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Titolo:
Small-diameter portacaval H-graft shunt: A paradigm shift back to surgicalshunting in the management of variceal bleeding in patients with preservedliver function
Autore:
Hillebrand, DJ; Kojouri, K; Cao, S; Runyon, BA; Ojogho, O; Concepcion, W;
Indirizzi:
Loma Linda Univ, Med Ctr, Inst Transplantat, Dept Surg,Div Transplantat Surg, Loma Linda, CA 92354 USA Loma Linda Univ Loma Linda CA USA 92354 at Surg, Loma Linda, CA 92354 USA Loma Linda Univ, Med Ctr, Dept Med, Div Gastroenterol Hepatol, Loma Linda,CA 92354 USA Loma Linda Univ Loma Linda CA USA 92354 Hepatol, Loma Linda,CA 92354 USA
Titolo Testata:
LIVER TRANSPLANTATION
fascicolo: 4, volume: 6, anno: 2000,
pagine: 459 - 465
SICI:
1527-6465(200007)6:4<459:SPHSAP>2.0.ZU;2-0
Fonte:
ISI
Lingua:
ENG
Soggetto:
INTRAHEPATIC PORTOSYSTEMIC SHUNT; DISTAL SPLENORENAL SHUNT; HEPATIC BLOOD-FLOW; PORTAL-HYPERTENSION; CONTROLLED TRIAL; ENCEPHALOPATHY; CIRRHOSIS; COMPLICATIONS; SCLEROTHERAPY; HEMORRHAGE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
25
Recensione:
Indirizzi per estratti:
Indirizzo: Hillebrand, DJ Loma Linda Univ, Med Ctr, Inst Transplantat, Dept Surg,Div Transplantat Surg, 11234 Anderson St,Rm 1405, Loma Linda, CA 92354 USA LomaLinda Univ 11234 Anderson St,Rm 1405 Loma Linda CA USA 92354
Citazione:
D.J. Hillebrand et al., "Small-diameter portacaval H-graft shunt: A paradigm shift back to surgicalshunting in the management of variceal bleeding in patients with preservedliver function", LIVER TRANS, 6(4), 2000, pp. 459-465

Abstract

Small-diameter portacaval H-graft (SDPHG) shunts are partial portosystemicshunts that control variceal bleeding while preserving nutrient blood flowto the liver, minimizing postoperative encephalopathy and liver failure. Since July 1, 1997, we placed SDPHG shunts in 18 patients (age, 52.1 +/- 2.6years; range, 35 to 72 years) with cirrhosis (Child's class A, B, and C in6, 10, and 2 patients, respectively) and refractory variceal bleeding who were not candidates for transplantation. Ten procedures (55.6%) were urgentor emergent, SDPHG shunts effectively reduced the portacaval pressure gradient (18 +/- 3 v, 5 +/- 2 mm Hg; P <.05), Surgical times (210 +/- 11 minutes), estimated blood losses (358.3 +/- 107.8 mL), transfusion requirements (0 transfusions in 10 patients; 55.6%; mean, 0.9 +/- 0.3 units), and postoperative hospitalization (7.7 +/- 1.0 days) were excellent. Surgical mortality (30 days) was 0%. During 14.0 +/- 1.9 months (range, 1.1 to 29.1 months) of follow-up, 4 patients (22.2%) died, including both patients with Child'sclass C cirrhosis, The cumulative 1-year survival rate was 82.1% (Child's class A, B, and C, 83.3%, 90%, and 0%, respectively). Long-term survivors had significantly lower preoperative Child-Pugh scores compared with nonsurvivors (7.8 +/- 0.3 v 9.5 +/- 1.0; P <.05). Postoperative encephalopathy developed in 3 survivors (20%). Fifteen patients (83.3%) have not experienced rebleeding; shunt failure led to rebleeding in only 1 patient (5.6%). SDPHGshunt placement can be performed with low morbidity and surgical mortalityNon-transplantation candidates with Child's class A and B cirrhosis have excellent long-term survival with this safe, effective, and definitive treatment for refractory variceal bleeding.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 03/07/20 alle ore 23:02:37