödande åderbråck i matstrupen - en jämförande studie mellan kirurgisk shunt och lokal behandling



Patienter med skrumplever riskerar många komplikationer. Den mest fruktade är blödning från oesofagusvaricer, dvs åderbråck i matstrupen. Fyrtio procent av patienterna avlider om de inte får behandling. Anledningen till att patienter med skrumplever (cirros) utvecklar oesofagusvaricer är att blodflödet från tarmen via portådern hindras vid dess passage genom levern. Trycket stiger i portådern och blodet tvingas ta andra vägar för att komma förbi den cirrotiska levern. I matstrupen upparbetas därför tunnväggiga åderbråck genom vilka tarmblodet passerar förbi levern. En tredjedel av patienterna med oesofagusvaricer får blödningar vilka kan behandlas på två sätt: antingen leder man genom en shuntoperation blodflödet förbi levern eller behandlar åderbråcken i matstrupen.



Det finns åtskilliga shuntkonstruktioner beskrivna. Vi har valt en som är tekniskt enkel och som inte tidigare utvärderats (Less)
Abstract
This thesis is aimed at evaluating the clinical results of two treatments in patients with bleeding oesophageal varices; the mesocaval interposition shunt (MI shunt) and repeated endoscopic sclerotherapy (ST). 24 patients were randomised to MI shunt and 21 patients to the ST group (mean age 51.6?9.2 and 53.6?10.5 years). Complications include shunt occlusion in 4 %, oesophagitis in 33 % and oesophageal stricture in 10 %. There was a significantly higher rebleeding rate in the ST group (18 vs 3), survival was not affected by treatment except in Child's C patients where a slightly longer survival was found in the MI group. Evaluation of hepatic encephalopathy showed that the MI group showed a progressive general reduction as opposed to the... (More)
This thesis is aimed at evaluating the clinical results of two treatments in patients with bleeding oesophageal varices; the mesocaval interposition shunt (MI shunt) and repeated endoscopic sclerotherapy (ST). 24 patients were randomised to MI shunt and 21 patients to the ST group (mean age 51.6?9.2 and 53.6?10.5 years). Complications include shunt occlusion in 4 %, oesophagitis in 33 % and oesophageal stricture in 10 %. There was a significantly higher rebleeding rate in the ST group (18 vs 3), survival was not affected by treatment except in Child's C patients where a slightly longer survival was found in the MI group. Evaluation of hepatic encephalopathy showed that the MI group showed a progressive general reduction as opposed to the ST group during 1 year follow-up. The MI shunt did not induce any major alterations of gastrointestinal hormones, amino acids or lysosomal enzymes during long-term follow-up. In a second study we evaluate the total experience of MI shunt surgery during the same period. This re (Less)
Please use this url to cite or link to this publication:
author
opponent
  • Docent Thörne, Anders, Huddinge Hospital, Huddinge, Sweden
organization
publishing date
type
Thesis
publication status
published
subject
keywords
repeated sclerotherapy, mesocaval interposition shunt, lysosomal enzymes, hepatic encephalopathy, bleeding oesophageal varices, Liver cirrhosis, portal hypertension, oesophageal manometry, Surgery, orthopaedics, traumatology, Kirurgi, ortopedi, traumatologi
pages
124 pages
publisher
Department of Surgery, Clinical Sciences Lund, Lund University
defense location
Lecture room 1, Central Building, University Hospital, Lund
defense date
1997-05-26 10:15
external identifiers
  • Other:ISRN: LUMEDW/MESL--1098--SE
language
English
LU publication?
yes
id
621392cc-a4ff-4c02-a184-ea81539c9c0c (old id 29291)
date added to LUP
2007-06-13 13:46:25
date last changed
2016-09-19 08:45:14
@phdthesis{621392cc-a4ff-4c02-a184-ea81539c9c0c,
  abstract     = {This thesis is aimed at evaluating the clinical results of two treatments in patients with bleeding oesophageal varices; the mesocaval interposition shunt (MI shunt) and repeated endoscopic sclerotherapy (ST). 24 patients were randomised to MI shunt and 21 patients to the ST group (mean age 51.6?9.2 and 53.6?10.5 years). Complications include shunt occlusion in 4 %, oesophagitis in 33 % and oesophageal stricture in 10 %. There was a significantly higher rebleeding rate in the ST group (18 vs 3), survival was not affected by treatment except in Child's C patients where a slightly longer survival was found in the MI group. Evaluation of hepatic encephalopathy showed that the MI group showed a progressive general reduction as opposed to the ST group during 1 year follow-up. The MI shunt did not induce any major alterations of gastrointestinal hormones, amino acids or lysosomal enzymes during long-term follow-up. In a second study we evaluate the total experience of MI shunt surgery during the same period. This re},
  author       = {Isaksson, Björn},
  keyword      = {repeated sclerotherapy,mesocaval interposition shunt,lysosomal enzymes,hepatic encephalopathy,bleeding oesophageal varices,Liver cirrhosis,portal hypertension,oesophageal manometry,Surgery,orthopaedics,traumatology,Kirurgi,ortopedi,traumatologi},
  language     = {eng},
  pages        = {124},
  publisher    = {Department of Surgery, Clinical Sciences Lund, Lund University},
  school       = {Lund University},
  title        = {Bleeding Oesophageal Varices. A Clinical Study of Mesocaval Interposition Shunting and Endoscopic Sclerotherapy},
  year         = {1997},
}