AIM: To describe a method for the transjugular intrahepatic portal systemic shunt(TIPS) placement performed with the aid of contrast-enhanced computed tomography(CECT) and three-dimensional reconstructed vascular imag...AIM: To describe a method for the transjugular intrahepatic portal systemic shunt(TIPS) placement performed with the aid of contrast-enhanced computed tomography(CECT) and three-dimensional reconstructed vascular images(3D RVIs), and to assess its safety and effectiveness. METHODS: Four hundred and ninety patients were treated with TIPS between January 2005 and December 2012. All patients underwent liver CECT and reconstruction of 3D RVIs of the right hepatic vein to portal vein(PV) prior to the operation. The 3D RVIs were carefully reviewed to plan the puncture path fromthe start to target points for needle pass through the PV in the TIPS procedure. R E S U LTS :The improved TIPS procedure was successful in 483(98.6%) of the 490 patients. The number of punctures attempted was one in 294(60%) patients, 2 to 3 in 147(30%) patients, 4 to 6 in 25(5.1%) patients and more than 6 in 17(3.5%) patients. Seven patients failed. Of the 490 patients, 12 had punctures into the artery, 15 into the bile duct, eight into the gallbladder, and 18 through the liver capsule. Analysis of the portograms from the 483 successful cases indicated that the puncture points were all located distally to the PV bifurcation on anteroposterior images, while the points were located proximally to the bifurcation in the three cases with intraabdominal bleeding. The complications included three cases of bleeding, of whom one died and two needed surgery. CONCLUSION: Use of CECT and 3D RVIs to plan the puncture path for TIPS procedure is safe, simple and effective for clinical use.展开更多
AIM:To present a dedicated series of transjugular intrahepatic porto-systemic shunts(TIPS) in the elderly since data is sparse on this population group.METHODS:A retrospective review was performed of patients at least...AIM:To present a dedicated series of transjugular intrahepatic porto-systemic shunts(TIPS) in the elderly since data is sparse on this population group.METHODS:A retrospective review was performed of patients at least 65 years of age who underwent TIPS at our institutions between 1997 and 2010.Twentyfive patients were referred for TIPS.We deemed that 2 patients were not considered appropriate candidates due to their markedly advanced liver disease.Of the 23 patients suitable for TIPS,the indications for TIPS placement was portal hypertension complicated by refractory ascites alone(n = 9),hepatic hydrothorax alone(n = 2),refractory ascites and hydrothorax(n = 1),gastrointestinal bleeding alone(n = 8),gastrointestinal bleeding and ascites(n = 3).RESULTS:Of these 23 attempted TIPS procedure patients,21 patients had technically successful TIPS procedures.A total of 29 out of 32 TIPS procedures including revisions were successful in 21 patients with a mean age of 72.1 years(range 65-82 years).Three of the procedures were unsuccessful attempts at TIPS and 8 procedures were successful revisions of our existing TIPS.Sixteen of 21 patients who underwent successful TIPS(excluding 5 patients lost to follow-up) were followed for a mean of 14.7 mo.Ascites and/or hydrothorax was controlled following technically successful procedures in 12 of 13 patients.Bleeding was controlled following technically successful procedures in 10 out of 11 patients.CONCLUSION:We have demonstrated that TIPS is an effective procedure to control refractory complications of portal hypertension in elderly patients.展开更多
AIM:To investigate the effect of transjugular intra-hepatic porto-systemic shunt (TIPS) on malnutrition in portal hypertensive cirrhotic patients.METHODS: Twenty-one patients with liver cirrhosis and clinical indicati...AIM:To investigate the effect of transjugular intra-hepatic porto-systemic shunt (TIPS) on malnutrition in portal hypertensive cirrhotic patients.METHODS: Twenty-one patients with liver cirrhosis and clinical indications for TIPS insertion were investigated before and 1, 4, 12, 52 wk after TIPS. For each patient we assayed body composition parameters [dry lean mass, fat mass, total body water (TBW)], routine liver and kidney function tests, and free fatty acids (FFA). Glucose and insulin were measured for the calculation of the homeostasis model assessment insulin resistance (HOMA-IR); liver function was measured by the galactose elimination capacity (GEC); the severity of liver disease was graded by model for end-stage liver disease (MELD).RESULTS: Porto-systemic gradient decreased after TIPS (6.0±2.1 mmHg vs 15.8±4.8 mmHg, P<0.001). Patients were divided in two groups according to initial body mass index. After TIPS, normal weight patients had an increase in dry lean mass (from 10.9±5.9 kg to 12.7±5.6 kg, P=0.031) and TBW (from 34.5±7.6 L to 40.2±10.8 L,P=0.007), as well as insulin (from 88.9±49.2 pmol/L to 164.7±107.0 pmol/L,P=0.009) and HOMA-IR (from 3.36%±2.18% to 6.18%±4.82%,P=0.023). In overweight patients only FFA increased significantly (from 0.59±0.24 mmol/L to 0.93±0.34 mmol/L, P=0.023).CONCLUSION: TIPS procedure is effective in lowering portal pressure in patients with portal hypertension and improves body composition without significant changes in metabolic parameters.展开更多
完全性内脏反位(complete situs inversus viscerum,CSIV)是一种罕见的先天性畸形,其胸、腹脏器与正常人成镜面反位分布,其发生率约1/10 000,部分患者可能合并其他染色体畸形。CSIV由于其特殊的内脏分布,可能增加临床诊断及手术治疗的...完全性内脏反位(complete situs inversus viscerum,CSIV)是一种罕见的先天性畸形,其胸、腹脏器与正常人成镜面反位分布,其发生率约1/10 000,部分患者可能合并其他染色体畸形。CSIV由于其特殊的内脏分布,可能增加临床诊断及手术治疗的难度。展开更多
目的:探讨对肝内门体分流术后出院患者运用互联网进行综合护理的实施效果。方法:采用方便抽样法,选取2018年6月至2019年6月在江苏大学鼓楼临床医学院消化科行肝内门体分流术的肝病患者120例,按入院时间分为两组:2018年6至12月的患者作...目的:探讨对肝内门体分流术后出院患者运用互联网进行综合护理的实施效果。方法:采用方便抽样法,选取2018年6月至2019年6月在江苏大学鼓楼临床医学院消化科行肝内门体分流术的肝病患者120例,按入院时间分为两组:2018年6至12月的患者作为对照组,实施常规护理及出院后1,3,6个月进行电话随访;2019年1至6月的患者作为实验组,制订出院计划,运用互联网综合护理对患者进行干预,以自我护理能力测量表(Exercise of Self-Care Agency Scale,ESCA)与健康调查量表(Short form 36 Health Survey Questionnaire,SF-36)评价两组患者的自我护理能力及生存质量的改善情况。结果:入院时实验组和对照组自我护理能力的4个维度及总评分差异无统计学意义(P>0.05),干预6个月后,实验组自我护理能力的4个维度及总分均高于对照组,差异有统计学意义(P<0.01);入院时实验组生存质量的8个维度评分与对照组差异无统计学意义(P>0.05),干预6个月后,实验组生存质量的8个维度评分均高于对照组,差异有统计学意义(P<0.05)。结论:运用互联网进行综合护理能明显提高经颈静脉肝内门体分流术(transjugular intrahepatic portal systemic shunts,TIPS)患者的自我护理能力,从而形成有效的自我管理能力,提高患者的生活质量。展开更多
基金Supported by General Hospital of Chengdu Military Command,No.2013YG-B009
文摘AIM: To describe a method for the transjugular intrahepatic portal systemic shunt(TIPS) placement performed with the aid of contrast-enhanced computed tomography(CECT) and three-dimensional reconstructed vascular images(3D RVIs), and to assess its safety and effectiveness. METHODS: Four hundred and ninety patients were treated with TIPS between January 2005 and December 2012. All patients underwent liver CECT and reconstruction of 3D RVIs of the right hepatic vein to portal vein(PV) prior to the operation. The 3D RVIs were carefully reviewed to plan the puncture path fromthe start to target points for needle pass through the PV in the TIPS procedure. R E S U LTS :The improved TIPS procedure was successful in 483(98.6%) of the 490 patients. The number of punctures attempted was one in 294(60%) patients, 2 to 3 in 147(30%) patients, 4 to 6 in 25(5.1%) patients and more than 6 in 17(3.5%) patients. Seven patients failed. Of the 490 patients, 12 had punctures into the artery, 15 into the bile duct, eight into the gallbladder, and 18 through the liver capsule. Analysis of the portograms from the 483 successful cases indicated that the puncture points were all located distally to the PV bifurcation on anteroposterior images, while the points were located proximally to the bifurcation in the three cases with intraabdominal bleeding. The complications included three cases of bleeding, of whom one died and two needed surgery. CONCLUSION: Use of CECT and 3D RVIs to plan the puncture path for TIPS procedure is safe, simple and effective for clinical use.
文摘AIM:To present a dedicated series of transjugular intrahepatic porto-systemic shunts(TIPS) in the elderly since data is sparse on this population group.METHODS:A retrospective review was performed of patients at least 65 years of age who underwent TIPS at our institutions between 1997 and 2010.Twentyfive patients were referred for TIPS.We deemed that 2 patients were not considered appropriate candidates due to their markedly advanced liver disease.Of the 23 patients suitable for TIPS,the indications for TIPS placement was portal hypertension complicated by refractory ascites alone(n = 9),hepatic hydrothorax alone(n = 2),refractory ascites and hydrothorax(n = 1),gastrointestinal bleeding alone(n = 8),gastrointestinal bleeding and ascites(n = 3).RESULTS:Of these 23 attempted TIPS procedure patients,21 patients had technically successful TIPS procedures.A total of 29 out of 32 TIPS procedures including revisions were successful in 21 patients with a mean age of 72.1 years(range 65-82 years).Three of the procedures were unsuccessful attempts at TIPS and 8 procedures were successful revisions of our existing TIPS.Sixteen of 21 patients who underwent successful TIPS(excluding 5 patients lost to follow-up) were followed for a mean of 14.7 mo.Ascites and/or hydrothorax was controlled following technically successful procedures in 12 of 13 patients.Bleeding was controlled following technically successful procedures in 10 out of 11 patients.CONCLUSION:We have demonstrated that TIPS is an effective procedure to control refractory complications of portal hypertension in elderly patients.
文摘AIM:To investigate the effect of transjugular intra-hepatic porto-systemic shunt (TIPS) on malnutrition in portal hypertensive cirrhotic patients.METHODS: Twenty-one patients with liver cirrhosis and clinical indications for TIPS insertion were investigated before and 1, 4, 12, 52 wk after TIPS. For each patient we assayed body composition parameters [dry lean mass, fat mass, total body water (TBW)], routine liver and kidney function tests, and free fatty acids (FFA). Glucose and insulin were measured for the calculation of the homeostasis model assessment insulin resistance (HOMA-IR); liver function was measured by the galactose elimination capacity (GEC); the severity of liver disease was graded by model for end-stage liver disease (MELD).RESULTS: Porto-systemic gradient decreased after TIPS (6.0±2.1 mmHg vs 15.8±4.8 mmHg, P<0.001). Patients were divided in two groups according to initial body mass index. After TIPS, normal weight patients had an increase in dry lean mass (from 10.9±5.9 kg to 12.7±5.6 kg, P=0.031) and TBW (from 34.5±7.6 L to 40.2±10.8 L,P=0.007), as well as insulin (from 88.9±49.2 pmol/L to 164.7±107.0 pmol/L,P=0.009) and HOMA-IR (from 3.36%±2.18% to 6.18%±4.82%,P=0.023). In overweight patients only FFA increased significantly (from 0.59±0.24 mmol/L to 0.93±0.34 mmol/L, P=0.023).CONCLUSION: TIPS procedure is effective in lowering portal pressure in patients with portal hypertension and improves body composition without significant changes in metabolic parameters.
文摘目的:探讨对肝内门体分流术后出院患者运用互联网进行综合护理的实施效果。方法:采用方便抽样法,选取2018年6月至2019年6月在江苏大学鼓楼临床医学院消化科行肝内门体分流术的肝病患者120例,按入院时间分为两组:2018年6至12月的患者作为对照组,实施常规护理及出院后1,3,6个月进行电话随访;2019年1至6月的患者作为实验组,制订出院计划,运用互联网综合护理对患者进行干预,以自我护理能力测量表(Exercise of Self-Care Agency Scale,ESCA)与健康调查量表(Short form 36 Health Survey Questionnaire,SF-36)评价两组患者的自我护理能力及生存质量的改善情况。结果:入院时实验组和对照组自我护理能力的4个维度及总评分差异无统计学意义(P>0.05),干预6个月后,实验组自我护理能力的4个维度及总分均高于对照组,差异有统计学意义(P<0.01);入院时实验组生存质量的8个维度评分与对照组差异无统计学意义(P>0.05),干预6个月后,实验组生存质量的8个维度评分均高于对照组,差异有统计学意义(P<0.05)。结论:运用互联网进行综合护理能明显提高经颈静脉肝内门体分流术(transjugular intrahepatic portal systemic shunts,TIPS)患者的自我护理能力,从而形成有效的自我管理能力,提高患者的生活质量。
