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Optimal treatment strategies for hepatic portal venous gas:A retrospective assessment

World Journal of Gastroenterology 2020年第14期26卷 1628-1637页

作者： Masanori Gonda tatsuya osuga Yoshihiro Ikura Kazunori Hasegawa Kentaro Kawasaki Takatoshi Nakashima Department of Gastroenterology Takatsuki General HospitalTakatsuki 5691192Japan Department of Pathology Takatsuki General HospitalTakatsuki 5691192Japan Department of Surgery Takatsuki General HospitalTakatsuki 5691192Japan

BACKGROUND Hepatic portal venous gas(HPVG)generally indicates poor prognoses in patients with serious intestinal *** surgical removal of the damaged portion is effective,some patients can recover with conservative *** To establish an optimal treatment strategy for HPVG,we attempted to generate computed tomography(CT)-based criteria for determining surgical indication,and explored reliable prognostic factors in non-surgical *** Thirty-four cases of HPVG(patients aged 34-99 years)were *** for surgery had been determined mainly by CT findings(***-air,embolism,lack of contrast enhancement of the intestinal wall,and intestinal pneumatosis).The clinical data,including treatment outcomes,were analyzed separately for the surgical cases and non-surgical *** Laparotomy was performed in eight cases(surgical cases).Seven patients(87.5%)survived but one(12.5%)*** each case,severe intestinal damage was confirmed during surgery,and the necrotic portion,if present,was ***-occlusive mesenteric ischemia was the most common cause(n=4).Twentysix cases were treated conservatively(non-surgical cases).Surgical treatments had been required for twelve but were abandoned because of the patients’poor general ***,however,three(25%)of the twelve inoperable patients *** remaining 14 of the 26 cases were diagnosed originally as being sufficiently cured by conservative treatments,and only one patient(7%)*** analyses of the fatal(n=10)and recovery(n=16)cases revealed that ascites,peritoneal irritation signs,and shock were significantly more frequent in the fatal *** mortality was 90%if two or all of these three clinical findings were *** HPVG related to intestinal necrosis requires surgery,and our CT-based criteria are probably useful to determine the surgical *** non-surgical cases,ascites,peritoneal irritation signs and shock were closely associated

关键词： Hepatic portal venous gas Surgical treatment Conservative treatment Computed tomography Intestinal necrosis Prognostic factor

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Changing common sense:Anti-platelet/coagulation therapy against cirrhosis

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World Journal of Hepatology 2015年第13期7卷 1730-1734页

作者： Yoshihiro Ikura tatsuya osuga Department of Pathology Takatsuki General Hospital Department of Gastroenterology Takatsuki General Hospital

Until recently,anti-platelet/coagulation therapy had not been recommended for patients with *** venous thrombosis is one of the representative complications of cirrhosis and ischemic disorders associated with atherosclerosis are not infrequent in cirrhotic patients,many clinicians have tended to hesitate to introduce anti-platelet/coagulation therapy to their ***,this is due to the increased risk of hemorrhagic diathesis in cirrhotic ***,accumulating evidence has revealed the benefits of anti-platelet/coagulation therapy for cirrhotic *** addition to the safety of the therapy carried out against cardiovascular diseases in cirrhotic patients,some clinical data have indicated its preventive effect on venous ***,the efficacy of antiplatelet/coagulation therapy against cirrhosis itself has been demonstrated both clinically and *** conceptual basis for application of anti-platelet/coagulation therapy against cirrhosis was constructed through two pathologic studies on intrahepatic thrombosis in cirrhotic *** may be better to use thrombopoietinreceptor agonists,which have been tested as a treatment for cirrhosis-related thrombocytopenia,in combination with anti-platelet drugs to reduce the risk of venous *** the last decade,the World Journal of Gastroenterology,a sister journal of World Journal of Hepatology,has been one of the main platforms of active discussion of this theme.

关键词： Anti-platelet/coagulation therapy Cirrhosis Hemorrhagic diathesis Thrombosis Thrombocytopenia

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