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1.
Article in Chinese | WPRIM | ID: wpr-932779

ABSTRACT

Objective:To study the clinical results of personalized surgical treatment for portal hypertension based on portal venous hemodynamics.Methods:A retrospective study was performed on patients with portal hypertension who underwent surgical treatment from January 2016 to December 2020 at the People’s Hospital of Ningxia Hui Autonomous Region and Wuhai People’s Hospital. Of 229 patients included into this study, there were 156 males and 73 females, with age of (4±11) years old. Portal vein CT and ultrasound doppler examination were performed preoperatively and portal vein manometry and ultrasound doppler examination were performed intraoperatively to evaluate portal venous hemodynamics. Based on the evaluation results, different surgical treatments were adopted. Postoperative complications and results of the operations were recorded. Long-term outcomes were evaluated by the rate of recurrence of gastroesophageal varices which was classified as disappearance, mild, moderate and severe according to endoscopic findings.Results:All the 229 patients completed the operations successfully. All together 13 operative treatments were used: (1) simple splenectomy ( n=11); (2) devascularization ( n=176), including 86 patients with splenectomy combined with extensive devascularization, 44 patients with splenectomy combined with selective devascularization and with preservation of paraesophageal veins, 39 patients with splenectomy combined with selective devascularization and reconstruction of spontaneous portosystemic shunt (34 patients with selective devascularization and reconstruction of spontaneous gastrorenal shunt and 5 patients with selective devascularization and reconstruction of spontaneous splenorenal shunt), 4 patients with secondary devascularization for variceal recurrence and 3 patients with devascularization and preservation of spleen; (3) shunt procedures were performed in 42 patients including 21 patients with splenectomy combined with coronary renal shunt, 11 patients with splenectomy combined with coronary-caval shunt, 6 patients with distal splenorenal shunt, 2 patients with proximal splenorenal shunt combined with devascularization, 1 patient with right gastroepiploic vein-inferior vena cava shunt and 1 patient with trans-inferior mesenteric vein coronary renal shunt. There were no operative deaths. The Clavien-Dindo grade 3 and above postoperative complication rate was 6.6% (15/229). Two hundred and eight patients were followed up for 6-60 months, with a median follow-up of 38 months. Severe recurrent varices were found in 21 patients (10.1%, 21/208), with 5 patients (2.4%, 5/208) presented with variceal bleeding. The rate of severe varices after selective shunting and selective devascularization by reconstructing the spontaneous portosystemic shunt (4.2%, 3/72) was significantly lower than that of the other devascularization procedures (13.7%, 17/124)(χ 2=4.53, P=0.033). Conclusion:Better clinical results were achieved by selecting the appropriate surgical procedures based on portal venous hemodynamic characteristics of patients. Selective shunting and selective devascularization by reconstructing the spontaneous portosystemic shunts significantly reduced the recurrence rate of severe varies.

2.
Article in Chinese | WPRIM | ID: wpr-932745

ABSTRACT

Objective:To study the efficacy, feasibility and safety of transjugular intrahepatic portosystemic shunt (TIPS) in treatment of recurrent portal hypertension after splenectomy and devascularization in patients presenting with upper gastrointestinal bleeding.Methods:Cirrhotic patients with recurrent portal hypertension after splenectomy and devascularization and presenting with upper gastrointestinal bleeding from August 2015 to December 2020 were studied. Thirty-nine patients were included in this study. There were 24 males and 15 females, with age of (51.56±9.08) years old. These patients were treated with TIPS by using the Viabahn stent. Intraoperative portal vein pressure, success operative rate, hemostasis rate after surgery, changes in hematological indicators and postoperative efficacy and complication rate were studied.Results:Thirty-eight of 39 patients successfully underwent TIPS shunt and 1 patient failed because of portal vein spongiosis. The success rate was 97.44%(38/39). Thirty-three patients underwent TIPS and variceal vein embolization, while 5 patients were treated with TIPS alone. Thirty-nine Viabahn stents with a diameter of 8 mm were implanted in 38 patients, of which 5 patients had the stent expanded to its nominal diameter of 8 mm. The remaining 33 patients (86.84%) had a shunt with a diameter of 6 mm. The hemostasis rate of postoperative gastrointestinal bleeding was 97.37% (37/38). The portal vein pressure and portal venous pressure gradient decreased from (31.28±6.24), (20.61±5.14) mmHg (1 mmHg=0.133 kPa) to (19.58±4.69), (9.24±3.07) mmHg respectively, the differences were significant (all P<0.001). All patients were followed-up for 3 to 36 months, with a median follow-up of 12 months. The postoperative rebleeding rate was 6.90% (2/29). The incidence of hepatic encephalopathy was 13.79% (4/29), and the incidence of shunt disorder was 13.79% (4/29). Conclusion:TIPS was safe, effective and feasible in treating patients with recurrent portal hypertension after splenectomy and devascularization presenting with upper gastrointestinal bleeding. Most patients obtained good clinical outcomes with a 6 mm diameter shunt.

3.
Journal of Chinese Physician ; (12): 641-644, 2022.
Article in Chinese | WPRIM | ID: wpr-932111

ABSTRACT

The standard management of portal hypertension and its complications is one important part in achieving the goal of eliminating hepatitis B in 2030. There existing considerable controversy on the management of clinical issues related to portal hypertension: establishing a non-invasive portal pressure prediction model is an urgent need in clinic; emergency management of variceal bleeding is in need of real world evidence; and guidance regarding the management of portal hypertension and its complications is desiderating data validation from Chinese. Designing appropriate and high-quality clinical research on portal hypertension could provide credible evidence for clinical decision, contributing to the precision implement of diagnosis and treatment decisions on portal hypertension and its complications.

4.
Journal of Clinical Hepatology ; (12): 2155-2159, 2022.
Article in Chinese | WPRIM | ID: wpr-942679

ABSTRACT

With the deeper understanding of the pathophysiological mechanism of portal hypertension and the enrichment and refinement of examination methods, special portosystemic collateral veins (PSCVs) caused by portal hypertension are constantly identified and recognized. However, early identification and diagnosis and formulation of reasonable and effective treatment regimens are difficult issues in clinical practice due to complicated clinical manifestations, difficulties in diagnosis and treatment, severe complications, poor prognosis, and high mortality. This article elaborates on the anatomic structure, clinical significance, diagnostic methods, and treatment of special PSCVs caused by portal hypertension.

5.
Journal of Clinical Hepatology ; (12): 1220-1223, 2022.
Article in Chinese | WPRIM | ID: wpr-924687

ABSTRACT

Portal hypertension-related complications are the major cause of death in patients with advanced chronic liver disease (ACLD). Hepatic venous pressure gradient is the golden standard for assessing portal hypertension, and upper gastrointestinal endoscopy is an important method for screening and assessing esophageal and gastric varices and its severity; both methods are invasive and inappropriate for portal hypertension screening and monitoring. Noninvasive approaches, such as transient elastography, acoustic radiation force impulse, and shear wave elastography, have been used for the evaluation of portal hypertension in ACLD patients, especially the screening, stratified diagnosis, and monitoring of clinically significant portal hypertension.

6.
Journal of Clinical Hepatology ; (12): 918-922, 2022.
Article in Chinese | WPRIM | ID: wpr-923309

ABSTRACT

Previous studies believe that patent paraumbilical vein in cirrhotic portal hypertension can reduce portal venous flow, portal venous pressure, and the development of esophageal varices and esophageal variceal bleeding, but there are still controversies over this issue in clinical practice. This article reviews the formation of portal systemic collateral circulation, the characteristics of the paraumbilical vein, the definition and diagnosis of patent paraumbilical vein, and the influence of patent paraumbilical vein on the development of esophageal varices and esophageal variceal bleeding, and it is believed that patent paraumbilical vein may not reduce the development of esophageal varices and esophageal variceal bleeding. Contrary to the previous points of view, patent paraumbilical vein should be regarded as a manifestation of the progression of cirrhotic portal hypertension, which can lead to the complications such as hepatic encephalopathy, and therefore, targeted prevention measures should be adopted in clinical practice.

7.
Acta cir. bras ; 37(1): e370103, 2022. tab
Article in English | LILACS-Express | LILACS, VETINDEX | ID: biblio-1364251

ABSTRACT

ABSTRACT Introduction: Portal hypertension still represents an important health problem worldwide. In the search for knowledge regarding this syndrome, experimental studies with animal models have proven to be useful to point the direction to be taken in future randomized clinical trials. Purpose: To validate the experimental model of portal hypertension and esophagogastric varices in a medium-sized animal. Methods: This study included five minipigs br1. Midline laparotomy with dissection of the portal vein and production of a calibrated stenosis of this vein was performed. Measurement of pressure in the portal venous and digestive endoscopic were performed before and five weeks after the production of a stenosis. Results: All animals were 8 months old, average weight of 17 ± 2.5 kg. The mean pressure of the portal vein immediately before the partial ligation of the portal vein was 8.9 + 1.6 mm Hg, with 26.6 + 5.4 mm Hg in the second measurement five weeks later (p < 0.05). No gastroesophageal varices or hypertensive portal gastropathy were seen at endoscopy procedures in our sample at any time in the study. Conclusion: Portal vein ligation in minipigs has been validated in the production of portal hypertension, but not in the formation of esophageal varices.

8.
Journal of Clinical Hepatology ; (12): 596-600, 2021.
Article in Chinese | WPRIM | ID: wpr-873804

ABSTRACT

ObjectiveTo investigate the clinical effect of laparoscopic splenectomy and pericardial devascularization (LSPD) in patients with portal hypertension and the long-term effect of LSPD. MethodsA total of 40 portal hypertension patients with Child-Pugh A/B liver function who received LSPD in The First Hospital of Jilin University from August to December 2017 were enrolled as surgical group, and 44 portal hypertension patients with Child-Pugh A/B liver function who received conservative treatment during the same period of time was enrolled as internal medicine group. The patients were followed up to June 30, 2019, and liver function parameters, upper gastrointestinal bleeding, and portal vein thrombosis were recorded for all patients at each time point. The t-test was used for comparison of normally distributed continuous data between two groups; an analysis of variance was used for comparison between multiple groups, and the Bonferroni test was used for further comparison between two groups. The Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution; between multiple groups, and the Mann-Whitney U test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. ResultsAt 6, 12, and 24 months after discharge, compared with the internal medicine group, the surgical group had a significantly higher level of cholinesterase (t=3.527, 3.849, and 5.555, all P<0.05) and a significantly lower Child-Pugh score (t=2.498, 2.138, and 2.081, all P<0.05). Compared with the internal medicine group at 12 and 24 months after discharge, the surgical group had a significantly higher level of albumin (t=3.120 and 2.587, both P<0.05) and a significantly lower incidence rate of upper gastrointestinal bleeding (χ2=4.947 and 5.155, both P<0.05). At 24 months after discharge, the surgical group had a significantly lower number of patients who had a significant increase in alpha-fetoprotein level than the internal medicine group (χ2=4.648, P=0.031). At 12 months after discharge, the surgical group had a significantly higher incidence rate of portal vein thrombosis than the internal medicine group (χ2=4.395, P=0.036). The surgical group had significant improvements in albumin (F=2.959, P=0.013), cholinesterase (F=11.022, P<0001), prothrombin time (H=94.100, P<0.001), and Child-Pugh score (F=3.742, P=0.003) from admission to 12 and 24 months after surgery. ConclusionIn portal hypertension patients with Child-Pugh A/B liver function, LSPD can improve liver function and reduce the incidence rate of upper gastrointestinal bleeding, and the high incidence rate of portal vein thrombosis can be effectively reduced by oral aspirin and rivaroxaban.

9.
Journal of Clinical Hepatology ; (12): 515-521, 2021.
Article in Chinese | WPRIM | ID: wpr-873795

ABSTRACT

With the comprehensive application of a variety of treatment methods, the survival time of patients with primary liver cancer is gradually increasing. For patients with early-stage liver cancer and portal hypertension, local ablation therapy can achieve long-term survival and play a positive role in stabilizing portal venous pressure, preserving liver function, and reducing complications. In addition, it can be combined with other techniques such as transarterial chemoembolization, transjugular intrahepatic portosystemic shunt, splenectomy, and pericardial devascularization to further improve treatment outcome. Several measures can be taken in the perioperative period to improve the management efficiency of patients after ablation, such as objective evaluation of portal venous pressure, prevention of esophagogastric variceal bleeding, correction of hypersplenism, prevention of postoperative liver failure, and multidisciplinary team management.

10.
Article in Chinese | WPRIM | ID: wpr-908474

ABSTRACT

Portopulmonary hypertension is a rare and serious complication of portal hypertension, which is very easy to miss diagnosis in clinic, and relatively difficult to treat. The authors elaborate in depth of the epidemiology, pathogenesis, diagnosis, treatment and prognosis of portopulmonary hypertension.

11.
International Journal of Surgery ; (12): 675-679, 2021.
Article in Chinese | WPRIM | ID: wpr-907503

ABSTRACT

Objective:To investigate the clinical application and efficacy of laparoscopic splenectomy combined with disconnection in megalosplenia and portal hypertension.Methods:The clinical data of 58 patients with splenomegaly of portal hypertension treated in the Department of Hepatobiliary and Pancreatic Surgery of Huangshi Central Hospital of Eastern Hubei Medical Group from January 2016 to January 2020 were analyzed retrospectively, they were divided into laparoscopy group ( n=34) and laparotomy group ( n=24), Laparoscopic splenectomy combined with devascularization was performed in the laparoscopic group, and open splenectomy combined with devascularization was performed in the open group.The general data, operation time, intraoperative bleeding, postoperative exhaust time, postoperative hospital stay and the incidence of postoperative complications (abdominal bleeding, B/C pancreatic leakage, abdominal infection, etc.) were compared between the two groups. The measurement data obeying normal distribution was expressed by mean±standard deviation ( Mean± SD), and the t test was used comparison between groups, and the chi-square test or Fisher exact probability was used comparison between enumeration data. Results:The surgery was successful in both two groups. 2 cases in the laparoscopic group were converted to laparotomy, There was no death in perioperative period.The operation time of laparoscopy group was (205.3±28.6) min and that of laparotomy group was (156.4±20.7) min, which was significantly longer than that of laparotomy group ( P=0.012). The intraoperative bleeding volume of laparotomy group was (327.2±39.5) mL, which was significantly higher than that of laparoscopy group (246.5±32.3) mL. there was significant difference between the two groups ( P<0.05). The postoperative exhaust time and postoperative hospital stay in the laparoscopic group were (2.6±1.4) d and (9.7±2.3) d, the laparotomy group were (3.8±1.5) d and (12.9±2.7) d respectively. The laparoscopy group was shorter than the laparotomy group. The difference between the two groups was statistically significant ( P<0.05). There were 0 case of abdominal bleeding, 2 cases of B/C pancreatic leakage and 3 cases of abdominal infection in the laparoscopic group, 1 case of abdominal bleeding, 2 cases of B/C pancreatic leakage and 5 cases of abdominal infection in the open group. The incidence of postoperative complications in the laparoscopic group was lower than that in the open group, but there was no significant difference between the two groups( χ2=2.807, P=0.088). Conclusions:Laparoscopic splenectomy combined with devasculation is safe and feasible, with advantages such as little trauma, quick recovery of postoperative intestinal function and short hospital stay, which benefit patients. However, the operation is difficult and requires high technical and psychological quality of surgeons.

12.
Journal of Clinical Hepatology ; (12): 2935-2938, 2021.
Article in Chinese | WPRIM | ID: wpr-906893

ABSTRACT

Hepatic venous pressure gradient (HVPG) is the "gold standard" for diagnosing portal hypertension and determining its severity, but its wide clinical application is limited due to its invasiveness and difficulties in operation. The replacement of HVPG by noninvasive methods has become a research hotspot in recent years; however, the accuracy of the existing serological and imaging methods remains to be discussed, and such methods cannot completely replace HVPG in clinical practice. Liver biopsy has been widely used in clinical practice for many years and is still an indispensable method for the diagnosis of some liver diseases. Recent studies have found that several pathological indicators after liver biopsy, such as collagen area, fibrous septal thickness, nodule size, microvascular density, and density and area of bile ducts and lymphatic vessels, can not only judge the severity of liver fibrosis, but also have a good correlation with portal venous pressure, which provides new ideas for diagnosing cirrhotic portal hypertension and evaluating the severity of portal hypertension.

13.
Journal of Clinical Hepatology ; (12): 2767-2769, 2021.
Article in Chinese | WPRIM | ID: wpr-906856

ABSTRACT

Malnutrition is common in patients with liver cirrhosis, especially with a high incidence rate in the decompensated stage, which mainly manifests as protein-energy malnutrition and has a negative impact on the prognosis of patients. The main causes of malnutrition in liver cirrhosis are insufficient intake and increased consumption. Body composition assessment is an important method to evaluate the type of malnutrition in liver cirrhosis. European Society for Parenteral and Enteral Nutrition (ESPEN) guidelines suggest that Nutritional Risk Screening 2002 (NRS2002) should be used for nutritional risk screening, and cirrhotic patients with an NRS2002 score of ≥3 are considered at the risk of malnutrition. ESPEN guidelines recommend a daily energy intake of 30-35 kcal/kg and a daily protein intake of 1.2-1.5 g/kg for patients with liver cirrhosis. Transjugular intrahepatic portosystemic shunt can effectively reduce portal hypertension in patients with liver cirrhosis and help to improve their nutritional status.

14.
Journal of Clinical Hepatology ; (12): 2764-2766, 2021.
Article in Chinese | WPRIM | ID: wpr-906855

ABSTRACT

Esophageal and gastric variceal bleeding (EGVB) is a serious complication of portal hypertension, and it is necessary to control the progression of esophageal and gastric varices in clinical practice and prevent and treat EGVB; however, the mortality rate associated with variceal rupture and bleeding remains high at present. As for clinical treatment, risk classification of patients should be performed based on clinical and hemodynamic features and individualized treatment should be adopted, taking into account the balance of "embolization, shunt, and perfusion" of portal hypertension, so as to improve the clinical outcome and prognosis of patients with liver cirrhosis.

15.
Journal of Clinical Hepatology ; (12): 2760-2763, 2021.
Article in Chinese | WPRIM | ID: wpr-906854

ABSTRACT

The portal vein system is the main blood supply system of the liver, and damage to the portal vein system caused by cirrhotic portal hypertension may be the second hit to the liver. Protection of the portal vein will ensure sufficient blood supply of the liver and maintain its structure and function. Starting from the physiological structure and pathological changes of the portal vein, this article elaborates on the adverse effect of portal hypertension on the liver from the three new perspectives of thrombosis of the portal system, abnormal angiogenesis, and disturbance of hepatic sinusoidal homeostasis. It is suggested to change the current status of passive treatment of portal hypertension complications and encourage scientific exploration to reduce portal hypertension from multiple angles as early as possible to avoid repeated endoscopic devascularization of collateral circulation and splenectomy, so as to reduce various factors for the damage of the portal system, maintain the homeostasis of the portal system, and protect the liver.

16.
Journal of Clinical Hepatology ; (12): 2756-2759, 2021.
Article in Chinese | WPRIM | ID: wpr-906853

ABSTRACT

Globally, the population living with liver cirrhosis is growing. There is the largest number of cirrhosis patients in China throughout the world. Acute-on-chronic liver failure (ACLF) is a clinical syndrome of sudden hepatic decompensations such as variceal bleeding, spontaneous bacterial peritonitis, hepatic encephalopathy and hepatorenal syndrome seen in patients with liver cirrhosis. ACLF leads to poor quality of life and high mortality. Portal hypertension is not only a consequence of the development of cirrhosis, but also a secondary or even superimposed attack to the development of cirrhosis. It is necessary to early reduce intrahepatic resistance by transjugular intrahepatic portosystemic shunt and drugs to improve the prognosis.

17.
Journal of Clinical Hepatology ; (12): 2617-2621, 2021.
Article in Chinese | WPRIM | ID: wpr-905003

ABSTRACT

Objective To investigate the clinical features, liver histopathological features, treatment, and prognosis of primary myelofibrosis (PMF)-associated hepatic vascular disease and portal hypertension. Methods A retrospective analysis was performed for the clinical and pathological features of 68 patients who were diagnosed with PMF in 960 Hospital of the PLA Joint Logistics Support Force and Xijing Hospital of Digestive Diseases, Air Force Medical University, from July 2010 to December 2020, among whom 22 patients had hepatic vascular disease/portal hypertension as the main manifestation. The patients were divided into two groups according to the presence or absence of thrombosis, and treatment and prognosis were summarized. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used to compare long-term survival rate between the two groups. Results Among the 68 patients with PMF, 22 had hepatic vascular disease and/or portal hypertension, resulting in a prevalence rate of 32.35%, and among these 22 patients, 13 (59.1%) had extrahepatic portal vein occlusion, 1 (4.5%) had Budd-Chiari syndrome, and 8 (36.4%) had portal hypertension. Biopsy was performed for 7 patients, and pathological results showed extramedullary hematopoiesis in the liver and varying degrees of infiltration of lymphocytes, plasma cells, and eosinophils at the lobular and portal areas, but the lobular structure was normal. A total of 7 patients died during follow-up, among whom 5 died of complications associated with thrombosis or portal hypertension. The overall median survival time was 57.99 months for all patients; the median survival time was 45.33 months in patients with thrombosis and 64.00 months in patients without thrombosis, and although there was no significant difference between the two groups ( χ 2 =3.035, P =0.081), the non-thrombosis group tended to have better survival and prognosis than the thrombosis group. Conclusion The possibility of PMF as the primary disease should be considered for patients with hepatic vascular disease and portal hypertension. Patients with PMF should be screened for hepatic vascular disease, and early intervention should be given. The patients without thrombosis tend to have better survival and prognosis than those with thrombosis.

18.
Journal of Clinical Hepatology ; (12): 2435-2438, 2021.
Article in Chinese | WPRIM | ID: wpr-904965

ABSTRACT

Liver cirrhosis is the end stage of various chronic liver diseases, and portal hypertension is a main complication of liver cirrhosis. In this pathological state, spontaneous portosystemic shunt (SPSS), as the collateral circulation of the portal venous system, has not attracted enough attention in terms of occurrence mechanism and clinical value. The analysis shows that although SPSS is a natural shunt channel, further studies are still needed to clarify whether it can be used as a decompression method for portal hypertension, and a deeper understanding of SPSS will provide important guiding significance for the diagnosis and treatment of portal hypertension.

19.
Journal of Clinical Hepatology ; (12): 2435-2438, 2021.
Article in Chinese | WPRIM | ID: wpr-904915

ABSTRACT

Liver cirrhosis is the end stage of various chronic liver diseases, and portal hypertension is a main complication of liver cirrhosis. In this pathological state, spontaneous portosystemic shunt (SPSS), as the collateral circulation of the portal venous system, has not attracted enough attention in terms of occurrence mechanism and clinical value. The analysis shows that although SPSS is a natural shunt channel, further studies are still needed to clarify whether it can be used as a decompression method for portal hypertension, and a deeper understanding of SPSS will provide important guiding significance for the diagnosis and treatment of portal hypertension.

20.
Article in Chinese | WPRIM | ID: wpr-911472

ABSTRACT

Essential thrombocythemia (ET) is a chronic myeloproliferative neoplasm (MPN) featured by clonal proliferation of platelets, thrombosis and hemorrhage. Portal hypertension is a serious complication of ET associated with poor prognosis. We report a patient with ET complicated with acute upper gastrointestinal hemorrhage and intestinal perforation due to portal hypertension. She had an uneventful recovery after surgical and endoscopic treatment.

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