Abstract:Abstract:Objective
To explore the status and perioperative management of liver transplantation in treatment of portal hypertension.
Methods Clinical data of 56 patients with portal hypertension who underwent orthotropic liver transplantation (OLT) from February 2000 to April 2004 were studied retrospectively.Incidence of complications,and inhospital mortality and survival rate were analyzed. Platelet count after OLT was measured and liver blood flow was monitored by Doppler.
Results Among the 56 OLT patients, 6 cases(10.7%) underwent simultaneous splenectomy. Incidence of complications was 40.3%,and inhospital mortality and 1-,2-,and 3- year survival rate after OLT were 12.5% and 87.46%,85.19% and 81.58% respectively. Platelet count reached a nadir at posttransplant day 3.
Conclusions OLT is an effective method for radical treatment of portal hypertension. Perioperative management is of vital importance for success of the operation and patient′s prognosis.

Abstract:Abstract:Objective
To study a new operative method for treatment of hepatic venous occlasion without associated pathologic change of inferior vena cava or longsegment stricture.
Methods A total of 44 cases of Buddchiari syndrome with hepatic venous occlusion without pathologic change or longsegment stricture of inferior vena cava underwent combined mesocaval Cshunt, ligation of splenic artery, and esophagogastric devascularization.
Results Preshunt portal venous pressure was 36cmH2O(31~45 cmH2O, １cmH2O=0.0098kＰa) and postshunt pressure fell to 26 cmH2O(21~33 cmH2O),the mean reduction was 10 cmH2O. One patient died of liver failure. A slight degree of hepatic encephalopathy occurred in 2patients who recovered after conservative treatment.Chylorrhea occurred in 4 patients, and it spontaneously disappeared 7d to 3.5months after operation. 39 patients(88.6% follow up) were followed up for 6months to 7years , and there was no case of recurrent bleeding nor hepatic encephalopathy. Ascites disappeared in 31cases,and was markedly reduced in 7 cases .The prosthetic grafts were patent as shown by color Doppler ultra sound in all followedup patients.
Conclusions This operation is simple and effective for BCS with hepatic venous occlusion but not associated with inferior vena caval pathologic change or longsegment stricture.

Abstract:Abstract:Objective
To investigate the indications for interventional therapy of BuddChiari syndrome(BCS) and surgical treatment after stent failure.
Methods A retrospective analysis of the clinical data of 21 patients with mistakes in treatment of BCS by stent placement in inferior vena cava(IVC).
Results Among the 21 cases with mistakes, the indications were inappropriately selected in 6 cases, the main hepatic vein was obstructed by the stent in 1 case, dilated accessory veins were occluded in 10 cases, the stent was displaced in 3 cases, and the stent failed to unfold in 1 case. Nineteen cases were converted to operation; of these patients, a shunt was performed in 18 cases, and radical excision of diaphragmatic web of IVC was done in 1 case. Operation was successful in all 19 cases. After shunt procedure in the 18 cases, the free portal pressure significantly decreased(P<0.05); no patient died perioperatively. 15 cases were followed up for 6 months to 6 years. The effective rate was 86.7%(13/15), recurrence rate was 6.7%(1/15), and 1 case died of hepatic encephalopathy.
Conclusions Indication for interventional therapy for BCS should be stricv.Various types of shunt can be selected for cases of mistakes or recurrences related to interventional therapy.

Abstract:Abstract:Objective To investigate the relevant factors for development of early postoperative complications in patients with portal hypertension due to advanced schistosomiasis, and to offer a theoretical basis for preventing the occurrence of postoperative complications.
Methods The cases of advanced schistosomiasis with portal hypertension operated upon over the past 40 years were retrospectively reviewed.
Results In 8 240 cases, the complication rate was 19.66% at one month after operation, and the mortality rate was 15.31%. The main causes of death were MDOS, massive hemorrhage into abdominal cavity, hepatorenal syndrome and recurrence of bleeding of upper alimentary tract. Conclusions The relevant factors for development of early complications after operation in patients with portal hypertension is related to the cause of portal hypertension, whether or not there is a history of ascites, the timing of operation and the stage of liver function(Child′s classification).

Abstract:Abstract:Objective
To evaluate the therapeutic effects of EN，PN support on postoperative recovery of patients with portal hypertension.
Methods 135 patients with portal hypertension who underwent esophagogastric devasularization were randomly divided into three groups:EN,PN and control group. Postoperatively, EN and PN nutritional support and routine fluid replacement therapy was respectively given to the 3 groups. Several clinical and laboratory parameters were studied in order to determine the therapeutic effect of the two different forms of nutrition.
Results Nutritional status and immunological function of patients were improved in both EN and PN study groups but with no significant difference, while alterations in liver function and incidence of abdominal infection were higher in PN group.
Conclusions EN is an optimal form of nutritional support for patients with portal hypertension after operation.

Abstract:Abstract:Objective
To discuss the diagnosis, selection of type of operation, and prevention and treatment of perioperative complications of abdominal aortic aneurysm (AAA). Methods The clinical data of 96 patients who underwent open surgical treatment of AAA, at Xijing Hospital between January, 1990 and June, 2004 were retrospectively reviewed. Among those, 82 patients with infrarenal AAA underwent aneurysmectomy and graft repair. 12 cases were treated by aneurysmal wrapping with Dacron. In 2 patients with suprarenal false AAA, lateral aneurysmectomy and repair was performed.
Results The distance between renal artery and the neck of the aneurysm was determined by arteriography, MRA or EBT. Nintythree patients were cured, and three cases died, with an operative mortality of 3.1%(3/96). The operative mortality was 50.0%(2/4) in 4 cases who had urgent operation because of ruptured AAA, while the operative mortality rate of the cases undergoing elective surgical repair was 1.1%(1/92, P<0.05). Postoperative complications of AAA: 6 cases had symptoms of sigmoid colon ischemia; 2 cases had extremity ischemic symptoms; and 2 cases had acute renal insufficiency. All of these patients recovered completely. The total operative complication rate was 21.3％. 82 cases have been followedup for 6 months to 15 years, and the fiveyear survival rate was 81.7%. Conclusions Aneurysmectomy and prosthetic vascular graft repair is the basic method of treatment for AAA.

Abstract:Abstract:Objective
To discuss the diagnostic methods and management of ruptured abdominal aortic aneurysm(AAA) and to analyse the main factors that influence prognosis.
Methods The clinical data of 15 cases of ruptured infrarenal AAA treated in our hospital from 1998~2004 were retrospectively analysed. The main clinical manifestations were abdominal pain and/or back pain,low blood pressure or shock, and pulsating abdominal mass. 8 cases were diagnosed by DSA and/or sCTA; Doppler ultrasonic examination suggested rupture of abdominal aortic aneurysm in 2 cases; 2 cases had known history of AAA prior to rupture; and 3 cases were diagnosed during operation. All of the patients underwent surgical operation. Successful clamping of the abdominal aorta above the neck of AAA was accomplished in 13 cases. Of these, the aorta was occluded below the diaphragm in 4 cases, and below the renal arteries in 9 cases.
Results Seven cases(46.6%) died in the perioperative period. 2 died of blood loss from aneurysm that ruptured into the free abdominal cavity, 1died of myocardial infarction 5 days postoperatively, 2 died of respiratory failure 3 days and 7 days postoperatively, and 2 died of renal failure 4 days and 8 days after operation. Severe complications did not develop in the remaining patients.
Conclusions Patients who present with the trilogy of abdominal pain and/or back pain, low blood pressure or shock and pulsating abdominal mass can be diagnosed easily. CT and Doppler ultrasonic examination are indicated for patients with questionable diagnosis and have stable vital signs. Operation is effective treatment for ruptured AAA. The crux of the operation is to mack an aortic occlusion proximal to the site of rupture of aorta to effectively control bleeding. Patients with rupture of AAA into the free peritoneal cavity or those with acute myocardial infarction, acute renal failure or respiratory complications had poor prognosis.

Abstract:Abstract:Objective
To study the management of femoral artery pseudoaneurysm caused by heroin injection.
Methods 11 cases of femoral artery pseudoaneurysm were treated. 4 cases presented with ruptured aneurysm and were treated emergently by direct ligation of the aneurysmal artery through a femoral incision. 2 cases underwent elective operation in which the iliac artery was initially exposed through an extraperitoneal lower abdominal incision to control bleeding, and then the aneurysmal artery was ligated through a femoral incision.
Results All of the operations were successful, and no gangrene of the affected limb occurred.
Conclusions Arterial ligation for femoral artery pseudoaneurysm caused by heroin injection is simple and effective. Intraoperative observation of distal arterial backflow,measurement of arterial pressure and intraoperative arteriography can improve the safety of the operation.

Abstract:Abstract:Objective To study the relationship between deep venous thrombosis(DVT) of lower extremity and Cockett′s syndrome(CS) in aged patients.
Methods Eighty nine patients with iliofemoral vein thrombosis, admitted during past 13 years, were divided into elder（>60 years）group and younger（≤60）group. Analysis of the pathogenesis of DVT in the 2 groups was made and the relationship of DVT and CS between the 2 groups was compared. There were 43 patients in elder group and 46 in younger group. All patients were treated by thrombectomy.
Results There were 25 (58.1%) patients with concomitant CS in elder group and 37 (80.4%) in younger group. There was a significant difference between the two groups (χ2=5.2274, P<0.05).
Conclusions CS is an important etiological factor for DVT. The incidence of DVT with CS in elder group is lower than that in younger group; but in the elderly, the incidence of DVT increases due to keeping to bed, trauma, fracture, tumor, high coagulability and other factors.

Abstract:Abstract:Objective To evaluate the effective treatment for and prevention of complications.
Methods The diagnosis and treatment of 32 patients with acute arterial ischemia of the lower extremity were analyzed retrospectively. 4 cases were treated with thrombolytic therapy, 28 cases underwent emergency operation, of which 3 cases underwent amputation after embolectomy, and 25 cases were treated by arteriotomy of femoral artery and embolectomy with Fogarty catheter(7 cases underwent concomitant arterioplasty).
Results One patient in the nonoperative group died; but there was no mortality in the operated group. Limb amputation was done in 3 cases, and limbs were saved in 28 cases.
Conclusions For acute arterial ischemia of the lower extremity, emergency arteriotomy of femoral artery plus embolectomy is the treatment of choice. This therapeutic approach can lower mortality and limb amputation rate.

Abstract:Abstract:Objective To investigate the effects of angiopioetins and tyrosine kinase receptor Tie2 ，vascular endothelial growth factor （VEGF）on the angiogenesis and progression of hepatocellular carcinoma（HCC）.
Methods With the methods of RTPCR and immunohistochemistry, the specimens from 28 HCC patients, 10 cirrhotics, and 10 normal livers were analysed, and the relationship between angiopioetins, VEGF expression and the clinical pathological characteristics of HCC was studied.
Results Ang/Tie2 and VEGF were significantly upregulated in HCC compared to cirrhotic tissue and normal liver tissue. Immunohistochemical staining also showed increased expression of Ang2,VEGF,Tie2 protein in HCC. A high Ang2/Ang1mRNA ratio and high VEGF in HCC were closely associated with tumor vascular invasion and microvascular density level which assesssed by CD34.
Conclusions Ang /Tie2 and VEGF may play critical roles in promoting tumor angiogenesis and progression in human HCC.

Abstract:Abstract:Objective:To investigate potential mechanism of arsenic trioxide (As2O3) and/or adriamycin (ADM) induces apoptosis in hepatocellular carcinoma (HCC) cells. Methods:Human hepatocellular carcinoma cells, HepG2, were treated with As2O3 combined with/without ADM in various concentrations for various time, and then the expression of survivin was detected by immunocytochemistry and RT-PCR respectively. Results:(1)Before the cells were interfered with drugs, survivin was highly expressed in HepG2 cells. (2)Expression of survivin was reduced in cells treated with various concentrations of As2O3 or ADM , and the reduction was dependent on durg concentration and time, these two factors were interrelated. (3)Expression of survivin was reduced more markedly in cells treated with ADM than in those treated with As2O3 and the reduction was additionally increased in cells treated with a combination of the two compounds. Conclusions:(1)Either As2O3 or ADM can downregulate the expression of survivin in HepG2 cells in a concentration-or time-dependent manner; (2)At the same concentration, ADM is more effective than As2O3 on the downregulation of survivin expression in HepG2 cells, but the effect can be enhanced by combination of these two drugs. (3)As2O3 and ADM may induce apoptosis in HepG2 cells through the downregulation of survivin expression and thus exert their anti-cancer effect. Their combination may enhance their anti-tumor effect, so that in clinical use, the dosage of each durg may be reduced.

Abstract:Abstract:Objective:To study apoptosis of small bowel epithelial cells during rejection of small bowel grafts and explore the correlation between apoptosis and cytokine(Interleukin-1β). Methods:Heterotopic small intestinal transplantation was performed in SD and Wistar rats. All recipients were divided into three groups: Group I isograft(SD-SD);Group II allograft(Wistar-SD);Group III treatment control(Wistar -SD treated with cyclosporine A). The grafts were harvested on day 1, 3, 5, 7 after operation. All graft samples were examined for apoptotic cells of graft epithelial cells with TUNEL method. Serum IL-1β levels were detected by sandwich ELISA method. Results:The TUNEL method showed that in Wistar→SD group, apoptosis of intestinal mucosa epithelial cells occurred during mild, moderate and severe rejection, and the number of apoptotic cells increased with increase of severity of rejection(P<0.01), and was significantly higher than in SD→SD group(P<0.01). The number of apoptotic cells was also increased in Wistar→SD+CsA group(P<0.01). Rejection was mild in SD→SD group, and the number of apoptotic cells was not significantly changed(P>0.05). ELISA method showed no significant change of serum IL-1β in SD→SD group(P>0.05), but in Wistar→SD group and Wistar→SD+CsA group, the serum IL-1β levels increased as the number of apoptotic cells increased(P<0.01). Increase in level of IL-1β and increase in number of apoptotic cells showed a significant positive correlation(r=0.798, P<0.01). Conclusions: Apototic phenomena are present during rejection of small intestinal graft. IL-1β can promote the development of cell apoptosis.

Abstract:为提高门奇断流术治疗门静脉高压症的手术效果，笔者回顾性分析近13年来用门奇断流术治疗59例门静脉高压症患者的临床资料及随访结果。结果示，全组无手术死亡；除急症手术组有2例分别在术后16个月和28个月出现再出血外，其余均治愈，生存质量提高。笔者的体会是：门奇断流术是治疗门静脉高压症简便而合理的术式。为了提高手术效果，对患者应定期行胃镜检查，争取在出血前期及时手术；同时规范手术操作，以实现门奇静脉的完全断流。