Peritoneovenous shunt operation is a convenient therapy for intractable ascites. However, it accompanies postshunt coagulopathy, that sometimes leads to poor prognosis. We have attempted to alleviate this complication by preoperative cleansing of abdominal cavity using 5l of saline containing 5000 U of heparin. Serial determination of coagulation markers suggests that this new approach is effective to prevent the coagulation abnormality.

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Hassab's operation is a surgical procedure for choice in patients with esophago-gastric (EG) varices. We applied this procedure in 8 patients with liver cirrhosis accompanied by giant splenomegaly, hypersplenism and porto-systemic shunt irrespective of the presence of EG varices, and evaluated the effects of the surgery on liver function tests. A significant increase in white blood cell and platelet counts, serum total protein level, and serum albumin level as well as a significant decrease in serum level of total bilirubin and prothrombin time prolongation were observed three months after surgery. In addition, Child-Pugh scores decreased significantly from 8.5 (6-11) to 6.5 (5-9) (p <0.05). We suggested that Hassab's operation has a potential to improve hypersplenism, protein catabolism and impaired liver functions possibly through an increase in effective hepatic blood flow and restoration of nutritional state.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Portal vein thrombosis (PVT) is a well-recognized complication of liver cirrhosis (LC) and often induces severe portal hypertension, refractory ascites and variceal bleeding. We report on a case of refractory ascites and high-risk esophago-gastric varices due to extensive PVT. The patient's refractory ascites prevented surgical intervention to improve his hemodynamic status. We thus performed a transjugular intrahepatic portosystemic shunt (TIPS) and balloon dilatation of the occluded segment. After this procedure, the patient's ascites disappeared rapidly and we could carry out the required surgical procedure safely.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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