Primary animal experiment to test the feasibility of a novel Y-Z magnetic hepatic portal blocking band

BACKGROUND Hepatic portal blood flow occlusion is a common technique for reducing hepatic hemorrhage during hepatectomy.We designed a novel Y-Z magnetic hepatic portal blocking band(Y-Z MHPBB)based on the principle of magnetic compression technique.AIM To introduce the Y-Z MHPBB device and verify the feasibility of this device for hepatic portal blood flow occlusion in dogs.METHODS Ten beagles were randomly divided into the experimental group and control group.The operation time,intraoperative blood loss,the number of portal blood flow occlusions,the total time spent on adjusting the blocking band,and the average time spent on adjusting the blocking band were recorded.The surgeons evaluated the feasibility and flexibility of the two portal occlusion devices.RESULTS Laparoscopic hepatectomy was successfully performed in both the experimental group and control group.There was no statistical difference between the two groups in the operation time,intraoperative blood loss,and the number of hepatic portal blood flow occlusions.With respect to the total time spent on adjusting the blocking band and the average time spent on adjusting the blocking band,the experimental group showed significantly better outcomes than the control group,with a statistical difference(P<0.05).The operators found that the Y-Z MHPBB was superior to the modified T-tube in terms of operational flexibility.CONCLUSION The Y-Z MHPBB seems to be an ingenious design,accurate blood flow occlusion effect,and good flexibility;and it can be used for hepatic portal blood flow occlusion during laparoscopic hepatectomy.

Peripheral blood cell variations in cirrhotic portal hypertension patients with hypersplenism

Objective: To explore peripheral blood cell variations in hepatic cirrhosis portal hypertension patients with hypersplenism. Methods: Clinical data of 322 hypersplenism patients with decreased peripheral blood cells, admitted with cirrhotic portal hypertension, was retrospectively studied over the last 17 years. Results: In 64% (206/322) of patients, more than 2 kinds of blood cell were decreased, including 89 cases of pancytopenia (43.2%), 52 cases of WBC + PLT decrease (25.2%), 29 cases of RBC + PLT decrease (14.1%), and 36 cases of WBC + RBC decrease (17.5%); in 36% (116/322) of patients, single type blood cell decrease occurred, including 31 cases of PLT decrease (26.7%), 29 cases of WBC decrease (25%) and 56 cases of RBC decrease (48.3%). Of 227 routine bone marrow examinations, bone marrow hyperplasia was observed in 118 cases (52.0%), the remainder showed no hyperplasia. For the distinct scope and extent of peripheralblood cell decreases, preoperative blood component transfusions were carried out, then treated by surgery, after whole group splenectomy, the peripheral blood cell count was significantly higher ( P <0.05). Conclusions: Of portal hypertensive patients with splenomegaly and hypersplenism, 64% have simultaneous decrease in various blood cells, 36% have decrease in single type blood cells, 52% of patients have bone marrow hyperplasia. A splenectomy can significantly increase the reduction of peripheral blood cells.

Causes of Peripheral Blood Cytopenias in Patients with Liver Cirrhosis Portal Hypertension and Clinical Significances

Liver cirrhosis portal hypertension patients to reduce the number of blood cells are common in clinical, and often affect the prognosis. This paper discusses cirrhotic portal hypertension patients complicated by the reason of the decrease in the number of peripheral blood cells and what is the clinical significance of these reasons so as to provide theoretical support for the choice of treatment. Splenomegaly and hypersplenism caused should be the main reason for reducing the number of blood cells, but not all, other reasons are alcohol and virus inhibition of bone marrow, liver function impairment, autoimmune damage and loss of blood, etc. If it is a function of the spleen hyperfunction caused by blood cells decreases, blood should rise to normal after splenectomy, or consider other reason or there are other reasons at the same time.

Clinical and experimental study of effect of Raondix Salviae Militiorrhiza and other blood activating and stasis eliminating Chinese herbs on hemodynamics of portal hypertension

AIM To study the effects of Radix Salviae Militiorrhiza (RSM), other blood-activating and stasis-eliminating Chinese herbs on hemodynamics of portal hypertension.METHODS Portal pressure of cirrhotic dogs after chronic common bile duct ligation was measured directly; portal blood flow in patients with liver cirrhosis were detected by ultrasound Doppler.RESULTS After administration of RSM and Radix Angelicae Sinensis (RAS) by intravenous infusion in cirrhosis dogs, the portal venous pressure (Ppv), wedge hepatic venous pressure (WHVP), hepatic venous pressure gradient (HVPG), were significantly decreased (P＜0.05-0.01), but the mean arterial pressure (MAP), and the heart rate (HR) remained unchanged. When nifedipine was used, Ppv, WHVP, MAP and HR were significantly decreased (P＜0.05), and the MVPG unchanged (P＞0.05). After administration of RSM, RSM+nifedipine and RSM+Hirudin+Nifedpin for 10-12 weeks, the diameter of portal vein (Dpv), spleen vein (Dsv), the portal venous flow (Qpv) and splenic venous flow (Qsv) in patients with hepatic cirrhosis were significantly lowered (P＜0.05-0.01), and the effect of RAS was weaker.CONCLUSIONS The efficacy of decreasing Ppv by Chinese herbs-RSM, RAS, etc. as compared with nifedipine, demonstrated that the Chinese herbs were slower in action than that of nifedipine, but more long-lasting and without side effects. Hence, long-term administration of Chinese herbs, would be more beneficial.

Cirrhotic portal hypertension: From pathophysiology to novel therapeutics

Portal hypertension and bleeding from gastroesophageal varices is the major cause of morbidity and mortality in patients with cirrhosis. Portal hypertension is initiated by increased intrahepatic vascular resistance and a hyperdynamic circulatory state. The latter is characterized by a high cardiac output, increased total blood volume and splanchnic vasodilatation, resulting in increased mesenteric blood flow. Pharmacological manipulation of cirrhotic portal hypertension targets both the splanchnic and hepatic vascular beds. Drugs such as angiotensin converting enzyme inhibitors and angiotensin Ⅱ type receptor 1 blockers, which target the components of the classical renin angiotensin system(RAS), are expected to reduce intrahepatic vascular tone by reducing extracellular matrix deposition and vasoactivity of contractile cells and thereby improve portal hypertension. However, these drugs have been shown to produce significant offtarget effects such as systemic hypotension and renal failure. Therefore, the current pharmacological mainstay in clinical practice to prevent variceal bleeding and improving patient survival by reducing portal pressure is non-selective-blockers(NSBBs). These NSBBs work by reducing cardiac output and splanchnic vasodilatation but most patients do not achieve an optimal therapeutic response and a significant proportion of patients are unable to tolerate these drugs.Although statins, used alone or in combination with NSBBs, have been shown to improve portal pressure and overall mortality in cirrhotic patients, further randomized clinical trials are warranted involving larger patient populations with clear clinical end points. On the other hand, recent findings from studies that have investigated the potential use of the blockers of the components of the alternate RAS provided compelling evidence that could lead to the development of drugs targeting the splanchnic vascular bed to inhibit splanchnic vasodilatation in portal hypertension. This review outlines the mechanisms related to the pathogenesis of portal hypertension and attempts to provide an update on currently available therapeutic approaches in the management of portal hypertension with special emphasis on how the alternate RAS could be manipulated in our search for development of safe, specific and effective novel therapies to treat portal hypertension in cirrhosis.

两种不同取血部位制备桂枝汤含药血清对其抗炎作用影响差异的研究

目的基于两种不同取血部位制备桂枝汤含药血清,探讨其抗炎作用差异。方法取雄性SD大鼠按10倍临床剂量给药(桂枝汤汤剂生药1 g/mL),取门静脉血、外周血含药血清,采用快速液相-三重四级杆质谱联用仪(rapid resolution liquid chromatography-triple quadrupole mass spectrometry,RRLC-QQQ-MS/MS),建立桂枝汤汤剂、含药血清中8种化学成分含量测定方法,并对含量进行测定。取对数生长期小鼠脑微血管内皮细胞(brain-derived endothelial cells.3,bEnd.3)模型,用白细胞介素(interleukin,IL)-1β刺激,建立细胞炎症模型,使用bEnd.3细胞作为正常组。除正常组、模型组外,设置桂枝汤汤剂高、中、低剂量组(分别含5%、2.5%、1.25%桂枝汤汤剂),门静脉含药血清高、中、低剂量组(分别含20%、10%、5%门静脉含药血清)和外周血含药血清高、中、低剂量组(分别含20%、10%、5%外周血含药血清),ELISA法测定细胞外液中的前列腺素(prostaglandin,PG)E_(2)含量。结果含量测定结果显示汤剂中芍药苷、芍药内酯、甘草苷、甘草酸比例相对较高,血清中肉桂酸、6-姜酚含量相对较高,较汤剂中新出现甘草次酸等代谢物。门静脉血清中以上8种化合物含量均高于外周血血清。5%桂枝汤汤剂中甘草酸含量为798.13 ng/mL,20%门静脉含药血清中甘草酸含量为316.22 ng/mL,20%外周血中甘草酸含量为481.17 ng/mL,药物中成分的含量在同一数量级。与模型组比较,将高、中、低剂量桂枝汤汤剂添加到bEnd.3细胞培养体系中,高、中、低剂量桂枝汤组细胞外液中PGE_(2)的水平均明显高于模型组(P<0.05),而门静脉或外周血含药血清组细胞外液中PGE_(2)的水平均明显低于模型组(P<0.05),且门静脉血清的药效作用显著强于相同浓度的外周血血清(P<0.05)。结论桂枝汤汤剂经胃肠道给药后,门静脉含药血清相较外周血含药血清显示出更高的成分含量与抗炎作用。这一发现提示采用门静脉含药血清而非传统的外周血含药血清在中药方剂研究中的重要性。

Portal vein pulsatility index is a more important indicator than congestion index in the clinical evaluation of right heart function

AIM： To study the changes of portal blood flow in congestive heart failure. METHODS： We studied the congestion index （CI） and portal vein pulsatility index （PI） in patients with varied degrees of congestive heart failure using ultrasonic Doppler. Ten patients with mean right atrial pressure （RA） 〈10 mmHg were classified as group 1 and the remaining 10 patients with RA〉 10 mmHg as group 2. RESULTS： There were no difference on cardiac index （HI, P= 0.28）, aortic pressure （AO, P= 0.78）, left ventricular end-diastolic pressure （LVED, P=0.06）, maximum portal blood velocity （Vmax, P= 0.17）, mean portal blood velocity （Vmean, P=0.15） and portal blood flow volume （PBF, P= 0.95） between the two groups. Group 2 patients had higher pulmonary wedge pressure （PW, 29.9 ± 9.3 mmHg vs 14.6±7.3 mmHg, P=0.002）, pulmonary arterial pressure （PA, 46.3± 13.2 mmHg vs 25.0±8.2 mmHg, P=0.004）, RA （17.5±5.7 mmHg vs 4.7±2.4 mmHg, P〈 0.001）, right ventricular end-diastolic pressure （RVED, 18.3±5.6 mmHg vs 6.4±2.7 mmHg, P〈0.001）, CI （8.7±2.4 vs 5.8± 1.2, P=0.03）, and PI （87.8±32.3% vs 27.0±7.4%, P〈0.001） than Group 1. CI was correlated with PI （P〈0.001）, PW （P〈0.001）, PA （P〈0.001）, RA （P=0.043）, RVED （P=0.005）, HI （P〈0.001）, AO （P〈0.001）, CO （P〈0.001）, LVED （P〈0.001）, Vmax （P〈0.001）, Vmax （P〈0.001）, cross-sectional area of the main portal vein （P〈0.001） and PBF （P〈0.001）. CI could be as high as 8.3 in patients with RA〈 10 mmHg and as low as 5.9 in those with RA≥10 mmHg.CONCLUSION： Our data show that RI is a more significant indicator than CI in the clinical evaluation of high RA≥ 10 mmHg, whereas CI is better than PI in the assessment of left heart function.

肝移植术后严重门静脉狭窄的三维可视化成像与门静脉支架植入术疗效分析

目的分析肝移植术后严重门静脉狭窄的三维成像特征与优势,评估门静脉支架植入术效果。方法回顾性分析10例肝移植术后因严重门静脉狭窄接受门静脉支架植入的患者的临床资料,分析严重门静脉狭窄的影像学特征、三维重建的成像优势及介入治疗效果。结果10例患者中狭窄类型包括向心性缩窄3例,曲折成角致狭窄2例,受压狭窄2例,长段狭窄和(或)血管闭塞3例。三维重建图像在狭窄的准确判断、狭窄类型的辨别和狭窄累及长度判断方面具有优势。所有患者均成功接受门静脉支架植入术,支架植入后门静脉最狭窄处直径较治疗前增加[(6.2±0.9)mm比(2.6±1.7)mm,P<0.05],吻合口流速较治疗前下降[(57±19)cm/s比(128±27)cm/s,P<0.05],近肝处门静脉主干流速较治疗前增加[(41±6)cm/s比(18±6)cm/s,P<0.05]。1例患者因介入穿刺引起肝内血肿,经保守观察治疗后好转,其余患者均未出现相关并发症。结论三维可视化技术可以立体直观展示狭窄部位、特征与严重程度,有利于临床医师进行治疗决策和辅助介入操作。及时的门静脉支架植入术可以有效逆转病变进程并改善门静脉血流。

门静脉血循环肿瘤细胞、C反应蛋白/清蛋白、糖类抗原199/糖类抗原50比值联合评估根治性胰腺癌切除术后生存情况的研究

目的:研究门静脉血循环肿瘤细胞(CTCs)、C反应蛋白/清蛋白(CAR)、糖类抗原199/糖类抗原50(CA199/CA50)比值联合评估根治性胰腺癌切除术后患者的生存情况。方法:选取我院2018年1月—2020年1月收治的83例接受胰腺癌根治术患者。检测患者门静脉血的CTCs、CAR、CA199/CA50水平,比较不同病理特征患者的CTCs、CAR、CA199/CA50水平。对患者随访2年,分析生存与死亡患者门静脉血CTCs、CAR、CA199/CA50水平,采用受试者工作特征曲线分析CTCs、CAR、CA199/CA50对患者术后生存的评估价值,并用Kaplan-Meier生存曲线分析CTCs、CAR、CA199CA50对肝癌患者的影响。结果:存在淋巴结转移、TNM分期Ⅲ期和低分化程度患者的门静脉血CTCs、CAR、CA199/CA50水平均高于不存在淋巴结转移、TNM分期为Ⅰ-Ⅱ期和中高分化程度的患者(P<0.05)。与死亡组患者相比,生存组患者门静脉血CTCs、CAR、CA199/CA50水平更低(P<0.05)。门静脉血CTCs、CAR、CA199/CA50对于根治性胰腺癌切除术患者预后评估的灵敏度分别为78.9%、78.8%和73.7%,特异度分别为90.6%、91.0%和91.2%,三者联合对根治性胰腺癌切除术患者预后评估的灵敏度为89.5%,特异度为93.7%,三者联合对于根治性胰腺癌切除术患者预后的灵敏度和特异度均高于各项单独检测。CTCs正常组(n=50)的生存率为86.00%,高于CTCs升高组(n=33)的63.63%;CAR正常组(n=47)的生存率为82.97%,高于CAR升高组(n=36)的69.44%;CA199/CA50正常组(n=53)的生存率为88.67%,高于CA199/CA50升高组(n=30)的56.66%,差异有统计学意义(P<0.05)。结论:门静脉血CTCs、CAR、CA199CA50比值联合评估根治性胰腺癌切除术后的生存价值较高,三者联合的灵敏度和特异性高于各项单独检测。

经食管超声监测体外循环心脏手术中门静脉血流量与术后肝损伤的相关性研究

目的:监测体外循环心脏手术中门静脉血流量(PVBF)变化,探讨PVBF与体外灌注流量及术后肝损伤的关系。方法:选取2022年8月—2023年8月在遵义医科大学附属医院行CPB心脏手术患者87例,利用经食管超声心动图(TEE)获得门静脉血流收缩期峰值流速(PSV)、舒张末流速(EDV)、阻力指数(RI)、搏动指数(PI)和时间平均峰值流速(TAPV),记录各时间点体外灌注流量(VPF)值并计算PVBF。同时收集术后肝功能生化指标:丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)、白蛋白(ALB)、胆碱酯酶(CHE)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT),探讨门静脉血流参数与肝功能变化的关系。将肝功能生化指标术前与术后以及体外灌注期间PVBF、VPF在肝功能正常组和异常组分别进行差异性比较,不同时间段门静脉参数、VPF进行重复测量方差分析,术后肝损伤危险因素采用回归分析,使用受试者工作特征曲线分析VPF对预测肝损伤的最佳截断值。结果:87例患者中术后出现肝损伤者75例,发生率为86.21%。术后第1、3、5天,肝损伤患者的AST、TBIL和DBIL高于术前,CHE和ALP低于术前,差异有统计学意义(P<0.05)。术后第5天,肝损伤患者的ALT高于术前,差异有统计学意义(P<0.05)。术后第1、3天,肝损伤患者的GGT低于术前;术后第5天,肝损伤患者的GGT高于术前,差异有统计学意义(P<0.05)。肝损伤患者术前术后的ALB比较,差异无统计学意义(P>0.05)。CPB期间,肝功能正常组的PVBF和VPF高于肝损伤组,差异有统计学意义(P<0.05)。CPB开始后,患者的PVBF均高于开胸前,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,CPB期间的PVBF值和升主动脉阻断时间是体外循环患者术后肝功能损伤的(P<0.05)。VPF的ROC曲线下面积(AUC)为0.752(P<0.05),临界值大于3.6 L/min。结论:当VPF大于3.6 L/min时,可能从一定程度上减轻术后肝损伤。PVBF和升主动脉阻断时间是CPB患者术后肝损伤的独立危险因素。

Highly metabolic thrombus of the portal vein:^(18)F fluorodeoxyglucose positron emission tomography/computer tomography demonstration and clinical significance in hepatocellular carcinoma

AIM： To assess the ability of ^18F-fluorodeoxyglucose positron emission tomography/computer tomography （^18F-FDG PET/CT） to differentiate between benign and malignant portal vein thrombosis in hepatocellular carcinoma （HCC） patients.METHODS： Five consecutive patients who had HBV cirrhosis, biopsy-proven HCC, and thrombosis of the main portal vein and/or left/right portal vein on ultrasound （US）, computer tomography （CT） or magnetic resonance imaging （MRI） were studied with ^18F-FDG PET/CT. The presence or absence of a highly metabolic thrombus on ^18F-FDG PET/CT was considered diagnostic for malignant or benign portal vein thrombosis, respectively. All patients were followed-up monthly with US, CT or MRI. Shrinkage of the thrombus or recanalization of the vessels on US, CT or MRI during follow-up was considered to be definitive evidence of the benign nature of the thrombosis, whereas enlargement of the thrombus, disruption of the vessel wall, and parenchymal infiltration over follow-up were considered to be consistent with malignancy. ^18SF-FDG PET/CT, and US, CT or MRI results were compared.RESULTS： Follow-up （1 to 10 mo） showed signs of malignant thrombosis in 4 of the 5 patients. US, CT or MRI produced a true-positive result for malignancy in 4 of the patients, and a false-positive result in 1. ^18F-FDG PET/CT showed a highly metabolic thrombus in 4 of the 5 patients. ^18F-FDG PET/CT achieved a true-positive result in all 4 of these patients, and a true-negative result in the other patient. No false-positive result was observed using ^18F-FDG PET/CT.CONCLUSION： ^18F-FDG PET/CT may be helpful in discriminating between benign and malignant portal vein thrombi. Patients may benefit from ^18F-FDG PET/CT when portal vein thrombi can not be diagnosed exactly by US, CT or MRI.

基于超声造影定量参数、超声血流参数构建肝硬化并发门静脉血栓的诊断模型

目的基于超声造影定量参数、超声血流参数构建肝硬化并发门静脉血栓的诊断模型,并进行验证。方法选择2019年4月至2023年7月收治的97例肝硬化并发门静脉血栓患者为研究组,另选择同时间段收治的56例肝硬化未并发门静脉血栓患者为对照组。记录患者超声造影定量参数[峰值强度、达峰时间、曲线下面积(AUC)]与超声血流参数[门静脉内径(PVD)、门静脉流速(PVV)],分析肝硬化并发门静脉血栓的影响因素。构建并验证肝硬化并发门静脉血栓的诊断模型。结果研究组AUC、峰值强度、PVD分别为(2147.85±372.41)dB/s、(16.33±4.29)dB、(16.83±4.67)mm,高于对照组的(1259.34±196.25)dB/s、(11.06±3.10)dB、(12.26±3.35)mm,差异有统计学意义(P<0.05);研究组达峰时间、PVV分别为(47.19±6.58)s、(10.69±2.43)cm/s,低于对照组的(79.23±10.17)s、(14.98±3.65)cm/s,差异有统计学意义(P<0.05)。研究组天冬氨酸氨基转移酶、活化部分凝血活酶时间(APTT)、丙氨酸氨基转移酶分别为(27.15±4.38)s、(29.48±4.71)U/L,低于对照组的(30.24±5.66)s、(42.53±5.89)U/L,差异有统计学意义(P<0.05);研究组D-二聚体为(3.19±0.57)μg/mL,高于对照组的(1.46±0.93)μg/mL差异有统计学意义(P<0.05)。峰值强度(OR=5.135,95%CI:2.257~11.680)、AUC(OR=4.540,95%CI:1.996~10.328)、PVD(OR=5.801,95%CI:2.550~13.196)、达峰时间(OR=4.242,95%CI:1.865~9.649)、PVV(OR=4.513,95%CI:1.984~10.267)、APTT(OR=0.237,95%CI:0.104~0.540)为肝硬化并发门静脉血栓的影响因素(P<0.05)。列线图模型诊断肝硬化并发门静脉血栓的灵敏度为89.69%(95%CI:73.41%~94.15%),特异度为91.07%(95%CI:74.28%~96.43%),AUC为0.905(95%CI:0.882~0.963)。结论基于超声造影定量参数(AUC、峰值强度、达峰时间)、超声血流参数(PVD、PVV)构建肝硬化并发门静脉血栓的列线图诊断模型有助于早期筛查肝硬化并发门静脉血栓风险。

Combined splenocaval or mesocaval C shunt and portoazygous devascularization in the treatment of portal hypertension: analysis of 150 cases

BACKGROUND: Portal hypertension is a common disease and its major surgical therapeutic approaches include devascularization and shunting. This study was undertaken to investigate the effects of combined splenocaval or mesocaval C shunt and portoazygous devascularization (combined procedures) on portal hypertension. METHODS: The clinical data of 150 patients with portal hypertension who had undergone combined procedures at the First Affiliated Hospital of Zhengzhou University from May1990 to May 2003 were analyzed retrospectively. RESULTS: The mean free portal pressure (FPP) was 25.6±1.83 mmHg, 18.0±2.07 mmHg and 18.4±2.19 mmHg before operation, after splenectomy plus splenocaval or mesocaval C shunt, and combined procedures, respectively. There was no operative death in all patients. The 1-7 year follow-up of 100 patients showed rebleeding in 3 patients, encephalopathy in 4, thrombosis of artificial vascular graft in 3, and dying from liver failure in 2. CONCLUSIONS: The combined procedures can not only decrease portal pressure but also preserve hepatic blood flow to some extent. It may be one of the best choices for treating portal hypertension in China.

基于能谱CT成像的脾脏血流参数在CPH患者GOV程度中的评估价值

目的探讨基于能谱CT成像的脾脏血流参数在肝硬化门静脉高压症(CPH)患者食管胃底静脉曲张(GOV)程度中的评估价值。方法回顾性分析80例CPH患者临床资料(研究组),另将同期肝脏CT正常的38例患者纳入对照组,记录基于能谱CT成像行腹部增强CT扫描的各参数,以胃镜检查结果胃金标准,分析基于能谱CT成像的脾脏血流参数在评估CPH患者GOV程度中的价值。结果胃镜检查发现,0级16例,1级19例、2级33例、3级12例;对照组脾静脉直径(D-SV)、脾脏实际门静脉期碘浓度(IC-S)、脾脏体积(V-S)、脾脏碘容量(IV-S)均较研究组更低(P<0.05),随着疾病分级的递增,研究组V-S、IC-S、IV-S、D-SV呈升高趋势(P<0.05);以0级患者作为对照,经分析得出脾脏血流各参数联合在CPH患者GOV中诊断AUC值为0.879,敏感度为71.25%、特异度为89.37%;脾脏血流各参数联合在CPH患者GOV重度中诊断AUC值为0.825,敏感度为70.33%、特异度为83.69%。结论应用能谱CT检测,可结合功能学及形态学角度,分析不同程度GOV患者脾脏血流动力学改变情况,对GOV早期诊断及曲张严重程度的评估提供客观依据,值得推广。

超声造影在肝硬化门静脉高压症行经颈静脉肝内门体分流术后效果监测中的应用

目的:探讨超声造影(CEUS)在肝硬化门静脉高压症行经颈静脉肝内门体分流术(TIPS)术后效果监测中的应用价值。方法:回顾性分析2016年11月—2019年5月四川省人民医院收治的肝硬化门静脉高压症行TIPS治疗的59例患者的临床资料。所有患者均在术后1个月、3个月、6个月、1年行常规超声随访,对怀疑常规超声支架存在功能障碍的患者行CEUS检查,以数字减影血管造影(DSA)检查结果为金标准,观察CEUS对支架功能的诊断价值。结果:59例行TIPS治疗患者中共行常规超声检查154例次,常规超声提示功能障碍23例次,行CEUS提示功能障碍13例次,最后行DSA检查确诊功能障碍13例次。结论:CEUS可反映TIPS支架内的血流灌注情况,对于常规超声诊断困难的患者,可选择CEUS做补充检查。

乙型肝炎肝硬化并发食管静脉曲张患者超声检测肝脏血流参数和红细胞分布宽度与淋巴细胞比值变化

目的探讨乙型肝炎肝硬化并发食管静脉曲张(EV)患者肝血流超声参数和红细胞分布宽度(RDW)与淋巴细胞比值(RLR)的变化。方法2018年4月~2021年3月我院收治的乙型肝炎肝硬化患者188例,均接受多普勒超声和超声造影检查,检测肝静脉减震指数(HV-DI)、门静脉流速(PVV)、门静脉内径(PVD)和门静脉充血指数(PV-CI)。接受胃镜检查,记录EV及其程度。结果内镜检查发现,120例并发EV;肝硬化并发EV组PVV和HVAT分别为(15.2±2.3)cm/s和(15.3±2.4)s,显著低于肝硬化组【分别为(18.9±2.4)cm/s和(22.1±3.5)s,P<0.05】,而PVD、PV-CI、HV-DI和RLR分别为(1.6±0.2)cm、(0.4±0.1)cm/s、(0.8±0.1)和(24.2±3.5),均显著高于肝硬化组【分别为(1.3±0.2)cm、(0.2±0.1)cm/s、(0.6±0.1)和(9.2±1.1),P<0.05】;33例重度EV患者PVV和HVAT分别为(12.8±2.5)cm/s和(8.2±0.9)s,显著低于42例中度EV患者【分别为(14.2±2.1)cm/s和(12.5±3.1)s,P<0.05】或45例轻度EV患者【分别为(17.9±2.1)cm/s和(23.1±3.4)s,P<0.05】,而PVD、PV-CI、HV-DI和RLR分别为(2.2±0.3)cm、(0.7±0.1)cm/s、(1.5±0.1)和(32.7±4.1),显著高于中度EV患者【分别为(1.5±0.1)cm、(0.4±0.1)cm/s、(0.7±0.1)和(26.7±2.8),P<0.05】或轻度EV患者【分别为(1.3±0.1)cm、(0.2±0.1)cm/s、(0.4±0.1)和(15.6±1.5),P<0.05】;在随访的12个月里,EV患者发生EV出血(EVB)72例,出血组PVV和HVAT显著低于未出血组,而PVD、PV-CI、HV-DI和RLR均显著高于未出血组(P<0.05)。结论监测肝血流超声参数和RLR变化可能为预测乙型肝炎肝硬化并发EVB提供预警,值得进一步研究应用。

根治幽门螺杆菌对乙型肝炎肝硬化失代偿期患者肝功能、门静脉血流及远期预后的影响

目的:探讨根治幽门螺杆菌(Hp)对乙型肝炎肝硬化失代偿期患者肝功能、门静脉血流以及远期预后的影响。方法:收集2016年1月至2018年12月我科收治的感染HP的乙型肝炎肝硬化失代偿期患者170例的临床病例资料,根据治疗方法,分为对照组(采用基础治疗)和研究组(采用抗病毒、护肝、补充白蛋白等基础治疗+根治HP)对比分析两组患者的临床数据,探讨根治HP与患者肝功能、门静脉血流及患者远期预后的关系,并比较随访2年内两组患者并发症发生率、总死亡率、无进展生存率。结果:治疗3个月时两组患者门静脉主干内径、门静脉最大血流速度、门静脉平均流速以及血氨较治疗前均有明显改善,且研究组患者改善程度显著优于对照组;在随访2年时间里,研究组患者并发消化道出血、肝性脑病、肝衰竭以及死亡率明显低于对照组;研究组患者6个月、1年、2年无进展生存率为100.0%、81.2%、55.3%显著高于对照组85.8%、61.2%、34.1%,均P<0.05。Cox回归分析显示,PFS和OS是独立预测因素。结论:根治幽门螺杆菌有助于降低乙型肝炎肝硬化失代偿期患者并发症发生率,改善其远期预后。

TEE测量的门静脉时间平均峰值流速和门静脉血流量与体外循环时的灌注量之间的关系探讨

目的:评估食管超声心动图(TEE)在成人体外循环(ECC)下心内直视手术中实时监测肝脏门静脉血流的可行性。探讨TEE测量的门静脉时间平均峰值流速和门静脉血流量与体外循环时的灌注量之间的相关性。方法:选取2022年8月-2023年5月遵义医科大学附属医院行ECC下心内直视手术患者61例,手术中利用TEE监测心脏的同时测量门静脉内径和时间平均峰值流速(TAPV)并计算出门静脉血流量(PVBF)。记录体外循环参数、门静脉血流动力学指标。分析体外灌注量(VPF)与PVBF、平均动脉压(MAP)与PVBF的关系。结果:符合纳入标准并成功放入食管超声的患者中有58例患者获得满意的门静脉右支主干声像图,3例患者未能显示出门静脉,TEE显示门静脉成功率95.1%。ECC后患者循环稳定时门静脉搏动指数(PI)、阻力指数(RI)均较ECC前明显降低、PVBF较ECC前明显增高。体外灌注期间TAPV与VPF、PVBF与VPF均呈正相关(P<0.05),TAPV与MAP、PVBF与MAP均呈负相关(P<0.05)。结论:TEE可以作为一种ECC中实时动态监测门静脉血流的有效工具;成人ECC下心内直视手术体外灌注期间,ECC灌注量是决定门静脉血流灌注的主要因素。

肝硬化门静脉血栓病人继发多种抗凝剂依赖假性血小板减少症误诊为肝素诱导的血小板减少症1例

目的为血小板减少的诊断提供可能的思路。方法回顾性分析武汉科技大学附属天佑医院消化内科收治的1例肝硬化门静脉血栓病人继发多种抗凝剂依赖假性血小板减少症的临床资料。结果该病人为继发于肝硬化门静脉血栓治疗过程中出现的多种抗凝剂依赖假性血小板减少症。结论当肝硬化病人血小板减少时,应注意排除多种抗凝剂依赖假性血小板减少症。

老年肝硬化门静脉高压伴上消化道急性出血预后与血细胞参数及BUN/Cr比值、 PALBI评分的关系分析

目的探讨老年肝硬化门静脉高压伴上消化道急性出血预后与血细胞参数、血尿素氮/肌酐(BUN/Cr)比值和肝病分级评分(PALBI)的关系。方法选取2017年3月至2022年3月在我院进行治疗的92例老年肝硬化门静脉高压伴上消化道急性出血患者作为研究组,另选50例未发生上消化道出血的老年肝硬化门静脉高压患者为对照组,记录患者的红细胞分布宽度(RDW)、血小板(PLT)、红细胞压积(HCT)水平,对患者的血尿素氮、肌酐水平进行分析,采用PALBI评分对患者的生存预后进行预测分析。对研究组患者进行随访1年,根据患者的预后情况将其分为生存组和死亡组,比较其血细胞参数、BUN/Cr比值、PALBI评分差异。结果与对照组患者相比较,研究组患者的RDW、MPV水平升高,PLT、HCT、PCT水平降低(P<0.05)。与对照组患者相比较,研究组患者的BUN水平、Cr水平、BUN/Cr值及PALBI评分均升高(P<0.05)。经Pearson相关系数分析,患者的PALBI评分与BUN水平、Cr水平、BUN/Cr值、RDW水平均呈正相关(r=0.241,P=0.004;r=0.259,P=0.002;r=0.987,P<0.001;r=0.166,P=0.048),与PLT、HCT水平呈负相关(r=-0.207,P=0.014;r=-0.576,P<0.001)。随访期结束时,研究组92例患者有32例患者死亡,纳入死亡组,其他60例患者纳入生存组。与生存组患者相比较,死亡组患者的RDW、MPV水平升高,PLT、HCT、PCT水平降低(P<0.05)。与生存组患者相比较,死亡组患者的BUN水平、Cr水平、BUN/Cr值及PALBI评分均升高(P<0.05)。结论血细胞参数、BUN/Cr比值和PALBI评分在老年肝硬化门静脉高压伴上消化道急性出血的预后评估中具有重要的临床意义,可为预测患者的生存情况提供有价值的参考。