Objective
To evaluate the feasibility of X-ray guided access to the extrahepatic segment of the main portal vein (PV) to create a transjugular extrahepatic portacaval shunt (TEPS).
Methods
5F pigtail catheter was inserted into the main PV as target catheter by percutaneous transhepatic path under ultrasound guidance. The RUPS-100 puncture system was inserted into the inferior vena cava (IVC) by transjugular path under ultrasound guidance. Fluency covered stent was deployed to create the extrahepatic portacaval shunt after puncturing the target catheter from the IVC under the X-ray guidance, then shunt venography was performed. Enhanced CT of the abdomen helped identify and quantify the patency of the shunt and the presence of hemoperitoneum.
Results
The extrahepatic portacaval shunts were created successfully by only 1 puncture in 6 pigs. No extravasation was observed in shunt venography. One pig died of anesthesia on the day of operation. The extrahepatic portacaval shunts were failed in 2 pigs 3 days after the operation (one was occluded and the other one was narrowed by 80%). The extrahepatic portacaval shunts were occluded 2 weeks after the operation in the remaining 3 pigs. The shunts were out of the liver and no hemoperitoneum was identified at necropsy in the 6 pigs.
Conclusion
TEPS is technically safe and feasible under the X-ray guidance.
ObjectiveTo investigate impact of splenectomy plus pericardial devascularization on liver hemodynamics and liver function for liver cirrhosis patients with portal hypertension.
MethodsThe internal diameter, maximum velocity, minimum velocity, mean velocity, and flow volume of portal vein and hepatic artery of 42 cases of liver cirrhosis with portal hypertension were measured by Doppler ultrasonic instrument on day 1 before operation and on day 7 after operation. The free portal pressures at different phases (after open abdomen, after splenic artery ligation, after splenectomy, and after devasculanrization) were read from the disposable pressure sensor. Twenty-four healthy people through physical examination were selected as control.
Results① The free portal pressure of liver cirrhosis patients with portal hypertension was decreased from (29.12±1.40) mm Hg after open abdomen to (22.71±1.21) mm Hg after splenic artery ligation, and further decreased to (21.32±1.12) mm Hg after splenectomy, but increased to (22.42±1.15) mm Hg after devasculanrization, the difference was statisticly different (all P < 0.01). ② Compared with the healthy people, for the liver cirrhosis patients with portal hypertension, the internal diameter, maximum velocity, minimum velocity, and flow volume of portal vein were significantly enlarged (all P < 0.01), which of hepatic artery were significantly reduced (all P < 0.01) on day 1 before operation; On day 7 after operation, the internal diameter of portal vein was significantly reduced (P < 0.01), the maximum velocity, minimum velocity, and mean velocity of portal vein were significantly enlarged (all P < 0.01), but the internal diameter of hepatic artery was significantly reduced (P < 0.01), the maximum velocity, minimum velocity, mean velocity, and flow volume of hepatic artery were significantly enlarged (all P < 0.01). For the liver cirrhosis patients with portal hypertension, compared with the values on day 1 before operation, the internal diameter and the flow volume of portal vein were significantly reduced (all P < 0.01) on day 7 after operation; the internal diameter, maximum velocity, minimum velocity, mean velocity, and flow volume of hepatic artery were significantly enlarged (all P < 0.01) on day 7 after operation. ③ The Child-Pugh classification of liver function between before and after surgery had no significant difference (χ2=1.050, P > 0.05). ④ No death and no hepatic encephalopathy occurred, no thrombosis of splenic vein or portal vein was observed on day 7 after surgery.
Conclusionsplenectomy plus pericardial devascularization could decrease portal vein pressure and reduce blood flow of portal vein, while increase blood flow of hepatic artery, it doesn't affect liver function.
OBJECTIVE The purpose of this study was to study the effect of splenopneumopexy for patients with portal hypertension in children. METHODS From March 1993 to April 1998, splenopneumopexy was performed on six children with portal hypertension. Doppler ultrasound and radionuclide were used to demonstrate the portopulmonary shunt after operation. RESULTS The bleeding from the esophageal varices was controlled and the esophageal varices were eliminated gradually. The symptoms pertaining to hypertension were disappeared. The patency of the shunt was maintained without the formation of thrombosis. No pulmonary complication was observed. CONCLUSION The results indicated that splenopneumopexy was a safe and effective procedure for patients with portal hypertension in children.
42 Wistar rats were divided into three groups at random, liver cirrhosis (LC), portal vein stricture (PVS) and sham operation (SO) group. The changes of barrier capability of gastric mucosa in portal hypertensive rats were observed. The results demonstrated: the splanchnic blood flow of the portal hypertensive rats increased, as compared with the normal control group (Ｐ＜0.001), but actually gastric mucosa was under the condition of ischemia. Mucosa of gastric wall glycoprotein and PGE2 of gastric mucosa decreased, as compared with the normal control (Ｐ＜0.01); and more seriously decreased in cirrhotic portal hypertensive rats, there was no significant difference about amount of the basal acid secretion (BAS) among the three groups, but the amount of H＋ backdiffusion (H＋BD) was obviously increased, as compared with the normal control group (Ｐ＜0.001). The amount of H＋BD of cirrhotic portal hypertensive rats was the highest among this three groups. The results suggest that the barrier capability of gastric mucosa with portal hypertension is lower than that of the normal control group and much lower with cirrhotic portal hypertensive rats. The portal hypertensive gastropathy is associated with the lower capability of defense of gastric mucosa. The condition of liver function contributes to the change of barrier capability of gastric mucosa.
Objective To explore the influence of cirrhotic portal hypertension and its complications on liver transplantation. Methods The literatures of the recent years on influence of hepatic cirrhotic portal hypertension on liver transplantation were reviewed. Results Splenomegaly, hypersplenism, portal vein thrombosis, portosystemic shunt and collateral flow in cirrhotic patients will increase the difficulty of liver transplantation and lead to more postoperative complications. Appropriate handling of these conditions can achieve a higher success rate of liver transplantation. Conclusion Correct management of end-stage cirrhotic portal hypertension and its complications can expand the indications of liver transplantation and improve long-term survival rates.
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.
Objective To introduce the mechanisms of graft injuries after small-for-size liver transplantation and protective measures. Methods Recently relevant literatures were reviewed and summarized. Results Portal hypertension after small-for-size liver transplantation induces mechanical injuries as well as hepatic sinusoidal microcirculation disturbance and cytokines release, which worsened the injuries. Decrease portal pressure by surgery or drug could improve grafts function. ConclusionComprehending the mechanisms of graft injuries will contribute a lot for the living donor liver transplantation.
ObjectiveTo evaluate clinical efficacy of the modified Sugiura procedure with cardia transection in treatment of recurrent portal hypertension with upper gastrointestinal bleeding.
MethodsFrom January 2007 to January 2015, there were 28 cases of recurrent portal hypertension with upper gastrointestinal bleeding were treated by the modified Sugiura procedure with cardia transection in The Second People's Hospital of Yichang and The Zigui County People's Hospital, collecting the clinical data of them and then summarizing the therapeutic effect.
ResultsAll cases underwent surgery successfully with no operative death. The operative time was 120-300 minutes with an average of 160 minutes. About surgical blood loss was 100-500 mL, with an average of 210 mL. Two cases suffered from postoperative gastrointestinal bleeding, 6 cases suffered from postoperative gastric dysfunction, and no one suffered from anastomotic leakage, anastomotic stenosis, and portal vein thrombosis. Three cases died in reason of liver failure and hepatic coma. There were 24 cases were followed up for 6-60 months, with the median of 33 months. No recurrence of gastrointestinal bleeding happened during the follow-up period. Sixteen cases underwent gastroscopy in 6 months after surgery, according to the results, the clinical effect was fine. For grade of varicose veinsm, there were 14 cases of grade GⅠ and 2 cases of grade GⅡ. For shape of varicose veins, there were 11 cases of grade F1 and 5 cases of grade F2.
ConclusionThe modified Sugiura procedure with cardia transection is a safe and thorough operation for recurrent portal hypertension with bleeding.
【Abstract】ObjectiveTo inquire the therapeutic effect of retroperitoneal splenic autotransplantation combined with lower esophageal transection in the treatment of hepatic cirrhosis induced portal hypertension with randomized comparasion.MethodsThe hepatic cirrhosis induced portal hypertension patients with Child A or B grade of liver function were randomly divided into splenic autotransplantation group and splenectomy group.In the splenic autotransplantation group, retroperitoneal transplantation of pedicled autosplenic tissue combined with modified lower esophageal transection was performed,while in the splenectomy group, splenectomy combined with modified lower esophageal transection was conducted.The general conduction, splenic scanning, liver function, serum tuftsin and IgM levels in patients were observed 2 to 6 months after operation, and compared with those before operation. ResultsOne patient died in the splenectomy group on the 6th postoperative day, rebleeding occurred in one case of the splenic autotransplantation group. The levels of tuftsin and IgM in splenic autotransplantation group were higher than those of splenectomy group after operation, with significant difference (P＜0.01). The liver function between two groups showed no difference (Pgt;0.05).ConclusionSpleen autografts could maintain the basic immune function of spleen and survive for a long time.
【Abstract】Objective To explore the dynamic expression of TNF-α and VEGF in the development of esophageal varices in rats with portal hypertension. Methods Sixty male SD rats were randomly divided into the experimental group and the control group. In the experimental group, a two-stage ligation of portal vein plus ligation of the left adrenal vein was performed.After establishment of the model, the expression of TNF-α、VEGF and PCNA in the lower esophagus was detected with immunohistochemical SP technique on 7 d、14 d、21 d and comparision of these data with control group was performed respectively. In the control group, a sham-operation was performed, was also divided.Results The portal venous pressure in the experimental group was significantly higher than that of the control, so did the vessel number and the total vascular area of the submucosal veins in the lower esophagus. Compared with the control subgroups, the expression of TNF-α and VEGF on the 21 d subgroup was ber, while PCNA was ber on the 14 d and 21 d. Conclusion In the development of esophageal varices of portal hypertension, VEGF possibly plays a role in the varices developemt, and TNF-α may be responsible for the damage of esophageal mucosa.
