Objective To compare the difference of the changes of platelet counts after splenectomy between the patients with splenic rupture and patients with cirrhosis and portal hypertension, and to analyze the possible reasons and clinical significance. Methods The platelet count of 47 splenic rupture patients and 36 cirrhosis patients who had been carried out splenectomy from July 2008 to December 2009 in our hospital were counted, and the differences in platelet count and it’s change tendency of two groups were compared. Results In the splenic rupture group，the platelet count of all 47 patients increased abnormally after operation, the maxlmum value of platelet count among 300×109/L-600×109/L in 6 cases，600×109/L-900×109/L in 21 cases，and above 900×109/L in 20 cases. In the cirrhosis group，the maxlmum value of platelet count after operation was above 300×109/L in 26 cases，100×109/L-300×109/L in 8 cases，and below 100×109/L in 2 cases. The difference of maxlmum value of platelet count in the two groups had statistic significance（P=0.00）. Compared with the cirrhosis group, the platelet count increased more significant and decreased more slow in splenic rupture group（P＜0.05）.The abnormal days and rising range of platelet count were higher in patient with Child A than Child B and C（P=0.006，P=0.002）. Conclusions The change of platelet count after operation in splenic rupture group was obviously different from cirrhosis group because of the difference of the liver function and body situation of patients. To patients with splenic rupture or cirrhosis, appropriate treatment based on the platelet count and liver function could obtain good therapeutic effect.
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 introduce the clinical significance and pathophysiologic aspects of the circulatory and cardiac complications in terminal stage cirrhosis. Methods Recently relevant literatures were reviewed and summarized. Results Haemodynamic changes in cirrhosis arose on the basis of combined humoral and nervous dysregulation, with abnormalities in cardiovascular regulation, volume distribution and cardiac performance. Conclusion Comprehending the mechanisms of cardiovascular complications will contribute a lot for the treatment of terminal stage cirrhosis.
Objective To explore the clinical value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid （Gd-EOB-DTPA） enhanced magnetic resonance （MR） imaging for cirrhosis-related nodules. Methods Nineteen patients who were suspected cirrhosis with lesions of liver were prospectively included for Gd-EOB-DTPA enhanced MR imaging test between Nov. 2011 and Jan. 2013. The hepatobiliary phase （HBP） images were taken in 20 minutes after agents’ injection. The images were diagnosed independently in two groups： group A， including the plain phase and dynamic phase images； group B， including plain phase， dynamic phase， and HBP phase images. The signal intensity （SI） of lesions in HBP images， background liver SI， and background noise standard deviation were measured by using a circular region of interest， then the lesion signal to noise ratio （SNR） and contrast signal to noise ratio （CNR） were calculated. Results Nineteen patients had 25 tumors in all， including 18 hepatocelluar carcinoma （HCC） and 7 regenerative nodule （RN） or dysplastic nodule （DN）， with the diameter ranged from 0.6 cm to 3.2 cm （average 1.3 cm） . Sixteen HCC manifested hypo SI relative to the normal liver， while 2 HCC manifested hyper SI at HBP. Five HCC had cystic necrosis with the necrotic area， and there were no enhancement in artery phase， while performed flocculent enhancement at HBP. Six RN or DN showed hyper SI while another 1 showed iso SI to background liver at HBP. The diagnostic accuracy rates of group A and group B were 80.0% （20/25） and 92.0% （23/25）. SNR of RN or DN at HBP was 132.90±17.21， and of HCC was 114.35±19.27， while the CNR of RN or DN was 19.47±8.20， and of HCC was 112.15±33.52. Conclusion Gd-EOB-DTPA enhanced MR imaging can improve the diagnosis capacity of cirrhosis-related nodules， so as to develop more accurate and reasonable treatment options.
In order to observe the effect of hepatocyte growth promoting factor (pHGF) on liver regeneration of rat with cirrhosis after hepatectomy, IBAS Ⅱ auto image analysis technology was used to measure the variety of DNA ploid rate of hepatocytes and OPTDM of enzymes by liver histochemistry after hepatectomy; serum levels of the glutamicpyruvic transaminase (SGPT) and indocyanine green retention rate in 15 minute (ICG15) were tested to measure the function of the remanent liver. The results revealed that tetraploid hepatocytes lowered greatly and diploid, quintploid and ＞quintploid hepatocytes increased apparently in group A. OPTDM of enzymes by liver histochemistry showed no significant difference at the first day after operation in each group (Ｐ＞0.05); SDH and LDH of group A were significantly higher than those of group B and AkP, AcP were significantly lower at the second or fifth day after hepatectomy. Serum tests showed that SGPT, ICG15 of group A decreased apparently at the fifth day after operation. The results demonstrate that pHGF not only stimulates the regeneration of the remanent liver but also accelerates the functional mature of the regenerative hepatocytes and the functional recovery of the remanent liver after resection of cirrhotic liver of rats.
The aim of this study is to assess ischemia/reperfusion injury in carbon tetrachloride induced cirrhotic liver as compared to normal liver in the rats. Results showed that in cirrhotic liver, instead of diminishing the hepatic vein nitric oxide level increased significantly after ischemia from 8.04 μmol/L to 11.52 μmol/L and remained high till 5 hrs after reperfusion. The hepatic adenosine triphosphate (ATP) contents decreased as that seen in normal rat but did not restore to normal till the end of 5 hrs after reperfusion. Based on these findings, it is postulated that in cirrhotic liver, ischemia/reperfusion injury is aggrvated as evidenced by of nitric oxide, and extended diminishing in ATP.
Twelve patients with multiple vavices were found adjacent to the common bile duct during cholecystectomy and exploration of the common blie duct in the presence of stones. Eleven of them were with cirrhosis. The authors recommend that retrograde cholecystecotomy, or partial cholecystestomy with electrical cauterization of the remaining gallbladder mucosa ,or even cholecystostomy be the optimal selection in the presence of a large venous channel in calot’s triangle. Multiple fine-needle puncture of the bile duct can be performed over the vascullar area until bile is aspirated; extracting the choledocholith from a transduodenal sphincterotomy is another selective maneuver; and if bleeding occurs, suturing for hemostasis can be placed on the connective tissue over both sides of the lacerated vessel instead of the wall of varices.
ObjectiveTo investigate impact of splenectomy plus pericardial devascularization on liver hemodynamics and liver function for liver cirrhosis patients with portal hypertension. MethodsThe internal diameter, maximum velocity, minimum velocity, mean velocity, and flow volume of portal vein and hepatic artery of 42 cases of liver cirrhosis with portal hypertension were measured by Doppler ultrasonic instrument on day 1 before operation and on day 7 after operation. The free portal pressures at different phases (after open abdomen, after splenic artery ligation, after splenectomy, and after devasculanrization) were read from the disposable pressure sensor. Twenty-four healthy people through physical examination were selected as control. Results① The free portal pressure of liver cirrhosis patients with portal hypertension was decreased from (29.12±1.40) mm Hg after open abdomen to (22.71±1.21) mm Hg after splenic artery ligation, and further decreased to (21.32±1.12) mm Hg after splenectomy, but increased to (22.42±1.15) mm Hg after devasculanrization, the difference was statisticly different (all P < 0.01). ② Compared with the healthy people, for the liver cirrhosis patients with portal hypertension, the internal diameter, maximum velocity, minimum velocity, and flow volume of portal vein were significantly enlarged (all P < 0.01), which of hepatic artery were significantly reduced (all P < 0.01) on day 1 before operation; On day 7 after operation, the internal diameter of portal vein was significantly reduced (P < 0.01), the maximum velocity, minimum velocity, and mean velocity of portal vein were significantly enlarged (all P < 0.01), but the internal diameter of hepatic artery was significantly reduced (P < 0.01), the maximum velocity, minimum velocity, mean velocity, and flow volume of hepatic artery were significantly enlarged (all P < 0.01). For the liver cirrhosis patients with portal hypertension, compared with the values on day 1 before operation, the internal diameter and the flow volume of portal vein were significantly reduced (all P < 0.01) on day 7 after operation; the internal diameter, maximum velocity, minimum velocity, mean velocity, and flow volume of hepatic artery were significantly enlarged (all P < 0.01) on day 7 after operation. ③ The Child-Pugh classification of liver function between before and after surgery had no significant difference (χ2=1.050, P > 0.05). ④ No death and no hepatic encephalopathy occurred, no thrombosis of splenic vein or portal vein was observed on day 7 after surgery. Conclusionsplenectomy plus pericardial devascularization could decrease portal vein pressure and reduce blood flow of portal vein, while increase blood flow of hepatic artery, it doesn't affect liver function.
ObjectiveTo evaluate the sensitivity, specificity, and accuracy of magnetic resonance imaging (MRI) in characterizing cirrhosis-related nodules. MethodsThe databases such as the Cochrane Library, PubMed, EMbase were searched on computer from 1998 to 2012.The reviewers screened the trials according to strict inclusion and exclusion criteria, extracted the data, and assessed the methodology quality.Meta-analysis was performed using the metadisc 1.40 software.The acquired pooled sensitivity, specificity, and summary receiver operating characteristic (SROC) curve were used to describe the diagnostic value.The pooled likelihood ratio was calculated based on the pooled sensitivity and specificity. ResultsSix case-control studies involving 917 patients diagnosed with cirrhosis who were suspected to have hepatic nodules were included and 776 masses were confirmed by the biopsy or postoperative histopathology.The pooled statistical results of meta-analysis showed that the sensitivity and specificity of MRI were 87%(83%-89%) and 79%(73%-84%) respectively, the positive and negative likelihood ratios of MRI were 3.95 and 0.18 respectively, and the area under the SROC curve (AUC) was 0.895 6.The sensitivity and specificity of CT were 69%(65%-73%) and 83%(77%-88%) respectively, the positive and negative likelihood ratios of CT were 3.29 and 0.42 respectively, and the AUC was 0.728 7.The sensitivity, positive likehood ratio, and accuracy of MRI in characterizing cirrhosis-related nodules were higher than those of CT. ConclusionAccording these evidences, the MRI should be the first imaging examination for qualitative diagnosis of cirrhosis-related nodules.