Results and Prospects of Portosystemic Shunting in Patients with Liver Cirrhosis

Nazyrov, F. G.; Devyatov, A. V.; Бабаджанов, А. Х.

doi:10.16931/1995-5464.2015231-39

Cited by 4 publications

(1 citation statement)

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“…The obtained positive results of drug anti-relapse treatment with the appointment of a course of special antiparasitic drugs, even after an ideally performed operation, make it possible to introduce the technique into widespread practice and reduce the frequency of complications. Thus, chemotherapy or anthelmintic therapy is used to influence small-sized echinococcus [20,21].…”

Section: клінічна медицинаmentioning

confidence: 99%

Improvement of Treatment and Prevention of Liver Echinococcosis

Abbasalieva¹

2022

Ukr. ž. med. bìol. sportu

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The purpose of the study was to determine optimal pathogenetically justified methods and means to improve the results of diagnosis and treatment of liver echinococcosis. Materials and methods. During treatment, on the 1st, 3rd, 5th, and 10th day of the postoperative period, patients were examined for the functional state of the liver by blood analysis for the amount of proinflammatory cytokines TNF-α, IL-6, IL-4 and IL-10, IL-1. The activity of humoral immunity was assessed based on the level of immunoglobulins IgA, IgG and IgM. Results and discussion. On the 1st day after the operation, the level of IgA increased and amounted to 5.56 ± 0.1 q/L. The improvement in the dynamics of indicators was observed on the 5th day of observations, and this trend persisted up to 10 days after surgical treatment. On day 5, a significant decrease in the concentration of the main proinflammatory cytokines TNF-α, IL-6 and IL-4 was revealed, compared with the indicators before treatment and on the first day after treatment – 12.5 ± 0.6 pg/ml; 11.7 ± 0.3 pg/ml and 4.0 ± 0.2 pg/ml, respectively. This treatment regimen resulted in a marked decrease in TNF-α, IL-6 and IL-10 levels on day 10. The initial level of cytokines and immunoglobulins indicates a pronounced immunosuppressive effect on the body of a parasitic disease. A significant decrease in cytokines IL-1, IL-6 and IL-10 in patients after surgery and a decrease in indicators after maintenance therapy can serve as a potential immunological marker for evaluating its effectiveness. When studying the cytokine profile in the patients we examined, there was a significant increase in the level of TNF-α and IL-6 in blood serum relative to the control values, which is directly dependent on the severity of the pathological process and the functional state of the liver and suppresses the secretion of anti-inflammatory cytokines, which was confirmed by data from foreign authors. As well as the works published earlier, the data of our studies show that Echinococcus granulosus cysts induce a strong antibody response in most patients, causing, at the same time, a reaction of antigen-specific antibodies of various classes with different intensity and specificity against the background of their synthesis and increased secretion. It is necessary to note an increase in quantitative and qualitative indicators of IgG, IgM and IgA levels in the blood serum of patients with liver echinococcosis, with IgG predominance. Conclusion. A comprehensive study of inflammatory mediators and the dynamics of cytokine levels makes it possible to diagnose complications in time and prevent possible relapses of the disease. The data obtained made it possible to justify the further use of imunofan and to develop recommendations for the management of patients with liver echinococcosis in the postoperative period

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Section: клінічна медицинаmentioning

confidence: 99%

Improvement of Treatment and Prevention of Liver Echinococcosis

Abbasalieva¹

2022

Ukr. ž. med. bìol. sportu

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Portosystemic shunting procedures for complicated portal hypertension: modern opportunities of mini-invasive technique

et al. 2021

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Aim. To improve the results of treatment for patients with complicated portal hypertension of cirrhotic genesis using the transjugular intahepatic portosystemic shunt with endovascular obliteration of the inflow pathways to the esophageal-gastric varicose veins.Material and methods. Transjugular intahepatic portosystemic shunt was performed in 172 patients with gastroesophageal variceal bleeding. The patients were divided into 3 clinical groups. The shunting procedure was applied to 62 patients. Another 110 patients underwent transjugular intahepatic portosystemic shunt and selective obliteration of the esophageal-gastric vein inflow pathways. The short-term and long-term results (up to 140 months), the incidence of thrombosis, recurrent bleeding and mortality, as well as their relationship with the established risk factors for complications were traced.Results. All patients achieved an effective reduction in the portosystemic pressure gradient and a reduction in the manifestations of portal hypertension. Recurrence of bleeding caused by shunt thrombosis occurred in 23 (13.3%) patients. In clinical group I (n = 62), this complication was noted in 9 (14.5%) patients, in II (n = 54) – 11 (20.4%) cases, in III (n = 56) – only in 3 (5.4%) cases. Bleeding-free survival decreased from 1.0 to 0.82 in 83.9 months, then plateaued. A sharp decrease in the Kaplan–Meier curve from 1.0 to 0.88 was observed within 24.5 months after the intervention. The largest number of deaths was in group I (30.6%), the smallest in group III (7.1%).Conclusion. Transjugular intahepatic portosystemic shunt supplemented by obliteration the inflows of the esophagealgastric varicose veins provides complete eradication of varicose veins, helps to reduce the frequency of recurrent bleeding and death.

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Transjugular Portosystemic Shunting in Refractory Cirrhotic Ascites

Хоронько

Козыревский

Дмитриев

et al. 2021

Rossijskij žurnal gastroènterologii, gepatologii, koloproktolog

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Aim. Improvement of refractory ascites (RA) outcomes in underlying cirrhotic portal hypertension (PH) through optimising the transjugular intrahepatic portosystemic shunting (TIPS) procedure among therapy measures.Materials and methods. The survey included 107 patients with RA admitted to portal hypertension units of the Rostov State Medical University Surgical Clinic during 2007—2020. The patients were randomly assigned to two cohorts similar by gender, age, cirrhosis aetiology and condition severity. The control cohort had conventional paracentesis and albumin infusion. In cohort 2, 57 patients had minimally invasive endovascular TIPS surgery in a recommended setting.Results. TIPS eliminated PH in all 57 patients of cohort 2. Cohort 1 was reported with progressive esophagogastric varices (EGV), their enlargement in 37 and rupture in 11 patients during the first 12 months. Cohort 2 revealed the grade 3—2 and 2—1 EGV reduction in 24 (41.1%) patients with shunt surgery and in 39 (68.4%) patients in one year. Esophagogastric variceal bleeding (EGVB) developed in 9 patients in cohort 1, with 7 lethal outcomes. No variceal bleeding was observed in cohort 2, with 7 patients having the portosystemic shunt dysfunction.Conclusion. The TIPS procedure is justified in cirrhotic PH patients with RA for reducing the mortality rate in a one year follow-up.

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Results and Prospects of Portosystemic Shunting in Patients with Liver Cirrhosis

Cited by 4 publications

References 0 publications

Improvement of Treatment and Prevention of Liver Echinococcosis

Improvement of Treatment and Prevention of Liver Echinococcosis

Portosystemic shunting procedures for complicated portal hypertension: modern opportunities of mini-invasive technique

Transjugular Portosystemic Shunting in Refractory Cirrhotic Ascites

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