AIM:To determine the effect of free serotonin concentrations in plasma on development of esophageal and gastric fundal varices. METHODS:This prospective study included 33 patients with liver cirrhosis and 24 healthy c...AIM:To determine the effect of free serotonin concentrations in plasma on development of esophageal and gastric fundal varices. METHODS:This prospective study included 33 patients with liver cirrhosis and 24 healthy controls. Ultrasonography and measurement of serotonin concentration in plasma were carried out in both groups of subjects. The upper fiber panendoscopy was performed only in patients with liver cirrhosis. RESULTS:The mean plasma free serotonin levels were much higher in liver cirrhosis patients than in healthy controls (219.0 ± 24.2 nmol/L vs 65.4 ± 18.7 nmol/L,P < 0.0001). There was no significant correlation be-tween serotonin concentration in plasma and the size of the esophageal varices according to Spearman coefficient of correlation (rs =-0.217,P > 0.05). However,the correlation of plasma serotonin concentration and gastric fundal varices was highly significant (rs =-0.601,P < 0.01). CONCLUSION:Free serotonin is significant in pathogenesis of portal hypertension especially in development of fundal varices,indicating the clinical value of serotonergic receptor blockers in these patients.展开更多
AIM:To examine the portal hemodynamics of gastric fundal varices (GV) without gastro-renal shunt (GRS), and to retrospectively investigate the effects of various kinds of treatment on eradication. METHODS: Ninety-four...AIM:To examine the portal hemodynamics of gastric fundal varices (GV) without gastro-renal shunt (GRS), and to retrospectively investigate the effects of various kinds of treatment on eradication. METHODS: Ninety-four liver cirrhosis patients at high- risk of GV were treated in our hospital and enrolled in this study. We retrospectively examined their characteristics, liver function, and portal hemodynamics of GV. We performed balloon-occluded retrograde transvenous obliteration (BRTO) at first. If it was not technically possible to perform BRTO, endoscopic injection sclerotherapy using α-cyanoacrylate glue (CA) or percutaneous transhepatic obliteration (PTO) was performed. RESULTS: Among the 94 patients, a GRS was present in 79 (84.0%), and absent in the remaining 15 (16.0%). The subphrenic vein was connected to the inferior vena cava as the drainage vein in 13 (86.7%) out of the 15 cases without GRS. We performed BRTO in 6 patients, CA in 4 patients and PTO in 5 patients. The eradication rate was 100% for each procedure, but the rate of early recurrence within 6 mo was 16.7% for BRTO, 50.0% for CA and 40.0% for PTO, respectively. CONCLUSION: We should examine the hemodynamics before treatment of GV irrespective of the existence of GRS. If this hemodynamic examination reveals that the drainage vein connects directly to the inferior vena cava in GV without GRS, BRTO may be an effective treatment for GV with GRS.展开更多
目的:探讨C T门静脉成像(c o m p u t e d tomography angiography,CTA)在门脉高压合并胃底静脉曲张(gastric fundal varices)患者的分流状态的评估以及治疗方案的选择价值.方法:回顾性分析2011-01/2014-06安徽医科大学附属第一医院诊...目的:探讨C T门静脉成像(c o m p u t e d tomography angiography,CTA)在门脉高压合并胃底静脉曲张(gastric fundal varices)患者的分流状态的评估以及治疗方案的选择价值.方法:回顾性分析2011-01/2014-06安徽医科大学附属第一医院诊断门脉高压症患者40例,分别进行内镜以及CTA检查,记录内镜下分型以及CTA血供,测量门脉系统血管直径,记录分流道特点,综合评估分流道状态.相关数据进行进一步统计学分析.结果:40例患者均存在胃底静脉曲张,其中两例CTA提示胃底静脉曲张而胃镜检查未发现.CTA和内镜检查对于曲张胃底静脉的形态对照的一致性检验(Kappa=0.870),差异有统计学意义(P<0.01).GOV2型和IGV型伴胃和/或脾-肾分流的几率较大,达到60.87%.本组病例中,存在胃/脾-肾分流道的19例,门静脉直径平均为1.39 cm±0.25 cm;余无胃/脾-肾分流道形成,门静脉直径的平均值1.56 cm±0.31 cm.其中有5例分流道直径>5 mm患者选择了经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)治疗合并分流道封堵术,患者症状均得到控制.对于无分流道以及分流道直径较小患者使用组织胶治疗胃底静脉曲张,术后观察未有出现组织黏合剂栓塞情况,治疗安全有效.结论:CTA可显示胃底静脉曲张侧枝循环的类型及特点,而分流状态的评估对于该类患者治疗方案的选择以及预后评估有着重要价值.展开更多
基金Supported by The Ministry for Science, Technology and Development of Republic of Serbia, No. 14501B
文摘AIM:To determine the effect of free serotonin concentrations in plasma on development of esophageal and gastric fundal varices. METHODS:This prospective study included 33 patients with liver cirrhosis and 24 healthy controls. Ultrasonography and measurement of serotonin concentration in plasma were carried out in both groups of subjects. The upper fiber panendoscopy was performed only in patients with liver cirrhosis. RESULTS:The mean plasma free serotonin levels were much higher in liver cirrhosis patients than in healthy controls (219.0 ± 24.2 nmol/L vs 65.4 ± 18.7 nmol/L,P < 0.0001). There was no significant correlation be-tween serotonin concentration in plasma and the size of the esophageal varices according to Spearman coefficient of correlation (rs =-0.217,P > 0.05). However,the correlation of plasma serotonin concentration and gastric fundal varices was highly significant (rs =-0.601,P < 0.01). CONCLUSION:Free serotonin is significant in pathogenesis of portal hypertension especially in development of fundal varices,indicating the clinical value of serotonergic receptor blockers in these patients.
文摘AIM:To examine the portal hemodynamics of gastric fundal varices (GV) without gastro-renal shunt (GRS), and to retrospectively investigate the effects of various kinds of treatment on eradication. METHODS: Ninety-four liver cirrhosis patients at high- risk of GV were treated in our hospital and enrolled in this study. We retrospectively examined their characteristics, liver function, and portal hemodynamics of GV. We performed balloon-occluded retrograde transvenous obliteration (BRTO) at first. If it was not technically possible to perform BRTO, endoscopic injection sclerotherapy using α-cyanoacrylate glue (CA) or percutaneous transhepatic obliteration (PTO) was performed. RESULTS: Among the 94 patients, a GRS was present in 79 (84.0%), and absent in the remaining 15 (16.0%). The subphrenic vein was connected to the inferior vena cava as the drainage vein in 13 (86.7%) out of the 15 cases without GRS. We performed BRTO in 6 patients, CA in 4 patients and PTO in 5 patients. The eradication rate was 100% for each procedure, but the rate of early recurrence within 6 mo was 16.7% for BRTO, 50.0% for CA and 40.0% for PTO, respectively. CONCLUSION: We should examine the hemodynamics before treatment of GV irrespective of the existence of GRS. If this hemodynamic examination reveals that the drainage vein connects directly to the inferior vena cava in GV without GRS, BRTO may be an effective treatment for GV with GRS.
文摘目的:探讨C T门静脉成像(c o m p u t e d tomography angiography,CTA)在门脉高压合并胃底静脉曲张(gastric fundal varices)患者的分流状态的评估以及治疗方案的选择价值.方法:回顾性分析2011-01/2014-06安徽医科大学附属第一医院诊断门脉高压症患者40例,分别进行内镜以及CTA检查,记录内镜下分型以及CTA血供,测量门脉系统血管直径,记录分流道特点,综合评估分流道状态.相关数据进行进一步统计学分析.结果:40例患者均存在胃底静脉曲张,其中两例CTA提示胃底静脉曲张而胃镜检查未发现.CTA和内镜检查对于曲张胃底静脉的形态对照的一致性检验(Kappa=0.870),差异有统计学意义(P<0.01).GOV2型和IGV型伴胃和/或脾-肾分流的几率较大,达到60.87%.本组病例中,存在胃/脾-肾分流道的19例,门静脉直径平均为1.39 cm±0.25 cm;余无胃/脾-肾分流道形成,门静脉直径的平均值1.56 cm±0.31 cm.其中有5例分流道直径>5 mm患者选择了经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)治疗合并分流道封堵术,患者症状均得到控制.对于无分流道以及分流道直径较小患者使用组织胶治疗胃底静脉曲张,术后观察未有出现组织黏合剂栓塞情况,治疗安全有效.结论:CTA可显示胃底静脉曲张侧枝循环的类型及特点,而分流状态的评估对于该类患者治疗方案的选择以及预后评估有着重要价值.
