目的 分析彩色多普勒超声对肝硬化患者门静脉血流改变的评价作用。 方法 选择2010年1月－2011年4月收治的50例肝硬化患者作为观察组，其中代偿期患者27例，失代偿期患者23例；同时设置健康对照组50名，比较两组的门静脉内径（Dpv）、门静脉平均血流速度（Vpv）、门静脉血流量（Qpv）。 结果 观察组患者的Dpv增宽，Vpv减慢，Qpv减少，与对照组比较，差异均有统计学意义（P＜0.05）；且失代偿期患者的改变更为明显，与代偿期患者间差异有统计学意义（P＜0.05）。 结论 彩色多普勒超声检查门静脉血流改变可以对肝硬化患者进行初步确诊。
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.
ObjectivesTo systematically review the efficacy of laparoscopic hepatectomy (LH) and open hepatectomy (OH) on the hepatocellular carcinoma patients with cirrhosis.MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were searched online to collect the cohort studies of LHvs.OH on hepatocellular carcinoma patients with cirrhosis from inception to November 31st, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 15 cohort studies involving 1 720 patients were included. The results of meta-analysis showed that: compared with OH, LH had less blood loss (MD=–226.94, 95%CI –339.87 to –114.01, P<0.000 1), lower transfusion rate (OR=0.48, 95%CI 0.27 to 0.83,P=0.009), less occurrence of complications (OR=0.32, 95%CI 0.23 to 0.45, P<0.000 01), shorter postoperative hospital stay (MD=–3.66, 95%CI –5.19 to –2.14,P<0.000 01), lower mortality rate (OR=0.47, 95%CI 0.24 to 0.92,P=0.03), wider surgical margin (OR=0.78, 95%CI 0.20 to 1.36, P=0.009), higher 1, 3 and 5-year survival rate (OR=2.47, 95%CI 1.35 to 4.51, P=0.003; OR=1.62, 95%CI 1.11 to 2.36, P=0.01; OR=1.58, 95%CI 1.19 to 2.10, P=0.002, respectively) and 1-year disease free survival rate (OR=1.69, 95%CI=1.20 to 2.39, P=0.003). There were no significant differences in operation time (MD=28.64, 95%CI –7.53 to 64.82, P=0.12), tumor size (MD=–0.37, 95%CI –0.75 to 0.02, P=0.06), 3-year disease free survival rate (OR=1.14, 95%CI 0.86 to 1.51, P=0.36) and 5-year disease free survival rate (OR=0.99, 95%CI 0.77 to 1.28, P=0.97) between the two groups.ConclusionsThe perioperation and short-term postoperative outcomes of LH are significant in HCC patients with cirrhosis, and which have good long-term prognosis. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
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 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.
ObjectiveTo investigate the clinical value of small-for-size left lobe liver auxiliary partial orthotopic liver transplantation (APOLT) in the treatment of decompensated cirrhosis. MethodThe preoperative and postoperative clinical data of 4 patients who received small-for-size left lobe liver APOLT in 2023 were retrospectively described and analyzed. ResultsOne patient suffered metabolic liver disease cirrhosis and the other three suffered hepatitis B cirrhosis, all of whom presented with decompensated cirrhosis. Preoperative evaluation showed that the graft-to-recipient weight ratio was less than 0.6%. All recipients underwent left hemihepatectomy. The grafts were derived from living donors in 3 cases, from donation after citizen death in 1 case. After APOLT treatment, 4 patients and grafts survived, 1 patient experienced transplantation rejection and recovered after modified anti-rejection therapy. Three patients with hepatitis B cirrhosis were treated with nucleoside analogues and hepatitis B immunoglobulin, the hepatitis B virus DNA was negative at the end of follow-up, one of three patients with hepatitis B cirrhosis showed negative results for hepatitis B virus in the graft biopsy at month one after surgery. ConclusionsFrom the summary results of these cases, small-for-size left lobe liver APOLT can be used to treat decompensated cirrhosis. The application and popularization of this treatment regimen is expected to expand the donor pool and benefit more decompensated cirrhosis patients with lower Model for End-stage Liver Disease score.
ObjectivesTo systematically review the risk factors of hepatocellular carcinoma (HCC) in patients with hepatic B surface antigen (HBsAg).MethodsScopus, EMbase, PubMed, and The Cochrane Library databases were systematically searched for relevant studies on HCC after HBsAg seroclearance from inception to October 31st, 2017. Two reviewers independently screened literature, extracted the data, and evaluated the risk of bias in the included studies. Meta-analysis was then conducted using R 3.5.3 software.ResultsA total of 28 studies involving 105 411 patients were included. Among 105 411 patients with chronic hepatitis B (CHB), 7 656 patients occurred spontaneously HBsAg seroclearance, while 1 248 patients had HBsAg seroclearance after interferon or nucleoside analogue therapy. The rate of HBsAg seroclearance was 6.77%. Meta-analysis showed that risk factors for HCC after serum HBsAg conversion included cirrhosis (OR=6.43, 95%CI 3.56 to 11.60, P<0.001), male (OR=2.72, 95%CI 1.66 to 4.46,P<0.001), and age ≥50 years at HBsAg seroclearance (OR=3.71, 95%CI 2.17 to 6.35,P<0.001).ConclusionsPatients with CHB after HBsAg seroclearance are still at risk of developing HCC. Therefore, periodic surveillance is recommended, especially for male patients, patients with cirrhosis, and patients who experience HBsAg seroclearance when over 50.
ObjectiveTo investigate the influence of strengthening intervention on antiviral treatment compliance for cirrhosis patients following chronic hepatitis B. MethodsOne hundred patients with cirrhosis following chronic hepatitis B undergoing antiviral treatment between January 2007 and January 2009 were randomly divided into intervention group and control group with 50 patients in each group.Patients in the control group received routine care.For patients in the intervention group,besides routine care,strengthening education on the disease,medication guide,and weekly telephone follow-up after discharge were also added.On the time points of 6,12,18,24,30,36 months after patients were discharged,we followed them up with self-designed questionnaire,and compared the two groups of patients on the rates of fully complying with doctors,not fully complying with doctors and completely not complying with doctors.And the reasons were also analyzed. ResultsEighteen months after being discharged,the two groups had no significant difference in the rate of complying with doctors (P>0.05),while the difference was significant 24,30,36 months after leaving the hospital (P<0.05).The reasons were not following the doctors were mainly high cost and unsatisfying treatment effect.In the control group,the reasons also included lack of knowledge about the disease and lack of guidance and supervision. ConclusionThrough strengthening nursing intervention,patients'treatment compliance can be improved significantly.
Objective To investigate predictive value of procalcitonin (PCT) and C-reactive protein (CRP) levels for spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis ascites. Methods The clinical data of 140 patients with liver cirrhosis ascites treated in our hospital from January 2012 to January 2016 were retrospectively analyzed. According to the presence of SBP, these patients were divided into SBP group and non-SBP group. The clinical data were compared between these two groups. The receiver operating characteristic (ROC) curve was constructed to assess their sensitivities and specificities of PCT and CRP for diagnosis of SBP. Results The PCT and CRP levels of the SBP group were significantly higher than those of the non-SBP group (P<0.05). The differences of serum ALT, AST and white cell count between the SBP group and the non-SBP were not statistically significant (P>0.05). The ROC curve analysis showed that the area under the ROC curve of PCT and CRP were 0.895 and 0.926, their corresponding cut-off value 2.1 μg/L and 24.8 mg/L, the sensitivities were 86.9% and 89.5%, the specificities were 85.1% and 83.5%, respectively. Conclusion Abnormally elevated PCT and CRP levels might have an important detective value for SBP in patients with liver cirrhosis ascites.