Risk Factor of Nonshunting Operation for Esophageal Varices

Kaoru Ohashi, Toshiro Maruyama, Shinsuke Ohura, Isamu Watanabe, Kuniaki Kojima, Masaki Fukazawa, Tomoe Beppu, Shunji Futagawa

The Second Department of Surgery, School of Medicine Juntendo University

In order to elucidate the therapeutic safety of the nonshunting operation for esophageal varices, risk factors were investigated retrospectively in 432 cases of liver cirrhosis. To examine preoperative risk factors, the timing of surgery, Child's classification. ICG clearance test, routine liver function tests, glucose tolerance test and the presence or absence of hepatoma were compared between the operative death cases and survivors. The results were as follows: 1) For prophylactice, elective and emergent operations, the operative mortality of patients in Child's class C was significantly higher than that of those in class A or B (p<0.01). 2) The operative mortality of patients showing ICG-R₁₅≥50%, K-ICG<0.04, and Alb<3.5 g/dl, ChE<300 IU/l, PT<40%, HP<40%, T-Cho<100 mg/dl and T-Bil≥2.5 mg/dl was significantly higher (p<0.05). 3) With emergent operation, the operative mortality of patients with hepatoma was significantly higher than that of patients without hepatoma (p<0.01). From the above results, the nonshunting operation for esophageal varices was considered risky for cases of Child's class C with more than 50% ICG-R₁₅, and less than 0.04 K-ICG.

Key words
risk factors for surgical treatment of esophageal varrices, nonshunting operation for esophageal varices, preoperative evaluation of hepatic reserve

Reprint requests
Kaoru Ohashi The Second Department of Surgery, School of Medicine Juntendo University
2-1-1 Hongo, Bunkyo-ku, Tokyo, 113 JAPAN

Accepted
June 14, 1993

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