Mansour Dina, Masson Steven, Hammond John, Leithead Joanna A, Johnson Jill, Rahim Mussarat Nazia, Douds Andrew C, Corless Lynsey, Shawcross Debbie L, Heneghan Michael A, Tripathi Dhiraj, McPherson Stuart, Bonner Emily, Botterill Gemma, West Rebecca, Donnelly Mhairi, Grapes Allison, Hollywood Coral, Ross Valerie
Gateshead Health NHS Foundation Trust, Gateshead, UK.
Newcastle University, Newcastle upon Tyne, UK.
Frontline Gastroenterol. 2023 Jul 28;14(6):474-482. doi: 10.1136/flgastro-2023-102432. eCollection 2023.
The prevalence of cirrhosis has risen significantly over recent decades and is predicted to rise further. Widespread use of non-invasive testing means cirrhosis is increasingly diagnosed at an earlier stage. Despite this, there are significant variations in outcomes in patients with cirrhosis across the UK, and patients in areas with higher levels of deprivation are more likely to die from their liver disease. This three-part best practice guidance aims to address outpatient management of cirrhosis, in order to standardise care and to reduce the risk of progression, decompensation and mortality from liver disease. Part 1 addresses outpatient management of compensated cirrhosis: screening for hepatocellular cancer, varices and osteoporosis, vaccination and lifestyle measures. Part 2 concentrates on outpatient management of decompensated disease including management of ascites, encephalopathy, varices, nutrition as well as liver transplantation and palliative care. In this, the third part of the guidance, we focus on special circumstances encountered in managing people with cirrhosis, namely surgery, pregnancy, travel, managing bleeding risk for invasive procedures and portal vein thrombosis.
近几十年来，肝硬化的患病率显著上升，预计还会进一步上升。非侵入性检测手段的广泛应用意味着肝硬化越来越多地在早期被诊断出来。尽管如此，英国肝硬化患者的治疗结果存在显著差异，贫困程度较高地区的患者死于肝病的可能性更大。这份由三部分组成的最佳实践指南旨在解决肝硬化的门诊管理问题，以规范治疗并降低肝病进展、失代偿和死亡的风险。第一部分涉及代偿期肝硬化的门诊管理：肝细胞癌、静脉曲张和骨质疏松症的筛查、疫苗接种及生活方式措施。第二部分专注于失代偿期疾病的门诊管理，包括腹水、肝性脑病、静脉曲张、营养的管理以及肝移植和姑息治疗。在本指南的第三部分，我们关注肝硬化患者管理中遇到的特殊情况，即手术、妊娠、旅行、侵入性操作出血风险的管理以及门静脉血栓形成。
