【Abstract】ObjectiveTo explore the appropriate surgical management of the primary hepatocellular carcinoma with hypersplenism. MethodsOf 67 patients who has primary hepatocellular carcinoma with hypersplenism, 17 cases had hepatectomy combined with splenectomy, 7 cases had hepatectomy only, and the other 43 patients were treated with hepatic artery embolization and splenic artery embolization. ResultsThe symptoms of hypersplenism disappeared and the hemogram became normal 30 d after operation in 17 patients who had hepatectomy combined with splenectomy, but worsened in 7 patients who only had simple hepatectomy and 6 cases of those patients were treated with splenic artery embolization 3-7 months after operation. In 43 patients treated with hepatic artery embolization and splenic artery embolization, 79%（34/43）had improved hypersplenism symptoms and the hemogram became normal. ConclusionThe treatment of primary hepatocellular carcinoma with hypersplenism should be strived for hepatectomy combined with splenectomy. If the liver mass cannot be resected, hepatic artery embolization and splenic artery embolization should be chosen.
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.
ObjectiveTo explore the therapeutic effects of spleen aminopeptide on connective tissue disease-related interstitial lung disease (CTD-ILD) and its mechanism for anti-fibrosis.
MethodsNinety patients with CTD-ILD admitted between February 2014 and May 2015 were recruited in the study. The CTD-ILD patients were randomly divided into group A (conventional therapy alone) and group B (conventional therapy plus spleen aminopeptide). Peripheral blood collected from CTD-ILD patients were subjected to performance of flow cytometric analysis and cytokine/chemokines profiling by liquid Chip and ELISA assay. Pulmonary function test and high resolution CT (HRCT) scan were performed before and after the treatments for 12 weeks. Human cytomegalovirus (HCMV) DNA in the patients' blood was tested by Q-PCR.
ResultsSignificantly improved lung function and HRCT score were observed in group B, but not in group A. The levels of Treg and IFN-γ were significantly increased in group B, compared with those in group A where markedly increased IL-6, IL-10 and IL-17 were detected (P < 0.05). There was higher virus negative reversal rate in group B than that in group A (P < 0.05).
ConclusionSpleen aminopeptid can effectively regulate deregulated immune microenvironment in CTD-ILD patients and inhibit HCMV replication, thereby block pulmonary fibrotic development.
【Abstract】ObjectiveTo investigate the effects of liver transplantation on splenic function in rats with hepatic cirrhosis. MethodsHepatic cirrhosis model was established in rats by subcutaneous injections of carbon tetrachloride. Liver transplantation model was established with twocuff technique. Spleen index, morphological changes of spleen were observed before and after liver transplantation in hepatic cirrhosis rats. Spleen T lymphocyte subgroups before and after liver transplantation were also assayed by immunofluorescence staining and flow cytometry. ResultsBefore liver transplantation, spleen index was increased from (2.42±0.11) mg/g to (3.62±0.14) mg/g， P＜0.01; pathological examination of spleen samples showed that the areas of white pulp were decreased from (23.47±2.30)% to (7.70±2.01)%， P＜0.01， and the areas of spleen trabecula were increased from (1.75±0.61)% to (4.46±0.71)%， P＜0.01. Meanwhile, the ratio of CD4/CD8 of spleen T lymphocyte subgroups was decreased from 2.67±0.15 to 1.18±0.15, P＜0.01. After liver transplantation, spleen index was decreased from (3.62±0.14) mg/g to (2.62±0.11) mg/g， P＜0.01; pathological examination of spleen showed that the areas of white pulp were increased from (7.70±2.01)% to (15.07±1.97)%， P＜0.01, and those of spleen trabecula were decreased from (4.46±0.71)% to (3.11±0.51)%， P＜0.05. Meanwhile, the ratio of CD4/CD8 of spleen T lymphocyte subgroups was increased from 1.18±0.15 to 2.32±0.11, P＜0.01. ConclusionImpaired function of spleen resulting from liver function damage can be improved in rats with hepatic cirrhosis after liver transplantation.
OBJECTIVE: To evaluate the histological characteristics of xenogeneic graft-versus-host disease (GVHD), and to differentiate it from the allogeneic GVHD. METHODS: The original articles related to the characteristics of xenogeneic GVHD and the relationship between xenogeneic GVHD and allogeneic GVHD were widely reviewed in the past decade. RESULTS: Xenogeneic GVHD was different from allogeneic GVHD in the speed of development, position and features of pathological changes, due to the incompatibility of common simulative signals, adhesive molecules and difference of antigens. Xenogeneic spleen transplantation could induce xenogeneic GVHD. CONCLUSION: Xenogeneic GVHD can be used as a model to mimic rejection in xenotransplantation and to evaluate the compatibility of xenotransplantation.
Objective To study the effect of splenectomy on the anti-tumor immunity in rats with induced hepatocellular carcinoma (HCC). Methods At the second and fourth month of the induced HCC, the NK cell activity, TNF-α level and total lymphcyte in blood were measured in the group of splenectomy and the control group. Results There were no different in the total lymphcyte and TNF-α in the blood in two groups, but there were significant difference in the NK cell activity between the group of splenectomy and the control group (Ｐ＜0.05). Conclusion There are some change in the anti-tumor immunity after splenectomy in rats, in which NK cell activity is at low level continuously. TNF-α isn′t affected after the second month after splenectomy.
Objective To improve the diagnosis and treatment of complications following spleen transplantation. Methods Five cases of spleen transplantation performed to treat severe hemophilia A were analyzed retrospectively .Results Hemorrhage was found in 2 cases that one was from small vessels of spleen porta and the other one was retroperitoneal hemorrhage. Acute rejection was diagnosed in early stage to all in which it happened to 1 case within 5 days, happened to 3 cases from the fifth day to the tenth postoperative day and happened to 1 cases after the tenth day. Infection was found in 2 patientsone with incision infection and the other with infection retroperitoneal infection. All but one who died from hydrocephalus recovered as a result of timely diagnosis and treatment.Conclusion It is of great significance to the recipients with transplanted spleen that the complications are detected comprehensively and treated in time.
ObjectiveTo evaluate the therapeutic effect of transplantation of mesenchymal stem cells(MSCs) through the spleen for acute live failure in rat, and to observe migration of transplanted MSCs in vivo.
MethodsOne male SD rat was sacrificed to collect MSCs, and MSCs were isolated, expanded, and purified by density gradient centrifugation combined with adhere culture method. The surface antigen expressions of MSCs in the fourth generation were detected by immunohistochemistry method. Twenty-four female rats were given D-galactosamine and tumor necrosis factor α(TNF-α) to establish models of acute liver failure, and then divided into experimental group and blank control group, each group enrolled 12 rats. MSCs of male rat were transplanted into the spleen of female acute liver failure rats in experimental group at 24 hours after model establishment, but rats of blank control group were injected saline(0.5 mL). After the MSCs transplantation, blood samples of rats in 2 groups were got to test levels of serum alanine aminotransferase (ALT), total bilirubin(TBIL), and albumin(ALB). PCR method was used to determine the expression of sex determining region Y gene(SRY gene), and HE staining was used to observe the pathological change of liver tissues of rats in 2 groups.
ResultsThe MSCs of the fourth generation expressed CD44 and CD29, but didn't express CD34. There were 5(41.7%) and 3 rats(25.0%) survived at 72 hours, in 1 week and 2 weeks after MSCs transplantation in experimental group and blank control group, respectively, and the survival rate was higher in experimental group(P<0.05). The expression of SRY mRNA was detected in rats of experimental group, as well as the damage of liver tissues in rats of experimental group improved. Compared with blank control group, the levels of ALT and TBIL were lower in experimental group at all time points after MSCs transplantation(P<0.05), but in 1 week and 2 weeks after MSCs transplantation, the levels of ALB in experimental group were higher(P<0.05).
ConclusionMSCs can migrate to liver tissue, settle down, and exert the function of replacing hepatocyte after it has been transplanted into the spleen.
ObjectiveTo investigate the feasibility and safety of spleen-preserving distal pancreatectomy (SpDP), and to discuss the indications and techniques of SpDP. MethodsThe clinical data of seven patients underwent SpDP between January 2004 and December 2007 in Xinhua Hospital were analyzed retrospectively. ResultsOut of the seven cases, one case received the SpDP combined with partial splenic vessel resection, while the other cases received the SpDP with splenic vessel preservation. The operation time was (2.93±0.38) h and the intraoperative blood loss was (392.86±109.65) ml. Only one case suffered from pancreatic fistula, who finally recovered after medicine therapy and percutaneous drainage. There was no other complication or operative mortality. The postoperative platelet count was (273±43.76)×109/L and the postoperative hospital stay was (17.86±8.07) d. For six cases of patients, no recurrence and metastasis was found after the followup (49.2±14.4) months （30-72 months）. ConclusionSpDP is a safe and feasible procedure, which is worthy for selected cases such as benign neoplasm of the body and tail of the pancreas.
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.
