目的:探討肝硬化門脈高壓性結腸病與肝功能分級、食管靜脈曲張、下消化道出血的關系以及內鏡下特征,為診治該類疾病提供一些依據。方法:回顧性分析48例肝硬化門脈高壓患者臨床表現及內鏡特征,并對其并發的肝硬化門脈高壓性結腸病進行分析。結果:48例肝硬化門脈高壓患者中, 肝硬化門脈高壓性結腸病發生率542%。 隨著肝硬化門脈高壓病程的延長,其門脈高壓性結腸病的發生率明顯增加,下消化道出血的機會也明顯增加;而門脈高壓性結腸病的發生與肝功能分級無關。結論:肝硬化門脈高壓患者常出現門脈高壓性結腸病。門脈高壓性結腸病是肝硬化門脈高壓患者下消化道出血的主要原因,但不是唯一原因。
目的：分析原發性膽汁性肝硬化(PBC)患者的臨床特征,以提高對該病診治的認識。方法：分析17例PBC患者的一般資料、臨床表現、生化指標、免疫學指標及病理學改變。結果：PBC主要累及中年女性，易合并干燥綜合征（SS）。膽管酶升高及抗線粒體M2抗體陽性有助于本病診斷。治療首選熊去氧膽酸，糖皮質激素、免疫抑制劑適用于合并SS者。結論：早期診斷、早期治療PBC是防止發展為終末期肝硬化的關鍵。
Objective To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with gastric coronary vein embolization for the treatment of liver cirrhosis with gastroesophageal varices hemorrhage, and evaluate its application value. Methods The data of 50 patients with liver cirrhosis who were treated with TIPS combined with gastric coronary vein embolization between June 2009 and January 2013 were retrospectively analyzed. According to Child-Pugh Liver Grade, the patients were divided into grade A liver function group (n=6), grade B liver function group (n=18), and grade C liver function group (n=26); according to the type of stent implantation, the patients were divided into covered stent group (n=29) and bare stent group (n=21). The 1-week and 1-, 3-, 6-, and 12-month postoperative liver function changes were compared, and the 2-year postoperative rebleeding rate, survival rate, stent restenosis rate, and hepatic encephalopathy incidence were observed. Results The success rate of surgery was 100.0% (50/50), and the success rate of emergency surgery was 100.0% (3/3) in 3 patients with active bleeding. The portal vein pressure decreased from (39.46±2.82) cm H2O (1 cm H2O=0.098 kPa) before the surgery to (25.62±2.13) cm H2O after the surgery, and the difference was statistically significant (P<0.05). In grade A and grade B liver function groups, and covered stent and bare stent groups, the differences between preoperative and postoperative liver function indexes were not statistically significant (P>0.05); in grade C liver function group, the 1-week, 1-month, 3-month postoperative values of alanine aminotransferase, aspartate aminotransferase, total bilirubin and direct bilirubin increased compared with the preoperative values, and the differences were statistically significant (P<0.05). The postoperative 2-year rebleeding rate was 12.0% (6/50), and the postoperative 2-year incidence of hepatic encephalopathy was 16.0% (8/50). The postoperative 2-year stent stenosis rate was 26.0% (13/50) in the 50 cases, which was 13.8% (4/29) in covered stent group and 42.9% (9/21) in bare stent group, respectively. The postoperative 2-year survival rate was 90.0% (45/50). Conclusions TIPS combined with gastric coronary vein embolization in the treatment of liver cirrhosis with gastroesophageal varices bleeding has the exact effect, low rebleeding rate, fewer complications, and can be repeated. The preoperative evaluation of patients’ liver function, the application of stent of diameter 8 mm, paying attention to the perioperative period and regular follow-up treatment are helpful to reduce or prevent the occurrence of hepatic encephalopathy, stent stenosis and other complications.
ObjectiveTo study the application value of multi-slice CT portography (MSCTP) in the diagnosis and evaluation of esophageal and gastric varices (EGV) caused by cirrhosis. MethodsPatients with cirrhosis diagnosed between September 2009 and December 2012 were screened in this study. And the consistency of MSCTP and digestive endoscopy in the diagnosis, classification and grading of EGV in cirrhosis were evaluated. ResultsA total of 78 patients were included in this study, and there were 55 patients with EGV diagnosed by endoscopy, including 35, 16 and 4 patients with GOV1, GOV2 and IGV1 respectively by Satin type standards; and the number of patients with mild, moderate and severe EGV by general grading standards was 2, 15, and 37, respectively. In this cohort, the findings of MSCTP examination also showed that 58 patients had EGV, including 36, 17, 4 and 1 patients with GOV1, GOV2, IGV1 and IGV2 by Satin type standards; and the number of patients with grade I,Ⅱ andⅢ EGV by Kim grading standards was 5, 16 and 37, respectively. Statistical analysis showed that there was a high consistency between endoscopy and MSCTP in the diagnosis (Kappa=0.712, P=0.000), typing (Kappa=0.732, P=0.000) or grading (Kappa=0.863, P=0.000) of EGV. ConclusionMSCTP has a high application value in the diagnosis and severity evaluation of EGV in patients with cirrhosis.
Cirrhosis is an end stage of condition of various liver diseases with specific clinic and pathologic process. The incidence is high and it seriously affects the quality of life for patients. In order to obtain the best prevention and treatment for end-stage cirrhosis, we searched The Cochrane Library (Issue 3, 2004), SUMsearch (1981~2004) and MEDLINE (1981~2004), and identified 15 systematic reviews and 65 randomized controlled trials. We critically assessed the quality of studies. The results showed the principal treatment of cirrhosis was to deal with complications, such as the prevention and treatment of variceal bleeding, the treatment of ascites etc.
Objective To investigate the general situation of self-management behavior of patients with cirrhosis, and analyze its influencing factors. Method From January to June 2015, the in-patients with liver cirrhosis were recruited from Gastroenterology Ward of a comprehensive hospital in Chengdu city by convenience sampling method, and a series of questionnaires were used in the research, including self-management behavior scale, social support scale (SSRS), quality of life questionnaire (WHOQOL-BREF) and sociodemographic characteristics. Results One hundred and sixty-eight patients were enrolled. The self-management behavior of patients with cirrhosis scored an average of 50.4±11.3, which was in the medium level. Self management behavior was positively and significantly correlated with social support (r=0.488, P<0.001) and the overall quality of life (r=0.554, P<0.001). Multiple linear regression indicated that the gender and course of the disease were two influencing factors. Moreover, female experienced better self-management behavior than men (t=27.090, P<0.001); and the longer the course of the disease was, the better the self-management behavior could be found (t=34.057, P<0.001). Conclusion We should strengthen the health education of self-management in patients with cirrhosis, and make full use of the patients’ social support system, so as to improve the patients’ self-management behavior as well as the treatment of diseases and their quality of life.
ObjectiveTo explore it's advantages and disadvantages through analyzed the data of associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) operation in 3 cases of liver cancer patients with cirrhosis. MethodsThe data of 3 patients perfomed ALPPS operation were retrospectively analyzed, through the preoperative evaluation, intraoperative and postoperative treatment points analyzed to explore the pros and cons. ResultsOne case died of hepatic failure, and the remaining two cases were still alive. The highest score of MELD of liver failure in death case was 18.8 scores, and the other cases of MELD score were decreased after second operation. The average increased volume of liver was 225 mL, and the liver volume was significantly increased (P=0.002). ConclusionsALPPS make a portion of huge liver cancer patients combining with cirrhosis having a chance to surgery. But it is necessary to consider in patients with preoperative state, surgical risk, prognosis and economic conditions,in order to determine whether patients can benefit from ALPPS.
【摘要】 目的 探討腹水引起的腹內高壓對肝硬化小鼠肺組織水通道蛋白1（AQP1）和水通道蛋白5（AQP5）表達的影響。 方法 雄性美國癌癥研究所（Institudo of Cancer Reseach，ICR）小鼠50只，隨機取10只作正常對照組（腹壓0 cm H2O，1 cm H2O=0.098 kPa），其余40只用四氯化碳建立肝硬化小鼠模型，并隨機分為4組:肝硬化（腹壓0 cm H2O）組、肝硬化（腹壓5 cm H2O）組、肝硬化（腹壓10 cm H2O）組、肝硬化（腹壓20 cm H2O）組，通過腹腔注射不同量的白蛋白生理鹽水形成不同的腹壓，并維持腹壓24 h后取肺組織行病理、免疫組織化學、肺濕/干比值及實時熒光定量PCR檢測AQP1和AQP5 mRNA表達量。 結果 與正常對照小鼠相比，肝硬化小鼠肺AQP5、AQP1表達明顯下降（Plt;0.05）；肝硬化小鼠隨著腹內壓的升高，肺濕/干比值升高，AQP5、AQP1表達相應增加（Plt;0.05）。 結論 肝硬化可以影響肺AQP1、AQP5的表達；肝硬化小鼠隨著腹內壓的升高，AQP1、AQP5表達相應增加，并與肺水腫的嚴重程度密切相關。【Abstract】 Objective To investigate the role of intra-abdominal hypertension caused by ascites on the expression of Aquaporin (AQP) 1 and AQP 5 in the lung of cirrhotic mice. Methods We randomly chose 10 from 50 male Institude of Cancer Research (ICR) mice to form the control group [intra-abdominal pressure (IAP)=0 cm H2O, 1 cm H2O=0.098 kPa]. The model of cirrhosis were prepared by subcutaneous injection of carbon tetrachloride for the rest 40 mice which were then randomly divided into 4 groups: cirrhosis (IAP=0 cm H2O) group, cirrhosis (IAP=5 cm H2O) group, cirrhosis (IAP=10 cm H2O) group, and cirrhosis (IAP=20 cm H2O) group. Saline with different volume of albumin was injected into the peritoneum of each mouse in order to form different IAP. After 24 hours, analysis of pathology, immunochemistry and wet/dry ratio was done for the lungs of these mice; and the expression of AQP1 and AQP5 at the protein and mRNA levels were analyzed by IHC and qRT-PCR. Results Compared with the normal mice, the expression of AQP1 and AQP5 in lungs of cirrhotic mice were significantly lower (Plt;0.05). Both the lung wet/dry ratio and the expression of AQP1 and AQP5 raised with the increase of IAP. Conclusion Cirrhosis can affect the expression of AQP1 and AQP5 in lungs. The expression of AQP5 and AQP1 in lungs of cirrhotic mice increases with the increase of IAP, which is also closely correlated with the severity of pulmonary edema.