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.

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.

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.

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.

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.

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.

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.

Determination of correlation of Adjusted Blood Requirement Index with outcome in patients presenting with acute variceal bleeding

AIM： To determine the correlation of Adjusted Blood Requirement Index （ABRI） with the 7th day outcome in patients presenting with acute variceal bleeding.METHODS： All patients presenting with acute variceal hemorrhage （AVH） were included. Patients with previous band ligation, sclerotherapy, gastrointestinal or hepatic malignancies were excluded. Patients were managed as per standard protocol for AVH with terlipressin and band ligation. ABRI scores were calculated using the formula outcome of alive or expired up to the 7th day after treatment. The correlation between ABRI and mortality was estimated and a receiver operative characteristic （ROC） curve was plotted.RESULTS： A total of 113 patients （76 male; 37 female） were included. On assessment, 18 were in Child＇s Pugh Class A, 82 in Class B and 13 were in Class C. The median number of blood units transfused ± inter-quartile range was 3.0 ± 2.0. The median ± inter-quartile range for ABRI was 1.3 ± 1.1. The ROC curve of ABRI for expiry showed a significantly large area of 0.848 （P 〈 0.0001; 95% CI： 0.75-0.95）. A significant correlation of log transformation of ABRI with an outcome of mortality was present （P 〈 0.0001）.

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.

脾切除贲门周围血管离断术治疗肝硬化门静脉高压症疗效观察

目的观察脾切除贲门周围血管离断术(SPD)治疗肝硬化门静脉高压症(PHT)的效果及对患者血流循环和血清白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)的影响。方法选择贵港市人民医院肝胆胰外科2020年5月—2024年4月诊治的116例肝硬化PHT患者进行回顾性分析,根据患者手术方式不同分为研究组(61例)和对照组(55例),研究组予腹腔镜下SPD治疗,对照组予开腹SPD治疗。比较两组治疗前后肝功能、血流循环、血常规和血清IL-6、TNF-α水平,并统计术后并发症情况。结果研究组第1天引流量与对照组相比差异无统计学意义(P>0.05),而术后胃肠道恢复时间、引流管拔除时间、手术时间、出血量及住院时间均短于对照组(P<0.05);术后1个月,相比于术前两组患者总胆红素(TBIL)、谷丙转氨酶(ALT)和凝血酶时间(PT)水平均下降,白蛋白(ALB)水平则升高,且研究组的TBIL、ALT、PT水平更低,ALB水平更高(P<0.05);术后门静脉、脾静脉的静脉直径(VD)、血流量(VF)较术前减小,流速(VV)水平较术前升高,且研究组VD、VF更小,VV水平更高(P<0.05);术后白细胞计数(WBC)、血小板计数(PLT)水平均较术前升高,且研究组相较于对照组更高(P<0.05)。两组患者术后7 d、1个月血清IL-6、TNF-α水平均较术前降低,且研究组降低幅度大于对照组(P<0.05);术后对照组并发症总发生率显著高于研究组(P<0.05)。结论腹腔镜SPD术式相比于开腹SPD术式,可减少肝硬化PHT患者术中出血量及术后并发症,有利于改善患者肝功能及血流动力学,降低IL-6、TNF-α水平。

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。

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。

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。

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。

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。

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。

门静脉高压症患者围手术期血小板、凝血和纤溶变化的临床意义

目的 探讨肝硬化合并门静脉高压 (PHT )的不同Child分级患者围手术期血小板数、凝血和纤溶指标变化的临床意义。 方法 对PHT组 17例ChildB级和 6例ChildC级患者分别行部分门体分流术和贲门周围血管离断术治疗 ,测定围手术期血小板、凝血和纤溶指标 ,并与无PHT的肝硬化患者对比。 结果 术前PHT组ChildB级患者除血小板数量下降外 ,其他反映血小板功能、凝血和纤溶指标与对照组比较均差异无显著性 (P >0 .0 5 ) ;而ChildC级患者除血小板数量下降外 ,GMP -14 0 ,FPA和D-二聚体明显增高 ( P <0 .0 5 )。术后PHT组ChildC级患者血小板数量及凝血因子Ⅷ :C均较B级组显著下降 (P <0 .0 5 ) ,GMP -14 0在ChildB级组中明显升高 ,而在ChildC级却明显下降。 结论 手术有诱发ChildC级患者并发DIC的可能 ,术中Fg和FⅧ

腔镜下第一肝门血流阻断器在部分肝切术中的应用

目的探讨腔镜下肝门阻断器在肝叶切除术中的作用。方法使用自行研究发明的肝门血流阻断器,在电视腹腔镜引导下,经穿刺卡进入腹腔。在游离切断待切肝叶(肝段)肝周韧带后,将肝门血流暂时阻断,为23例肝胆疾病患者作肝叶、肝段切除,与另12例未使用阻断器者进行比较,了解术中出血、输血、手术历时、术后恢复情况等指标有无差异。结果阻断组23例患者全部经腹腔镜手术成功,术中出血为100～800ml,平均413ml;手术历时60～300min,平均166min;术后出现肺部感染1例,肝断面胆汁漏1例,22例治愈,1例好转出院;平均住院时间6d。未阻断组,12例中有3例中转开腹,术中出血为200～2500ml,平均为1083ml,历时180～360min,平均210min;术后1例创面渗血,短期内再次剖腹手术止血;1例胆漏,第2天剖腹缝扎创面,术后全部康复出院,平均住院8d。结论腔镜下第一肝门血流阻断器在肝叶切除术中应用可减少术中出血,缩短手术时间,提高手术成功率,是腔镜肝叶切除术的必备器械。

部分性脾动脉栓塞治疗脾功能亢进

目的探讨脾功能亢进行脾部分栓塞时对门脉压力及外周血液变化的影响。方法对36例脾功能亢进患者,采用Seldinger's法经皮脾动脉超选择性插管造影,计数直径>1mm的脾内动脉血管数。用明胶海绵碎屑(1mm×1mm×1mm)或PVA颗粒实行脾动脉栓塞,栓塞上述血管的60%～80%,并进行1～36个月(平均20个月)临床随访观察对比手术前后门脉压力、血液成分的变化。结果平均门脉压力由4.05kPa降至2.51kPa,外周血液红细胞由2.0×1012/L升至4.20×1012/L,白细胞从3.2×109/L升至5.0×109/L,血小板从40×109/L升至150×109/L。食管静脉曲张引发上消化道出血4例中,术后3例未再出血。结论栓塞程度以脾血管数为计数单位,控制在60%～80%时,可较好地改善脾功能亢进患者外周血象、门静脉压力,减轻食管静脉曲张程度。