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Objective: To analyze the relationship of hepatic transit time and portal vein pressure in the patients with portal hypertension and esophagogastric varices, and to clarify its clinical significance. Methods: A total of 50 hospitalized patients underwent esophagogastric venous embolization due to portal hypertension and esophagogastric varices were selected as observation group, and 50 patients without history of liver disease and clinical manifestations of liver disease (hospitalized or out-patient) were selected as control group. All patients underwent liver contrast enhanced ultrasound. The free portal pressure (FPP) was measured by ultrasound guided portal vein puncture for operating pathways in the patients in observation group. The hepatic artery-hepatic vein transit time (HA-HVTT), the hepatic portal vein-hepatic vein transit time (PV-HVTT), the liver parenchyma- hepatic vein transit time (PA-HVTT) of the patients were compared between two groups. The correlations between HA-HVTT, PV-HVTT, PA-HVTT and FPP of the patients in observation group were analyzed. Results: The HA-HVTT, PV-HVTT and PA-HVTT of the patients in observation group were significantly shorter than those in control group 0=5.078, P<0. 01; t=\2. 163, P<0. 01; t=2. 649, PC0.01). The HA-HVTT, PV-HVTT and PA-HVTT had negative correlations with FPP in observation group ( r= 0.799, P
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Objective:To analyze the relationship of hepatic transit time and portal vein pressure in the patients with portal hypertension and esophagogastric varices, and to clarify its clinical significance.Methods:A total of50hospitalized patients underwent esophagogastric venous embolization due to portal hypertension and esophagogastric varices were selected as observation group, and 50patients without history of liver disease and clinical manifestations of liver disease (hospitalized or out-patient) were selected as control group, All patients underwent liver contrast enhanced ultrasound.The free portal pressure (FPP) was measured by ultrasound guided portal vein puncture for operating pathways in the patients in observation group.The hepatic artery-hepatic vein transit time (HA-HVTT) , the hepatic portal vein-hepatic vein transit time (PV-HVTT) , the liver parenchymahepatic vein transit time (PA-HVTT) of the patients were compared between two groups.The correlations between HA-HVTT, PV-HVTT, PA-HVTT and FPP of the patients in observation group were analyzed.Results:The HA-HVTT, PV-HVTT and PA-HVTT of the patients in observation group were significantly shorter than those in control group (t=5.078, P＜0.01;t=12.163, P＜0.01;t=2.649, P＜0.01) .The HA-HVTT, PV-HVTT and PA-HVTT had negative correlations with FPP in observation group (r=-0.799, P＜0.01;r=-0.554, P＜0.01;r=-0.735, P＜0.01) .The linear relationship between HA-HVTT and FPP was Y=-0.410X+7.254;the linear relationship between PV-HVTT and FPP was Y=-0.355X+4.983;the linear relationship between PA-HVTT and FPP was Y=-0.566X+4.997.Conclusion:Liver transit time can be used as an effective index to judge the portal vein pressure, and it can provide the theroretical basis for the diagnosis and treatment of portal hypertension in the patients.
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Introducción: Las hemorragias digestivas altas por várices esofagogástricas constituyen un problema clínico-quirúrgico y aún mantienen una mortalidad excesivamente alta. Objetivo: Estimar la carga de mortalidad y sus causas relacionadas con la enfermedad, así como los factores asociados según variables seleccionadas. Material y Métodos: Estudio observacional, descriptivo y transversal de 39 pacientes ingresados con este diagnóstico en el servicio de Cirugía General del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba durante el cuatrienio 2013-2016. Resultados: Predominaron los pacientes masculinos, en las edades medias de la vida y con varios factores de riesgo asociados. La Clase B de Child-Pugh, así como las Clases de sangrado II y III fueron las más frecuentes. El diagnóstico fue eminentemente clínico. El tratamiento endoscópico se realizó en tres pacientes y la aplicación de la sonda de Sengstaken-Blakemore resultó infrecuente. Se operaron 7 enfermos, que representan 43,7 por ciento de los que fallecieron. La tasa de mortalidad osciló entre 22,2 por ciento en 2013 hasta 41,0 por ciento en 2016. Conclusiones: La persistencia del sangrado digestivo alto variceal obedece a la pobre utilización del tratamiento endoscópico y al no uso de los derivados de la somatostatina, asociado a niveles de mortalidad elevados y en íntima relación con un grado de insuficiencia hepática avanzada y las intervenciones urgentes; hubo correspondencia entre las causas directas de muerte y la enfermedad en análisis(AU)
Introduction: Variceal upper gastrointestinal bleeding constitutes a clinical surgical problem that still has an excessively high mortality. Objective: To estimate the burden of mortality and its causes related to the disease, as well as the associated factors according to selected variables. Material and Methods: An observational, descriptive, and cross-sectional study was conducted in 39 patients who were admitted with this diagnosis to the General Surgery Service of the Saturnino Lora Teaching Provincial Hospital of Santiago de Cuba during 2013-2016. Results: Middle-aged male patients with several associated risk factors predominated in the study. Child-Pugh Class B and Classes II and III bleedings were the most frequent ones. The diagnosis was eminently clinical. Endoscopic treatment was carried out in three patients and the application of the Sengstaken-Blakemore tube was infrequent. 7 patients received surgical treatment, who account for the 43,8 percent of those who died. Mortality rate ranged from 22,2 percent in 2013 to 41,0 percent in 2016. Conclusions: The persistence of variceal upper gastrointestinal bleeding responds to the poor use of endoscopic treatment and the non-use of somatostatin derivates. It is also associated with high levels of mortality, and in close relationship with a grade of advanced hepatic failure and urgent interventions. There was a correspondence between the direct causes of death and the disease under analysis(AU)
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Humans , Male , Female , Esophageal and Gastric Varices/mortality , Gastrointestinal Hemorrhage/mortality , Esophageal and Gastric Varices/complications , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Study , Gastrointestinal Hemorrhage/bloodABSTRACT
Objective To investigate the clinical value of pharyngeal protection tube in endoscopic therapy for patients with liver cirrhosis and esophagogastric varices. Methods The clinical data of 120 patients from January 2013 to October 2016, suffered from liver cirrhosis and esophagogastric varices, and accepted the endoscopic therapy were analyzed retrospectively. 60 patients underwent endoscopic therapy and were meanwhile applied pharyngeal protection tube; 60 cases were treated with the assistance of routine endoscopy. The completion rate of treatment and the incidence of complications were observed and compared between the two groups. Results Pharyngeal protection tube group: The completion rate of endoscopic treatment in the pharynx protective tube group was 98.3%, without complications. In the control group, the completion rate of the treatment under endoscopy was 88.3%, and there were 7 cases of aspiration, asphyxia and inhalation pneumonia. Conclusions Using pharyngeal protection tube to protect airway can improve the safety and completion rate of endoscopic treatment of esophageal and gastric varices, reduce the incidence of complications, and the pharyngeal protection tube is simple and cost-effective, which is worthy of clinical application.
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Objective To assess the efficacy and safety of different diameter covered stents used in transjugular intrahepatic portosystemic shunt (TIPS) for esophagogastric varices with bleeding (EGVB). Methods The clinical data of 68 patients with portal hypertension due to cirrhosis, who received TIPS for EGVB during the period from Desember 2010 to February 2015, were retrospectively analyzed. Among the 68 patients, covered stent with diameter of 7mm was used in 30 (small stent group) and covered stent with diameter of 8mm was employed in 38 (big stent group). Using Kaplan-Meier method, the cumulative digestive tract no-rebleeding rate, the patency rate of shunt and the survival rate of both groups were analyzed. Logrank test was used to make comparison between the two groups, and chi-square test was conducted to compare the incidence of hepatic encephalopathy between the two groups. Results The operative success rate was 100％ in 68 patients. The patients were followed up for 0.1-52.3 months, with a mean of (19.4±16.0) months. The 3-, 6-and 12-month cumulative digestive tract no-rebleeding rates were 86.54％, 79.30％ and 74.90％ respectively in the small stent group, which were 91.87％, 85.93％ and 81.63％ respectively in the big stent group, but the differences between the two groups were not statistically significantly (X2=0.05, P=0.83). The 3-, 6-and 12-month cumulative patency rates of shunt in the small stent group were 95.00％, 80.19％ and 70.17％ respectively, which in the big stent group were 96.15％, 91.97％ and 81.07％ respectively, and no statistically significant differences existed between the two groups (X2=0.40, P=0.53). The 3-, 12-, 24-and 48-month cumulative survival rates in the small stent group were 93.33％, 86.67％, 75.11％ and64.38％ respectively, while those in the big stent group were 97.37％, 94.23％, 88.68％ and 76.02％ respectively, and the differences between the two groups were not statistically significantly (X2=2.21, P=0.14). Postoperative hepatic encephalopathy occurred in 15 patients (15/68, 22.06％), the incidences of hepatic encephalopathy in the small stent group and in the big stent group were 20.00％ (6/30) and 23.68％ (9/38) respectively, the difference between the two groups was not statistically significantly (X2=0.13, P=0.72). Conclusion Compared with the use of 7mm covered stent, the use of 8mm covered stent in TIPS neither can improve the curative effect nor can reduce the incidence of hepatic encephalopathy.
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Objective To evaluate the clinical efficacy and safety of endoscopic selective varices devascularization. Methods A retrospective analysis was performed on the data of 153 cirrhosis patients with esophagogastric varices undergoing endoscopic treatment. The traditional treatment group with 70 cases underwent traditional "sandwich method"(lipiodol?tissue adhesive?lipiodol), and the selective treatment group with 83 cases was treated by modified"sandwich method"(lauromacrogol?tissue adhesive?saline)with selective varices devascularization.The improvement rate,effective rate,significant effective rate,rebleeding rate and complications were compared between the two groups.Results One month after treatment,28 cases (47.8%)were significant effective and 15 cases(19.6%)were effective in the traditional treatment group;and 48 cases(60.0%)were significant effective and 24 cases(20.0%)were effective in the selective treatment group. The difference on effective rate and significant effective rate was statistically significant (rs=-0.260,P=0.001). Improvement rate of the traditional treatment group and selective treatment group was 61.4%(43/70)and 86.7%(72/83)respectively,and the difference was statistically significant(χ2=11.626,P=0.001).Within two weeks after treatment, the rebleeding rate of the two group was 8.57%(6/70)and 4.82%(4/83), respectively, and there was no significant difference(bilateral P=0.514, unilateral P=0.271). Within three months after treatment, the rebleeding rate of the traditional treatment group was significantly higher than that of the selective treatment group[21.4%(15/70)VS 9.3%(8/83),χ2=4.133,P=0.042]. No serious complications occurred in the two groups. The incidence of overall complication of the selective treatment group was slightly higher than that of the traditional treatment group [33.7%(28/83)VS 27.1%(19/70)], but the difference was not statistically significant(P>0.05). Conclusion Endoscopic selective varices devascularization has good efficacy and safety, and is worthy of further study.
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Background:Esophagogastric variceal bleeding is a severe and commonly seen complication of portal hypertension in patients with liver cirrhosis. Prevention of rebleeding remains an important issue in the management of patients suffered from the disease. Aims:To evaluate the efficacy and safety of percutaneous transhepatic variceal embolization(PTVE) combined with partial splenic embolization(PSE)for treatment of esophagogastric variceal bleeding in patients with liver cirrhosis. Methods:Ten liver cirrhosis patients with esophagogastric variceal bleeding were prospectively selected and treated by PTVE combined with PSE. The blood flow of portal system was measured by Doppler ultrasonography pre- and post-operatively;meanwhile peripheral blood cells were counted. A 1-2-year follow-up was carried out and the rebleeding and procedure-related complications were recorded. Results:The postoperative inner diameter of main portal vein,as well as the blood flow velocity of main portal vein and splenic vein were significantly reduced as compared with those before operation(P < 0. 05). Three months after operation,the peripheral white blood cell and platelet were still significantly higher than those before operation(P < 0. 05). During 1-year follow-up,rebleeding appeared in 2 patients,one of them was found having main portal vein thrombosis developed,and was treated by endoscopic esophageal variceal ligation because the gastric varices was not as evident as ever. The rebleeding rate and incidence of portal system thrombosis after the PTVE-PSE procedure was 20. 0% and 10. 0%,respectively. Conclusions:PTVE combined with PSE seemed efficient for alleviating portal hypertension,and might be recommended as a safe and effective interventional therapy for liver cirrhosis patients with esophagogastric variceal bleeding.
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Objetivo: verificar as frequências das causas de hemorragia digestiva alta (HDA) em pacientes portadores de cirrose hepática (CH) atendidos em um hospital geral universitário. Métodos: analisaram-se os prontuários médicos de todos os pacientes portadores de CH atendidos no Hospital de Clínicas da Universidade Federal de Uberlândia durante o período de janeiro de 2006 a dezembro de 2008. Coletaram-se dados referentes às idades, causa da CH, presença de varizes esofagogástricas, causas de HDA e suas evoluções durante a internação. Para as comparações das frequências analisadas, utilizou-se o teste exato de Fisher. Resultados: foram analisados prontuários de 359 pacientes, sendo 266 (74,1%) homens e 93 (25,9%) mulheres, com idade média (desvio padrão) de 53,6 ± 13,4 anos. Entre eles, 317 submeteram-se à endoscopia digestiva alta e 246 (77,6%) tinham varizes esofágicas ou esofagogástricas; 115 (32,0%) apresentaram HDA e as causas foram varizes esofágicas (65,2%), úlcera péptica gástrica (12,2%) ou duodenal (6,1%), varizes gástricas (5,2%), síndrome de Mallory-Weiss (1,7%) e lesão aguda da mucosa gastroduodenal (2,6%); em 7% dos casos, a causa não pôde ser definida. A frequência de sangramento por úlceras pépticas foi maior (OR = 4,67; IC = 1,35 ? 16,16) entre os pacientes com CH com causa alcoólica [18/208 (8,6%) vs 3/151 (2,0%)]. Entre os 21 (18,3%) pacientes que morreram, as causas da HDA foram varizes esofágicas em 13 (52,4%) e gástricas em 2 (9,5%); em 8 (38,1%) não foram identificadas. Conclusão: um terço dos pacientes teve HDA e as causas mais frequentes foram as varizes esofagogástricas. Sangramentos por úlcera péptica foram mais frequentes entre os pacientes com CH de causa alcoólica. As frequências de mortes durante a internação foram semelhantes àquelas descritas na literatura hodiernamente.
Objectives: to assess the frequency of the causes of upper gastrointestinal bleeding (UGIB) in patients with liver cirrhosis (LC) attended at an university teaching hospital. Methods: we analyzed the medical records of all patients with LC treated at the Clinical Hospital of Federal University of Uberlandia in the period from January 2006 to December 2008. The data were collected regarding age, cause of LC, esophagogastric varices, causes of UGIB and its evolution during hospitalization. For comparisons of frequencies analyzed, Fisher?s exact test was employed. Results: we analyzed 359 patients? medical records, 266 (74.1%) men and 93 (25.9%) women with a mean age of (SD) 53.6 ± 13.4 years. Among them, 317 were submitted to the esophagogastroduodenoscopy and 246 (77.6%) had esophageal or esophagogastric varices, 115 (32.0%) had UGIB and the causes were esophageal varices (65.2%), gastric (12 2%) or duodenal (6.1%) peptic ulcers, gastric varices (5.2%), Mallory-Weiss syndrome (1.7%) and acute erosive gastroduodenitis(2.6%); in 7% of cases the cause could not be defined. The frequency of bleeding peptic ulcers was higher (OR = 4.67, CI: 1.35 to 16.16) among patients with LC due to alcohol (18/208 [8.6%]vs 3/151 [2.0%]). Among the 21 (18.3%) patients who died, the causes of UGIB were esophageal varices in 13 (52.4%) and gastric varices in 2 (9.5%); in 8 (38.1%) it was not identified. Conclusion: one third of patients had UGIB and the most frequent causes were the esophagogastric varices. Peptic ulcer bleeding was more frequent among patients with LC due to alcoholism. The frequency of deaths during hospitalization was similar to those described in today is literature.
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Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Gastrointestinal Hemorrhage , Liver Cirrhosis , Peptic Ulcer , Esophageal and Gastric Varices , Cross-Sectional Studies , Retrospective Studies , Hospitals, University , Hypertension, Portal , Liver Cirrhosis, AlcoholicABSTRACT
Objective To evaluate the effect of percutaneous transhepatic obliteration(PTO)of gastroesophageal varices in liver cirrhosis.Methods Fifty-six cirrhotic patients suffering from gastroesophageal varices were treated with PTO,including 35 during emergency bleeding,10 after stoppage of hemorrhage and 11 with severe gastroesophageal varices for prevention of bleeding.Results Catheterization and embolization of gastroesophageal varices were successfully performed in all 56 patients(100%).Bleeding stopped after PTO as an emergency treatment was achieved in 35 patients with upper gastrointestinal bleeding.Among them,PTO was performed in 11 patients for preventing variceal hemorrhage,gastroesophageal varices disappeared in 7 and alleviation was obtained evidently in 4.47 patients were followed up for 2-60 months with recurrent bleeding in 5,death in 4 on causes of rebleeding of alimentary tract(1 case),hepatic failure(1 case), hepatocellular carcinoma(2 cases).Conclusion PTO is a safe and effective treatment for gastroesophageal varices in cirrhotic patients and should be recommended extensively.