胆道閉鎖術後の門脈圧亢進症 : とくに食道静脈瘤を中心に

概要

論文の詳細を見る
Thirty four patients with biliary atresia have undergone Kasai operation in our clinic during the past 12 years. Of 21 patients with good bile excretion, 8 have been surviving for more than 2 years. Four of these survivors and 2 who subsequently died of hepatic failure after successful operation achieving bile excretion have developed portal hypertension with esophagel varices. More than 30 similar patients have been reported in the literature. Esophageal varices after successful Kasai operation develop in the one fourth of the patients who are expected to be cured. Half of these will develop hemorrhage. Portal hypertension related to biliary atresia can be classified into the acute and chronic types. The acute type was with poor prognosis due to severe postoperative cholangitis. Almost all patients with the chronic type survived, if the esophageal varices were well controlled conservatively or operatively. Transthoracic esophageal transection with paraesophagogastric devascularization seems to be the treatment of choice, and splenectomy should be added through the diaphragm in patients with hypersplenism.
日本小児外科学会の論文
1982-04-20