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Accurate ultrasonography-based portal pressure assessment in patients with hepatocellular carcinoma

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World Journal of Gastrointestinal Oncology 2020年第8期12卷 931-941页

作者： Yu Zhang Zhong Wang Zhen-Dong Yue Hong-Wei Zhao Lei Wang Zhen-Hua Fan Yi-Fan Wu Fu-LiangHe Fu-Quan Liu Department of Interventional Therapy Peking University Ninth School of Clinical MedicineBeijing Shijitan Hospital and Capital Medical UniversityBeijing 100038China

BACKGROUND portal pressure is of great significance in the treatment of hepatocellular carcinoma(HCC),but direct measurement is complicated and costly;thus,noninvasive measurement methods are urgently *** To investigate whether ultrasonography(US)-based portal pressure assessment could replace invasive transjugular *** A cohort of 102 patients with HCC was selected(mean age:54±13 years,male/female:65/37).Pre-operative US parameters were assessed by two independent investigators,and multivariate logistic analysis and linear regression analysis were conducted to develop a predictive formula for the portal pressure gradient(PPG).The estimated PPG predictors were compared with the transjugular PPG *** was conducted on another cohort of 20 non-surgical *** The mean PPG was 17.32±1.97 *** analysis identified the association of the following four parameters with PPG:Spleen volume,portal vein diameter,portal vein velocity(PVV),and portal blood flow(PBF).Multiple linear regression analysis was performed,and the predictive formula using the PVV and PBF was as follows:PPG score=19.336-0.312×PVV(cm/s)+0.001×PBF(mL/min).The PPG score was confirmed to have good accuracy with an area under the curve(AUC)of 0.75(0.68-0.81)in training *** formula was also accurate in the validation patients with an AUC of 0.820(0.53-0.83).CONCLUSION The formula based on ultrasonographic Doppler flow parameters shows a significant correlation with invasive PPG and,if further confirmed by prospective validation,may replace the invasive transjugular assessment.

关键词： portal pressure gradient Hepatic vein pressure gradient Hepatocellular carcinoma Transjugular portal pressure portal vein pressure

Role of echo Doppler ultrasonography in the evaluation of postprandial hyperemia in cirrhotic patients

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World Journal of Gastroenterology 2008年第2期14卷 260-264页

作者： Ozdogan Osman Atalay Huseyin Cimsit Cagatay Tahan Veysel Tokay Sena Giral Adnan Imeryuz Nese Baltac|oglu Feyyaz Tuney Davut Erzen Canan Tozun Nurdan Department of Gastroenterology Marmara University School of Medicine Istanbul Turkey Department of Internal Medicine Marmara University School of Medicine Istanbul Turkey Department of Radiology Marmara University School of Medicine IstanbulTurkey

AIM: To assess the role of echo-Doppler ultrasonography in postprandial hyperemia in cirrhotic patients by comparing the results with the hepatic vein catheterization ***: Patients with cirrhosis, admitted to the portal hemodynamic laboratory were included into the study. After an overnight fast, echo-Doppler ultrasonography (basal and 30 min after a standard meal) and hemodynamic studies by hepatic vein catheterization (basal, 15 min and 30 min after a standard meal) were performed. Ensure Plus (Abbot Laboratories, North Chicago, IL) was used as the standard liquid meal. Correlation analysis of the echo-Doppler and hepatic vein catheterization measurements were done for the basal and postprandial ***: Eleven patients with cirrhosis (5 Child A, 4 Child B, 2 Child C) were enrolled into the study. After the standard meal, 8 of the 11 patients showed postprandial hyperemia with increase in portal blood flow, portal blood velocity and hepatic venous pressure gradient. Hepatic venous pressure gradient in the postprandial period correlated positively with postprandial portal blood velocity (r = 0.8, P < 0.05) and correlated inversely with postprandial superior mesenteric artery pulsatility index (r = -1, P < 0.01).CONCLUSION: Postprandial hyperemia can be efficiently measured by echo-Doppler ultrasonography and the results are comparable to those obtained with the hemodynamic studies.

关键词： Postprandial hyperemia Echo-Doppler Hemodynamic study Cirrhosis portal hypertension portal pressure

Hemoperitoneum in cirrhotic patients without abdominal trauma or tumor

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Hepatobiliary & Pancreatic Diseases International 2011年第6期10卷 644-648页

作者： Yuan-Ji Ma,En-Qiang Chen,Jia-Jie Lu,Ming-Zhen Tan and Hong Tang Center of Infectious Diseases,West China Hospital,Sichuan University,Chengdu 610041,China Center of Infectious Diseases West China Hospital Sichuan University Chengdu 610041 China

BACKGROUND:Hemoperitoneum is associated with several emergency conditions and is especially evident when it occurs in patients with liver *** study aimed to assess the clinical characteristics of cirrhotic patients who did not have abdominal trauma or tumor but who developed ***:We reviewed the clinical records of 1276 consecutive cirrhotic patients with hemoperitoneum at our center between January 2007 and December *** was confirmed by abdominal ***:Of the 1276 cirrhotic patients,19 were found to have hemoperitoneum,but only 6 did not have abdominal trauma or *** occurrence of spontaneous hemoperitoneum in the cirrhotic patients was therefore 0.5%.Hemoperitoneum can occur spontaneously in severely decompensated cirrhotic patients with intra-abdominal collateral vessels and high scores on the model for end-stage liver disease and Child-Pugh-Turcotte *** patients presented with abdominal distension,abdominal pain,increased abdominal girth and hemodynamic instability with a significant drop in the hemoglobin *** patients died of hemorrhagic shock within 24 hours,and the other 3 died of hepatic encephalopathy or spontaneous bacterial peritonitis after 5 to 10 days because of further decompensation of the ***:Hemoperitoneum can occur in cirrhotic patients who do not have abdominal trauma or *** mainly occurs in severely decompensated end-stage cirrhotic *** patients with hemoperitoneum have a poor prognosis.

关键词： liver cirrhosis portal pressure hemoperitoneum abdominal paracentesis

The beneficial impacts of splanchnic vasoactive agents on hepatic functional recovery in massive hepatectomy porcine model

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Hepatobiliary Surgery and Nutrition 2021年第3期10卷 325-336页

作者： Hye-Sung Jo Jae Hyun Han Yoon Young Choi Jin-I Seok Young-In Yoon Dong-Sik Kim Division of HBP Surgery and Liver Transplantation Department of SurgeryKorea University College of MedicineSeoulRepublic of Korea Department of Surgery St.Vincent’s HospitalCollege of MedicineThe Catholic University of KoreaSeoulRepublic of Korea Department of Biomedical Science Korea University College of Medicine Graduate SchoolSeoulRepublic of Korea Division of Hepatobiliary Surgery and Liver Transplantation Department of SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea

Background:Excessive portal pressure after massive hepatectomy can cause hepatic sinusoidal injury and have deleterious impacts on hepatic functional recovery,contributing to developing post-hepatectomy liver *** study aimed to assess the effects of splanchnic vasoactive agents on hepatic functional recovery and regeneration while clarifying the underlying mechanism,using a 70%hepatectomy porcine ***:Eighteen pigs undergoing 70%hepatectomy were involved in this study and divided into three groups:control(n=6),terlipressin(n=6),and octreotide(n=6).Terlipressin(0.5 mg)and octreotide(0.2 mg)were administered 3 times a day for each group with the first dose starting just before surgery until the 7th postoperative day,at which time the surviving pigs were *** the period,portal pressure,liver weight,biochemical analysis,histological injury score,and molecular markers were evaluated and compared between ***:The 7-day survival rates in the octreotide,terlipressin,and control groups were 100%,83.3%,and 66.7%,*** portal pressures decreased in both terlipressin and octreotide groups than the control group at 30 minutes,1 hour and 6 hours after *** amount of regeneration measured by liver weight to body weight ratio at the time of sacrifice in the terlipressin group was smaller than that in the control group(117%vs.129%,P=0.03).Serum aspartate aminotransferase(AST)and total bilirubin levels at 1 and 6 hours after hepatectomy and prothrombin time/international normalized ratio(PT/INR)at 6 hours after hepatectomy were significantly improved in the terlipressin and octreotide groups compared to the control *** endothelin-1(ET-1)was significantly lower in the terlipressin group than that in the control group 6 hours after hepatectomy(P<0.01).The histological injury score in the control group was significantly higher than that in the terlipressin group on the 7th postoperative day(P<0.01).Conclusions:Splanc

关键词： Hepatectomy portal pressure terlipressin somatostatin

A rabbit model of non- cirrhotic portal hypertension by repeated injections of E. coli through indwelling cannulation of the gastrosplenic vein

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Hepatobiliary & Pancreatic Diseases International 2004年第3期3卷 417-422页

作者： Swati Omanwar Moattar R. Rizvi Rachna Kathayat Brij K. Sharma Giryesh K. Pandey Mohammad A. Alam Veena Malhotra Shiv K. Sarin Departments of Gastroenterology G. B. Pant Hospital New Delhi India Departments of Pathology G. B. Pant Hospital New Delhi India

BACKGROUND: Non-cirrhotic portal hypertension is acommon cause of portal hypertension in developing coun-tries. To understand its etiopathogenesis we developed ananimal model by repeated portal endotoxemia inducedthrough the gastrosplenic ***: Twenty-nine rabbits (1.5-2.0 kg) were divid-ed into control (group n = 13) and experimental ( groupn = 16) groups. Heat killed E. coli were injected throughan indwelling cannula into the gastrosplenic vein in pre-sensitized animals. The animals were sacriflced at 1, 3 and6 ***: The mean portal pressure in group animalswas significantly (P portal lympho-cytic infiltrates and kupffer cell hyperplasia. No significantanomalies were detected by liver function ***: The rabbit model showed significantsplenomegaly with a persistent increase in portal pressureand mild fibrosis without hepatic parenchymal injury, quiteakin to non-cirrhotic portal fibrosis as seen in humans. Re-current intra-abdominal infection may play an importantrole in the pathogenesis of non-cirrhotic portal fibrosis.

关键词： non-cirrhotic portal fibrosis non-cirrhotic portal hypertension portal hypertension variceal bleeding portal pressure animal models idiopathic portal hypertension