门静脉高压症治疗方法的演变及个体化治疗原则

Q4 Medicine
D. Efimov, D. Fedoruk, A. Nosik, L. Kirkovsky, O. N. Kozak, E. L. Avdey, A. V. Savchenko, S. Korotkov, A. Shcherba, O. Rummo
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引用次数: 1

摘要

目标分析明斯克外科、移植学和血液学科学与实践中心旨在减轻门静脉高压综合征并发症的各种策略。材料和方法。对接受过不同类型治疗的患者进行回顾性观察:分流手术形成门腔吻合、经颈静脉门体分流术和肝移植。分析了以下参数:并发症发生率、住院死亡率、生存率和围手术期指标。后果自1980年以来,该中心共进行了131例分流手术,自2008年以来,共进行了880例肝移植和232例经颈静脉门体分流术。在68名接受分流安置的代偿性肝硬化患者中,没有医院死亡率的报告,而在Child-Pugh B型肝硬化和Child-Pugh C型肝硬化患者中的死亡率分别达到19.5%和87.5%。TIPS后,总病例死亡率达到9.9%(移植前TIPS后为8.2%,最终治疗后为12.8%)。肝移植后,住院死亡率达到7.7%。结论:50多年来,由于建立了为这些患者提供完整周期的所有治疗措施的机构,门静脉高压症的管理策略发生了重大变化。患有门静脉高压综合征并发症的患者往往在医院接受最有效的治疗,这些医院在合理的保守治疗、血管内手术和移植方面有经验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evolution of approaches to portal hypertension syndrome and principles underlying treatment personalization
Aim. To analyze various strategies aimed at mitigating complications of the portal hypertension syndrome at the Minsk Scientific and Practical Center for Surgery, Transplantology, and Hematology.Material and methods. Patients who had undergone different types of treatment were retrospectively observed: shunt surgery to form portacaval anastomoses, transjugular portosystemic shunt placement, and liver transplantation. The following parameters were analyzed: incidence of complications, hospital mortality rate, survival rate, and perioperative indicators.Results. Since 1980, 131 shunt surgeries have been performed at the Center, while 880 liver transplantations and 232 transjugular portosystemic shunt placement procedures have been performed since 2008. Among 68 patients with compensated cirrhosis who had undergone shunt placement, no hospital mortality rate was reported, whereas in patients with Child-Pugh B cirrhosis and Child–Pugh C cirrhosis, it reached 19.5% and 87.5%, respectively. Following TIPS, the overall case mortality rate amounted to 9.9% (following TIPS prior to transplantation – 8.2%, following TIPS used as the final treatment – 12.8%). After liver transplantation, in-hospital mortality rate reached 7.7%.Conclusion. Over 50 years, the strategy for managing portal hypertension has undergone significant changes due to the establishment of institutions providing a complete cycle of all treatment measures for such patients. Patients suffering from the complications of the portal hypertension syndrome tend to receive the most effective treatment in hospitals having experience in rational conservative therapy, endovascular procedures, and transplantation.
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来源期刊
Annals of HPB Surgery
Annals of HPB Surgery Medicine-Gastroenterology
CiteScore
0.70
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