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1.
Medicine (Baltimore) ; 100(7): e24783, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607830

RESUMO

ABSTRACT: To evaluate the feasibility and potential value of 2D Parametric Parenchymal Blood Flow (2D-PPBF) for the assessment of perfusion changes following partial spleen embolization (PSE) in a retrospective observational study design.Overall, 12 PSE procedures in 12 patients were included in this study. The outcome of the study was the platelet response (PR), calculated as the percentage increase of platelet count (PLT), following PSE. To quantify perfusion changes using 2D-PPBF, the acquired digital subtraction angiography series were post-processed. A reference region-of-interest (ROI) was placed in the afferent splenic artery and a target ROI was positioned on the embolization territory of the spleen on digital subtraction angiography series pre- and post-embolization. The ratios of the target ROIs to the reference ROIs were calculated for the Wash-In-Rate (WIR), the Time-To-Peak (TTP) and the Area-Under-the-Curve (AUC). Comparisons between pre- and post-embolization data were made using Wilcoxon signed-rank test and Spearman's rank correlation coefficient (r). Afterwards, the study population was divided by the median of the TTP before PSE to analyze its value for the prediction of PR following PSE.Following PSE, PLT increased significantly from 43,000 ±â€Š21,405 platelets/µL to 128,500 ±â€Š66,083 platelets/µL with a PR of 255 ±â€Š243% (P = .003). In the embolized splenic territory, the pre-/post-embolization 2D-PPBF parameter changed significantly: WIRpre-PSE 1.23 ±â€Š2.42/WIRpost-PSE 0.09 ±â€Š0.07; -64 ±â€Š46% (p = 0.04), TTPpre-PSE 4.41 ±â€Š0.99/TTPpost-PSE 5.67 ±â€Š1.52 (P = .041); +34 ±â€Š47% and AUCpost-PSE 0.81 ±â€Š0.85/AUCpost-PSE 0.14 ±â€Š0.08; -71 ±â€Š18% (P = .002). A significant correlation of a 2D-PPBF parameter with the PLT was found for TTPpre-PSE/PLTpre-PSE r = -0.66 (P = .01). Subgroup analysis showed a significantly increased PR for the group with TTPpre-PSE >4.44 compared to the group with TTPpre-PSE ≤4.44 (404 ±â€Š267% versus 107 ±â€Š76%; P = .04).2D-PPBF is an objective approach to analyze the perfusion reduction of embolized splenic tissue. TTP derived from 2D-PPBF has the potential to predict the extent of PR during PSE.


Assuntos
Embolização Terapêutica/métodos , Hiperesplenismo/diagnóstico por imagem , Hipertensão Portal/diagnóstico por imagem , Artéria Esplênica/cirurgia , Adolescente , Adulto , Angiografia Digital/métodos , Embolização Terapêutica/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Hiperesplenismo/etiologia , Hiperesplenismo/cirurgia , Hipertensão Portal/complicações , Hipertensão Portal/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Adulto Jovem
2.
Zhonghua Gan Zang Bing Za Zhi ; 29(1): 54-59, 2021 Jan 20.
Artigo em Chinês | MEDLINE | ID: mdl-33541024

RESUMO

Objective: To investigate the clinical efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) with the use of Viator stent in the treatment of cirrhotic portal hypertension. Methods: 43 cases with cirrhotic portal hypertension were implanted with Viatorr stent during TIPS procedure from March 2016 to August 2018. Serological indicators, color Doppler ultrasound, gastroscopy, rebleeding, ascites and hepatic encephalopathy were regularly followed up. Portal venous pressure, liver and kidney function, coagulation indexes were compared by t-test. Stent patency rate, hepatic encephalopathy incidence, rebleeding rate and survival rate were calculated by Kaplan-Meier curve. Results: TIPS procedure success rate was 100% in all patients. Portal pressure gradient was decreased from (25.57 ± 5.50) mmHg to (9.76 ± 2.92) mmHg before and after operation. Alanine aminotransferase (ALT) was significantly higher at 1 month after operation than before operation, but there was no significant difference between 3 and 6 months after and before operation. Total bilirubin, serum ammonia and prothrombin time at 1, 3, and 6 months after operation were higher than before operation. Albumin had no significant change compared with before operation, and creatinine and urea nitrogen were lower than before operation. The cumulative rebleeding rates at 12 and 24 months after operation was 0% and 9%, respectively. Of the 26 patients with ascites, 22 cases (84.6%) had complete disappearance of ascites and 3 (11.5%) had significant decrease of ascites. The cumulative incidence of hepatic encephalopathy at 3, 6, 12 and 24 months after surgery was 11.6%, 17.3%, 21.9% and 21.9%, respectively. The cumulative incidence of stent dysfunction at 12 and 24 months after surgery was 5.6% and 23.7%, respectively. The cumulative survival rate at 12 months and 24 months after surgery was 91.9%. Conclusion: TIPS procedure with Viatorr stent can effectively reduce portal pressure and rebleeding rate, improve intrahepatic shunt patency rate, and will not increase the risk of postoperative hepatic encephalopathy, and has a higher cumulative survival rate.


Assuntos
Varizes Esofágicas e Gástricas , Encefalopatia Hepática , Hipertensão Portal , Derivação Portossistêmica Transjugular Intra-Hepática , Hemorragia Gastrointestinal , Humanos , Hipertensão Portal/cirurgia , Pressão na Veia Porta , Stents , Resultado do Tratamento
3.
Z Gastroenterol ; 59(1): 24-34, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33429447

RESUMO

INTRODUCTION: In the management of patients with decompensated liver cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) insertion is well-established but common recommendations in the follow up management are inconsistent. Doppler sonography is commonly used for detection for TIPS dysfunction whilst data on the impact of elective invasive examinations are scarce. AIM: The aim of this retrospective analysis is to evaluate potential benefits of elective invasive examinations in the follow up management of patients after TIPS insertion METHODS: Data of all patients receiving TIPS at the university hospitals of Muenster and Bonn between 2013 and 2018 (n = 534) were collected. The impact of performance of elective invasive examinations at 12 months after TIPS insertion on the occurrence of liver related events (LREs) and frequency of TIPS revisions within 24 months after TIPS insertion was analyzed. RESULTS: No significant differences were found concerning occurrence of liver related events after 24 months depending on whether an elective invasive examination was performed. Occurrence of hepatic encephalopathy, relapse of initial indication for TIPS, as well as death or liver transplantation all did not differ. These findings were verified by a subgroup analysis including only patients who did not experience a LRE or TIPS revision within the first 12 months after TIPS procedure. CONCLUSION: The analyzed data suggest no evidence for a beneficial impact due to implementation of an elective invasive examination program after TIPS insertion. Invasive examinations should remain reserved to patients with suspected TIPS dysfunction.


Assuntos
Procedimentos Cirúrgicos Eletivos/efeitos adversos , Varizes Esofágicas e Gástricas/cirurgia , Hipertensão Portal/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Varizes Esofágicas e Gástricas/etiologia , Seguimentos , Encefalopatia Hepática , Humanos , Hipertensão Portal/complicações , Derivação Portossistêmica Transjugular Intra-Hepática/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
4.
Z Gastroenterol ; 59(1): 43-49, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33429449

RESUMO

Non-cirrhotic portal vein thrombosis (PVT) in patients with antiphospholipid syndrome (APS) is a rare complication, and the management has to be determined individually based on the extent and severity of the presentation. We report on a 37-year-old male patient with non-cirrhotic chronic PVT related to a severe thrombophilia, comprising APS, antithrombin-, factor V- and factor X-deficiency. Three years after the initial diagnosis of non-cirrhotic PVT, the patient presented with severe hemorrhagic shock related to acute bleeding from esophageal varices, requiring an emergency transjugular intrahepatic portosystemic stent shunt (TIPSS). TIPSS was revised after a recurrent bleeding episode due to insufficient reduction of the portal pressure. Additionally, embolization of the dilated V. coronaria ventriculi led to the regression of esophageal varices but resulted simultaneously in a left-sided portal hypertension (LSPH) with development of stomach wall and perisplenic varices. After a third episode of acute esophageal varices bleeding, a surgical distal splenorenal shunt (Warren shunt) was performed to reduce the LSPH. Despite anticoagulation with low molecular weight heparin and antithrombin substitution, endoluminal thrombosis led to a complete Warren shunt occlusion, aggravating the severe splenomegaly and pancytopenia. Finally, a partial spleen embolization (PSE) was performed. In the postinterventional course, leukocyte and platelet counts increased rapidly and the patient showed no further bleeding episodes. Overall, this complex course demonstrates the need for individual assessment of multimodal treatment options in non-cirrhotic portal hypertension. This young patient required triple modality porto-systemic pressure reduction (TIPSS, Warren shunt, PSE) and involved finely balanced anticoagulation and bleeding control.


Assuntos
Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/etiologia , Hipertensão Portal/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Trombofilia , Trombose Venosa , Adulto , Varizes Esofágicas e Gástricas/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Humanos , Hipertensão Portal/diagnóstico , Masculino , Equipe de Assistência ao Paciente , Veia Porta/fisiopatologia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Stents
5.
AJR Am J Roentgenol ; 216(3): 698-703, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33439047

RESUMO

OBJECTIVE. Splenomegaly and thrombocytopenia are common complications in patients with cirrhosis. The present study aimed to evaluate changes in splenic volumes and platelet counts after TIPS insertion. MATERIALS AND METHODS. A total of 104 patients who had a diagnosis of portal hypertension and had undergone TIPS placement between November 2015 and August 2019 were enrolled in this retrospective cohort study. We retrospectively calculated splenic volumes before TIPS placement and at 1-2 and 6-12 months after TIPS placement and monitored the platelet count at 1, 3, 6, and 12 months after TIPS placement. RESULTS. The mean (± SD) portal pressure gradient before TIPS placement was 28.3 ± 4.6 mm Hg; after TIPS placement, it was 11.3 ± 4.5 mm Hg (p < .001). The mean splenic volume of all 104 patients before TIPS placement was 868 ± 409 cm3, and at 1-2 months after TIPS placement, it was 710 ± 336 cm3 (p < .001). Among the 43 patients for whom splenic volume data were available at both 1-2 and 6-12 months after TIPS placement, the mean splenic volume decreased from 845 ± 342 cm3 to 691 ± 301 cm3 and then to 674 ± 333 cm3, respectively. Correspondingly, the number of patients with severe thrombocytopenia decreased from 25 patients (35.7%) before the TIPS procedure to 16 patients (22.9%) in the 1-2 months after TIPS placement and then to 11 patients (15.7%) in the 6-12 months after TIPS implantation. The increase in the platelet count was significantly correlated with decreasing splenic volume (r2 = 0.3735; p < .001). CONCLUSION. In most patients, TIPS placement resulted in a significant decrease in splenic volume and a significant increase in the platelet count during the same period.


Assuntos
Hipertensão Portal/cirurgia , Cirrose Hepática/complicações , Derivação Portossistêmica Transjugular Intra-Hepática , Baço/patologia , Esplenomegalia/terapia , Trombocitopenia/terapia , Adulto , Idoso , Pressão Sanguínea , Feminino , Veias Hepáticas , Hepatite B/complicações , Hepatite C/complicações , Humanos , Hipertensão Portal/etiologia , Cirrose Hepática/virologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Contagem de Plaquetas , Estudos Retrospectivos , Esplenomegalia/etiologia , Esplenomegalia/patologia , Trombocitopenia/etiologia
6.
J Postgrad Med ; 66(4): 209-211, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33037167

RESUMO

Cavernomatous transformation of the portal vein, seen in extrahepatic portal venous obstruction (EHPVO), can cause impingement or ischemic insult on bile ducts manifesting as "portal cavernoma cholangiopathy" (PCC). Bile duct wall calcification in portal biliopathy is a rare occurrence and has not been reported in the literature to the best of our knowledge. We report a 59-year-old male, a known case of EHPVO, who had undergone laparoscopic cholecystectomy, splenectomy, and splenorenal shunt in the past. The patient had now presented to us in view of recurrent episodes of cholangitis for which a bilioenteric bypass was planned. Intraoperatively, dilated and densely thickened bile ducts with multiple pericholedochal collaterals were noted. Incision of common hepatic duct and left hepatic duct showed completely calcified ductal wall with no visible healthy mucosa. Calcifications were removed partially from the bile duct walls near choledochotomy site. With the anticipation of futile benefit from bilioenteric bypass, Roux-en-Y HJ was abandoned. Hepaticoduodenostomy was done to prevent bile leak from choledochotomy site.


Assuntos
Ductos Biliares/cirurgia , Colangite/diagnóstico , Colestase/etiologia , Doenças do Ducto Colédoco/etiologia , Hipertensão Portal/complicações , Icterícia/etiologia , Ductos Biliares/diagnóstico por imagem , Coledocostomia , Colestase/diagnóstico por imagem , Doenças do Ducto Colédoco/diagnóstico por imagem , Humanos , Hipertensão Portal/cirurgia , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
Z Gastroenterol ; 58(9): 877-889, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32947633

RESUMO

For 30 years the transjugular intrahepatic portosystemic shunt (TIPS) is successfully used for the treatment of portal hypertension. Indication for TIPS in relation to variceal bleeding and refractory ascites is scientifically documented and defined by national and international guidelines. For rare indications such as hepatorenal syndrome, portal vein thrombosis or the neodjuvant TIPS larger evidence-based studies are missing. An important contraindication and the leading clinical complication after TIPS is the development of hepatic encephalopathy (HE). Reduction of post-TIPS HE is therefore aimed through development of further technical enhancements of the TIPS-stents.


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Encefalopatia Hepática/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
12.
J Vasc Interv Radiol ; 31(5): 754-758, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32359522

RESUMO

This brief report describes 3 patients with infected extrahepatic splanchnic venous stents or stent grafts. These devices had been placed to treat prehepatic portal hypertension 4 wk, 3 mo, and 31 mo, respectively, before readmission for fever. Blood cultures and fluorine-18 fludeoxyglucose positron emission tomography/CT were positive in all. With systemic antibiotic treatment, 2 patients showed a clinical recovery. In the third patient, antibiotic treatment failed. Therefore, the infected stent graft was surgically removed and a splenorenal shunt was created. No recurrent splanchnic venous infection was observed in these 3 patients.


Assuntos
Antibacterianos/administração & dosagem , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/instrumentação , Hipertensão Portal/cirurgia , Infecções Relacionadas à Prótese/terapia , Stents/efeitos adversos , Resultado do Tratamento , Adolescente , Idoso , Implante de Prótese Vascular/efeitos adversos , Remoção de Dispositivo , Procedimentos Endovasculares/efeitos adversos , Humanos , Hipertensão Portal/diagnóstico , Hipertensão Portal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Pressão na Veia Porta , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Circulação Esplâncnica
14.
Transplant Proc ; 52(5): 1503-1506, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32278579

RESUMO

Hepatopulmonary syndrome (HPS) is characterized by intrapulmonary microvasculature dilatation that causes intrapulmonary shunting and leads to a gas exchange abnormality in the presence of liver diseases, which is the most common cause of respiratory insufficiency in these patients. HPS doubles the risk of death, and liver transplantation (LT) is the only curative therapeutic option so it should be considered in patients with severe HPS, with excellent survival rates post-LT. However, pretransplant Pao2 <45 mm Hg has been associated with an increase in post-transplant morbidity and mortality, but it does not imply a contraindication for LT. The resolution of HPS usually occurs within 6 months post-LT, but it can take 1 year. Portopulmonary hypertension (PoPH) is defined as pulmonary arterial hypertension (PAH) that develops in the setting of portal hypertension with or without liver disease in the absence of other causes of PAH. The prevalence of PoPH is 5% to 10% among liver transplant (LT) candidates. The impact of LT on PoPH is unpredictable. Therefore, despite conferring a high morbidity and mortality, PoPH itself is not an indication for liver transplantation. It may be considered a contraindication for LT in severe cases.


Assuntos
Síndrome Hepatopulmonar/cirurgia , Hipertensão Portal/cirurgia , Hipertensão Pulmonar/cirurgia , Hepatopatias/cirurgia , Transplante de Fígado/métodos , Feminino , Síndrome Hepatopulmonar/complicações , Humanos , Hipertensão Portal/complicações , Hipertensão Pulmonar/complicações , Hepatopatias/complicações , Masculino
15.
Curr Med Sci ; 40(1): 117-122, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32166673

RESUMO

This study was conducted to compare the feasibility, safety and effectiveness of the combined-laparoscopic splenectomy and esophagogastric devascularization (C-LSED) with open splenectomy and esophagogastric devascularization surgery (OSED) in patients with portal hypertension due to liver cirrhosis. From February 2014 to June 2018, 68 patients with portal hypertension were diagnosed as having serious gastroesophageal varices and/or hypersplenism in our center. Thirty patients underwent C-LSED and 38 patients received OSED. Results and outcomes were compared retrospectively. No patients of C-LSED group required an intraoperative conversion to open surgery. Significantly shorter operating time, less blood loss, lower transfusion rates, shorter postoperative hospital stay, lower rates of complications were found in C-LSED group than in C-LSED group (P<0.05). No death and rebleeding were documented in both groups during the follow-up periods of one year. Postoperative endoscopy revealed that varices in the patients of both groups were alleviated significantly from severe to mild, and in a part of cases, the varices disappeared. The final results suggest that the C-LSED technique is superior to open procedure, due to slightly invasive, simplified operative procedure, significantly shorter operating time, less intraoperative bleeding and lower post-operative complication rates. And C-LSED offers comparable long-term effects to open surgery.


Assuntos
Hipertensão Portal/cirurgia , Laparoscopia/métodos , Cirrose Hepática/complicações , Esplenectomia/métodos , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Hipertensão Portal/etiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos
16.
Zhonghua Wai Ke Za Zhi ; 58(3): 183-188, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32187922

RESUMO

The cirrhotic portal hypertension is very common worldwide and poses a serious threat to the health of patients.Over past three decades, the surgical treatment for cirrhotic portal hypertension was strongly challenged by the drugs, endoscopy, interventional therapy and liver transplantation.However, under the multidisciplinary team(MDT) cooperative diagnosis and treatment mode, the surgical treatment still plays a unique and irreplaceable role.Laparoscopic pericardial vascular devascularization is characterized by less injury and bleeding, rapid postoperative recovery, which will coexist with open surgery for portal hypertension. It is important to focus on the development and application of new methods, new technologies and new concepts under the MDT cooperative diagnosis and treatment mode, giving full play to the advantages of each discipline and advocate standardized, individualized and precise treatment should be emphasized to maximize patient clinical benefits.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Hipertensão Portal/cirurgia , Cirrose Hepática/cirurgia , China , Humanos , Laparoscopia , Esplenectomia
17.
Pediatr Surg Int ; 36(5): 637-641, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32206893

RESUMO

PURPOSE: The aim of the study was to test the feasibility of spleen stiffness measurement (SSM) by two-dimensional shear wave elastography (2D-SWE) and compare data on its diagnostic use with upper gastrointestinal endoscopy in children with extrahepatic portal hypertension (EHPH) before and after surgery. METHODS: A total of 44 children were included in this study [34 children with EHPH (main group)] and 10 controls (7.57 ± 1.22 years), who underwent ultrasonography including SSM by 2D-SWE. Patients in the main group also underwent upper gastrointestinal endoscopy (UGE) and CT angiography. The main group was divided into three subgroups: Group A: patients with EHPH without large spontaneous portosystemic shunts (n = 15); Group B: patients with EHPH with large spontaneous portosystemic shunts (n = 9); Group C: patients with EHPVO and after surgical portosystemic shunts (n = 10). RESULTS: According to UGE, children in group A had significantly higher grades of esophageal varices (EV) (2.3 ± 0.14; p < 0.001) compared to those in groups B and C. After surgical shunting procedures (in group C), the grade of EV declined to 0.37 ± 0.14. There was significant difference (p < 0.001) in the mean SS of children in group A (70 ± 4.64 kPa) compared to those in group B (37.04 ± 4.62 kPa) and group C (26.3 ± 2.9 kPa). After surgery, SS decreased but remained elevated compared with controls (26.3 ± 2.9 vs 17.85 ± 1.3 kPa; p = 0.016). The SS showed a small but significant correlation with grades of EV (r = 0.56, p = 0.002). CONCLUSIONS: The SS measured by 2D-SWE is feasible in children with EHPH and the results reflect the presence or degree of EV, thus elastography of spleen is useful in monitoring portal hypertension before and after shunt surgeries.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Hipertensão Portal/diagnóstico , Monitorização Fisiológica/métodos , Veia Porta/diagnóstico por imagem , Baço/diagnóstico por imagem , Doenças Vasculares/diagnóstico , Adolescente , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada , Constrição Patológica , Elasticidade , Endoscopia do Sistema Digestório , Feminino , Humanos , Hipertensão Portal/fisiopatologia , Hipertensão Portal/cirurgia , Masculino , Veia Porta/cirurgia , Derivação Portossistêmica Cirúrgica , Baço/fisiopatologia , Doenças Vasculares/cirurgia
18.
Transplant Proc ; 52(2): 566-568, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32057499

RESUMO

BACKGROUND: The presence of collateral circulation in liver cirrhosis patients with portal hypertension is quite frequent due to re-permeabilization of closed embryonic channels. In some cases, these shunts could measure over 1 cm wide, therefore, containing a significative blood flow. Its management during liver transplantation could be challenging due to possible complications resulting from either ligation of the shunts or from ignoring them. We present the case of a patient with recurrent hepatic encephalopathy (HE) and a large spontaneous portosystemic shunt (SPSS) who submitted to liver transplant and review the literature identifying options, complications, and outcomes with the aim of facilitating decision making. MATERIAL AND METHODS: A 68-year-old, Spanish man diagnosed with liver cirrhosis with portal hypertension and recurrent episodes of HE is proposed for LT. The patient's Child-Pugh score was A6-B7, and the Model for End-stage Liver Disease score was 12. Preoperatively, a computed tomography scan showed a large SPSS running to the inferior cava vein. During the surgery, a small-sized portal vein and a large shunt measuring almost 3 cm wide were identified. After reperfusion, portal vein flow was 1000 to 1100 mL/min. Owing to the previous HE and the risk of low portal flow, the shunt was closed increasing the portal flow to 1800 mL/min. The patient was discharged without any complications. CONCLUSIONS: The presence of large SPSSs are frequent during LT. Decision making intraoperatively can be challenging due to possible complications derived from ligation of the SPSS or from ignoring it. Either preoperative assessment of a further HE risk or portal vein flow measurement after reperfusion are essential to achieve a correct resolution.


Assuntos
Encefalopatia Hepática/cirurgia , Complicações Intraoperatórias/cirurgia , Transplante de Fígado/métodos , Veia Porta/anormalidades , Malformações Vasculares/cirurgia , Idoso , Circulação Colateral , Encefalopatia Hepática/complicações , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/cirurgia , Complicações Intraoperatórias/etiologia , Ligadura/efeitos adversos , Ligadura/métodos , Cirrose Hepática/complicações , Cirrose Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Masculino , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Recidiva , Tomografia Computadorizada por Raios X , Malformações Vasculares/complicações , Veia Cava Inferior/diagnóstico por imagem
20.
BMC Surg ; 19(1): 191, 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-31830972

RESUMO

AIM: To investigate clinical efficacy of transjugular intrahepatic portal shunt (TIPS) for the treatment of cirrhotic portal hypertension. METHODS: 71 cases of patients with cirrhotic portal hypertension and esophageal and gastric variceal bleeding hospitalized from January 2014 to June 2017 were enrolled and treated with TIPS. The change of portal pressure and serum biochemical indexes before and after TIPS were compared, and re-hemorrhage rate, ascites incidence, complications, and survival rate were calculated. RESULTS: 71 patients (male/female 47/24, aged 29-77 years, average 48.9 ± 9.8 years) with cirrhotic portal hypertension received TIPS. The success rate of TIPS was 93% (66/71). During 1-24 months (mean 12.5 ± 7 months) follow-up of 66 patients, 61 cases survived and 5 cases died. The portal pressure decreased significantly from 40.48 ± 3.15 cmH2O to 23.59 ± 4.41 cmH2O after TIPS (P < 0.05). During the follow-up, the incidence of hepatic encephalopathy was 12.1%, the incidence of re-hemorrhage was 18.2%, and there were 4 cases of stent dysfunction, with 1 case of bare stent and 3 cases of dual stent. CONCLUSION: TIPS is an effective procedure for the treatment of cirrhotic portal hypertension complications, since it can reduce portal pressure and significantly alleviate ascites. Liver function is impaired in short-term after TIPS, but TIPS has no significant effect on liver function in middle-term.


Assuntos
Hipertensão Portal/etiologia , Hipertensão Portal/cirurgia , Cirrose Hepática/complicações , Derivação Portossistêmica Transjugular Intra-Hepática , Adulto , Idoso , Ascite/etiologia , Varizes Esofágicas e Gástricas/etiologia , Feminino , Hemorragia Gastrointestinal/etiologia , Encefalopatia Hepática/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Falha de Prótese , Recidiva , Stents , Taxa de Sobrevida , Resultado do Tratamento
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