中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

2018 No. 10

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Editorial
Pathogenesis and multidisciplinary diagnosis and treatment of portal vein embolization
Zhu FengShang, Yang ZhangQing
2018, 34(10): 2043-2046. DOI: 10.3969/j.issn.1001-5256.2018.10.001
Abstract:
Portal vein embolization involves different pathophysiological processes such as primary or secondary portal vein thrombosis and extrahepatic portal vein occlusion. After clarifying the connotation of portal vein embolization, this article briefly introduces the etiology and grading system of portal vein embolization, as well as its pathogenesis and multidisciplinary collaborative diagnosis and treatment methods, and emphasizes the importance of multidisciplinary collaboration.
Discussions by experts
Treatment of portal vein thrombosis: Selection of anticoagulants
Zhang Yu, Liu FuQuan
2018, 34(10): 2047-2052. DOI: 10.3969/j.issn.1001-5256.2018.10.002
Abstract:
Portal vein thrombosis ( PVT) has become a common disease in clinical practice, and with the development of digital imaging, the detection rate of PVT has been increased significantly. PVT treatment is a multimodality therapy based on anticoagulant therapy and includes interventional treatment and surgical treatment. This article discusses the latest viewpoints of anticoagulant therapy for PVT and points out that the regimen of anticoagulant therapy should be selected based on patient's conditions.
Interventional treatment of portal vein thrombosis
Ma JingQin, Luo JianJun
2018, 34(10): 2053-2057. DOI: 10.3969/j.issn.1001-5256.2018.10.003
Abstract:
With the increase in the diagnosis rate of portal vein thrombosis ( PVT) , the interventional treatment for PVT has attracted more and more attention. Mechanical thrombolysis and drug thrombolysis combined with systemic anticoagulant treatment can partly or even completely reverse the local and systemic hemodynamic changes after PVT, restore portal venous flow, and reduce portal venous pressure. The methods and approaches for interventional treatment should be selected based on patients' conditions. The superior mesenteric artery approach has a relatively low risk, but it does not have a satisfactory thrombolytic effect in subacute/chronic PVT or PVT in the main portal vein with collateral formation. The portal vein approach is the most commonly used method for interventional treatment at present, including the percutaneous transhepatic approach, the percutaneous trans-splenic approach, and the mesenteric vein approach. Transjugular intrahepatic portosystemic shunt can provide a low-resistance outlet for the portal system and thus reduce portal venous pressure and improve blood stream stasis in the portal vein. The interventional treatment of PVT is a comprehensive interventional therapy that combines multiple methods and approaches. These methods and approaches used alone or in combination based on patients' conditions can achieve a good clinical effect and reduce complications and mortality.
Surgical diagnosis and treatment of portal vein thrombosis
Zhang Ying, Liu QingYan, Li ZhiWei
2018, 34(10): 2058-2062. DOI: 10.3969/j.issn.1001-5256.2018.10.004
Abstract:
Portal vein thrombosis refers to thrombotic lesions in the portal vein and is caused by various etiologies. Its clinical manifestations vary with location, extension, degree of vascular occlusion, and formation time, and severe thrombosis may cause gastrointestinal congestion and necrosis, liver insufficiency, esophagogastric variceal bleeding, and portal hypertensive biliary disease and even threatens patients' life.Color Doppler ultrasound and contrast-enhanced abdominal computed tomography/magnetic resonance imaging are important auxiliary examinations for the diagnosis of portal vein thrombosis and play a vital role in early diagnosis and treatment, severity evaluation, and guidance for targeted treatment of this disease. Therapies of portal vein thrombosis depend on its severity and mainly target portal vein thrombosis and its complications. Surgical treatment should be performed for patients with intestinal congestion and necrosis, portal hypertension with esophagogastric variceal bleeding, splenomegaly, hypersplenism, portal hypertensive biliary disease, and end-stage liver disease. This article reviews the advances in the etiology, clinical manifestations, diagnosis, and surgical treatment of portal vein thrombosis.
Mechanisms of the development and progression of portal vein thrombosis
Yang YuanYuan, Wang XiaoYan
2018, 34(10): 2063-2068. DOI: 10.3969/j.issn.1001-5256.2018.10.005
Abstract:
Portal vein thrombosis ( PVT) refers to the process of thrombosis in the portal vein or its branches and can lead to portal hypertension and a series of pathophysiological changes. PVT is often caused by various etiologies, including hypercoagulable state, reduced portal flow velocity, and vascular endothelial injury. This article reviews the mechanisms of the development and progression of PVT and points out that the etiology of PVT should be evaluated comprehensively to assist treatment.
Source of portal vein tumor thrombosis and advances in its diagnosis and treatment
Hu MuRen, Ge BuJun
2018, 34(10): 2069-2075. DOI: 10.3969/j.issn.1001-5256.2018.10.006
Abstract:
Portal vein tumor thrombosis is one of the important factors that affect the treatment and prognosis of patients with malignancies.The early diagnosis and treatment of portal vein tumor thrombosis is of great significance to improve the prognosis of patients. However, at present, there is no standard and unified guideline for the diagnosis and treatment of portal vein tumor thrombosis. This article reviews the source as well as the advances in diagnosis and treatment of portal vein tumor thrombosis.
Therapeutic guidelines
Expert consensus on the imaging-guided multimode tumor ablation therapy system for malignant hepatic tumors
The Society of Interventional Therapy, China Anti- cancer Association, The Solid Tumor Theranostics Committee, Shanghai Anti- cancer Association
2018, 34(10): 2098-2102. DOI: 10.3969/j.issn.1001-5256.2018.10.009
Abstract:

Imaging-guided multimode tumor ablation therapy system for malignant hepatic tumors is a therapeutic technique, the performance of which is guided by medical imaging technology, and in the process of alternate conversion between cryoablation and thermal ablation, through accurate control of lesion area temperature and quantitative planning of ablation process, the in situ tumor cells and their circulatory system are thoroughly destroyed, and the active tumor antigens are simultaneously released at a maximum extent, thereby controlling the recurrence and metastasis of malignant hepatic tumors. In order to standardize the operative technique of multimode ablation therapy for malignant hepatic tumors, to enable hospitals at different levels have the ability to carry out the implementation of this therapy and to ensure medical safety and clinical efficacy, the Society of Interventional Therapy of China Anti-cancer Association and the Solid Tumor Theranostics Committee of Shanghai Anti-cancer Association have together organized domestic experts of multiple disciplines, who have been involved in the field of oncotherapy, to make a professional and serious discussion on the subject of“imaging-guided multimode tumor ablation therapy system for malignant hepatic tumors”, focusing on its indications, contraindications and techniques, and the final expert consensus is presented here.

Comprehensive guidelines for the diagnosis and treatment of pancreatic cancer (2018 version)
Pancreatic Cancer Committee of Chinese Anti-Cancer Association
2018, 34(10): 2109-2120. DOI: 10.3969/j.issn.1001-5256.2018.10.011
Abstract(5771) PDF (433KB)(3793)
Abstract:

Pancreatic cancer ranks the fifth leading cause of cancer-related death, while the incidence has increased in the recent years.Although available diagnosis and treatment have failed to significantly improve patients' outcome, some advances have been made along with the understanding of the new concepts from oncology over the past several years. Pancreatic Cancer Committee of Chinese Anti-Cancer Association worked out this latest edition of“The Clinical Practice Guidelines for Pancreatic Cancer ( version 2018) ”based on current situation to standardize and improve the diagnosis and treatment of pancreatic cancer in China. This guideline shows algorithms for the diagnosis involving classification and staging, the systematic treatment including surgical resection, systemic chemotherapy and radiation therapy, and the whole-course management model for patients with pancreatic cancer. Different from previous consensus, this guideline contains the discussions and recommendations of 19 hot-issues in the clinical practice for pancreatic cancer in a question-oriented form, such as selection of biopsy and specimen sites, clinical diagnostic criteria for pancreatic cancer, assessment of resectable pancreatic cancer, indications and methods of preoperative biliary drainage, application of laparoscopic surgery, effect of expanding resection on patients' outcomes, dissection of group 16 th lymph node in standard pancreaticoduodenectomy, prognostic value of serum tumor markers, and neoadjuvant therapy in patients with resectable pancreatic cancer, etc. This guideline aims to raise a better comprehensive understanding of the diagnosis and treatment of pancreatic cancer for specialists, and further improving and standardizing the clinical practice in different medical institutions.

An excerpt of  WHO guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection (2018)
Zhang LiJuan, Liu BingHua, Ma CuiHua, Du HuiQing, Han Tao, Jiang Yong
2018, 34(10): 2121-2123. DOI: 10.3969/j.issn.1001-5256.2018.10.012
Abstract:
Original articles_Liver fibrosis and liver cirrhosis
An analysis of urinary factors for predicting acute kidney injury in patients with liver cirrhosis
Xu ManMan, Chen Yu
2018, 34(10): 2124-2129. DOI: 10.3969/j.issn.1001-5256.2018.10.013
Abstract:
Objective To investigate the predictive factors for acute kidney injury ( AKI) in patients with liver cirrhosis. Methods A total of 105 patients with decompensated liver cirrhosis who visited Beijing YouAn Hospital from May 2017 to April 2018 were enrolled. These patients were divided into AKI group ( n = 49) and non-AKI group ( n = 56) . Their general information and laboratory results were collected, and urine samples were collected on admission to measure urinary angiotensinogen ( AGT) , urinary neutrophil gelatinase-associated lipocalin ( NGAL) , and urinary kidney injury molecule-1 ( KIM-1) , which were corrected for urinary creatinine ( UCr) . The t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data; the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed. The receiver operating characteristic ( ROC) curve was plotted to evaluate predictive efficiency. Results Compared with the non-AKI group, the AKI group had significantly higher proportions of patients with upper gastrointestinal bleeding and spontaneous bacterial peritonitis ( χ2= 11. 420 and 8. 083, both P < 0. 05) , significantly higher levels of leukocyte count, total bilirubin, direct bilirubin, urea nitrogen, and serum creatinine ( SCr) ( Z =-3. 401, -2. 082, -2. 207, -5. 872, and-7. 460, all P < 0. 05) , and a significantly lower level of blood sodium ( t =-4. 905, P < 0. 05) . The AKI group had significantly higher urinary NGAL/UCr and urinary KIM-1/UCr than the non-AKI group ( Z =-7. 654 and-2. 395, both P < 0. 05) . The multivariate analysis showed that SCr, blood sodium, and urinary NGAL/UCr were independent predictive factors for AKI in patients with liver cirrhosis ( all P < 0. 05) . The ROC curve analysis showed that at the cut-off value of 88. 1 μmol/L, SCr had a sensitivity of 93%, a specificity of 82%, and an area under the ROC curve ( AUC) of 0. 915 ( 95% confidence interval [CI]: 0. 850-0. 980) in predicting AKI; at the cut-off value of 1. 62 μg/g, urinary NGAL had a sensitivity of 87%, a specificity of 81%, and an AUC of 0. 950 ( 95% CI: 0. 911-0. 989) in predicting AKI; urinary NGAL combined with SCr had an AUC of 0. 964 ( 95% CI: 0. 931-0. 998) . Conclusion Urinary NGAL is an independent risk factor for AKI in patients with liver cirrhosis and can be used for the early diagnosis of AKI in these patients. Urinary AGT and KIM-1 cannot independently predict the development of AKI in liver cirrhosis, and their application value awaits further exploration.
Predictive value of coagulation test parameters for acute upper gastrointestinal bleeding in patients with liver cirrhosis
Zhang LiHang, Wang ShanJuan, Lu LunGen, Liu YanLi, Wang YiFei, Xie JinBi
2018, 34(10): 2130-2135. DOI: 10.3969/j.issn.1001-5256.2018.10.014
Abstract:
Objective To investigate the association between coagulation test parameters and acute upper gastrointestinal bleeding ( AUGIB) in patients with liver cirrhosis. Methods A total of 233 patients with liver cirrhosis who were hospitalized in Department of Gastroenterology, Jiading District Central Hospital, Shanghai University of Medicine & Health Sciences, from January 2013 to December 2016, and according to the presence or absence of AUGIB, they were divided into AUGIB group with 87 patients and non-AUGIB group with 146 patients. Related clinical data were collected, including name, sex, age, cause of liver cirrhosis, ascites, hepatic encephalopathy, blood parameters of the first blood test after admission [routine blood test results, total bilirubin ( TBil) , albumin, and creatinine], coagulation test results [prothrombin time ( PT) , prothrombin time activity ( PTA) , activated partial thromboplastin time ( APTT) , international normalized ratio ( INR) , fibrinogen ( FIB) , thrombin time ( TT) ], and D-dimer. The Child-Pugh score and Model for End-Stage Liver Disease ( MELD) score were calculated based on these data. The independent samples t-test was used for comparison of continuous data between two groups, and an analysis of variance was used for comparison between multiple groups. Logistic regression was used for univariate and multivariate analyses of related variables. Results Compared with the patients with Child-Pugh class A/B liver cirrhosis, the patients with Child-Pugh class C liver cirrhosis had significantly longer PT, APTT, and TT, a significantly higher INR, significant reductions in PTA and FIB, and significant increases in TBil and MELD score ( F = 62. 706, 33. 858, 17. 781, 63. 025, 46. 907, 7. 514, 23. 020, and20. 519, all P < 0. 05) . Of all 233 patients, only 175 underwent the measurement of D-dimer, and D-dimer was not measured for 58 patients, which caused data loss. According to the Child-Pugh class, the 175 patients who underwent D-dimer measurement were divided into Child-Pugh class A group with 33 patients, Child-Pugh class B group with 93 patients, and Child-Pugh class C group with 49 patients, and there was a significant difference in the level of D-dimer between these three groups ( 1. 63 ± 2. 15 mg/L vs 3. 48 ± 4. 25 mg/L vs 4. 24 ± 4. 79 mg/L, F = 4. 089, P = 0. 018) . Compared with the MELD ≥13 group, the MELD < 13 group had significantly longer PT, INR, and APTT and a significant reduction in PTA ( t = 7. 307, 7. 602, 3. 650, and 5. 546, all P < 0. 05) . Among the 87 patients in the AUGIB group, 76 had esophagogastric variceal bleeding, 9 had peptic ulcer, 1 had bleeding due to portal hypertensive gastropathy, and 1 had bleeding due to gastric carcinoma. Compared with the non-AUGIB group, the AUGIB group had a significantly longer APTT, a significantly higher FIB level, and a significantly higher Child-Pugh class ( t = 7. 178, 14. 644, and 30. 082, all P < 0. 05) . APTT and FIB were significantly associated with AUGIB ( APTT: likelihood ratio [LR]= 1. 09, 95% confidence interval [CI]: 1. 04-1. 14, P < 0. 001; FIB:LR = 2. 34, 95% CI: 1. 61-3. 41, P < 0. 001) . Conclusion The increases in PT, INR, and APTT parallel with Child-Pugh class and MELD score in patients with liver cirrhosis, and the prolongation of APTT and the increase in FIB can predict the possibility of AUGIB in patients with liver cirrhosis.
Effect of spleen-strengthening, dampness-removing, and hemostatic prescription on rebleeding within one year in cirrhotic patients with esophagogastric variceal bleeding
Hou YiXin, Zhang Qun, Yang ZhiYun, Yang YuYing, Jiang YuYong, Wang XianBo
2018, 34(10): 2136-2141. DOI: 10.3969/j.issn.1001-5256.2018.10.015
Abstract:
Objective To investigate the effect of spleen-strengthening, dampness-removing, and hemostatic prescription on rebleeding within one year in cirrhotic patients with esophagogastric variceal bleeding ( EGVB) . Methods A total of 750 cirrhotic patients with EGVB who were admitted to Beijing Ditan Hospital, Capital Medical University, from August 2008 to October 2016 were enrolled and followed up for one year. According to cumulative defined daily dose ( cDDD) , these patients were divided into traditional Chinese medicine ( TCM) group with 276 patients ( the dose of spleen-strengthening, dampness-removing, and hemostatic prescription ≥28 cDDD) and n* on-TCM group with 474 patients ( the dose of TCM < 28 cDDD) . The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was used to determine the influencing factors for EGVB rebleeding. Results The presence or absence of the treatment with spleen-strengthening, dampness-removing, and hemostatic prescription was one of the independent risk factors for rebleeding within one year in cirrhotic patients with EGVB ( odds ratio = 0. 076, 95% confidence interval: 0. 039-0. 126, P = 0. 002) . The TCM group had a significantly lower incidence rate of rebleeding within one year than the non-TCM group ( 43. 5% vs 55. 1%, χ2= 4. 246, P = 0. 025) . The median time of rebleeding was 95 days in the TCM group and 121 days in the non-TCM group, and there was a significant difference between the two groups ( Z = 1. 981, P = 0. 003) . Conclusion Spleen-strengthening, dampness-removing, and hemostatic prescription can reduce the risk of rebleeding within one year in cirrhotic patients with EGVB and shorten the time of rebleeding.
Original articles_Liver neoplasms
Influence of portal vein tumor thrombus on the clincial effect of FOLFOX4 chemotherapy regimen in treatment of advanced hepatocellular carcinoma
Yang Guang, Dong YaBing, Zhao LingLing, Cui GuoZhen, Zhao HengJun, Wang NanYa
2018, 34(10): 2142-2147. DOI: 10.3969/j.issn.1001-5256.2018.10.016
Abstract:
Objective To investigate the clinical effect of oxaliplatin-based chemotherapy regimen in the treatment of advanced hepatocellular carcinoma ( HCC) with portal vein tumor thrombus. Methods A retrospective analysis was performed for the clinical data of 37 patients who were diagnosed with BCLC stage C advanced HCC in Cancer Center of The First Hospital of Jilin University from December 2013 to June 2017 and received more than 2 courses of systemic chemotherapy with FOLFOX4 regimen. The association between clinical outcome and the presence or absence of portal vein tumor thrombus was analyzed. According to the presence or absence of portal vein tumor thrombus, these patients were divided into non-portal vein tumor thrombus group with 20 patients and portal vein tumor thrombus group with17 patients. The chi-square test and the Fisher's exact test were used for comparison of categorical data between groups, and the Mann-Whitney U test was used for comparison of continuous data between groups. The Kaplan-Meier method was used for survival analysis, and the log-rank test was used for comparison of survival curves between groups. After risk factors were screened out by the univariate analysis, the Cox proportional hazards model was used for multivariate analysis, and hazard ratio ( HR) and 95% confidence interval ( CI) were used.Results For all 37 patients, the median progression-free survival was 4 months ( range 1-30 months) and the median overall survival was 9 months ( range 1-34 months) . There were significant differences between the non-portal vein tumor thrombus group and the portal vein tumor thrombus group in objective response rate ( 40. 0% vs 5. 9%, χ2= 4. 1, P = 0. 042) and disease control rate ( 85. 0% vs35. 3%, χ2= 7. 65, P = 0. 006) . There were also significant differences between the two groups in survival time ( P < 0. 001) and 6-, 12-, and 24-month survival rates ( χ2= 16. 76, 8. 70, and 1. 12, P < 0. 001, P = 0. 003, and P < 0. 001) . Common toxic and side effects included leucopenia, neurotoxicity, gastrointestinal reactions, and liver injury, which were relieved after aggressive management. The Cox multivariate analysis showed that tumor burden ( HR = 0. 045, 95% CI: 0. 009-0. 216, P = 0. 001) and portal vein tumor thrombus ( HR =0. 181, 95% CI: 0. 066-0. 497, P < 0. 001) were independent prognostic factors. Conclusion Patients without portal vein tumor thrombus have a significantly better outcome after chemotherapy than those with portal vein tumor thrombus. Portal vein tumor thrombus is an independent negative prognostic factor for advanced HCC after systemic chemotherapy.
Value of serum des-γ-carboxy-prothrombin in the diagnosis and treatment of hepatocellular carcinoma
Sun Yu, Zhang HongHai, Yuan ChunWang, Hu CaiXia, Liu BoJun, Cui ShiChang, Qian ZhiLing, Zhang YingHua, Zhang YongHong, Zheng JiaSheng
2018, 34(10): 2148-2152. DOI: 10.3969/j.issn.1001-5256.2018.10.017
Abstract:
Objective To investigate the expression of des-γ-carboxy-prothrombin ( DCP) in serum in hepatocellular carcinoma ( HCC) patients and its association with tumor properties, pathology, and clinical features. Methods A total of 80 patients who were hospitalized and treated in our hospital from January 2016 to March 2018 and were diagnosed with HCC by pathology after surgical resection were enrolled. The serum levels of DCP and alpha-fetoprotein ( AFP) were measured before surgery and the correlation between them was analyzed. The association of DCP level with clinical data, imaging findings, and pathological results was analyzed. Mann-Whitney U test was used for comparison of continuous data between two groups, Kruskal-Wallis H test was used for comparison between multiple groups, and the Mann-Whitney U test was used for further comparison between two groups; the Spearman correlation analysis was performed to investigate correlation. Results There was no significant correlation between the serum levels of AFP and DCP in HCC patients ( r = 0. 141, P >0. 05) . In HCC patients, serum DCP level was significantly correlated with tumor diameter ( r = 0. 563, P < 0. 01) . The HCC patients with intrahepatic multiple tumors, distant metastasis, or macrovascular or microvascular invasion had a significantly higher serum DCP level than those with intrahepatic single tumor ( Z =-5. 484, P < 0. 001) or without distant metastasis ( Z =-4. 569, P < 0. 001) , macrovascular invasion ( Z =-3. 713, P < 0. 001) , or microvascular invasion ( Z =-3. 244, P = 0. 001) . According to the staging criteria in China, the patients with stage Ⅰ HCC had a significantly lower serum DCP level than those with stage Ⅱ/Ⅲ HCC ( P = 0. 005 and P < 0. 001) , while there was no significant difference in serum DCP level between the patients with stage Ⅱ HCC and those with stage Ⅲ HCC ( P = 0. 477) .The patients with Edmondson-Steiner grade Ⅱ/Ⅲ HCC had a significantly lower serum DCP level than those with Edmondson-Steiner grade IV HCC ( P < 0. 001 and P = 0. 002) , while there was no significant difference in serum DCP level between the patients with Edmondson-Steiner grade Ⅱ HCC and those with Edmondson-Steiner grade Ⅲ HCC ( P = 0. 133) . Conclusion In HCC patients, serum DCP level is associated with number of tumors, tumor size, clinical stage, distant metastasis, vascular invasion, and pathological grade.
Expression of D-bifunctional protein in hepatocellular carcinoma tissue and its correlation with alpha-fetoprotein and carbohydrate antigen 19-9
Lu Xin, Kong LingYu, Liu DianQing, Xu LinJi, Qiu Ning, Cheng Hua
2018, 34(10): 2153-2156. DOI: 10.3969/j.issn.1001-5256.2018.10.018
Abstract:
Objective To investigate the expression of D-bifunctional protein ( DBP) in hepatocellular carcinoma ( HCC) tissue and its correlation with serum tumor markers alpha-fetoprotein ( AFP) and carbohydrate antigen 19-9 ( CA19-9) , as well as the clinical value of DBP in early diagnosis and prognostic evaluation of HCC. Methods A total of 20 patients who underwent hepatectomy for liver cancer in Tangshan Maternal and Child Health Hospital and Tangshan People's Hospital from June 2015 to May 2017 were enrolled as experimental group, and 20 healthy subjects who underwent physical examination in these two hospital during the same period of time were enrolled as control group. Chemiluminescence was used to measure the expression of AFP and CA19-9, and immunohistochemistry was used to measure the expression of DBP, which was expressed as integrated optical density ( IOD) , in HCC tissue and adjacent tissue. The t-test was used for comparison of continuous data between groups, and the Pearson correlation analysis was used to investigate correlation between indices. Results The IOD value of DBP in HCC tissue was significantly higher than that in adjacent tissues ( 220. 52 ± 101. 30 vs 40. 49 ±19. 32, t =-7. 00, P < 0. 01) . The expression of DBP was positively correlated with that of AFP ( r2= 0. 868, P < 0. 01) and CA19-9 ( r2= 0. 814, P < 0. 01) . Conclusion The expression of DBP increases in HCC patients, which is closely associated with the development and progression of HCC. Therefore, it provides a new target for the diagnosis of HCC.
Original articles_Biliary diseases
Influencing factors for the prognosis of patients with early-stage intrahepatic cholangiocarcinoma after radical resection
Huang Jian, Jiang BeiGe, Yang Yuan, Gu FangMing, Yuan ShengXian, Pan ZeYa
2018, 34(10): 2157-2163. DOI: 10.3969/j.issn.1001-5256.2018.10.019
Abstract:
Objective To investigate the influencing factors for the prognosis of patients with early-stage intrahepatic cholangiocarcinoma ( ICC) after surgical treatment. Methods A total of 155 patients with early-stage ICC who underwent radical resection in The Third Affiliated Hospital of Second Military Medical University from January 2013 to December 2014 were enrolled in this study. Clinicopathological features and 1-, 2-, and 3-year overall survival rates and disease-free survival rates after surgery were analyzed. The Cox forward stepwise regression was used for the univariate and multivariate analyses of the influencing factors for the prognosis of early-stage ICC. Results Most patients with early-stage ICC were middle-aged men, with an average tumor diameter of 5. 8 ± 2. 5 cm. Most patients had normal liver function, but there were varying degrees of increase in carbohydrate antigen 19-9 ( CA19-9) level. Postoperative pathological examination revealed highly or moderately differentiated adenocarcinoma in most patients. The 1-, 2-, and 3-year overall survival rates after surgery were 76. 1%, 43. 9%, and 34. 1%, respectively, and the 1-, 2-, and 3-year disease-free survival rates were 50. 3%, 25. 0%, and 18. 1%, respectively. The Cox multivariate analysis showed that high CA19-9 level before surgery ( hazard ratio [HR]=1. 705, 95% confidence interval [CI]: 1. 096-2. 652, P = 0. 018) , liver cirrhosis ( HR = 2. 399, 95% CI: 1. 108-5. 196, P = 0. 026) , satellite nodules ( HR = 1. 918, 95% CI: 1. 124-3. 272, P = 0. 017) , and degree of tumor cell differentiation ( HR = 5. 568, 95% CI:2. 591-11. 965, P < 0. 0001) were independent risk factors for overall survival of patients early-stage ICC. Liver cirrhosis ( HR = 2. 142, 95% CI: 1. 054-4. 353, P = 0. 035) , satellite nodules ( HR = 2. 045, 95% CI: 1. 250-3. 343, P = 0. 004) , and degree of tumor cell differentiation ( HR = 2. 748, 95% CI: 1. 340-5. 638, P = 0. 006) were independent risk factors for disease-free survival of patients early-stage ICC. Conclusion Radical resection is the preferred treatment for patients with early-stage ICC. Preoperative CA19-9 ≥200 U/ml, liver cirrhosis, satellite nodules, and degree of tumor cell differentiation are independent risk factors for the prognosis of early-stage ICC.
Original articles_Others
Clinical features of autoimmune hepatitis in children: An analysis of 10 cases
Chen Jie, Liu YanMin, Huang ChunYang, Huang YunLi, Zhang XiaoDan, Ren MeiXin, Du XiaoFei, Bian XinQu, Liao HuiYu, Han Ying, Dan Jing
2018, 34(10): 2164-2168. DOI: 10.3969/j.issn.1001-5256.2018.10.020
Abstract:

Objective To investigate the clinical features and treatment outcome of children with autoimmune hepatitis ( AIH) . Methods A retrospective analysis was performed for the clinical data, liver pathology, treatment outcome, and follow-up data of 10 children with AIH who were treated in Beijing YouAn Hospital, Capital Medical University, from December 2008 to December 2017. Results The children were aged 3-16 years ( median 10 years) , and girls accounted for 70%. Of all patients, 5 had type 1 AIH, and 5 had type 2 AIH; 3 ( 30%) had an acute onset, 2 ( 20%) had a subacute onset, and 5 ( 50%) had a chronic onset. Elevation of aminotransferases was found in 8 children ( 80%) , and elevations of bilirubin, gamma-glutamyl transpeptidase, and immunoglobulin G were found in 7 children ( 70%) , 7 children ( 70%) , and 6 children ( 60%) , respectively. Among the 7 children who underwent liver biopsy, 3 had grade ≥3 liver inflammation, 4 had stage ≥3 liver fibrosis, 5 had interface hepatitis, 5 had plasma cell infiltration, 4 had rosette-like annulation of hepatocytes, and 7 had lymphocyte infiltration. One child died, and one was lost to follow-up; among the other 8 children, 6 had good response, 1 experienced recurrence, and one had poor response. 4 patients with type 2 AIH were treated with glucocorticoids combined with azathioprine, the disease was effectively controlled. Conclusion Children with AIH have diverse clinical manifestations, and some children have serious conditions. Most patients with type 2 AIH need the treatment of glucocorticoids combined with azathioprine.

Association between MBOAT7 rs641738 polymorphism and nonalcoholic fatty liver disease
Liao SongLing, Liu ShouSheng, Wang Cong, Chen LiZhen, Xin YongNing, Xuan ShiYing
2018, 34(10): 2169-2174. DOI: 10.3969/j.issn.1001-5256.2018.10.021
Abstract:

Objective To investigate the association between MOBAT7 rs641738 polymorphism and the development of NAFLD in the Chinese Han population in Qingdao, China, and to provide a theoretical basis for the prevention and treatment of NAFLD and its complication.Methods A total of 113 NAFLD patients who were treated in Qingdao Municipal Hospital and 74 healthy controls were enrolled in this study. Blood samples were collected, DNA was extracted, and PCR and time-of-flight mass spectrometry were used to determine the genotype of MBOAT7 rs641738. The chi-square test was used to determine whether the distribution of genotypes met the Hardy-Weinberg equilibrium, in order to assess the group representativeness of samples. Clinical data and biochemical results including liver function were collected.The chi-square test was used for comparison of sex and genotype and allele frequencies between the two groups. The independent samples t-test and Wilcoxon rank sum test were used for comparison of continuous data between the two groups. The relative risk of NAFLD associated with gene polymorphisms was expressed as odds ratio ( OR) and 95% confidence interval ( CI) , and the non-conditional logistic regression model was used to calculate OR and 95% CI. Results There was no significant difference in the distribution of CC, CT, and TT genotypes of MBOAT7 rs641738 between the NAFLD group and the control group ( χ2= 0. 157, P = 0. 692) , and there was also no significant difference in the distribution of C and T alleles between the two groups ( χ2= 0. 365, P = 0. 546) . The non-conditional logistic regression analysis showed that the carriers with CC + CT genotypes of MBOAT7 rs641738 had a similar risk of NAFLD as those with CC genotype ( OR = 0. 923, 95% CI: 0. 685-1. 245, P = 0. 692) ; there was also no significant difference after adjustment for sex, age, and body mass index ( corrected OR = 0. 893, 95% CI: 0. 652-1. 223, P = 0. 481) . In the NAFLD group, the carriers with CC + CT genotypes had significantly lower levels of total cholesterol and low-density lipoprotein than those with CC genotype ( t =-2. 348 and-2. 113, P = 0. 021 and0. 037) , and there were no significant differences in the other indices ( all P > 0. 05) . Conclusion There is no significant association between MBOAT7 rs641738 polymorphism and the risk of NAFLD in the Chinese Han population in Qingdao.

Effect of salvianolic acid B on oxidative stress in a cell model of nonalcoholic fatty liver disease
Chen XiaoQing, Ren YuFei, Kong WeiZong, Wang YingChun
2018, 34(10): 2175-2181. DOI: 10.3969/j.issn.1001-5256.2018.10.022
Abstract:

Objective To establish a cell model of nonalcoholic fatty liver disease ( NAFLD) by inducing HepG2 cells with oleic acid ( OA) in vitro, and to investigate the effect of salvianolic acid B ( Sal B) on oxidative stress in NAFLD cells and its possible mechanisms via the intervention of NAFLD cells with Sal B. Methods HepG2 cells were divided into control group, model group ( treated with OA) , and intervention group ( treated with OA + Sal B) . The CCK8 method was used to plot the standard cell growth curve, and the optimal drug intervention concentration and intervention time were determined for OA. Oil red O staining was used to observe intracellular lipid accumulation.The levels of alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , triglyceride ( TG) , and total cholesterol ( TC) were measured. A fluorescence microscope was used to measure the content of reactive oxygen species ( ROS) in cells. The TBA method was used to measure the content of malondialdehyde ( MDA) in cells. RT-qPCR and Western blot were used to measure the mRNA and protein expression of SOD2 and SIRT3. After SIRT3 was upregualted with SIRT3 overexpression plasmid, Sal B intervention was performed. Western blot was used to screen out the optimal ratio of transfection reagent to plasmid, and the change in relative expression of SIRT3 and SOD2 was measured. A one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups. Results The optimal concentration of OA for modeling was 1 mmol/L. The model group had higher levels of ALT and AST in cell culture supernatant than the control group, and the intervention group had lower levels of ALT and AST than the model group; there were significant differences between the three groups ( F = 1240. 075 and 471. 989, both P < 0. 05) . The model group had higher levels of TG and TC in cells than the control group, and the intervention group had lower levels of TG and TC than the model group; there were significant differences between the three groups ( F = 97. 530 and 39. 824, both P < 0. 01) . The model group had a higher MDA level than the control group, and the intervention group had a significantly lower MDA level than the model group; there was a significant difference between the three groups ( F = 336. 67, P < 0. 01) . There were significant differences in the mRNA expression of SIRT3 and SOD2 between the three groups ( F = 119. 35 and 32. 005, both P < 0. 01) ; the model group had significantly lower mRNA expression of SIRT3 and SOD2 than the control group ( P < 0. 05) , and the intervention group had significantly higher mRNA expression of SIRT3 and SOD2 than the model group ( P < 0. 05) . There were significant differences in the protein expression of SIRT3 and SOD2 between the three groups ( F = 67. 093 and 70. 314, both P < 0. 01) ; the model group had significantly lower protein expression of SIRT3 and SOD2 than the control group ( P < 0. 01) , and the intervention group had significantly higher protein expression of SIRT3 and SOD2 than the model group ( P < 0. 01) . The Western blot showed significant differences in the protein expression of SIRT3 and SOD2 between the empty plasmid+ Sal B group, plasmid group, empty plasmid group, and plasmid + Sal B group ( F = 287. 2 and 179. 8, both P < 0. 01) ; the empty plasmid + Sal B group and plasmid group had significantly higher protein expression of SIRT3 and SOD2 than the empty plasmid group ( P < 0. 05) , and the plasmid + Sal B group had significantly higher protein expression of SIRT3 and SOD2 than the plasmid group ( P < 0. 05) . Conclusion Sal B can reduce lipid accumulation and oxidative stress response in NAFLD cells and thus exert a protective effect on NAFLD cells.

Risk factors for variceal rebleeding after esophagogastric devascularization and splenectomy in patients with portal hypertension
Zhao XiaoFei, Lin DongDong, Li Ning, Zang YunJin, Guo QingLiang, Wu JuShan
2018, 34(10): 2182-2185. DOI: 10.3969/j.issn.1001-5256.2018.10.023
Abstract:

Objective To investigate the risk factors for variceal rebleeding after esophagogastric devascularization and splenectomy in patients with portal hypertension. Methods A retrospective analysis was performed for the clinical data of 244 patients with portal hypertension who were admitted to Beijing YouAn Hospital from April 2010 to September 2015 and underwent esophagogastric devascularization and splenectomy. According to the presence or absence of variceal rebleeding, these patients were divided into non-rebleeding group and rebleeding group. Preoperative, intraoperative, and postoperative clinical data were compared between the two groups. The t-test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed data between groups; the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed for statistically significant variables identified by the univariate analysis. Results Of all 244 patients, 38 ( 15. 6%) experienced variceal rebleeding. The univariate analysis showed that there were significant differences between the two groups in the history of variceal bleeding, preoperative ascites, total bilirubin after surgery, portal venous pressure after devascularization, portal venous pressure before and after splenectomy, and preoperative international normalized ratio ( χ2= 5. 530、4. 120, t = 3. 591、4. 098、2. 516、2. 622、4. 278, P = 0. 016, 0. 026, 0. 008, 0. 002, 0. 022, 0. 012, and 0. 003) . The multivariate logistic regression analysis showed that variceal rebleeding after esophagogastric devascularization and splenectomy was associated with the history of variceal bleeding ( 95% CI:1. 113-13. 704, P = 0. 033) , preoperative ascites ( 95% CI: 1. 257-5. 437, P = 0. 010) , and portal venous pressure after devascularization ( 95% CI: 1. 022-1. 172, P = 0. 010) . Conclusion History of variceal bleeding, preoperative ascites, and portal venous pressure after devascularization are independent risk factors for variceal rebleeding after esophagogastric devascularization and splenectomy.

Clinical features of hemophagocytic lymphohistiocytosis with abnormal liver function as the initial manifestation
Ceng QingHuan, Sun YaNan, Liu YuanZhi, Li Peng, Yu HaiBin, Wu YanJing, Xiong Feng, Zhang ShiBin
2018, 34(10): 2186-2189. DOI: 10.3969/j.issn.1001-5256.2018.10.024
Abstract:

Objective To investigate the clinical and laboratory features of hemophagocytic lymphohistiocytosis ( HLH) with abnormal liver function as the initial manifestation, and to increase the awareness of this disease. Methods A retrospective analysis was performed for the clinical data of 11 patients who attended the hospital due to abnormal liver function from November 2011 to October 2017 and were diagnosed with HLH, including their medical history, etiology, clinical manifestation, laboratory examination results, and prognosis. Results Of all11 patients, 9 ( 81. 8%) had infection as the etiology of HLH, and as for clinical manifestation, 11 ( 100%) had pyrexia and 9 ( 81. 8%) had splenomegaly. Laboratory examination showed varying degrees of abnormal liver function in all patients, among whom 10 ( 90. 9%) had elevated alanine aminotransferase, 11 ( 100%) had elevated aspartate aminotransferase, 10 ( 90. 9%) had an increase in total bilirubin, 9 ( 81. 8%) had a reduction in albumin, 10 ( 90. 9%) had a reduction in cholinesterase, 9 ( 81. 8%) had an increase in gamma-glutamyl transpeptidase, 10 ( 90. 9%) had an increase in alkaline phosphatase, and 5 ( 83. 3%) had an increase in lactate dehydrogenase. Elevated ferritin in the early course of the disease had the highest sensitivity ( 11/11, 100%) in the diagnosis of this disease, followed by triglyceride >3 mmol/L ( 6/7, 85. 7%) . In the early course of the disease, the positive rates of peripheral cytopenia of two or more lineages and reduced fibrinogen were 54. 5% and 45. 4%, respectively. Dynamic monitoring showed that all patients experienced peripheral cytopenia of two or more lineages. Hemophagocytosis was observed in all patients. NK cell activity and soluble CD25 ( s CD25) level were measured for 7 patients, and they all had a reduction in NK cell activity and an increase in s CD25 level. Conclusion Some diagnostic indices of HLH have a low positive rate in the early course of the disease. For patients with unexplained abnormal liver function and persistent fever, HLH cannot be excluded even if no significant peripheral cytopenia is observed in the early stage. The change in blood cells should be monitored, and laboratory examination including ferritin and blood lipids should be performed as early as possible to assist early diagnosis and treatment.

Case reports
Acute hepatitis E with hyperthyroidism: A case report
Kui YiWen, Mao MiaoMiao, Dong KaiHui, Jin QingLong
2018, 34(10): 2190-2191. DOI: 10.3969/j.issn.1001-5256.2018.10.025
Abstract:
A case of congenital hepatic fibrosis with lgG4-related disease
Li ZhengXin, Xing Feng, Zhou Yang, Chen GaoFeng, Liu ChengHai
2018, 34(10): 2192-2194. DOI: 10.3969/j.issn.1001-5256.2018.10.026
Abstract:
Hepatolenticular degeneration with polycystic ovary syndrome: a case report
Huang DeLiang, Zhu ZhiBin, Yu Hong, Zhao Qi, Jiang JinYan, Chen YuanYuan, Dai Wei
2018, 34(10): 2195-2196. DOI: 10.3969/j.issn.1001-5256.2018.10.027
Abstract:
A case of paroxysmal nocturnal hemoglobinuria with Budd-Chiari syndrome as the first manifestation
Wu KaiMin, Cao Shan, Zhang GuoYan, Chen GuoDong, Su Lin, Wang ZhiFeng, Liu YuLan
2018, 34(10): 2197-2199. DOI: 10.3969/j.issn.1001-5256.2018.10.028
Abstract:
Acute drug-induced liver injury progressing to chronic drug-induced liver injury with autoimmune hepatitis-like syndrome: A case report
Li Chen, Su HaiBin, Liu XiaoYan, Xu Xiang, Li Hui, Hu JinHua
2018, 34(10): 2200-2202. DOI: 10.3969/j.issn.1001-5256.2018.10.029
Abstract:
A case of portopulmonary hypertension
Yin Xin, Gao Hui, Zhang Yu, Zhang MingYuan, Jin QingLong, Wen XiaoYu
2018, 34(10): 2203-2205. DOI: 10.3969/j.issn.1001-5256.2018.10.030
Abstract:
A case of missed diagnosis of IgG4-related sclerosing cholangitis
Du HengRui, Wang ZhenJiang, Ren YanXian, Ma ZhiJian, Wang KeShen, Zhan Hao, Yu ZeYuan, Jiao ZuoYi
2018, 34(10): 2206-2207. DOI: 10.3969/j.issn.1001-5256.2018.10.031
Abstract:
Reviews
Research advances in the application of antiviral drugs during pregnancy for blocking mother-to-child transmission of hepatitis B virus
Wang HuiJuan, Duan ZhongPing, Zhang HuanHu, Ren Feng
2018, 34(10): 2208-2212. DOI: 10.3969/j.issn.1001-5256.2018.10.032
Abstract:
Mother-to-child vertical transmission is an important route of transmission for hepatitis B virus ( HBV) infection in patients with chronic hepatitis B, and the rate of HBV infection increases with the increase in the mother's HBV viral load. Although active and passive immunoprophylaxis has been implemented for neonates at present, the rate of mother-to-child vertical transmission of HBV remains around 10%. Therefore, pregnant women with a high viral load should receive antiviral therapy to reduce the viral load, in order to prevent and block the mother-to-child transmission of HBV and reduce the incidence rate of chronic hepatitis B. By retrieving related literature in China and foreign countries, this article describes the safety and efficacy of antiviral agents during pregnancy and provides a reliable basis for guiding medication during pregnancy.
Management and prevention of HBV reactivation in the context of immunosuppression
Dong KaiHui, Fang YiNa, Kui YiWen, Mao MiaoMiao, Guan YanEr, Wen XiaoYu, Jin QingLong
2018, 34(10): 2213-2216. DOI: 10.3969/j.issn.1001-5256.2018.10.033
Abstract:
HBV reactivation is commonly seen during immunosuppressive therapy and is associated with high incidence and mortality rates due to hepatitis outbreak and liver decompensation, and therefore, it should be taken seriously. However, the prevention and management of this potential complication is still a difficulty in clinical practice. This article reviews the diagnostic criteria and clinical outcomes of HBV reactivation, discusses the association of immunosuppressive therapy with the risk of HBV reactivation, and outlines the strategies for the prevention of HBV reactivation and recent advances. It is pointed out that early identification of patients with HBV infection before immunosuppressive therapy is of vital importance, and the initiation of antiviral therapy at the right moment based on risk stratification can effectively reduce the risk of HBV reactivation. We hope that this review can increase the awareness of HBV reactivation among clinicians and provide an effective reference for optimizing the management and prevention of HBV infection.
Dual role of autophagy in hepatitis B virus and related liver diseases
Peng JiaLi, Lai Xin, Wei Jia
2018, 34(10): 2217-2220. DOI: 10.3969/j.issn.1001-5256.2018.10.034
Abstract:
Autophagy is a process of lysosome degradation and has a dual role in the development and progression of diseases, i. e., it can promote cell survival and induce cell death. This article introduces the dual role of autophagy in hepatitis B virus ( HBV) , chronic hepatitis B, liver fibrosis, and hepatocellular carcinoma and the mechanism of action of autophagy in related liver diseases. It is pointed out that autophagy may be a future research direction for the treatment of HBV-related liver diseases and can provide new ideas for the treatment of liver fibrosis and hepatocellular carcinoma.
Significance of hepatitis B virus pregenomic RNA in the progression of chronic hepatitis B
Tan Ning, Luo Hao, Xu XiaoYuan
2018, 34(10): 2221-2223. DOI: 10.3969/j.issn.1001-5256.2018.10.035
Abstract:
Hepatitis B virus ( HBV) pregenomic RNA ( pgRNA) is the direct transcription product of HBV covalently closed circular DNA ( cccDNA) and can reflect the transcriptional activity of HBV cccDNA and the progression of chronic hepatitis B, which provides guidance for clinical treatment and prognostic prediction. Compared with other common serological markers for HBV infection, HBV pgRNA is more sensitive in reflecting HBV replication and the effect of antiviral therapy has a certain predictive value for endpoints in the stages of antiviral therapy. This article elaborates on the significance of HBV pgRNA in reflecting the changes in disease conditions with reference to the correlation of HBV pgRNA with HBcrAg and HBV cccDNA.
Research advances in anticoagulant therapy for liver fibrosis
Xia YiFu, Zhang ChunQing
2018, 34(10): 2224-2226. DOI: 10.3969/j.issn.1001-5256.2018.10.036
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Liver fibrosis is a pathological process in which chronic liver disease develops into liver cirrhosis. It is caused by diffuse proliferation of liver fibrous tissue on the basis of extensive necrosis of liver cells, resulting in destruction of the normal structure and blood supply of liver lobules. In the process of liver fibrosis, platelets aggregate in the sinusoids to form microthrombi, which may promote liver fibrosis.This article briefly describes the relationship between platelets and liver fibrosis and reviews the latest advances in anticoagulant therapy for improving liver function and liver fibrosis score. The molecular mechanism of anticoagulant therapy remains to be studied, and safe and effective anticoagulants may provide a new approach for the treatment of liver fibrosis.
Research advances in the pathogenesis and risk factors of non-obese non-alcoholic fatty liver fibrosis and liver cirrhosis
Chen YanZhen, Chen ChengLiang, Hong Yu, Wang Guan, Jiao Jian
2018, 34(10): 2227-2231. DOI: 10.3969/j.issn.1001-5256.2018.10.037
Abstract:
At present, non-alcoholic fatty liver disease ( NAFLD) has become the major cause of chronic liver disease in the world and is considered a common pathogenic factor of cryptogenic cirrhosis. In clinical practice, NAFLD is commonly seen in obese patients; however, it is not rare among non-obese individuals, especially in the Asian population. Non-obese NAFLD patients have similar metabolic profiles to obese NAFLD patients, but many studies have revealed that compared with obese NAFLD, non-obese liver fibrosis and liver cirrhosis have unique features. This article reviews the research advances in the pathogenesis and risk factors of non-obese non-alcoholic fatty liver fibrosis and liver cirrhosis in recent years, in order to gain a better understanding of the prevention, diagnosis, and treatment of this disease.
Research advances in the treatment of nonalcoholic fatty liver disease
Suo YuHong, Liu JinChun
2018, 34(10): 2232-2236. DOI: 10.3969/j.issn.1001-5256.2018.10.038
Abstract:
Nonalcoholic fatty liver disease ( NAFLD) has become the leading cause of abnormal liver enzymes in healthy individuals in China. Due to the complex pathogenesis of NAFLD, no consensus has been reached on the treatment of this disease. However, in recent years, more and more studies have put forward more pathogeneses and corresponding treatment recommendations. This article introduces and summarizes the research advances in the treatment of NAFLD, including lifestyle intervention, drug treatment, eradication of Helicobacter pylori, surgical treatment, regulation of intestinal microecology, and gene therapy.
Thromboprophylaxis and bleeding control in patients with liver disease in the intensive care unit
Xing WenLi, Li Qian
2018, 34(10): 2237-2240. DOI: 10.3969/j.issn.1001-5256.2018.10.039
Abstract:
Liver diseases are associated with complex abnormalities in the coagulation system as the liver is involved in the synthesis of various coagulation-related proteins. Laboratory and clinical evidence suggests that patients with liver disease may achieve a state of rebalanced hemostasis, but such balance is relatively unstable, and thus bleeding and thrombosis events are observed in clinical practice. Patients with acute or chronic liver diseases might be admitted to the intensive care unit ( ICU) due to serious complications such as bleeding and thrombosis. Gastrointestinal bleeding, systemic or local thrombosis, and coagulation events in extracorporeal circulation are common complications observed in patients with liver disease in the ICU. An individualized management plan of thromboprophylaxis and a wait-and-see policy for limited blood transfusion are reasonable for patients with liver disease.
Application of anticoagulants after transjugular intrahepatic portosystemic shunt
Jiang MingYuan, Huang Hua, Lu MingLiang, Lin FanYu, Zhang YingYuan
2018, 34(10): 2241-2244. DOI: 10.3969/j.issn.1001-5256.2018.10.040
Abstract:
Transjugular intrahepatic portosystemic shunt ( TIPS) , after nearly 30 years of continuous exploration and development, has been widely used in the treatment of complications of portal hypertension. TIPS has significant advantages in acute esophagogastric variceal bleeding, prevention of rebleeding, refractory peritoneal effusion, and Budd-Chiari syndrome; however, if postoperative anticoagulant measures are inappropriate, it can cause several complications, such as stent dysfunction and acute thrombosis, and lead to the recurrence of the symptoms of portal hypertension before TIPS, which greatly affects middle-and long-term clinical outcomes and survival rate. Maintenance of stent patency is the key to good postoperative treatment outcome, and therefore, anticoagulants play an important role in the prevention and treatment of post-TIPS thrombosis. At present, no consensus has been reached on post-TIPS anticoagulant therapy in China and foreign countries. This article reviews the research advances in the application of anticoagulants after TIPS.
Research advances in endoscopic treatment of biliary complications after liver transplantation
Xu Hui, Li Bing
2018, 34(10): 2245-2250. DOI: 10.3969/j.issn.1001-5256.2018.10.041
Abstract:
Liver transplantation remains the ultimate treatment regimen for patients with end-stage liver disease or acute liver failure. The incidence rate of biliary complications has significantly decreased with the improvement and development of organ preservation, novel immunosuppressants, perioperative management, and hepatobiliary surgery; however, there are still many challenges in the treatment of biliary complications after liver transplantation, which has become a major influencing factor for quality of life and survival time after liver transplantation. Biliary complications after liver transplantation include biliary stricture, anastomotic leakage, and cholelithiasis, and therapies include drugs, endoscopy, liver puncture and biliary drainage, and surgery. With the rapid development and wide use of endoscopic retrograde cholangiopancreatography ( ERCP) in recent years, the success rate of operation has reached as high as 90%-98%. Due to the advantages of low cost, low invasiveness, and relatively high safety, ERCP has become the first-line treatment of biliary complications after liver transplantation.
Individualized treatment of calculous cholecystitis
Du QianCheng, Zhou Ying, Zhang LingQiang, Hu ChenLiang, Fan HaiNing
2018, 34(10): 2251-2256. DOI: 10.3969/j.issn.1001-5256.2018.10.042
Abstract:
Calculous cholecystitis is a common disease in clinical practice. There are various therapies for this disease, mainly cholecystectomy, and laparoscopic cholecystectomy has always been considered the gold standard for the treatment of calculous cholecystitis. However, medication, percutaneous transhepatic gallbladder drainage, and gallbladder-preserving cholecystolithotomy can be selected based on patient age, conditions, comorbidities, and preference. This article briefly describes the features of medication, interventional treatment, and surgical treatment in patients with calculous cholecystitis and points out that the optimal treatment regimen should be selected based on the features of calculous cholecystitis in each patient. This article also proposes the individualized treatment mode for calculous cholecystitis.