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Current Status and Prospects in the Diagnosis and Treatment of Portal Hypertension

門靜脈高壓癥是慢性肝病的主要合并癥之一，它所導致的食管胃底靜脈曲張破裂出血死亡率可達30%～50%，是肝硬變患者的主要死亡原因。1概述自1945年Whipple等人倡導門體分流手術治療門靜脈高壓癥以來，各國學者作出了不懈努力，探求對這種頑癥的治療手段。最近20～30年在治療方法上出現了許多革新，如內窺鏡下曲張靜脈硬化劑注射、曲張靜脈套扎、門體靜脈選擇性分流（遠端脾腎分流）等。應用β受體阻滯劑心得安來預防或治療門靜脈高壓癥引起的上消化道出血取得了肯定的療效。小口徑人工血管門靜脈下腔靜脈搭橋分流減少了門體分流手術后腦病的發生率，而復發出血率幾乎可與傳統門腔分流術相比。經頸內靜脈肝內門體分流術（TIPSS）治療急性上消化道出血的療效十分肯定，尤其適用于手術風險大、肝功能差者。肝臟移植作為治療終末期不可逆性肝病的成熟手段，近年來也越來越多地應用于肝硬變門靜脈高壓癥的治療，與其它各種治療手段相比，肝移植可算是對門靜脈高壓癥治療的一種革命性的變化，一個成功的肝移植一勞永逸地解決了門靜脈高壓癥產生的根源，使門靜脈高壓癥得到根治。

Current Status and Perspectives in The Management of Portal Hypertension

Liver Transplantation for Hepatocellular Carcinoma

Long-Term Therapeutic Effect of Esophagogastric Devascularization Without Splenectomy in Treatment of Portal Hypertension with Esophagogastric Varices Hemorrhage

ObjectiveTo evaluate long-term therapeutic effect of esophagogastric devascularization without splenectomy in treatment of portal hypertension with esophagogastric varices hemorrhage. MethodsThe patients who took esophagogastric devascularization without splenectomy from 2008 to 2013 were followed-up in clinic or through phone. The remission of esophagogastric varices, rebleeding, survival and long-term postoperative complications were observed. ResultsA total of 32 patients were taken esophagogastric devascularization without splenectomy in Peking University People's Hospital from 2008 to 2013. One patient died during the perioperative period. Twenty-three patients were followed-up for 10-81 months with an average 45.5 months, of whom 7 patients had rebleeding, 5 patients died, 3 patients had new onset portal vein thrombosis, 2 patients had esophageal anastomotic strictures. ConclusionEsophagogastric devascularization without splenectomy is an effective method in treatment of portal hypertension with esophagogastric varices hemorrhage in selected patients.

MEASURING CONDITIONS OF HUMAN HEPATIC α1-ADRENERGIC RECEPTORS WITH RADIOLIGAND BINDING ANALYSIS

To quantitatively measure the α1-adrenergic receptors and select the suitable conditions of receptor-ligand binding assay. Radioligand binding analysis was used to measure the concentration of α1-adrenergic receptors, and the measuring conditions were selected, respectively. Under the selected conditions, the α1-adrenergic receptors in lier plasma membranes of 8 nonhepatopathy subjects were measured.Under such suitable conditions as ３H-prazosin concentration 0.1-2.0nmol/L, incubating temperature 37℃, reaction time 20 minutes and seperating free ligand from system with double layer of filter paper, the binding of 3H-prazosin to α1receptors from 8 nonhepatopathy subjects were saturable with a high affinity. The Bmax, Kd, RMC and Hill coefficient were 142.1±14.1 fmol per milligram of protein, 0.2382±0.0548 nM, 739.0±167.6 fmol per gram of liver and 0.90±0.03, respectively.The suitable conditions may be very important for measuring α1-adrenergic receptors in human liver plasma membranes, which should be considered in hepatopathy studies.

Experimental Study of Fibrin Glue for Preventing and Curing Postoperative Bleeding and Bile Leakage in House-HoldRabbit Following Partial Hepatectomy

【 Abstract 】 Objective To investigate the precautionary effect of fibrin glue on postoperative bleeding and bile leakage when used in partial hepatic resection. Methods House-hold rabbit partial hepatectomy model was prepared and 40 rabbits were divided into sham operation （ SO) group (n=10), control group (n=10) and protocol group (n=20) randomly. The SO rabbits received laparotomy only, while both the control and protocol group received partial hepatectomy. Fibrin glue was used in the protocol group following electric coagulation therapy while the control group received electric coagulation therapy only. The animals’ diet, weight and adverse effects were observed then, and the celiac drainage volume, levels of hemoglobin (Hg), WBC and TBil in celiac outflow and ALT, AST, LDH and TBil in rabbit serum were checked on schedule after operation. Results The average blood loss volume and operation time in the protocol group were (16.0±2.7) ml and (23.7±2.9) min respectively, which were lower than those in the control group 〔 (20.8 ± 3.5) ml and (27.3 ± 2.9) min (P ＜ 0.01) 〕 . The celiac drainage volume, levels of Hg, WBC and TBil in celiac outflow decreased gradually on postoperative days in protocol groups (P ＜ 0.05). The levels of Hg in celiac outflow of the protocol group on the 1st, 2nd and 7th postoperative day were lower than those of the control group (P ＜ 0.05), and the result of TBil was the same on the 1st, 2nd, 3rd, 5th and 7th postoperative day (P ＜ 0.05). The serum ALT, AST, LDH and TBil levels in the control and protocol groups were higher than those in the SO group significantly (P ＜ 0.01), while the serum ALT, AST (except on the 3rd postoperative day) and LDH levels in the protocol group were lower than those in the control group (P ＜ 0.05) in significance.All animals had good appetite, normal weight gain and no adverse reaction 　 and death occurred. Conclusion Application of fibrin glue may effectively prevent and cure the postoperative bleeding and bile leakage in partial hepatectomy without any adverse reaction.

胰體尾癌68例診治體會

兩院1990年2月至2001年2月間共收治胰腺癌287例，其中胰體尾癌68例，男43例，女25例，男∶女=1∶0.58； 年齡20~76歲，平均56歲，其中40~70歲56例，占82.4%。從出現首發癥狀至入院診斷時間為10天~1年，平均3.6個月。主要臨床表現見附表。.

Study of Liver Volume Measurement and Its Clinical Significance in Cirrhotic Patients with Portal Hypertension

Objective To study the value of the clinical application of stereography and measurement of liver volume in cirrhotic patients with portal hypertension. Methods By use of the personal computer and the software of threedimensional reconstruction and measurement system of liver faultage photograph, the liver volume in vivo was successfully measured and the threedimensional image of the liver rebuilt in 46 posthepatitic cirrhotics who were selected for orthotopic liver transplantation and in 30 noncirrhotic controls, and comparison with the reference volume of recipient liver was obtained by means of water deplacement after transplantation. Results The liver volume of cirrhotic patients with portal hypertension measured by software and water deplacement was (983.33±206.11) cm3, and (904.93±209.56) cm3 respectively. Comparison by means of linear regression analysis between volume measurement on threedimensional reconstruction software and reference volume showed a nearly ideal correlation coefficient(r=0.969,P＜0.01), the average error was 8.66%.The average of liver volume in controls was (1287.00±96.18) cm3, and was positively correlated to the height，weight and body surface area (r=0.845,0.833,0.932 respectively,P＜0.01)，and was different from that of cirrhotics. Liver volume of cirrhoitic patients with portal hypertension was related to their ChildPugh classification. The liver volume of patients in Child C group was significantly smaller than that of patients of Child B group, and was significantly correlated with Alb （r=0.496, P＜0.01） and TBIL（r=-0.493, P＜0.01）,PT(r=-0.517, P＜0.01), but was not significantly correlated with ALT（r=0.206，Pgt;0.05）,portal pressure（r=-0.093，P=0.539） and portosystemic shunt index (r=0.044，P=0.769). Conclusion The volume measurement of the liver by the threedimensional software is relatively accurate. Liver volume of cirrhotic patients with portal hypertension was significantly related to their liver function,and can reflect the liver reserve function.

Analysis on Therapeutic Effect of Selective Paraesophagogastric Devascularization Without Splenectomy for Treat-ment of Portal Hypertension with Upper Gastrointestinal Hemorrhage

Objective　To evaluate the therapeutic effect of selective paraesophagogastric devascularization withoutsplenectomy in treatment of portal hypertension with upper gastrointestinal hemorrhage. Methods　The clinical data of 27 patients who received selective paraesophagogastric devascularization without splenectomy from 2008 to 2011 were retrospectively analyzed. The hemogram， hepatic function， perioperative compliations， and free portal pressure （FPP） were observed. The patients were followed-up and the re-bleeding rate and survival rate were observed. Results　The FPP decreased significantly（P＜0.05） after operation. The complication rate was 33.3%（9/27） after operation， including2 cases（7.4%） stress ulcer bleeding， 1 case （3.7%） acute bleeding portal hypertensive gastropathy， 1 case （3.7%） deep venous thrombosis， 1 case （3.7%） acute lung injury， 1 case （3.7%） death of hepatic encephalopathy， 3 cases（11.1%） new onset portal vein thrombosis. Twenty-four patients were followed up for an average of 27 months （8-57 months）. The overal survival rate was 92.6% （25/27）. Conclusion　Selective paraesophagogastric devascularization without splenectomy is an effective method for treatment of portal hypertension with upper gastrointestinal hemorrhage.

Expression of the mRNA of Cancer-Testis Antigen 9 Gene in Hepatocellular Carcinoma

【Abstract】Objective To investigate the expression of the mRNA of cancer-testis antigen 9 (CT9) gene in hepatocellular carcinoma. Methods The expression of CT9 mRNA was detected through RT-PCR in HCC tissues and their adjacent non-HCC tissues from 45 HCC patients. From CT9 RT-PCR positive products, 3 samples were selected randomly and were sequenced. ResultsCT9 mRNA was detectable in 51.1%(23/45) of HCC samples, and no expression of CT9 mRNA was detected in the adjacent non-HCC tissues. In addition, the RTPCR products were proved to be CT9 cDNA by DNA sequencing. No relationship was found between the expression of CT9 mRNA and clinical factors such as age, sex, tumor size, degree of tumor differentiation, serum αfetoprotein level and infection of hepatitis B virus or hepatitis C virus （Pgt;0.05）. ConclusionCT9 mRNA is expressed with high percentage and specificity in hepatocellular carcinomas. The CT9 gene product is a potential target for antigenspecific immunotherapy of HCC.