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경내경정맥 간내문맥간정맥 단락술에 의한 식도정맥류 출혈의 치료 효과
탁원영(Won Young Tak),이양일(Yang Il Lee),최성곤(Seng Gon Choi),권중구(Joong Gu Kwen),이창형(Chang Hyung Lee),윤영미(Young Mee Youn),안병철(Byeong Cheol Ahn),곽규식(Kyu Sik Kwak),최용환(Yong Hwan Choi),정준모(Joon Mo Chung),김용주(Yo 대한내과학회 1994 대한내과학회지 Vol.46 No.1
N/A Objectives: This study was performed to examine the effectiveness and prognostic factors of the transjugular intrahepatic portosystemic stent shunt (TIFSS) for the treatment of variceal bleeding secondary to portal hypertension. Methods: Between October 1991 and February 1993, TIPSS was performed in 21cirrhotic patients with variceal hemorrhage in Kyungpook National University Hospital. We reviewed the medical records and compare the portal pressure, portohepatic pressure gradient (PHG) and the endoscopic findings before and after TIPSS. Mean (+SD) follow up period was 7.0±3.9 months. Results: The mean portal pressure prior to TIPSS was 29.2mmHg and dropped to 19.9mmHg(p<0.001), and mean PHG from 21.9mmHg to 11.9mmHg(p<0.001) after shunt establishment. Variceal decompression after TIPSS was identified by early (within 10days) follow up endoscopy in 14 of 16cases, and late (3months after) in 4 of 5cases. Hepatic encephalopathy was recorded in 9patients. However, only 4patients developed recurrent encephalopathy. Recurrent hepatic encephalopathy cases showed significant decrease of mean PHG (14.5mmHg) than transient (7.4mmHg) and without (9.6mmHg) encephalopathy cases (p<0 05). Child-Pugh class C was important factor in the development of recurrent hepatic encephalopathy. Five patients died during the follow up period, 1 month mortality rate was 4.8%, And overall 6month survival rate was 80%, but only 50% in case of Child-Pugh class C. Conclusion: These results suggest that TIPSS is an effective method of portal decompression for the treatment of variceal bleeding and the most important prognostic factors are preprocedual hepatic reserve and decrease of PHG.
안병철(Byeong Cheol Ahn),이양일(Yang Il Lee),최성곤(Seng Gon Choi),권중구(Joong Gu Kwen),이창형(Chang Hyung Lee),윤영미(Young Mee Yun),탁원영(Won Young Tak),관규식(Kyu Shik Kwak),최용환(Yong Hwan Choi),정준모(Joon Mo Chung) 대한내과학회 1994 대한내과학회지 Vol.46 No.1
N/A Background: Even though the hepatoma rupture has been known to be one of the fatal complications of hepatoma, the detailed studies on it were few in Korea. Methods: In order to investigate whether the he- patoma rupture can affect the survival of hepatoma patients or not, and also which factors can influence the prognosis of patients with hepatoma rupture, we studied 67 patients with hepatoma rupture and 74 age-matched hepatoma patients without rupture. Results: 1) Incidences of cirrhosis, ascites, hepatic encephalopathy, and unfavorable grade of Child`s classification were more prevalent in rupture group than in control group. Rupture group showed lower mean values of hemoglobin, prothrombin time, total protein and albumin, and higher mean level of GOT than those of control group. 2) But, there was no significant difference in survival time between rupture group and control group. 3) In rupture group, the survival time was more prolonged in patients with more favorable grade of Child`s classification, The survival time tended to be more prolonged in patients treated with TAE method than those managed with conservative treatment, but unfortunately, the results was statistically not significant, 4) In control group, survival time was prolonged in patients with more favorable grade of Child's classification and in those treated with TAE method. Conclusion: Treatment modality and liver status are most significant prognostic factors in hepatoma rupture patients and TAE method should be considered.