The hospital information structure, which is made up of various medical business systems, is suffering from the problems of the "information isolated island". Medical business systems in the hospital are mutually isomerous and difficult to become a whole. How to realize the internal barrier-free interaction of the patients effective medical information in the hospital and further to complete the area sharing of patients longitudinal diagnosis and treatment information has become a question having to be solved urgently in the process of healthcare informatization. Based on the HL7 standard, this paper refers to the IHE technical framework, expounds the overall structure of the interaction in the hospital internal and area sharing of medical information with the medical information exchange platform. The paper also gives the details of the whole process of the complete display of the discrete patient health information using Portal technology, which is saved in the business systems in different hospitals. It interacts internally through the information exchange platform and at last stores the information in the regional cinical data repository (CDR).
【Abstract】 Objective To study liver regeneration of the non-ligated liver lobes following portal branch ligation (PBL). Methods Sixty male Wistar rats were randomly divided into PBL group and sham operation (SO) group. Under ether anesthesia, the rats were subjected to PBL and sham operation, respectively. The animals were sacrificed on the 1st, 2nd, 3rd, 7th and 14th day respectively. The blood sample was collected from heart and the livers were harvested to determine serum alanine aminotransferase (ALT) levels and total liver weight, respectively. The hepatic histopathology was studied through light microscopy. The number of liver cell nuclear mitosis index was counted. The number of proliferative cell nuclear antigen (PCNA) index was counted by immunohistochemistry. The hepatic ultrastructural changes were studied under electron microscope. Results ①Elevated serum ALT level was observed in the first postoperative day in PBL group compared with SO group (P＜0.01)， but began to recover in the second day. ②No significant total liver weight change in PBL group and SO group were found. ③Liver cell nuclear mitosis index and PCNA index were markedly increased in PBL group compared with SO group in day 1-3 postoperative day (P＜0.01). It reached the peak in the second day and decreased slightly in the 3rd day, but still higher than SO group, then gradually return to normal lately. Conclusion The ligation of left portal branch can induce active regeneration of hepatic cell of non-ligated liver lobes in rats. The regeneration of non-ligated liver lobes may restore previous total liver weight. The ligation of 75% portal branch does not affect liver function and may be safely performed. The portal branch ligation in rats may be used as an animal model in study of liver regeneration.
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.
We had performed transjugular intrahepatic portosystemic stent shunt (TIPSS) in one hundred and three patients with advanced liver cirrhosis and portal hypertension from July,1993 to January, 1995. TIPSS was carried out successfully in ninty-eight out of 103 cases and the technical success rate was 95.2%. Acute variceal bleeding was immediatly controlled and portal pressure reduced by an average of 1.36±0.02 kPa after TIPSS. The disappearance of gastric cornoary and esophageal varices, the shrinkage of spleen and the reduction of ascite were observed . Three patients died of acute liver failure and one died of variceal redbleeding within 30 days of treatment. Mild encephalohthy was obserbed in 10 cases with TIPSS. At follow-up of 1～22 months, variceal rebleeding and ascite were observed in 6 patients and stenosis of shunt was evident is 12.5% of cases by the subsequent doppler sonography. According to this result, TIPSS is an effective method for the treatment of portal hypertension.
ObjectiveTo investigate the predictive factors of portal vein thrombosis (PVT) before and after splenectomy and gastroesophageal devascularization for liver cirrhosis with portal hypertension.
MethodsSixty-one cases of liver cirrhosis with portal hypertension who underwent splenectomy and gastroesophageal devascularization were enrolled retrospectively. The patients were divided into PVT group and non-PVT group based on the presence or absence of postoperative PVT on day 7. The clinical factors related with PVT were analyzed.
ResultsThere were 25 cases in the DVT group and 36 cases in the non-DVT group. The results of univariate analysis showed that the preoperative platelet (P=0.006), activated partial thromboplastin time (P=0.048), prothrombin time (P=0.028), and international normalized ratio (P=0.029), postoperative fibrin degradation product (P=0.002) and D-dimer (P=0.014) on day 1, portal venous diameter (P=0.050) had significant differences between the DVT group and non-DVT group. The results of logistic multivariate regression analysis showed that the preoperative platelet (OR=0.966, 95% CI 0.934-1.000, P=0.048) and postoperative fibrin degradation product on day 1(OR=1.055, 95% CI 1.011-1.103, P=0.017) were correlated with the PVT. The PVT might happen when preoperative platelet was less than 34.5×109/L (sensitibity 80.6%, specificity 60.0%) or postoperative fibrin degradation product on day 1 was more than 64.75 mg/L (sensitibity 48.0%, specificity 91.7%).
ConclusionPreoperative platelet and postoperative fibrin degradation product on day 1 might predict PVT after splenectomy and gastroesophageal devascularization for liver cirrhosis with portal hypertension.
To investigate the mechanisms of splanchnic hyperdynamics in portal hypertension (PHT), angiotensin Ⅱ(A-Ⅱ) receptor maximal binding capacity (Bmax) and dissociation constants (Kd) of splanchnic blood vessels in rats with prehepatic PHT were studied by radioligand binding analysis. The results showed that the A-Ⅱ receptor Bmax in the superior mesenteric artery and portal vein of PHT animals (206.9±39.3 fmol/mg protein and 31.5±9.2 fmol/mg protein respectively) was all significantly lower than that of the controls (297.2±44.7 fmol/mg protein and 53.4±12.1 fmol/mg protein respectively, Ｐ＜0.01). The A-Ⅱ receptor Kd in the superior mesenteric artery was markedly increased in PHT animals (1.03±0.11 nmol/L) compared with that in controls (0.88±0.08 nmol/L, Ｐ＜0.05). In the portal vein, the A-Ⅱ receptor Kd in PHT animals was slightly higher than in controls, but no significant difference was observed between the two groups. These results suggest that the vascular hyporesponsiveness to A-Ⅱ in PHT is caused partially by a reduction in number and a decrease in affinity of vascular A-Ⅱ receptors, and these changes may possibly lead to the formation of hyperdynamic circulation.
Objective To explore the causes and treatment of rebleeding after operation on portal hypertension patients. Methods The clinical data of 41 rebleeding cases underwent the operational between January 2000 and December 2009 in Peking Union Medical College Hospital were retrospectively analyzed. Results All 13 cases who got rebleeding after shunt operation received lienectomy, but for those who got rebleeding after lienectomy, 23 patients received Phemister or modified Phemister or expanded lienectomy and 5 patients received shunt operation. Surgical related complications occurred in 7 cases (17.1%) at 2 weeks after operation, including abdominal bleeding (3 cases), gastrointestinal bleeding (2 cases), and intractable ascites (2 cases). After the follow-up of 3-60 months (mean 39 months), all patients were still alive. During the follow-up, 3 cases of recurrent esophageal varices were observed and one of them got rebleeding.Conclusion The majority of rebleeding after lienectomy tend to be ascribed to the wrong operations chose, while bad operation skill often contribute to the rebleeding after shunt operation, suggesting ideal therapeutic effect for rebleeding can benefit from appropriate operation choose.
ObjectiveTo evaluate value of percutaneous interventional treatment for portal vein thrombosis combined with occlusion following liver transplantation.
Method The data of 3 patients with portal vein thrombosis combined with occlusion following liver transplantation underwent interventional treatment were analyzed retrospectively.
Resultsthe mural thrombi were detected preoperatively in the portal venous trunk for the 3 patients, all of which were classified as Yerdel's grade 1 and were underwent porto-portal anastomosis without thrombectomy during liver transplantation. Portal vein thrombosis combined with occlusion occured after 8 months postoperatively. The percutaneous transhepatic balloon venoplasty and self-expanding metallic stents placement was performed in 3 patients. The interventional treatment was successfully achieved in all the patients. The follow-up period ranged from 28 to 38 months, no complications occurred following interventional treatment, the graft function and survival of patients were good.
ConclusionPercutaneous interventional treatment is an efficacious and safe method to treat portal vein thrombosis combined with occlusion.
Electron spin resonance (ESR) spectroscopy and spin trapping agent PBN were applied to measure directly the changes of oxygen free redicals (OFR) in gastric mucosa of rats with portal hypertension (PHT) injured by shockreperfusion, and treated with superoxide dismutase (SOD), radix salviae miltiorrhizae (RSM), with concomitant monitoring activity of SOD and pathology of gastric mucosa. Results showed that the amount of OFR increased markedly in gastric mucosa of PHT rats during the shock-reperfusion. The pathological changes were in accordance with alteration of the amount of OFR and the activity of SOD. Gastric mucosa in PHT was more susceptible to shock-reperfusion insult than normal controls. The anti-oxidant SOD, RSM used at early stage exerted mild gastric mucosal insult through different mechanisms.
Objective This experiment is to compare the effect of two operations “disconnection” and “ligation” of separation of gastroesophageal peripharal blood vessel in portal hypertension and provide base of rational for selecting reasonable method of separation of gastroesophageal peripheral blood vessel in portal hypertension.MethodsFortyeight SD rats were induced to model of liver cirrhosis and portal hypertension by CCL4 . They were divided at random into 3 groups (16 rats each): disconnection group, ligation group and pseudooperation group. There was also a normal comparison group with 6 normal SD rats (laparotomy only). Thirty days and 100 days after the operation, 8 rats were killed respectively in every group except for the normal comparison group. Thirty days after the operation, the rats of normal comparison group were killed. The adhesion around gastric cardia and fundus with the building of new branch blood vessels, and the relative average blood vessel amounts and average vein caliber changes in submucosa layer and lamina propria layer of esophagus inferior segment were observed. ResultsIn the observation of adhesion around gastroesophageal and the building of new branch blood vessels after the operations, disconnection group was more marked than ligation group. In the observation of relative average blood vessel amounts and average vein calibers changes in submucosa layer and lamina propria layer of esophagus inferior segment, pseudooperation group was more marked than in normal comparison group in different time（P＜0.05）,and 30 days after the operations, disconnection and ligation groups were less serious than pseudooperation group（P＜0.05）. One hundred days after the operation, the two observation indexes of all the groups were more serious than before, and result of disconnection group was nearly close to pseudooperation group（Pgt;0.05）, but ligation group was still less serious than pseudooperation group(P＜0.05).Conclusion Both the “disconnection” and “ligation” operation have the same rank effect of separation of gastroesophageal peripharal blood vessel in short time. But the “ligation” operation makes less trauma, postoperative adhesion and vascularizition, then the separation effect of the “ligation” operation may sustain a relatively long time.
