@article{oai:niigata-u.repo.nii.ac.jp:00021955, author = {長谷川, 滋}, issue = {10}, journal = {新潟医学会雑誌, 新潟医学会雑誌}, month = {Oct}, note = {Prognositic significance of Child's classification determined after treatment was studied in 98 patients with esophageal varices treated by esophageal transection (surgical group) and 66 patients treated by endoscopic sclerotherapy (EIS group). Underlying disease was liver cirrhosis in all patients. in the surgical group, postoperative deterioration of Child's grading was seen in 25% of preoperative Child's A group and 34.3% of Child's B group. Most important contributing factor to this postoperative deterioration was blood loss during surgery. On the other hand, postoperative improvement to Child's B or A occurred in 52.6% of preoperatively determined Child's C group. Overestimation of hepatic dysfunction immediately after variceal hemorrhage seemed to contribute to this postoperative change in Child's grading. As the result, postoperative grading showed more faithful correlation to prognosis than preoperative one. On the contrary, no posttreatment change in Child's grading occurred in the EIS group. Endoscopic sclerotherapy seemed to give little damage to the patients by itself. For more strict comparison of the results of surgical and endoscopic treatment of esophageal varices, more precise criteria than Child's classification seemed necessary especially in emergency cases because estimation of hepatic functional reserve was often difficult immediately after hemorrhage., 食道静脈療症例の直達手術例98例,内視鏡的硬化療法症例66例を対象として,治療前後のChild分類による評価を行い, その意義を検討した. 厳達手術例の術前Child分類による評価ではA ,B群に比較し,C群の予後は不良であり,術前Child分類に一定の評価が認められた.術後(約1ヶ月)のChild分類の再評価ではA ,B,C群問に各々重症度に応じ,長期生存率に有意差が認められ,,直達手術の長期予後の推定には術後の再評価がさらに有用であると思われた.Child分類の術後変動を予測する因子としてはA群ではCh-E,K-ICG,B群ではT-Bil,C群ではAlb,Ch-Eであった.また,術後変動をきたす要因として,術中出血量が重要であった.Child B群となる項目数の少ないものは,術後A 群となる可能性が大きかった.一方,内視鏡的硬化療法では治療前後のChild分類の変動は少なく,治填前Child分類が予後をよく反映した.}, pages = {861--869}, title = {食道静脈瘤治療前後のChild分類の変動とその臨床的意義}, volume = {104}, year = {1990} }