Lazyrs'kyj V. Roentgensurgical methods of treatment of portal hypertension complicated by profuse bleeding from esophageal and gastric varicess in patients with liver cirrhosis

The dissertation is devoted to the development of etiopathogenic approach for treatment of patients with profuse bleeding from esophageal and gastric varicess in liver cirrhosis. Principles of individualized choice of type of Roentgensurgical interventions based on diagnosis and correction of changes of hepatosplanchnic blood circulation in patients with liver cirrhosis were worked out. Based on analysis of results of complex hemodynamic investigation of patients with profuse bleeding from esophageal and gastric varicess indications for certain methods of roentgenendovascular interventions were defined. Possibility of Roentgensurgical treatment of portal vein thrombosis occurred in liver cirrhosis and precipitating bleeding was proved in experiment on animals. Method of forming of extracorporeal portocaval shunt for control of profuse bleeding from esophageal and gastric varicess that provides rapid decrease of intraportal pressure and contributes bleeding control was developed and applied. Diagnosticand treatment algorithm was developed and applied that is based on individualized use of roentgensurgical methods of hemostasis.The proposed complex approach in treatment of study group compared with control group allowed to improve results in early and late postoperative periods number of bleeding recurrences decreased from 43,5 to 21,0%, mortality decreased from 71,6 to 31,5%.