Dopplerography modifications in patients with thrombosis of the spleno-portal venous axe: prospective, descriptive, consecutive study

Catedra de radiologie și imagistică, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu”, Chișinău, Republica MoldovaRezumat. Introducere. Tromboza portală, odată apărută, include diverse implicații clinice, cum ar fi agravarea hipertensiunii portale, instalarea ascitei rebele tratamentului cu diuretice, creșterea incidenței encefalopatiei portale și a sindromului hepatorenal. Este dovedit faptul că dereglările circulației hepatice, secundare modificărilor morfologice avansate din ciroza hepatică, crează premize pentru apariția trombozelor venoase pe axul spleno-portal. Sunt necesare metode imagistice accesibile de evaluare a modificărilor hemodinamice associate cirozei hepatice. Studiul prezent a avut drept scop indentificarea indicatorilor hemodinamici dopplerografici cu valoare predictivă importantă pentru evoluția complicațiilor trombotice asociate hipertensiunii portale cirogene. Material și metode. Grupul de cercetare a inclus 111 pacienți, diagnosticați clinico-bilogic și imagistic cu ciroză hepatică. Au fost evaluate sindroamele citolitic, colestatic, hepatopriv. Morfologia hepatică, inclusiv, personalizarea arborelui vascular, a fost evaluată prin ecografie convențională și doppler duplex color. La prelucrarea datelor au fost utilizate module de analiză statistică variațională, calculul indicatorilor de sensibilitate și specificitate. Rezultate. Viteza medie ponderată în timp în vena portă a fost semnificativ redusă la pacienții cirotici cu tromboze în diferite segmente ale axului spleno-portal: 11,00±0,73 cm/sec, comparativ cu cazurile, în care sistemul venos a fost permiabil: 13,60±0,22 cm/sec (p2,1 (RP 3,5). Concluzii. Evaluarea indicatorilor hemodinamici prin ecografie doppler duplex color a permis identificarea parametrilor cu valoare de pronostic în evoluția trombozelor portale, asociate cirozei hepatice.Abstract. Introduction. Once appeared, portal thrombosis includes several clinical implications, such as: worsening of portal hypertension, installation of non-responsive to diuretics ascites, elevation of portal encephalopathy and hepato-renal syndrome. It is a proven fact that, disturbances of liver circulation secondary to advanced morphological modifications from liver cirrhosis creates premises for thrombosis of the splenoportal venous axe. Accessible imagistic methods are necessary to evaluate hemodynamic modifications associated to liver ciropirhosis. The present study had the aim to identify dopplerography hemodynamic indicators with predictive value, important for evolution of thrombotic complications associated to portal hypertension in cirrhosis. Material and methods. The research group included 111 patients, diagnosed clinically, biologically and via imagistic methods with liver cirrhosis. The following syndromes have been evaluated: cytolytic, cholestatic, and hepatoprive. Liver morphology, personalization of the vascular tree inclusive, was evaluated using conventional echography and colour duplex Doppler. Data process was made using variational statistics analyse modules, and calculating indicators of sensibility and specificity. Results. Mean portal velocity was significantly reduced in cirrhotic patients with thrombosis in different segments of the hepato-portal venous axe: 11.0±0.73 cm/sec comparing to cases where the venous system was permeable 13.6±0.22 cm/sec (p<0.001), it was established that the portal venous index was significantly diminished -7.00±0.71, and portal hypertension index was elevated -2.90±0.23 (p<0.001), portal thrombosis was seen more often at portal hypertension index greater than 2.1 (RP 3.5). Conclusions. Evaluation of hemodynamic indicators by means of duplex colour Doppler echography offered the possibility to identify parameters with prognostic value in the evolution of portal thrombosis associated to liver cirrhosis

Вклад неинвазивных методов визуализации в прогнозировании цирроза печени и портальной гипертензии

USMF Nicolae Testemițanu, Catedra Radiologie și Imagistică, Conferința naţională de gastroenterologie şi hepatologie cu participare internaţională ”Actualităţi în gastroenterologie şi hepatologie” 16 iunie 2016 Chișinău, Republica MoldovaThe diagnosis by non-invasive methods of liver cirrhosis and portal hypertension is a difficult issue and a subject of continuing research of liver pathology. The present study aims to assess the contribution of imaging methods in prediction of liver cirrhosis evolution and associated portal hypertension (PHT) and highlighting the importance of color duplex Doppler ultrasound. In the period 2012-2014 in the Department of Internal Medicine, Gastroenterology discipline, Clinical Republican Hospital were investigated 222 patients diagnosed with liver cirrhosis associated with PHT. Main group were 111 patients, investigate by complex biological and clinical imaging, including ultrasound doppler duplex color. The control group comprised 111 patients, examined to two-dimensional ultrasound, endoscopy upper gastrointestinal, hepato-lienal scintigraphy and 28 patients received computed tomography angiograph regime. Study results found similar diagnostic accuracy of ultrasound Doppler and color duplex tomoangiografy in confirmation of cirrhosis (DMH 1.8, p=0.17596), valuing complex diagnostic approach to patients with chronic liver disease.Диагностика неинвазивными методами цирроза печени и портальной гипертензии является сложной проблемой и объектом непрерывных научных исследований в области патологии печени. Настоящее исследование направлено на оценку методов визуализации, их вклада в прогнозировании цирроза и портальной гипертензии, подчёркивая важность дуплексной допплерографии. В период 2012-2014 годов в Департаменте внутренней м едицины , дисциплина гастроэнтерология , Клинической Республиканской больницы исследовали 222 пациентов, диагностированных с портальной гипертензией, связанной с циррозом. Основную группу составили 111 пациентов, обследованных с помощью цветного дуплексного картирования с определением количественных параметров на артериальном и на венозном руслах. Контрольную группу составили 111 пациентов, которые были обследованы ультразвуком, фиброгастроскопией, сцинтиграфией, и 28 пациентов – компьютерной томографией в режиме ангиографии. Результаты показали информативность цветового дуплексного сканирования сопоставимые с томографией (DMH 1.8, p=0.17596), что делает обоснованным использование комплексного диагностического подхода к пациентам с хроническими заболеваниями печени

Оценка диагностических методов визуализации дл уточнения портальной гипертензии у больных с циррозом печени

USMF Nicolae Testemiţanu, CM Ana-Maria, mun. Chişinău, Conferinţa Naţională de Gastroenterologie și Hepatologie cu participare internaţională 20 iunie 2014 Chişinău, Republica MoldovaStaging the portal hypertension (PHT) is of particular importance in determining prognosis, the severity of which is directly correlated with the stage of liver disease. Noninvasive methods for the diagnosis of PHT were reviewed, treating separately and extensively for the contribution of eco Dopplerography. Emphasizing the important role that rational diagnostic protocol has which should be structured on opportunity to obtain a reliable diagnosis.Определение тяжести портальной гипертензии (ПГТ) имеет особое терапевтическое и прогностическое значение для больных с циррозом печени. В статье уточнены преимущества не инвазивных методов диагностики ПГТ, позволяющих с высокой точностью установить наличие заболевания, определить его стадию, а также выбрать наиболее эффективное лечение, особо выделив значение ультразвуковой допплерографии (УЗД). Подчеркивается необходимость и роль рационального диагностического протокола УЗД, структурированного и оптимизированного для адекватного диагноза

Clinical, endoimagistic and morfologic profile of pacients with portal hypertension due to cirrhosis and therapeutic options

Catedra de chirurgie nr. 2, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu”, Chișinău, Republica Moldova, Centrul Medical „Excellence”, Chișinău, Republica Moldova, Catedra de anatomie patologică, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu”, Chișinău, Republica MoldovaObiective. Hipertensiunea portală ocupă un rol principal printre cauzele de deces prin ciroză hepatică și are o prezentare clinică variabilă și un management terapeutic multimodal anevoios. Material și Metode. Am efectuat un studiu retrospectiv în Clinica I Chirurgie, Universitatea de Medicină și Farmacie ,,Nicolae Testemițanu”, în perioada anilor 2010-2020, care a inclus pacienții cirotici diagnosticați și tratați chirurgical pentru hipertensiune portală. Rezultate. În studiu au fost incluși 366 pacienți. Raportul bărbați/femei a fost de 149/217, cu vârsta medie de 46±5,27 ani. Scorul Child a celor incluși în studiu a fost A/B/C = 27/314/25. Diagnosticul a fost confirmat printr-o combinație de investigații clinice, biochimice, endoimagistice, chirurgicale și morfopatologice (Knodell-Desmet / Fibroscan). Ordinea operațiilor după frecvență a fost: devascularizare azygoportală Hassab (abord deschis – 302 cazuri, laparoscopic – 42 cazuri); transplant hepatic – 14 cazuri și anastamoze porto-cave – 8 cazuri. De asemenea, concomitent am efectuat 16 colecistectomii, 10 apendicectomii, 2 rezecții caudale de pancreas și o rezecție gastrică. Concluzii. Selecția pacienților cu ciroză hepatică și hipertensiune portală de interes chirurgical este riguroasă și necesită un consens interdisciplinar, unde gravitatea modificărilor hemodinamicii portale are valoare decesivă în adaptarea unui management selectiv și în obținerea unor rezultate terapeutice de succes.Objectives. Portal hypertension plays a major role among causes of death due to hepatic cirrhosis and it has a variable clinical presentation and a difficult multimodal therapeutic management. Material and method. We conducted a retrospective study within the Surgery Department No 1, USMF “Nicolae Testemițanu”, over the 2010-2020 period, which included cirrhotic patients diagnosed and surgically treated for portal hypertension. Results. The study included 366 patients. The male/female ratio was 149/217, and the average age of 46±5.27 years. Child score of those included in the study was A/B/C = 27/314/25. The diagnosis was confirmed by a combination of clinical, biochemical, imagistic, surgical and morphopathological investigations (Knodell-Desmet/Fibroscan). The order of surgical interventions by frequency was: Hassab azygoportal devascularization (open approach – 302, laparoscopic approach – 42 cases); liver transplantation – 14 cases and porto-cave anastamosis – 8 cases. Also, in association with first interventions, we performed 16 cholecystectomies, 10 appendicectomies, 2 pancreatic caudal resections and a gastric resection. Conclusion. The selection of patients with hepatic cirrhosis and portal hypertension PH of surgical interest is rigorous and requires an interdisciplinary consensus, where the severity of changes in the portal hemodynamics has a decisive value in adapting a selective management and in obtaining successful therapeutic results

Портальная гемодинамика в зависимости от степени тяжести цирроза печени

Catedra Radiologie și Imagistică Medicală, USMF Nicolae Testemițanu, Departamentul Medicină Internă, Disciplina Gastroenterologie, Clinica medicală nr. 4, USMF Nicolae Testemițanu, Catedra Chirurgie nr. 2, USMF Nicolae Testemițanu, Al IV-lea Congres Naţional de Gastroenterologie şi Hepatologie cu participare internaţională 25 - 26 iunie 2015 Chişinău, Republica MoldovaResearch of portal hemodynamic in portal hypertension associated with liver cirrhosis provides important information on the physiopathology of the disease and helps in exploring new alternative healing modalities. The present study is aimed at highlighting their correlations between parameters evaluated by color duplex Doppler sonography and the severity of liver cirrhosis using Child-Pugh score. The research group included 111 patients during the years 20122104, which were treated in the Department of Hepatology at the University Clinical Hospital. The severity of liver cirrhosis was assessed according to Child-Pugh classification prognosis, which included: Class A (5-6 points), Class B (7-8 points), Class C (10-15 points). Portal hemodynamic was studied by ultrasound color duplex Doppler assessment of quantitative parameters with both arterial and venous side and correlated with clinical and laboratory criteria Child-Pugh. The research has established a significant correlation between time-weighted average velocity in the portal vein, congestion index, vascular portal index, splenoportal index and portal hypertension index with clinical stage of the disease Иссл едование портальной гемодинамики при портальной гипертензии, связанной с циррозом печени, дает важную информацию о физиологии и патологии болезни, помогает в изучении новых альтернативных методов лечения. Целью исследования было выявить корреляцию между параметрами, измеряемыми при цветной дуплексной допплерографии, и тяжестью цирроза печени используя классификацию Child-Pugh. Было исследовано 111 пациентов в течение 20122104 г., которые принимали лечение в отделении гепатологии Республиканской клинической больницы. Количественная выраженность цирроза печени оценивали по классификации Child-Pugh, в которой вошли: класс A (5-6 ), B (7-8), C (10-15) баллов. Портальную гемодинамику изучали с помощью цветного дуплексного картирования с определением количественных параметров на артериальном и на венозном русле с последующей корреляцией с клиническими и лабораторными критериями классификации Child-Pugh. В ходе исследования была выявлена значимая корреляция усредненной скорости кровотока в воротной вене, индекса застоя, селезеночно-воротного и сосудисто-воротного индекса, индекса портальной гипертензии с клинической стадией заболевания

Вклад ультразвукового дуплексного доплеровского исследования в диагностике цирроза печени и пор- тальной гипертензии

Catedra Radiologie şi Imagistică Medicală, USMF „Nicolae Testemiţanu” Departamentul Medicină Internă, disciplina Gastroenterologie Clinica medicală nr. 4, USMF „N. Testemiţanu” Catedra Chirurgie nr. 2, USMF „N. Testemiţanu”Summary Proper evaluation of hypertension portals, though, remains to be a complicated issue and the subject of discussions due to lack or insuffi cient entries has a well defi ned and hemodynamic indices accepted evidence of vascular portal studies. In this work is analyzed the Doppler-duplex position intake in the study of portal hypertension and and its complications. There are also identifi ed and analysed the clues necessary to assess vascular hemodynamics in hepatic cirrhosis portal hypertension, both with the purpose of diagnosis and prognosis for complications. Надлежащая оценка портальной гипертензии оста- ется сложным вопросом и предметом обсуждения, из-за отсутствия или недостаточного дополнения четкого протокола рассмотрения и обшепринятых гемодинамических показателей для изучения сосуди- стых нарушений при портальной гипертензии. В на- стоящей статье анализируется вклад ультразвукового дуплексного доплеровского исследования в диагностике портальной гипертензии и осложнений. Определены и проанализированы необходимые индексы для оценки портальной гемодинамики при циррозе печени, как для диагностических, так и для прогностических осложнений

The importance of modern imagistic methods in diagnostics of portal hypertension and portal hipertensive cirrhogenic splenopatia

Catedra de chirurgie Nr. 2, USMF „N. Testemiţanu” Centrul Medical „Excellence”Dezvoltarea şi impunerea metodelor imagistice în practica medicală permit abordarea diagnostică complexă a splenopatiei portal hipertensive şi sindromului de hipertensiune portală. Autorii prezintă 176 de pacienţi operaţi pentru hipersplenism sever, la care examenul imagistic a adus un aport diagnostic şi terapeutic considerabil. rezultatele investigaţiilor imagistice obţinute confirmă că identificarea modificărilor hemodonamice şi a stadiului evolutiv al unei suferinţe hepatice este esenţială pentru diagnostic, tratament şi descifrarea secvenţelor evolutive.Development and implementation of the imagistic methods allowed us to establish the preoperative diagnosis. The authors present 176 patients subjected to surgery for severe forms of hypersplenism, cases in which imagistic investigation essentially contributed to diagnosis and treatment. The results of imagistic investigations identified the importance of hemodynamic changes and evolution status of hepatic cirrhosis for positive diagnostic and prescription of evolution steps of the hepatic disease