Time-associated changes in the disappearance rate of indocyanine green from the blood (K.ICG) as an index of liver function, were studied. Blood was drawn 5 times at 3-minute intervals from 32 patients. Early, intermediate, and late K.ICG values were 0.087 +/- 0.040, 0.082 +/- 0.038, and 0.076 +/- 0.033 min-1, respectively, showing serial decreases. When blood was drawn 8 times at 2-minute intervals from 22 other patients, the means of the K.ICG values at 11 time points showed a nearly linear relationship (r = -0.986). These findings indicated that K.ICG is approximated by a linear function of time, K(t) = -K'.t + K0. According to this function, K.ICG is considered to decrease by 1.96% every minute. The K.ICG value determined by the conventional method is, therefore, a mean disappearance rate of 15 minutes, and K0 is considered to reflect the initial reaction speed.
Of the 205 patients treated by endoscopic injection sclerotherapy in the past 8 years and 4 months, 70 patients (34.1%) have survived more than 3 years. There were more Child's class A patients (p < 0.05) and fewer Child's C patients (p < 0.01) in this group as compared to 51 patients who died within 3 years. In addition, complications due to hepatoma were significantly lower (p < 0.01) in this group. The long‐term cumulative survival rates of those who had already survived over 3 years were 82% at the 5‐year and 78% at the 7‐year follow‐up. There was no significant difference among 3 groups classified by severity of liver damage or timing of the therapy.
Rebleeding was noted in 13 patients (18.3%) and the cumulative bleeding rates were 9% at the 1‐year, 14% at the 3‐year, 18% at the 5‐year and 21% at the 7‐year follow‐up. In 12 of these patients hemostasis was obtained by the second sclerotherapy. There was no significant difference in the long‐term prognosis between patients who experienced repeat bleeding, and those who did not.
Endoscopic findings in patients with rebleeding were characteristic in that the red color sign remained pronounced despite the fact that the varices had shrunk from F2 or larger to F1 in 6 patients. Bleeding occurred from the gastric varices in 4 patients. One of them died due to gastric bleeding, but 3 were operated on after sclerotherapy.
For improving prognosis, it is important to carefully observe the clinical course and to perform additional aggressive treatments for complete obliteration of varices.
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