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Development of therapy for esophageal varices:medical splenectomy and formation of intrahepatic shunt

食管静脉曲张治疗进展：医学脾切除及肝内分流术

基本信息

批准号：
61480186
负责人：
OKUDA Kunio
金额：
$ 3.78万
依托单位：
Chiba University
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (B)
财政年份：
1986
资助国家：
日本
起止时间：
1986 至 1987
项目状态：
已结题

项目摘要

Esophageal verices is one of major causes of death in patients with portal hypertension such as liver cirrhosis, idiopathic portal hypertension,hepatocellular carcinoma stc.An operation consisting of esophageal transection and splenectomy is the best treatment for esophageal varices but it cannot be applied to patients with poor hepatic functional reserve.In these patients percutaneous transhepatic obliteration of esophageal varices and endoscopic sclerotherapy of esophageal verices have been performed.In this study,to develop a better medical treatment for esophageal varices,we studied portal hemodynamics in patients with liver cirrhosis and those with idiopathic portal hypertension, and in portal hypertensive dogs which we made.We could demonstrate that portal venous inflow (blood flow into the portal vein system)was significantly increased in patients with liver cirrhosis and those with idiopathic portal hypertension as well as in portal hyertensive dogs compared with their controls(normal subjects and nomal dofs).We further evaluated the effects of elective endoscopic sclerotherapy in comparison with elective percutaneous transhepatic obliteration of esophageal varices in patients with liver cirrhosis and esophageal varices.We could demonstrate that elective endoscopic intravariceal sclerotherapy is superior to elective percutaneoous transhepatic obliteration of esophageal verices in the prevention of recurrent variceal hemorrhage and mortality in nonalcholic cirrhosis.

食管静脉曲张是肝硬化、特发性门静脉高压症、肝癌等门静脉高压症患者死亡的主要原因之一。食管横断+脾切除联合手术是治疗食管静脉曲张的最佳方法，但不适用于肝功能储备较差的患者。食管静脉曲张和食管静脉曲张的内镜下硬化治疗已经进行。在本研究中，为了开发更好的治疗食管静脉曲张的药物，我们研究了肝硬化患者和特发性门静脉高压患者以及我们制作的门静脉高压犬的门静脉血流动力学。我们可以证明患者的门静脉流入（进入门静脉系统的血流量）显着增加肝硬化和特发性门静脉高压症患者以及门静脉高压犬与对照组（正常受试者和正常自由度）进行比较。我们进一步评估了肝硬化和食管静脉曲张患者中选择性内镜硬化治疗与选择性经皮肝穿刺闭塞术治疗食管静脉曲张的效果。内镜下静脉曲张硬化治疗在预防非酒精性肝硬化患者复发性静脉曲张出血和死亡率方面优于择期经皮肝穿刺食管静脉闭塞术。