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犬单发性肝外门体分流治疗中使用阿米洛利环缩器的评估:168例病例(1995 - 2001年)

Evaluation of ameroid ring constrictors for treatment for single extrahepatic portosystemic shunts in dogs: 168 cases (1995-2001).

作者信息

Mehl Margo L, Kyles Andrew E, Hardie Elizabeth M, Kass Philip H, Adin Christopher A, Flynn Alison K, De Cock Hilde E, Gregory Clare R

机构信息

Veterinary Medical Teaching Hospital, CA 95616, USA.

出版信息

J Am Vet Med Assoc. 2005 Jun 15;226(12):2020-30. doi: 10.2460/javma.2005.226.2020.

Abstract

OBJECTIVES

To evaluate use of an ameroid ring constrictor (ARC) for treatment for single extrahepatic portosystemic shunts (PSSs) and identify factors associated with postoperative death, continued portosystemic shunting, and long-term outcome in dogs.

DESIGN

Retrospective study.

ANIMALS

168 dogs with a single extrahepatic PSS.

PROCEDURE

Medical records of dogs that had a single extrahepatic PSS and were treated with an ARC were reviewed. Signalment, history, clinical signs, results of preoperative blood analyses and portal pressure measurements, PSS location, ARC size, postoperative complications, and postoperative scintigraphy results were recorded. Owners were interviewed 6 months to 6 years after surgery. Results-Postoperative complications developed in 10% of dogs. Postoperative mortality rate was 7.1%. Predictive factors for postoperative death included high preoperative WBC count and postoperative complications. Twenty-one percent of dogs in which portal scintigraphy was performed 6 to 10 weeks after surgery had continued shunting. Predictive factors for persistent shunting included low preoperative plasma albumin concentration, high portal pressure after complete occlusion, and high portal pressure difference (postocclusion minus baseline). Clinical outcome in 108 dogs was classified as excellent (80%), good (14%), or poor (6%). Predictive factors for excellent long-term clinical outcome included high preoperative plasma albumin concentration, low preoperative leukocytosis, low portal pressure after complete occlusion, absence of postoperative seizures, and absence of continued shunting.

CONCLUSIONS AND CLINICAL RELEVANCE

Use of an ARC for treatment for a single extrahepatic PSS resulted in low morbidity and mortality rates. Certain preoperative factors were associated with increased risk of postoperative death, continued portosystemic shunting, and long-term outcome.

摘要

目的

评估使用阿梅罗德环形缩窄器(ARC)治疗单一肝外门体分流(PSS)的效果,并确定与犬术后死亡、持续门体分流及长期预后相关的因素。

设计

回顾性研究。

动物

168只患有单一肝外PSS的犬。

方法

回顾性分析接受ARC治疗的单一肝外PSS犬的病历。记录品种、病史、临床症状、术前血液分析及门静脉压力测量结果、PSS位置、ARC尺寸、术后并发症及术后闪烁扫描结果。术后6个月至6年对犬主人进行访谈。结果-10%的犬出现术后并发症。术后死亡率为7.1%。术后死亡的预测因素包括术前白细胞计数高和术后并发症。术后6至10周进行门静脉闪烁扫描的犬中,21%存在持续分流。持续分流的预测因素包括术前血浆白蛋白浓度低、完全闭塞后门静脉压力高以及门静脉压力差大(闭塞后减去基线)。108只犬的临床结局分为优秀(80%)、良好(14%)或差(6%)。长期临床结局优秀的预测因素包括术前血浆白蛋白浓度高、术前白细胞增多症低、完全闭塞后门静脉压力低、无术后癫痫发作及无持续分流。

结论及临床意义

使用ARC治疗单一肝外PSS导致发病率和死亡率较低。某些术前因素与术后死亡、持续门体分流及长期预后风险增加相关。

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