Advances in Clinical and Experimental Medicine

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Advances in Clinical and Experimental Medicine

2008, vol. 17, nr 3, May-June, p. 359–367

Publication type: original article

Language: English

Creative Commons BY-NC-ND 3.0 Open Access

Esophageal Varices Part II – Invasive Methods of Treatment and Prophylaxis of Variceal Bleeding

Żylaki przełyku Część II – Inwazyjne metody leczenia i zapobiegania krwawieniom

Marek Bochnia1,, Dariusz Patkowski2,, Beata Rostkowska−Nadolska3,, Agnieszka Zatońska4,, Wojciech Dziewiszek5,

1 Department of Otolaryngology, Faculty of Dentistry, Silesian Piasts University of Medicine in Wrocław, Poland

2 Department of Pediatric Surgery and Urology, Silesian Piasts University of Medicine in Wrocław, Poland

3 Department of Otolaryngology, Silesian Piasts University of Medicine in Wrocław, Poland

4 District Railway Hospital in Wrocław, Poland

5 Department of Pharmacology, Silesian Piasts University of Medicine in Wrocław, Poland

Abstract

Portal hypertension (PH) is not a distinct disease, but a complex syndrome of hemodynamic disturbances. When hypertension persists for a long period, collateral circulation develops in the area of communication between the portal blood and the drainage basin of the superior or inferior caval vein. One of a dozen or so of the described anastomoses is the way through the submucosal plexus of the esophagus. The overloaded plexus become gradually wider and may transform into irregular varices. In controlling variceal bleeding, two endoscopic methods are usually used. Sclerotherapy (EVS) requires the use of strongly irritating agents, which causes a high risk of local and general complications. The other method, esophageal varix ligation (EVL), was introduced with the hope of achieving similar effectiveness without the mentioned dangers. The classical surgical methods include shunt and non−shunt operations and the transjugular intrahepatic portal−systemic stent−shunt (TIPSS). Total EV eradication is sometimes possible only after liver transplantation (LT).

Streszczenie

Po dłuższym czasie, w następstwie nadciśnienia wrotnego, rozwija się krążenie oboczne. Jednym z wielu połączeń powstających między dorzeczem krwi wrotnej i żyły czczej górnej lub dolnej jest podśluzówkowy splot przełyku, który przeładowany łatwo się rozszerza, tworząc tzw. żylaki. Do opanowywania i zapobiegania krwawieniom z żylaków przełyku najczęściej stosuje się dwie metody endoskopowe. Pierwsza z nich – skleroterapia wymaga użycia silnie drażniących preparatów, co jest obarczone wysokim ryzykiem komplikacji miejscowych i ogólnych. Drugą – podwiązywanie żylaków – wprowadzono w nadziei, że może być równie skuteczna, a pozbawiona tych niebezpieczeństw. W klasycznym postępowaniu chirurgicznym stosuje się najczęściej tzw. zespolenia omijające, operacje nieomijające i zaliczane często do radiologii interwencyjnej przezskórne, przezszyjne wewnątrzwątrobowe zespolenie wrotno−czcze – transjugular intrahepatic portal−systemic stent–shunt. Pełną, przyczynową eradykację choroby umożliwia jednak najczęściej dopiero przeszczep wątroby.

Key words

portal hypertension, complications, endoscopic treatment, surgical treatment

Słowa kluczowe

nadciśnienie wrotne, powikłania, metody endoskopowe, leczenie chirurgiczne

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