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1.
Arq Gastroenterol ; 49(2): 143-9, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22767002

RESUMO

CONTEXT: Transjugular intrahepatic portosystemic shunt (TIPS) is the non-surgical treatment option with low level of morbi-mortality and possibility of accomplishment in patients with severe hepatic dysfunction which aims at decompressing the portal system treating or reducing the portal hypertension complications. OBJECTIVE: Outline the profile analyze global and early mortality, and the complications presented by cirrhotic patients who underwent TIPS for treatment of digestive hemorrhage by portal hypertension. METHOD: Retrospective study based on the data bank of cirrhotic patients' medical reports, who underwent TIPS for digestive hemorrhage by portal hypertension treatment who did not respond to clinical endoscopic treatment, and were assisted from 1998 to 2010 in the Liver Transplant Service at a university hospital. The study was approved by the Committee of Ethics and Research. RESULTS: The sample was comprised of 72 (84.7%) patients, being 57 (79.2%) males, average age 47.7 years (age range from 16 to 85 years and SD = 13), 21 (29.2%) patients presented liver disease as cause excessive intake of alcoholic drinks; 21 (29.2%) contamination by hepatitis virus, 16 (22.2%) excessive alcohol intake associated with virus and 14 (19.4%) patients presented other causes. As for initial classification, 14 (20%) had Child-Pugh A, 33 (47.1%) Child-Pugh B and 23 (32.9%) Child-Pugh C. Initial MELD was obtained in 68 patients being 37 (54.4%) higher than 15 points while 31 (45.6%) had up to 15 points. Early death occurred in 19 (26.4%). Global mortality occurred in 41 (60.3%). CONCLUSIONS: Mortality is directly related to clinical factors of patients, being Child-Pugh and MELD classifications predictors of mortality, with more impact in patients with Child-Pugh class C and MELD > 15. The complications found were similar to those described in the literature, although the dysfunction by stent stenosis (26.4%) was lower than in the most of the studies and the encephalopathy incidence (58.3%) was higher. Probably, the high incidence of encephalopathy is explained by the low incidence of stenosis.


Assuntos
Hipertensão Portal/mortalidade , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipertensão Portal/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
2.
Arq. gastroenterol ; 49(2): 143-149, Apr.-June 2012. graf, tab
Artigo em Inglês | LILACS | ID: lil-640175

RESUMO

CONTEXT: Transjugular intrahepatic portosystemic shunt (TIPS) is the non-surgical treatment option with low level of morbi-mortality and possibility of accomplishment in patients with severe hepatic dysfunction which aims at decompressing the portal system treating or reducing the portal hypertension complications. OBJECTIVE: Outline the profile analyze global and early mortality, and the complications presented by cirrhotic patients who underwent TIPS for treatment of digestive hemorrhage by portal hypertension. METHOD: Retrospective study based on the data bank of cirrhotic patients' medical reports, who underwent TIPS for digestive hemorrhage by portal hypertension treatment who did not respond to clinical endoscopic treatment, and were assisted from 1998 to 2010 in the Liver Transplant Service at a university hospital. The study was approved by the Committee of Ethics and Research. RESULTS: The sample was comprised of 72 (84.7%) patients, being 57 (79.2%) males, average age 47.7 years (age range from 16 to 85 years and SD = 13), 21 (29.2%) patients presented liver disease as cause excessive intake of alcoholic drinks; 21 (29.2%) contamination by hepatitis virus, 16 (22.2%) excessive alcohol intake associated with virus and 14 (19.4%) patients presented other causes. As for initial classification, 14 (20%) had Child-Pugh A, 33 (47.1%) Child-Pugh B and 23 (32.9%) Child-Pugh C. Initial MELD was obtained in 68 patients being 37 (54.4%) higher than 15 points while 31 (45.6%) had up to 15 points. Early death occurred in 19 (26.4%). Global mortality occurred in 41 (60.3%). CONCLUSIONS: Mortality is directly related to clinical factors of patients, being Child-Pugh and MELD classifications predictors of mortality, with more impact in patients with Child-Pugh class C and MELD > 15. The complications found were similar to those described in the literature, although the dysfunction by stent stenosis (26.4%) was lower than in the most of the studies and the encephalopathy incidence (58.3%) was higher. Probably, the high incidence of encephalopathy is explained by the low incidence of stenosis.


CONTEXTO: Derivação portossistêmica transjugular intra-hepática (TIPS) é opção de tratamento não cirúrgico com baixo índice de morbimortalidade e possibilidade de realização em pacientes com disfunção hepática grave que visa descomprimir o sistema porta tratando ou reduzindo as complicações da hipertensão portal. OBJETIVO: Traçar o perfil, analisar mortalidade global e precoce, e as complicações apresentadas pelos pacientes cirróticos submetidos a TIPS para tratamento da hemorragia digestiva por hipertensão portal. MÉTODOS: Estudo retrospectivo baseado no banco de dados dos prontuários dos pacientes cirróticos submetidos a TIPS para tratamento da hemorragia digestiva por hipertensão portal que não responderam ao tratamento clínico-endoscópico e atendidos no período de 1998 a 2010 no Serviço de Transplante de Fígado de um hospital universitário. O estudo foi aprovado pelo Comitê de Ética e Pesquisa. RESULTADOS: Amostra foi composta de 72 (84,7%) pacientes, sendo 57 (79,2%) do sexo masculino, idade média de 47,4 anos (entre 16 e 85 anos e DP = 13); 21 (29,2%) pacientes apresentavam como causa da doença hepática o consumo excessivo de álcool; 21 (29,2%) a contaminação por vírus da hepatite, 16 (22,2%) o consumo excessivo de álcool associado a vírus e 14 (19,4%) pacientes apresentavam outras causas. Quanto à classificação inicial, 14 (20%) tinham Child-Pugh A, 33 (47,1%) Child-Pugh B e 23 (32,9%) Child-Pugh C. MELD inicial foi obtido em 68 pacientes, sendo 37 (54,4%) com mais de 15 pontos, enquanto 31 (45,6%) tiveram até 15 pontos. Óbito precoce ocorreu em 19 (26,4%). Mortalidade global ocorreu em 41 (60,3%). CONCLUSÃO: Mortalidade está diretamente relacionada a fatores clínicos dos pacientes, sendo as classificações de Child-Pugh e MELD preditoras de mortalidade, com maior impacto em pacientes com Child-Pugh classe C e MELD >15. As complicações encontradas foram semelhantes às descritas na literatura, porém a disfunção por estenose do stent (26,4%) foi menor que a maioria dos estudos e a incidência de encefalopatia (58,3%) superior. Provavelmente, esta alta incidência seja explicada pela baixa incidência de estenose.


Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Hipertensão Portal/mortalidade , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Hipertensão Portal/cirurgia , Estudos Retrospectivos , Índice de Gravidade de Doença
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