Objective To review the value of imaging assessment of stem cell transplantation in treatment for liver cirrhosis.Methods The related literatures in recent years were collected,and the applications of different radiological techniques and strategies of stem cell transplantation in treatment for liver cirrhosis were summarized.Results Stem cell transplantation in treatment for liver cirrhosis was feasible and effective. Radiological assessment could supply the prompt and accurate information for clinic to choose the proper therapeutic method.The curative effect could also be accurately assessed by radiological techniques.Conclusion Radiological examination is important for the assessment of stem cell transplantation in treatment for liver cirrhosis.
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.
42 Wistar rats were divided into three groups at random, liver cirrhosis (LC), portal vein stricture (PVS) and sham operation (SO) group. The changes of barrier capability of gastric mucosa in portal hypertensive rats were observed. The results demonstrated: the splanchnic blood flow of the portal hypertensive rats increased, as compared with the normal control group (Ｐ＜0.001), but actually gastric mucosa was under the condition of ischemia. Mucosa of gastric wall glycoprotein and PGE2 of gastric mucosa decreased, as compared with the normal control (Ｐ＜0.01); and more seriously decreased in cirrhotic portal hypertensive rats, there was no significant difference about amount of the basal acid secretion (BAS) among the three groups, but the amount of H＋ backdiffusion (H＋BD) was obviously increased, as compared with the normal control group (Ｐ＜0.001). The amount of H＋BD of cirrhotic portal hypertensive rats was the highest among this three groups. The results suggest that the barrier capability of gastric mucosa with portal hypertension is lower than that of the normal control group and much lower with cirrhotic portal hypertensive rats. The portal hypertensive gastropathy is associated with the lower capability of defense of gastric mucosa. The condition of liver function contributes to the change of barrier capability of gastric mucosa.
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.
Objective To study the value of the clinical application of stereography and measurement of liver volume in cirrhotic patients with portal hypertension. Methods By use of the personal computer and the software of threedimensional reconstruction and measurement system of liver faultage photograph, the liver volume in vivo was successfully measured and the threedimensional image of the liver rebuilt in 46 posthepatitic cirrhotics who were selected for orthotopic liver transplantation and in 30 noncirrhotic controls, and comparison with the reference volume of recipient liver was obtained by means of water deplacement after transplantation. Results The liver volume of cirrhotic patients with portal hypertension measured by software and water deplacement was (983.33±206.11) cm3, and (904.93±209.56) cm3 respectively. Comparison by means of linear regression analysis between volume measurement on threedimensional reconstruction software and reference volume showed a nearly ideal correlation coefficient(r=0.969,P＜0.01), the average error was 8.66%.The average of liver volume in controls was (1287.00±96.18) cm3, and was positively correlated to the height，weight and body surface area (r=0.845,0.833,0.932 respectively,P＜0.01)，and was different from that of cirrhotics. Liver volume of cirrhoitic patients with portal hypertension was related to their ChildPugh classification. The liver volume of patients in Child C group was significantly smaller than that of patients of Child B group, and was significantly correlated with Alb （r=0.496, P＜0.01） and TBIL（r=-0.493, P＜0.01）,PT(r=-0.517, P＜0.01), but was not significantly correlated with ALT（r=0.206，Pgt;0.05）,portal pressure（r=-0.093，P=0.539） and portosystemic shunt index (r=0.044，P=0.769). Conclusion The volume measurement of the liver by the threedimensional software is relatively accurate. Liver volume of cirrhotic patients with portal hypertension was significantly related to their liver function,and can reflect the liver reserve function.
The wister rats with cirrhotic portal hypertension induced by carbon tetrachloride/ethanal were divided into four groups;①distal splenocaval shunt(DSCS);②portal azygous devascularization (PAD);③mesocaval shunt side to side (MCS);and ④the conrol. Oral glucose toleronce test (OGTT), and glucagon loading test (GLT) were performed on them. The results revealed that the hepatic reserve function of the rats with DSCS and PAD had significant difference as compared with the control (Ｐ＜0.05), but that of the rat with MCS had no significant difference as compared with the control (Ｐ＞0.05).The present study indicates that the hepatic reserve function of rats with DSCS and PAD is better than that of the rats with MCS.
ObjectiveTo introduce the technique of threedimensional portal venography of multidetector row spiral CT and its clinical application in the evaluation of the portosystemic collateral shunts of liver cirrhosis. MethodsAll relevant literatures were retrospectively reviewed on the application of twodimensional and threedimensional reconstruction techniques such as MIP, SSD, VRT of multidetector row spiral CT to demonstrate the collateral vessels of liver cirrhosis.ResultsThe distribution, pathway and anatomy of portosystemic collateral vessels were well shown by multidetector row spiral CT portal venography. Conclusion Multidetector row spiral CT portal venography provides excellent depiction of the anatomic characteristics of the collateral shunts and enables the continuous tracing of vascular structures, thus it is very helpful in the imaging evaluation of the collateral vessels of liver cirrhosis.
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 application value of totally laparoscopic associating liver tourniquet and portal ligation for staged hepatectomy (ALTPS) using the anterior approach technique for hepatocellular carcinoma (HCC) with hepatitis B cirrhosis.
MethodsIn September, 2014, a patient suffered cirrhotic hepatocellular carcinoma in the right liver scheduled for two-stage liver resection, in whom the future liver remnant (FLR) was considered too small (FLR/standard liver volume:29.1%, FLR/body wight:0.49%). In the first stage, using totally laparoscopic technique, a tourniquet was placed around the parenchymal transection line on the Cantlie's line via an anterior approach through retrohepatic tunnel for staged right hepatectomy, and the right portal vein was ligated. In the second stage, totally laparoscopic right hemihepatectomy was carried out on 10 days after the first-stage operation that achieved sufficient hypertrophy of the FLR.
ResultsThe FLR on postoperative day 4 of the first stage increased from 301.48 to 496.45 mL (FLR/standard liver volume:47.9%, FLR/body wight:0.81%), with a 64.67% hypertrophy. And the FLR on postoperative day 8 of the first stage increased to 510.96 mL (FLR/standard liver volume:49.3%, FLR/body wight:0.84%), with a 69.48% hypertrophy. The remnant liver volume on postoperative day 5 of the second stage increased to 704.53 mL. The duration of the first stage was 180 min, intraoperative blood loss was 50 mL, and patient did not received a blood transfusion. The duration of the second stage was 220 min, intraoperative blood loss was 400 mL, and patient did not required a blood transfusion. No serious complications happened. The patient was discharged on 7 days after the second stage.
ConclusionsAs a effective, safe, simple, and "non-touch" technique which provided a less aggressive modification of the ALPPS procedureto achieve oncological efficacy, the totally laparoscopic ALTPS using the anterior approach technique also could achieve sufficient hypertrophy of the FLR in several days. A proper expansion of the indications for the procedure is safe and feasible in HCC patients with cirrhosis.
【Abstract】ObjectiveTo investigate the effects of rhGH on hypoalbuminemia in cirrhotic rats after partial hepatectomy. MethodsThirty rats were randomly divided into normal control group (n=6), liver cirrhosis group (LC group, n=6), liver cirrhosis and hepatectomy group (LCH group,n=6), PN (parenteral nutrition) group (n=6， given PN after hepatectomy) and rhGH+PN group (n=6,given rhGH and PN after hepatectomy). Liver function and blood glucose were measured. The expression of ALB mRNA was detected by RTPCR. Liver Ki67 immunohistochemistry was studied. ResultsCompared with PN group, serum ALP was lower; serum ALB and blood glucose were higher in rhGH+PN group. The expression of hepatic ALB mRNA was higher, and hepatic Ki67 labeling index was higher as well in this group. ConclusionrhGH can improve hypoalbuminemia after partial hepatectomy in cirrhotic rats with partial hepatectomy.
