Sujets)
Humains , Varices oesophagiennes et gastriques/physiopathologie , Varices oesophagiennes et gastriques/anatomopathologie , Varices oesophagiennes et gastriques/thérapie , Antagonistes bêta-adrénergiques , Cyanoacrylates/usage thérapeutique , Endoscopie digestive , Sclérothérapie , Facteurs de risque , Radiologie , Varices oesophagiennes et gastriques/classificationRésumé
Se presenta el caso de un paciente cirrótico con hipertensión portal severa y sangrado masivo por varices esofágicas con resangrado que fue tratado con éxito mediante una derivación portosistémica transyugular intrahepatica (TIPS) luego de haber agotado otras alternativas terapeuticas como la esclerosis endoscopica intravaricosa e infusión IV de somatostatina. Igualmente se analizan las diversas posibilidades terapéuticas en situaciones como ésta y se pasa revista a la literatura médica sobre el tema
Sujets)
Humains , Varices oesophagiennes et gastriques/chirurgie , Varices oesophagiennes et gastriques/classification , Varices oesophagiennes et gastriques/thérapie , Cirrhose du foie/chirurgie , Cirrhose du foie/complications , Cirrhose du foie/thérapieRésumé
In this work eighty one patients with gastric varices alone or oesophagogastric varices were included for sclerotherapy of gastric varices. Gastric varices were classified to: 1- isolated gastric varices, fifty three patient 2- gastric extension twenty eight patients of them cord type included twenty five patients while the bulbous type included three patients. Gastric varices of the isolated type were injected histocary1 successfully. Gastric extension type was injected histoacry1 when presenting in active bleeding or when it is of the bulbous type. Complications were minimal in the form of recurrent bleeding, fever pleural reaction and pulmonary embolism. Recurrent gastric varices occurred in the patients during the period of follow up reaching 2 years we succeeded in controlling the bleeding in 92.85% of cases with early recurrence in 5.56% and late recurrence in 1.79% and the mortality due to rebleedig was 7.5%. this verify the crucial role of tissue adhesive in managing gastric varices
Sujets)
Humains , Varices oesophagiennes et gastriques/classificationRésumé
Os autores comparam dois sistemas endoscópicos de classificaçäo de varizes de esôfago, um métrico e a classificaçäo em graus, avaliados simultaneamente em 70 exames endoscópicos de 53 pacientes com hipertensäo portal. Mostram que a classificaçäo por graus é pouco adequada, sobretudo em avaliaçöes seqüencias, pelo grande componente de subjetividade que lhe é inerente, mesmo quando executado por único examinador. O sistema métrico mostra-se, nesta circunstâncias, menos sujeito a influências subjetivas e com reprodutibilidade mais exata, sendo assim recomendado pelo autores