ObjectiveTo summarize the research progress of CT related to esophageal varices of cirrhotic patients complicated with portal hypertension.MethodsRelevant CT literatures of esophageal varices of cirrhotic patients complicated with portal hypertension were collected to make an review,then summarized the research status and progress of CT in the diagnosis and evaluation of lower esophageal varices.ResultCT had a good correlation with endoscopic diagnosis of esophageal varices, and CT was of great value in evaluating the presence, degree, and risk of esophageal varicose veins, especially in predicting the risk of esophageal varicose veins, which could be used as an effective modality to assist endoscopic examination to a certain extent.ConclusionsCT is an important examination method for esophageal varices, which has important value in diagnosis and evaluation. In the future, more further researches can be carried out to provide more strong and accurate support for the diagnosis and treatment of esophageal varices.
Two hundred and thirty patients with solid hepatic space-occupying lesions (SHSOL), on whom hepatic resection was performed in Zhongshan hospital, were analyzed. We found that liver cirrhosis could be a diagnostic marker of hepatocellular carcinoma in patients with SHSOL, for which the sensitivity being 85.2%, the specificity 96.3%, and the positive predictive value 98.7%.
Objective To study the diagnosis and treatment of portal hypertension in secondary biliary cirrhosis(PHSBC). MethodsTwenty-five cases of PHSBC within recent 16 years in our hospital were analyzed. Their clinical, pathological and follow-up data were reviewed retrospectively. They were divided into 4 groups according to their primary diseases:13 patients with hepatolithiasis, 6 with postoperative stricture of biliary duct, 4 with malignancy of biliary duct and 2 with others.Results All patients were diagnosed clinically, and 4 were further pathologically confirmed. Eight cases were treated conservatively, while the remaining 17 underwent operations according to their primary diseases, and one combined with splenectomy and esophagogastric devascularization. The rate of discharge with improvement by surgical and non-surgical treatment was 64.7% and 37.5%, and hospital mortality was 17.6% and 12.5% respectively. Conclusion The diagnosis of PHSBC mainly depends on its characteristic clinical manifestations. The early surgical resolution of bile duct obstruction is the key to good prognosis. If complicated with rupture and hemorrhage of oesophagofundal varices, the surgical procedure should be considered carefully.
ObjectiveTo summarize the research progress of the pathogenesis, diagnosis and treatment of sarcopenia in liver cirrhosis. MethodThe relevant literatures on studies of the pathogenesis, diagnosis and treatment of sarcopenia in liver cirrhosis in recent years were searched and reviewed. ResultsThe sarcopenia was a major complication that could not be ignored in patients with liver cirrhosis, and was closely related to the patient’s quality of life and prognosis. Various mechanisms such as metabolic abnormalities, malnutrition, myostatin, hyperammonemia, hormonal regulation of muscle homeostasis, ubiquitin-proteasome system and autophagy, physical activity, and dysbiosis of the intestinal flora were involved in the development of sarcopenia. There were various diagnostic methods for sarcopenia, but a unified gold standard was still lacking. In addition, some progress had been made in the treatment of sarcopenia in recent years. ConclusionsAlthough current studies obtains preliminary results about relation between liver cirrhosis and sarcopenia, there still exists many problems to be solved. Further research in future will benefit diagnosis and treatment of patients with sarcopenia in liver cirrhosis.
Objective To explore the influence of cirrhotic portal hypertension and its complications on liver transplantation. Methods The literatures of the recent years on influence of hepatic cirrhotic portal hypertension on liver transplantation were reviewed. Results Splenomegaly, hypersplenism, portal vein thrombosis, portosystemic shunt and collateral flow in cirrhotic patients will increase the difficulty of liver transplantation and lead to more postoperative complications. Appropriate handling of these conditions can achieve a higher success rate of liver transplantation. Conclusion Correct management of end-stage cirrhotic portal hypertension and its complications can expand the indications of liver transplantation and improve long-term survival rates.
摘要:目的: 探讨血清前白蛋白(prealbumin,PAB)、胆碱脂酶(cholinesterase,ChE)、总胆汁酸(total bile acid,TBA)在肝硬化中的检测价值。 方法 :测定105例肝硬化患者和30例健康人的前白蛋白、胆碱脂酶、总胆汁酸活性及肝功能生化指标,并按ChildPugh分级进行比较。 结果 :肝硬化组前白蛋白含量、胆碱脂酶活性均较对照组显著降低;按ChildPugh分级比较,肝硬化组前白蛋白含量在Child A级与对照组、B级与A级之间、在C级与B级之间差异有显著性(Plt;001);胆碱脂酶活性在Child A级与对照组、B级与A级、C级与B级之间差异有显著性(Plt;001)。总胆汁酸在Child B级与A级,C级与B级间有显著差异性,在A级与对照组间差异无显著性。 结论 :血清前白蛋白、胆碱脂酶在肝硬化早期评估中有很重要的价值,而总胆汁酸在肝硬化预后的判定中有重要价值。 Abstract: Objective: To evaluate the role of prealbumin (PAB), cholinesterase (ChE), and total bile acid (TBA) in evaluating liver reserve function in patients with liver cirrhosis. Methods : One hundred and five serum samples from patients with liver cirrhosis were detected in PAB, ChE, TBA and other biochemical markers. All patients were classified in accordance with ChildPugh scale. Results : For PAB, the differences among ChildPugh A, B, C and healthy group were statistically significant (t=1254, 1887, 2316) (Plt;001). For ChE, the differences among ChildPugh A, B, C and healthy group were statistically significant (t=1288, 0856, 1002) (Plt;001). For TBA, the differences among ChildPugh C group, B group and A group were statistically significant (t=0526, 1081)(Plt;001), the difference among ChildPugh A group and healthy group was not statistically significant (t=5615) (Pgt;005). Conclusion : PAB and ChE reflect liver reserve function earlier in patients with liver cirrhosis. The role of TBA is important in reflecting prognosis in patients with liver cirrhosis.
ObjectiveTo analyze and compare the clinical and pathological characteristics of patients with porto-sinusoidal vascular disease (PSVD) and liver cirrhosis (LC), so as to provide a reference for reducing misdiagnosis and missed diagnosis. MethodsThe patients who underwent liver biopsy in the Department of Infectious Diseases in the First Hospital of Lanzhou University from January 2008 to December 2022 were retrospectively collected. The clinical, biochemical, imaging, and liver biopsy pathological data of the patients with PSVD and LC were compared. ResultsA total of 45 patients with PSVD and 48 patients with LC were included. The males to females ratio in the patients with PSVD and LC was 25∶20 and 21∶27, respectively, and the average age of the patients with PSVD was younger than that of the patients with LC (P<0.001). The patients with PSVD had overall better liver function, although the proportion of the patients with the Child-Pugh class B in the two groups was all higher, the proportion of patients with the Child-Pugh class B and the end stage liver disease model score ≥10 points in the patients with PSVD was lower (nearly three times) than those in the patients with LC (P<0.05). The initial diagnosis rate of the patients with PSVD was lower than that of the patients with the LC (6.7% vs. 95.8%, χ2=74.0786, P<0.001). The imaging findings of the patients with PSVD as compared with LC showed that the proportion of the portal hypertension was higher (33.3% vs. 39.6%) in both, but the flow velocity of the portal vein was faster (P=0.039), and the extrahepatic bile duct diameter was smaller (P=0.001). The main specific manifestations of liver biopsy histopathology in the patients with PSVD were the portal occlusion [19 (42.2%)], nodular regenerative hyperplasia [1 (2.2%)], and incomplete septal cirrhosis or fibrosis [14 (31.1%)], as well as the non-specific manifestation was the fine bile duct reaction [8 (17.8%)]. And the proportion of the patients with the liver tissue inflammatory activity grading (G) and liver fibrosis staging (S) ＞G2S2 in the patients with PSVD was lower as compared with the patients with LC [12 (26.7%) vs. 48 (100%), χ2=54.560, P<0.001]. ConclusionThe diagnosis of PSVD and LC should “seek common ground while reserving differences”, and it is necessary that a routine examination in combination with imaging manifestation and liver pathology, and should focus on a liver vascular abnormality so as to reduce a rate of misdiagnosis.
ObjectiveTo summarize experience of laparoscopy combined with choledochoscopy common bile duct exploration for patients with schistosomiasis liver cirrhosis with common bile duct stones. MethodThe clinical data of 45 patients with schistosomiasis liver cirrhosis combined with common bile duct stones (liver function Child-Pugh grade A and B) admitted in this hospital from September 2012 to September 2015 were analyzed retrospectively. ResultsTwenty cases were successfully treated by laparoscopy combined with choledochoscopy (laparoscope group), 25 cases were treated by conventional open common bile duct exploration (laparotomy group). Two cases were converted to laparotomy due to bleeding during laparoscopic operation. The mean operation time, intraoperative bleeding, postopera-tive hospitalization time, and postoperative total complications rate had no significant differences between these two groups (P>0.05). There were 2 cases of pulmonary infection and 1 case of incision infection in the laparoscope group, and 1 case of grade A bile leakage and 1 case of pulmonary infection in the laparotomy group, there was no common bile duct stone residual in these two groups. ConclusionAlthough laparoscopic surgery is more difficult for schistosomiasis liver cirrhosis combined with common bile duct stones patients, it is safe and feasible. Appropriate perioperative management and precise laparoscopic and choledochoscopic operation are key to success of operation.
ObjectiveTo discuss the clinical characteristics of liver cirrhosis in elderly patients. MethodsWe retrospectively analyzed the clinical data of 67 patients (elderly group) with liver cirrhosis aged ≥60 treated between January 1998 and December 2010. Then, we compared these cases with another 72 liver cirrhosis patients (non-elderly group) aged<60. ResultsThe incidence of jaundice, ascites and albumin deficiency in the elderly patients was significantly higher than that in the non-elderly patients (P<0.05). Complications in the elderly group were relatively more, including electrolyte imbalance, infections, gastrointestinal bleeding, hepatic encephalopathy, liver cancer, liver and kidney syndrome and liver and lung syndrome, and the incidence of these complications was all significantly higher than the non-elderly group (P<0.05) except the liver and kidney syndrome (P>0.05). The causes of liver cirrhosis in both groups were similar. The most common cause was hepatitis B virus infection, followed by chronic alcoholism, but in the elderly group, chronic alcoholism, cholestasis, poisoning from medicines and poisons and liver blood circulation disorders were more common than the non-elderly group (P<0.05); hepatitis B and non-alcoholic fatty hepatitis were more common in the non-elderly group than in the elderly group (P<0.05). The elderly group had more Child-Pugh class C cases (P<0.05), while there were more class A cases in the non-elderly group (P<0.05). Twenty-six patients died in the elderly group with a mortality rate of 38.8%; while only 13 died in the non-elderly group with a mortality rate of 18.1%. The difference of mortality rate was significant between the two groups (P<0.05). Common causes of death in the elderly group were infection, hepatic encephalopathy, and electrolyte disorders and gastrointestinal bleeding, while the common causes of death in the non-elderly group were gastrointestinal bleeding and electrolyte disorders. ConclusionThe etiology, clinical manifestations and prognosis of liver cirrhosis in elderly patients differ from those in younger patients. We must pay more attention on treating complications of liver cirrhosis in elderly patients.
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.