CLINICAL AND STATISTICAL ASPECTS OF THE DEVELOPMENT AND COURSE OF BLEEDING FROM VARICOSE VEINS OF THE ESOPHAGUS IN PATIENTS WITH PORTAL HYPERTENSION
Summary. The aim of the study was to identify the main etiological factors that led to the development of portal hypertension — the leading cause of varicose bleeding, to analyze the clinical aspects of the course and methods of treatment of bleeding from varicose veins of the esophagus (EVV).
Materials and methods. We collected, processed and analyzed the results of treatment of 95 patients with bleeding from varicose veins of the esophagus hospitalized in the Dnipro Clinical Emergency Hospital, DGS “for 2017. The leading factor was established liver cir-rhosis — 92 cases (96.8 %). Moreover, in 42 cases (44.2 %), cirrhosis of the liver developed against the background of chronic viral hepatitis C. The endoscopic picture of this category of patients and the degree of blood loss were also assessed.
Results and its discussion. It was found that the most frequently detected VRV II–III st. — in 42 (44.2 %), III st. — in 27 (28.4 %), while 52 (54.7 %) patients showed dilatation of the venous trunks in all parts of the esophagus, in 29 (30.5 %) — in the mid-lower parts. Analysis of concomitant pathology helped to establish against the background of which diseases portal hypertension most often develops: viral hepatitis C was detected in 46 cases (48.4 %), coronary artery disease (diffuse cardiosclerosis) — in 29 (30.5 %), ischemic heart disease (atherosclerotic cardiosclerosis) — in 15 (15.8 %), hypertension II Art. — 26 (27.4 %), diabetes mellitus — 10 (10.6 %). All patients received conservative therapy, which was combined with mechanical methods of hemostasis (Sengstaken – Blakemore probe) in 24 cases (25.3 %), endoscopic hemostasis (ligation with latex rings) — in 3 cases (3.2 %), partial embolization of the splenic artery — in 3 cases (3.2 %), suturing of veins — in 1 (1.1 %). In 70 cases (73.7 %) a favorable outcome was noted, 25 cases (26.3 %) were fatal.
Conclusions. The main cause of bleeding from varicose veins of the esophagus is liver cirrhosis developed against the background of viral hepatitis C. Despite the widespread use of local endoscopic hemostasis techniques, recurrent bleeding occurs in 9.5 % of cases. The mortality rate for bleeding from varicose veins of the esophagus is 26.3 %, which corresponds to the world average trend.
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