Abstract
The clinical efficacies of endoscopic injection sclerotherapy (EIS) and trans-ileocecal obliteration (TIO) for esophago-cardiac varices (ECV) were studied on 50 patients who had had hepato-cellular carcinoma (HCC). The mean survival time (M±SD) after the confirmed diagnosis of HCC was 6.8±4.2 months in non-hemorrhagic cases, 3.1±1.3 months in hemorrhagic cases after preventional or elective EIS, 3.7±1.2 months in emergency hemorrhagic cases and 1.3±0.8 months in re-hemorrhagic cases after emergency treatment. According to these results, some cases without hemorrhage in their clinical courses had longer survival time than hemorrhagic cases and aggressive, preventional treatment to avoid the variceal hemorrhage should be necessary to improve the prognosis of HCC. However, for the reason of existence of portal hypertension due to tumor thrombi in the main branch of portal vein, it is difficult to treat the varices by EIS only. On the incidence of emergency cases and of variceal hemorrhagic cases after preventional or elective EIS, significant differences depended on the existence of tumor thrombi were observed in 29% to 62% (p<0.05). The incidence of re-hemorrhage after emergency EIS on both cases with or without tumor thrombi is 38% and 0%, respectively, and emergency hemostatic rate on the cases with tumor thrombi is no more than 50% by EIS. From these rerults, we conclude that a combination therapy with EIS and TIO must be performed to the patients who has tumor thrombi in the main branch of portal vein, and when we are going to treat patients who have severe EGV with good prognostic HCC, further additional treatment such as Hassab's operation must be recommended.
