摘要:目的: 探討血清前白蛋白(prealbumin,PAB)、膽堿脂酶(cholinesterase,ChE)、總膽汁酸(total bile acid,TBA)在肝硬化中的檢測價值。 方法 :測定105例肝硬化患者和30例健康人的前白蛋白、膽堿脂酶、總膽汁酸活性及肝功能生化指標,并按ChildPugh分級進行比較。 結果 :肝硬化組前白蛋白含量、膽堿脂酶活性均較對照組顯著降低;按ChildPugh分級比較,肝硬化組前白蛋白含量在Child A級與對照組、B級與A級之間、在C級與B級之間差異有顯著性(Plt;001);膽堿脂酶活性在Child A級與對照組、B級與A級、C級與B級之間差異有顯著性(Plt;001)。總膽汁酸在Child B級與A級,C級與B級間有顯著差異性,在A級與對照組間差異無顯著性。 結論 :血清前白蛋白、膽堿脂酶在肝硬化早期評估中有很重要的價值,而總膽汁酸在肝硬化預后的判定中有重要價值。 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.
Objective To investigate the mediating effect of nursing intervention of sleep hygiene on insomnia in patients with liver cirrhosis. Methods One hundred and eighteen cirrhotic patients with grade-A liver function and insomnia treated between June 2012 and January 2015 were divided into control group (n=52) and intervention group (n=66) with random number table method. The control group received conventional nursing only, while the intervention group was given nursing intervention of sleep hygiene. The sleep quality of patients in the two groups on admission and discharge were surveyed and compared based on Pittsburgh sleep quality index (PSQI). The nursing effect was also compared between the two groups on discharge. Results There was no statistically significant difference in total score and scores for each factor of PSQI between the two groups of patients on admission (P>0.05). However, the total score and scores for each factor of PSQI on discharge in both groups were significantly lower than those on admission (P<0.05). Besides, the scores in the intervention group were significantly lower than those in the control group (P<0.05). The effect of nursing in the intervention group was superior to that in the control group (P<0.001). Conclusions Nursing intervention of sleep hygiene can effectively improve sleep quality in cirrhotic patients with grade-A liver function. The role of nursing intervention in the treatment of insomnia should be taken seriously.
Objective To explore the cause, diagnosis, and treatment methods of portal vein thrombosis （PVT） after splenectomy. Methods The clinical data of 29 patients who were got splenectomy because of portal hypertension or traumatic splenic rupture from August 2002 to August 2008 in our hospital were analyzed retrospectively. Results Tweenty-seven patients with PVT were treated successfully, whose thrombi were absorbed completely or partially. One case died of peritonitis，septic shock，and multiple organ failure. One case died of hematemesis, hepatic coma，and multiple organ failure. Tweenty-four patients were followed up, the follow-up time was 0.5 to 3 years, the average was 2 years. Two cases died of massive hemorrhage, 1 case died of hepatic encephalopathy，and 1 case died of liver failure. Two cases occurred deep venous thrombosis in one year after treatment, and the remaining patients had no recurrence of venous thrombosis. Conclusions PVT have some connection with the raise of blood platelet and the hemodynamic changes of the portal vein system after splenectomy. Standardization of operation, early diagnosis, early line anticoagulant，and antiplatelet adhesion therapy are effective way to prevent and treat PVT.
【Abstract】ObjectiveTo prospectively study the effects of recombinant human growth hormone (rhGH) on the changes of liver function and nutritional metabolism in postoperative patients with cirrhosis and portal hypertension. MethodsFortyeight cases with liver cirrhosis and portal hypertension who were collected from February 2003 to January 2004 were randomly divided into 2 groups (24 patients in each group). All patients were given the low calorie parenteral nutrition support and exogenous albumen after operations. Patients in the study group received rhGH from the second day after operations and physiological saline was used in the control group instead. The effects were evaluated in terms of protein metabolism, liver function, blood glucose level at different phases before and after the intervene. Death rates of in patients were also recorded in both groups. ResultsThe rising amplitude of albumen in the study group had been significantly larger than that of the control group from the seventh day after intervene (P＜0.05). The blood transaminase levels (ALT，AST) in the study group were significantly lower than that of the control group (P＜0.05). The blood glucose level of both groups decreased over time and returned to normal on day 14 after intervene, but there was no significant difference for both glucose and plasma bilirubin level between the two groups before and after the intervene (Pgt;0.05). The rates of death were similar, although the length of stay in the study group was much shorter than that of the control group. ConclusionrhGH may inhibit the catabolism, correct hypoproteinemia, improve liver function for postoperative patients with cirrhosis and portal hypertension, and reduce their length of stay.
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.
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.
ObjectiveTo introduce the new nomenclature scheme of the International Working Group (1995) on hepatic nodules, and summarize the imaging features of various hepatic nodules in light of their pathological characteristics, and evaluate the diagnostic values of various imaging facilities.MethodsUltrasound, computed tomography(CT), magnetic resonance imaging(MRI), and angiographic CT were reviewed and introduced.ResultsMany of these types of hepatic nodules play a role in the de novo and stepwise carcinogenesis of hepatocellular carcinoma(HCC) in the following steps: regenerative nodule, lowgrade dysplastic nodule, highgrade dysplastic nodule, small HCC, and large HCC. Accompanying such transformations, there are significant alterations in the blood supply and perfusion of these hepatic nodules.ConclusionModern stateoftheart medical imaging facilities can not only delineate and depict these hepatic nodules, but also provide important clues for the characterization of focal hepatic lesions in most cases, thus facilitating the early detection, diagnosis and management of HCC in its early stage.
ObjectiveTo investigate the effect of intermittent Pringle (IP) and continuous hemi-hepatic vascular inflow occlusion (CHVIO) on the prognosis of patients with hepatocellular carcinoma (HCC) complicated with cirrhosis in laparoscopic liver resection (LLR).MethodsRetrospective analysis of consecutive 107 LLR patients with HCC complicated with liver cirrhosis at West China Hospital of Sichuan University between January 2015 and December 2017 was performed. Patients were divided into an IP group and a CHVIO group according to the method of hepatic vascular occlusion, intraoperative and postoperative outcome indicators and short-term prognosis were compared between the two groups.ResultsPatients in the IP group had shorter operative time [(237+90) min vs (285+118) min, P=0.041] and less blood loss [(279+24) mL vs (396+35) mL, P=0.012], without a significant increase in postoperative liver function [including ALT, AST, TBIL, and ALB], postoperative complications, induced flow, 1-year disease-free survival, and1-year survival (P>0.05).ConclusionsIP can reduce the operative time and blood loss in patients with HCC complicated with cirrhosis in LLR, and will not lead to deterioration of liver function, it is a recommended hepatic inflowocclusion method.
ObjectiveTo summarize the occurrence and development of hepatocirrhosis complicated with portal vein thrombosis (PVT), and summarize the status and prospect of anticoagulant treatment.MethodThe literatures and guidelines on the treatment of hepatocirrhosis complicated with PVT were collected and reviewed.ResultsPVT was one of the most common complications in patients with hepatocirrhosis. Its pathogenesis was complicated, and the coagulation function of patients with hepatocirrhosis was poor. In addition, patients with severe complications such as esophageal and gastric varicose bleeding (EVB) were often complicated. According to the current study, the formation of PVT was mainly related to the coagulation mechanism of patients, hemorheology changes of blood vessels, and their own factors. Treatment methods included drug therapy, interventional therapy, and surgical treatment. However, there was still controversy on anticoagulant therapy for hepatocirrhosis with PVT, and there was no complete consensus on anticoagulant indications, drug selection, course of treatment, and safety monitoring.ConclusionPVT should be treated with anticoagulant therapy under certain indications, but to ensure its safety and effectiveness, prospective large sample randomized controlled trials are still needed.
Objective To approach the prognosis after liver transplantation （LT） of liver function for Child grade A in patients with portal hypertension， and to compare with periesophagogastric devascularization with splenectomy （PDS）. Methods The data of 195 portal hypertension cases with Child A caused by hepatitis B cirrhosis who received surgical treatment of PDS （152 cases） or LT （43 cases） in division of liver transplantation center of West China Hospital of Sichuan University from 1999 to 2011 were retrospectively analyzed. The pre-， intra-， and postoperative variables in two groups that including patients’ age， score of Child， score of model for end-stage liver disease （MELD）， total bilirubin （TB），creatinine （Cr）， international normalized ratio （INR）， albumin （Alb）， complications of portal hypertension， amount of intraoperative bleeding and blood transfusion， operative time， and in the ICU and hospital stay time were compared. The postoperative outcomes were statistically analyzed including severe postoperative complications， short-term and long-term survival rates. Results Compared with PDS group， the amount of intraoperative bleeding and blood transfusion of LT group were morer （P＜0.05）， the operative time， in the ICU and hospital stay time of LT group were longer （P＜0.05）. The rate of severe postoperative complications in LT group was higher than that in PDS group 〔18.60% （8/43） vs. 1.97% （3/152），P＜0.05〕. The levels of TB and Cr during the postoperative period in LT group were higher than that in PDS group （P＜0.05）. Although the INR on day 1 after operation in LT group was higher than that in PDS group （P＜0.01）， but the difference disappeared soon on day 7 after operation in two groups （P＞0.05）.The 1-， 3-， and 5-year survival rates of the LT and PDS groups were 90.3%， 86.5%， 86.5%， and 100%， 100%， 100%， respectively， significant difference were observed in both short-term and long-term survival rates between the two groups （P＜0.05）. Conclusion LT offered no significant survival benefit to patients with portal hypertension and Child A due to hepatitis B cirrhosis， whereas PDS could be an effective treatment.