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.
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.
Objective To preliminarily summarize the diagnosis and treatment of coagulopathy in patient with severe hepatic cirrhosis who underwent orthotopic liver transplantation (OLT). Methods Preoperative coagulability, the replacement therapy by coagulation factors and platelet pre-and intraoperatively, intra-operative bleeding amount and blood transfusion amount and the relation to the postoperative course were analyzed retrospectively in 6 patients with severe hepatic cirrhosis who underwent OLT in the last year. Results All of the 6 patients had a Child-c preoperative hepatic function, 2 with prolongation of bleeding time. All of the 6 had a decrease of platelet count, with a mean platelet count of 25.3×１０９／Ｌ. Mean prolongation of prothrombin time was 10.7 seconds as compared with controls. Mean prolongation of activated partial thromboplastin time was 23.1 seconds as compared with controls. Mean fibrinogen was 1.5 g/L. Mean pre- and intra- operative transfusion of fresh frozen plasma was 788 ml, platelet 7.1×１０12， cryopreciptitate 5.5 units, fibrinogen 2.8 grams and lyophilized prothombin complex concentrate (LPCC) 1 700 units. The first 4 cases in the early period had a mean bleeding amount of 8 672.5 ml, with a mean transfusion of 9 215.0 ml. One of the 4 with the most massive intraoperative bleeding was complicated by severe internal milieu disturbance, DIC and fungus infection and died of the infection. Postoperatively the last 2 cases in the late period had a complete preoperative replacement of coagulation factors and platelet and had a only mean bleeding amount of 2 700 ml with a mean transfusion amount of 3 638 ml. Conclusion We initially consider that a preoperative complete replacement of coagulation factors and platelet according to the coagulability tests may lessen intraoperative bleeding and transfusion and make the patient an uneventful postoperative course.
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 effect and feasibility of gradual oral diethylnitrosamine (DENA) induced liver cirrhotic model in rats under avoirdupois monitoring. Methods Fifty Wistar rats (6 weeks old) were divided into 3 groups: normal control group （n=10）, traditional DENA induction group (receiving traditional oral DENA treatment, n=20）, gradual DENA induction group (receiving gradual oral DENA treatment under avoirdupois monitoring, n=20). The weight, mortality and liver cirrhosis formation were observed. Results After 4 weeks of inducing cirrhosis, the weight of traditional DENA induction group 〔(234.9±27.1) g〕 was significantly lower than that of normal control group 〔(264.8±33.7) g, P＜0.05〕. After 8 weeks of inducing cirrhosis, the weight of traditional DENA induction group 〔(251.5±34.3) g〕 was significantly lower than that of normal control group 〔(303.2±49.4) g， P＜0.01〕 and gradual DENA induction group 〔(277.5±27.6) g， P＜0.05〕. However, the difference between normal control group and gradual DENA induction group was not remarkable (P＞0.05). The mortality in traditional DENA induction group (35%) was significantly higher than that in normal control group (0) and gradual DENA induction group (0)， P＜0.05. But the rate of cirrhosis formation both in traditional DENA induction group and gradual DENA induction group was 100%. Conclusion Oral DENA induced cirrhotic model in rats is a simple, reproducible and reliable technique. Gradual oral technique, in which DENA is given under avoirdupois monitoring, can improve rat’s security and reduce mortality.
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.
Electron spin resonance (ESR) spectroscopy and spin trapping agent PBN were applied to measure directly the changes of oxygen free redicals (OFR) in gastric mucosa of rats with portal hypertension (PHT) injured by shockreperfusion, and treated with superoxide dismutase (SOD), radix salviae miltiorrhizae (RSM), with concomitant monitoring activity of SOD and pathology of gastric mucosa. Results showed that the amount of OFR increased markedly in gastric mucosa of PHT rats during the shock-reperfusion. The pathological changes were in accordance with alteration of the amount of OFR and the activity of SOD. Gastric mucosa in PHT was more susceptible to shock-reperfusion insult than normal controls. The anti-oxidant SOD, RSM used at early stage exerted mild gastric mucosal insult through different mechanisms.