[
Abstract]
[
Full Text PDF] （in Japanese / 3092KB）
[Members Only And Two Factor Auth.] J.Jpn. Surg. Soc.. 97(8): 648-652, 1996
Feature topic
PORTAL HYPERTENSION AFTER SUCCESSFUL HEPATIC PORTOENTEROSTOMY IN BILIARY ATRESIA
Sixty percent of 139 patients, with biliary atresia who underwent hepatic portoenterostomy (Kasai operation) from 1965 to 1994 became jaundice-free after the operation. Portal hypertnsion, which was confirmed by endoscopic observation of esophageal varices and/or thrombocytopenia (less than 100×10
3/mm
3), developed in 50％ of unicteric long-term suvivors. Esophageal varix was found initially between 11 months and 5 years of age in more than 70％ of these portal hypertensive patients. On the contrary, thrombocytopenia developed at 6 years or older age in 63％ of the patients. The incidence of portal hypertension was significantly lower in the patients whose seruln bilirubin decreased less than 2 mg/dl at 3 months after surgery than in the patients whose bilirubin stayed over 2 mg/dl at the same postoperative time. Furthermore, re-do operation related significantly to the incidence of portal hypertension in jaundice-disappeared patients. Prophylactic endoscopic injection sclerotherapy and/or variceal ligation were sufficiently effective in the management of esophageal varices. Partial splenic embolization as well as splenectomy seems to be a treatment of choice for hypersplenism.
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