Gastric antral vascular ectasia(GAVE) may cause gastrointestinal bleeding(GIB). The treatment of GAVE relies on endoscopic approaches such as electrocoagulation(argon plasma coagulation, laser therapy, heater probe th...Gastric antral vascular ectasia(GAVE) may cause gastrointestinal bleeding(GIB). The treatment of GAVE relies on endoscopic approaches such as electrocoagulation(argon plasma coagulation, laser therapy, heater probe therapy, radiofrequency ablation), cryotherapy, and band ligation. In refractory cases, antrectomy may be considered. In the event of an associated cirrhosis and portal hypertension, it has been suggested that antrectomy could be an option, provided the mortality risk isn't considered too great. We report the case of a 67-year-old cirrhotic patient who presented with GAVE related GIB, unresponsive to multiple endoscopic treatments. The patient had a good liver function(model for end-stage disease 10). After a multidisciplinary meeting, a transjugular intrahepatic portosystemic shunt(TIPS) procedure was performed, in order to treat the cirrhosis associated ascites. The outcome was successful. An antrectomy was then performed, with no recurrence of GIB and no transfusion need during three months of follow up. In this case, the TIPS procedure achieved a complete ascites regression, allowing a safer surgical treatment of the GAVE-related GIB.展开更多
Renal dysfunction is common in liver diseases,either as part of multiorgan involvement in acute illness or secondary to advanced liver disease.The presence of renal impairment in both groups is a poor prognostic indic...Renal dysfunction is common in liver diseases,either as part of multiorgan involvement in acute illness or secondary to advanced liver disease.The presence of renal impairment in both groups is a poor prognostic indicator.Renal failure is often multifactorial and can present as pre-renal or intrinsic renal dysfunction.Obstructive or post renal dysfunction only rarely complicates liver disease.Hepatorenal syndrome(HRS)is a unique form of renal failure associated with advanced liver disease or cirrhosis,and is characterized by functional renal impairment without significant changes in renal histology.Irrespective of the type of renal failure,renal hypoperfusion is the central pathogenetic mechanism,due either to reduced perfusion pressure or increased renal vascular resistance.Volume expansion,avoidance of precipitating factors and treatment of underlying liver disease constitute the mainstay of therapy to prevent and reverse renal impairment.Splanchnic vasoconstrictor agents,such as terlipressin,along with volume expansion,and early placement of transjugular intrahepatic portosystemic shunt(TIPS)may be effective in improving renal function in HRS.Continuous renal replacement therapy(CRRT)and molecular absorbent recirculating system(MARS)in selected patients may be life saving while awaiting liver transplantation.展开更多
目的探讨肝硬化患者经颈静脉肝内门体静脉分流术(TIPS)相关血管解剖的CT血管造影(CTA)表现。方法回顾性分析上腹部CT增强扫描并符合入组标准者共64例,分为正常组(n=27)和肝硬化组(n=37)。采集原始图像进行图像后处理,观察肝内外门静脉...目的探讨肝硬化患者经颈静脉肝内门体静脉分流术(TIPS)相关血管解剖的CT血管造影(CTA)表现。方法回顾性分析上腹部CT增强扫描并符合入组标准者共64例,分为正常组(n=27)和肝硬化组(n=37)。采集原始图像进行图像后处理,观察肝内外门静脉分支和肝静脉分支的分型,测量肝静脉与下腔静脉夹角、肝静脉间夹角、肝外门静脉与肝实质接触面接触比例,以及肝外门静脉及其分支的长度、直径和夹角等。结果 64例中,肝静脉Ⅰ型占67.1%,Ⅱ型32.9%;肝硬化组肝右静脉与下腔静脉夹角和肝左静脉与下腔静脉夹角较正常组明显增大[(64.6±8.5)°vs (42.8±8.2)°,(69.7±9.7)°vs (55.6±6.3)°;P均<0.01],肝中静脉与肝左静脉夹角较正常组明显增大[(64.6±15.4)°vs (55.8±17.0)°;P=0.035];肝硬化组门静脉主干长度、门静脉主干直径较正常组有所增加[(56.0±12.0)mm vs (46.5±7.6)mm,(16.6±4.2)mm vs (14.0±2.4)mm;P均<0.01];肝硬化组门静脉左支与肝脏紧密接触面比例较正常组减小[(33.5±9.4)%vs (42.8±21.1)%;P=0.03],但门静脉左支顶部与肝组织仍紧密连接。结论肝硬化时,肝静脉、门静脉位置和形态均发生明显改变,CTA术前准确评估为设计手术方案提供基础。展开更多
文摘Gastric antral vascular ectasia(GAVE) may cause gastrointestinal bleeding(GIB). The treatment of GAVE relies on endoscopic approaches such as electrocoagulation(argon plasma coagulation, laser therapy, heater probe therapy, radiofrequency ablation), cryotherapy, and band ligation. In refractory cases, antrectomy may be considered. In the event of an associated cirrhosis and portal hypertension, it has been suggested that antrectomy could be an option, provided the mortality risk isn't considered too great. We report the case of a 67-year-old cirrhotic patient who presented with GAVE related GIB, unresponsive to multiple endoscopic treatments. The patient had a good liver function(model for end-stage disease 10). After a multidisciplinary meeting, a transjugular intrahepatic portosystemic shunt(TIPS) procedure was performed, in order to treat the cirrhosis associated ascites. The outcome was successful. An antrectomy was then performed, with no recurrence of GIB and no transfusion need during three months of follow up. In this case, the TIPS procedure achieved a complete ascites regression, allowing a safer surgical treatment of the GAVE-related GIB.
文摘Renal dysfunction is common in liver diseases,either as part of multiorgan involvement in acute illness or secondary to advanced liver disease.The presence of renal impairment in both groups is a poor prognostic indicator.Renal failure is often multifactorial and can present as pre-renal or intrinsic renal dysfunction.Obstructive or post renal dysfunction only rarely complicates liver disease.Hepatorenal syndrome(HRS)is a unique form of renal failure associated with advanced liver disease or cirrhosis,and is characterized by functional renal impairment without significant changes in renal histology.Irrespective of the type of renal failure,renal hypoperfusion is the central pathogenetic mechanism,due either to reduced perfusion pressure or increased renal vascular resistance.Volume expansion,avoidance of precipitating factors and treatment of underlying liver disease constitute the mainstay of therapy to prevent and reverse renal impairment.Splanchnic vasoconstrictor agents,such as terlipressin,along with volume expansion,and early placement of transjugular intrahepatic portosystemic shunt(TIPS)may be effective in improving renal function in HRS.Continuous renal replacement therapy(CRRT)and molecular absorbent recirculating system(MARS)in selected patients may be life saving while awaiting liver transplantation.
文摘目的探讨肝硬化患者经颈静脉肝内门体静脉分流术(TIPS)相关血管解剖的CT血管造影(CTA)表现。方法回顾性分析上腹部CT增强扫描并符合入组标准者共64例,分为正常组(n=27)和肝硬化组(n=37)。采集原始图像进行图像后处理,观察肝内外门静脉分支和肝静脉分支的分型,测量肝静脉与下腔静脉夹角、肝静脉间夹角、肝外门静脉与肝实质接触面接触比例,以及肝外门静脉及其分支的长度、直径和夹角等。结果 64例中,肝静脉Ⅰ型占67.1%,Ⅱ型32.9%;肝硬化组肝右静脉与下腔静脉夹角和肝左静脉与下腔静脉夹角较正常组明显增大[(64.6±8.5)°vs (42.8±8.2)°,(69.7±9.7)°vs (55.6±6.3)°;P均<0.01],肝中静脉与肝左静脉夹角较正常组明显增大[(64.6±15.4)°vs (55.8±17.0)°;P=0.035];肝硬化组门静脉主干长度、门静脉主干直径较正常组有所增加[(56.0±12.0)mm vs (46.5±7.6)mm,(16.6±4.2)mm vs (14.0±2.4)mm;P均<0.01];肝硬化组门静脉左支与肝脏紧密接触面比例较正常组减小[(33.5±9.4)%vs (42.8±21.1)%;P=0.03],但门静脉左支顶部与肝组织仍紧密连接。结论肝硬化时,肝静脉、门静脉位置和形态均发生明显改变,CTA术前准确评估为设计手术方案提供基础。
