SURGICAL TACTICS AND SCOPE OF SURGICAL INTERVENTION FOR GASTROESOPHAGEAL BLEEDING IN PATIENTS WITH LIVER CIRRHOSIS

Abstract

The most dangerous and frequent complication of PG syndrome in patients with cirrhosis is bleeding from the urinary tract and gastrointestinal tract, which kills from 14.5% to 90% of hospitalized patients (Patsiora M.D., 1984; V.V. Vakhidov et al., 1988; Karimov Sh.I. et al., 1992, 1996; Johnson Wetal., 1988; Franco D. et al., 2000; , 2000). The mortality rate for this complication depends mainly on the functional reserve of the liver and the duration of bleeding (Sherzinger A.G. et al., 1986; Eramishantsev A.K. et al., 1996, 1998, Nazyrov F.G. et al., 1997;1999; Khashimov Sh.H., 1998, Callow A.D. 1984; According to M.D. Patsiora (1974, 1984), bleeding from the intrauterine veins is observed in 72% of patients with cirrhosis with PG, and in 80% it recurs and 60% of them die within one year. I. Littmann (1982) provides data that 35% of patients with cirrhosis experience the first bleeding, and within 1 year after bleeding, 70% of patients die. According to V.S. Savelyeva et al. (1983), with bleeding from intrauterine veins, mortality, regardless of the method of treatment, is 17-45%. According to W. Johnson et all. (1982) mortality after the first bleeding from varicose veins and gastrointestinal tract ranges from 50 to 80%; A.K.Eramishantsev, 1997; A.G. Scherzenger et al., 1997; S.J. Knechtle et al., 1999; V.A. Luketic et al., 2000 report that the first episode of such bleeding kills 30-40% of patients. M.A. Ballesteros Amozurrutia (1998) provides data according to which bleeding from the esophagus is observed in 80% of patients with varicose veins of the venous zone. Moreover, such bleeding accounts for 1/5 of all gastrointestinal bleeding, and the mortality rate in the first week reaches 27%, after a week - up to 41%, and after a year reaches 75%. In this regard, Vlachogiannakos J. et al., 2000 believe that such high mortality rates and the difficulty of predicting bleeding in PG can justify the treatment strategy for all patients with varicose veins of the esophagus and stomach in order to prevent the first bleeding.