COMPLEX TREATMENT OF PATIENTS WITH CIRRHOSIS COMPLICATED BY VARICEAL BLEEDING

This article deals with analysis of own experience of treatment of portal hypertension patients complicated with variceal bleeding. There were 390 patients with cirrhosis complicated with variceal bleeding under our supervision from 2006 to 2012. Endoscopic hemostasis was carried out in 296 patients, 158 patients of them were conducted endoscopic sclerotherapy, 98 — endoscopic clipping and ligation and 40 patients — endoscopic sealing. After a stop of bleeding and stabilization of patient condition in 82 cases for prevention of recurrence of bleedings we carried out endovascular embolization of a splenic artery by the technique which we elaborated ourselves. In 52 cases for the purpose of bleedings recurrence prevention we performed laparoscopic operations which consisted in coagulation and ligation of short veins and stomach arteries on big curvature. The remote results after only an endoscopic hemostasis, and an endoscopic hemostasis with the subsequent performance of laparoscopic and endovascular operations have been observed in 190 patients during 3 years. The most effective method of a local hemostasis is the endoscopic ligation and clipping of varices. Endovascular embolization of the splenic artery and also a laparoscopic devascularization of cardiac part of the stomach and abdominal part of the esophagus allows to reduce considerably frequency of bleedings recurrence and lethality in the remote period.