Abstract:Abstract:Objective:To compare prospectively the features and effects of combined operation (splenorenal shunt plus portal-azygous devascularization) and portal-azygous devascularization only（PCDV）on portal hypertension(PH). Methods:We summarized 360 cases of PH admitted from 1984 to 2004. All patients were randomly divided into two groups, one was combined operative group (250 patients) and the other was PCDV group (110 patients). The therapeutic effects and changes of portal hemodynamics were studied with doppler flowmeter(DCFI), free portal pressure(FPP) and digital subtraction angiography (DSA) pre-and post-operatively, and were measured directly during the course of the procedure. Results:(1)Postoperative bleeding:Of all the patients who underwent combined operation, no case of rebleeding occurred in the short period after operation, and the rebleeding rate was 8.0% in the long period of follow-up. In the patients who underwent PCDV, the rebleeding rate was 5.5% in the short period after operation, and 17.6% at long-term follow up(P<0.05) postoperatively. (2)The rate of hepatic encephalopathy in the combined operation group was 5.6% and in the PCDV group aws 4.4%(P>0.05). (3)There was a significant decrease in the diameter of portal vein, and FPP postoperatively in the combined operation group compared to PCDV group. There was a significant decreases of PVF in the PCDV group. But the decrease of PVF in the two groups had no significant difference. Conclusions:The combined procedure has merits of greater decrease of FPP, and alleviation of the condition of hyperdynamic blood flow in the portal vein. The clinical effect is also better than that of portal-azygous devascularization only.

Abstract:Abstract:Objective:To observe the clinical effects of pericardial devascularization(Hassab operation) combined with endoscopic variceal ligation(EVL) in the treatment of esophageal variceal bleeding(EVB) in portal hypertension and to discuss its rationality.Methods:The clinical data of 93 patients with EVB admitted in the recent 5 years being randomly divided into undergoing one of three surgical procedures including EVL,Hassab operation and the combined procedure respectively were analyzed and compared.Results:Acute hemostatic rate of the three procedures had no significant difference（P>0.05）.In the combined procedure group, no short-term bleeding occurred and the incidence of rebleeding was 5.7% during long-term follow-up.The incidence of rebleeding was significantly lower in the combined procedure group than in EVL and Hassab operation group（P<0.05）.Blood flow volume of azygos venous system decreased postoperatvely by 22.7%,30.4% and 45.7% in EVL,Hassab operation and the combined procedure respectively.Conclusions:The combined operation can interrupt abnormal portal-azygous shunts within and outside the gastroesophageal lumen and thus can radically treat esophageal varices and promote the disappearance of hypersplenism, so can significantly decrease azygous venous blood flow. It has the advantage of achieving secure stoppage of bleeding and has a low rate of rebleeding. The combined operation is a rational and feasible operation in the treatment of patients with esophageal variceal bleeding due to portal hypertension.

Abstract:Abstract:Objective:To discuss the therapeutic effect of simple portal-azygous disconnection and modified Sugiura operation(MSO) in the treatment of portal hypertension.Methods:The operative safety, postoperative recovery, complications and follow-up results were compared between 30 cases of simple (simple group) and 34 cases of MSO. Results:The basic clinical informations were comparable between the two groups（P>0.05）.No intra-or post-operative severe complications nor mortality occurred in either group. There was no significant difference between the two groups in operative blood loss, postoperative recovery time and hospital stay days（all P>0.05）. The number of cases with disappearance of esophagcal varices was significantly higher in MSO group than in the simple venous disconnection group(P<0.05).Conclusions:The obliteration rate of esophageal varices is significantly better after the modified Sugiura operation than after the traditional disconnection operation. However,the long-term therapeutic effects are similar.

Abstract:Abstract:Objective:To investigate the effects of combination of limited shunt and devascularization in the treatment of patients with portal hypertension. Methods:The follow-up results of 39 portal hypertension patients undergoing the combined operation were retrospectively analysed. Results:The postoperative free portal pressure decreased by 8cm H2O,and hepatopetal portal venous blood flow was maintained. All the patients were followed-up for 6 to 24 months, the results showed that various degreas of recovery of liver function in 18 patients. One patient had transient hepatic encephalopathy. Ascites disappeared in 38 patients and gastroesophageal varices improved in 82.1% of patients. No case of rebleeding occured. Conclusions:Limited shunt combined with devascularization can effectively maintain the blood supply to the liver, prevent upper gastroesophageal hemorrhage and reduce the occurrence rate of hepatic encephalopathy. It is a suitable operative method for the treatment of portal hypertensive patients.

Abstract:Abstract:Objective:To explore the effects of selenium enriched Spirulina platensis (Se-SP) on antioxidation and regeneration of rat hepatocytes after partial hepatectomy. Methods:Sixty-seven percent hepatectomy was performed in rats after high dose(H) and low dose(L) Se-SP was given via gastric tube for 7 days. Then selenium (Se), glutathione peroxidase (GPx), superoxide dismutase (SOD) and malondiaoldehyde(MDA) in hepatocytes were determined. The results were compared with normal saline giving via gastric tube before hepatectomy(C) and sham operation(S) groups.Hepatocytes were obtained before operation and 24h after operation,and the expression index of proliferating cell nuclear antigen (PCNA) in hepatocytes was detected by immunohistochemistry, and the DNA damage of hepatocytes induced by peroxide was analyzed by comet assay. Results:After partial hepatectomy, Se content, GPx and SOD activity, and PCNA expression index were obviously higher (P<0.05), whereas content of MDA was significantly lower (P<0.05) in hepatocytes of rats with high dose and low dose Se-SP(150mg/100/d) than those in control. The DNA oxidation damage in hepatocytes induced by peroxide (100 nM for 30 min) was decreased also in rats with high dose and low dose of Se-SP treatment. Conclusions:Se-SP has definite antioxidation and regeneration enhancing effects on rat hepatocytes after hepatectomy.

Abstract:Abstract:Objective:To study the effect of partial portal vein arterialization on the liver of rats after partial hepatectomy. Methods:Forty eight SD rats underwent partial hepatectomy and were divided into nonarterialization group and arterialization group. Dynamic observation of serum ALT and AST,and changes of ATP,ADP and AMP in hepatic tissues were determined at 2h,6h and 12h after operation.EC values were also calculated, and hepatic tissues were obtained for pathologic examination. Results:（1）Compared to nonarterialization group, the serum AST and ALT of arterialization group showed no significant difference on the 2nd hour after the operation(P>0.05)，but，serum AST and ALT were significantly decreased on the 12th hour in arterialization group (P<0.01 and P<0.05). （2）Compared with nonarterialization group, the ATP content of liver tissue and EC value were significantly increased on the 2nd，6 th and 12th hour in arterialization group (P<0.01 and P<0.05). （3）Hepatic pathological changes were exacerbated progressively with the prolonged duration of ischemia in nonarterialization group, while the injury of hepatic cells in arterialization group was mild. Conclusions:The partial arterialization of portal vein can lessen the damage of the liver after partial hepatectomy and transection of hepatic artery, and can improved the energy metabolism of the hepatic cells.

Abstract:Abstract:Objective:To investigate the protective effects of Ginkgo Biloba leaves(EGb) preconditioning on liver graft in rat liver transplantation. Methods:Male Sprague-Dawley rats were used as donors and recipients of orthotopic liver transplantation(OLT). The rats were randomly divided into EGb group, normal saline(NS) control group and sham operation(SO) group. The animals were killed at 2h, 6h, 24h after graft reperfusion. Plasma samples were collected for ALT and AST test. Liver tissues were collected to detect the expression of TNF-αmRNA and Bcl-2mRNA by RT-PCR. Also, liver tissues were used to detect rat liver histological change and apoptosis by TUNEL. Results:The serum levels of ALT in EGb group were significantly lower than the NS group(P<0.01) at 2h, 6h and 24h after reperfusion. The serum levels of AST in EGb group were significantly lower than the NS group(P<0.01) at 2h and 6h after reperfusion. The apoptosis index (AI) of liver tissue in EGb group was significantly lower than the NS group(P<0.01) at 2h, 6h and 24h after reperfusion. The expression of TNF-αmRNA was significantly lower in EGb group than the NS group(P<0.05) at 2h and 6h after reperfusion. The expression of Bcl-2mRNA was significantly higher in EGb group than the NS group(P<0.01) at 2h, 6h and 24h after reperfusion. Conclusions:Preconditioning with extracta of Ginkgo Biloba leaves can attenuate liver graft ischemia/reperfusion injury and apoptosis of rat hepatocytes by affecting the expression of TNF-αmRNA, and Bcl-2mRNA and exert a protective effect on the liver graft.

Abstract:Abstract:Objective:To investigate the effect of survivin antisense oligodeoxynucleotides (ASODN) on intimal hyperplasia(IH) in vein graft in rats.Methods:Autogenous vein graft model was established in 60 Wistar rats by transplanting the interior jugular vein to common jugular artery using microsurgical technique. The rats were divided into 5 groups according to different processing methods, including survivin ASODN 50μg and 200μg, scramble ODN 200μg, control group and lipoectin+pluronic group. Vein graft samples were harvested at 1 or 2 weeks after surgery and histomorphologic methods were used to compare the degree of IH.Survivin mRNA was measured by RT-PCR. Western blotting and immunohistochemistry methods also were used to detect the expression of survivin and PCNA. Apoptosis of VSMC was dectected by TUNEL. Results:IH was evident within 1 to 2 weeks after vein grafting, but was markedly inhibited by 50μg of survivin ASODN(P<0.05), and even higher inhibition rate in 200μg of survivin ASODN group(P<0.05). However, no effect was seen in the other group. The expression of survivin mRNA was also inhibited significantly by survivin ASODN. Expression of survivin and PCNA decreased markedly in survivin ASODN group, but the positive cells of TUNEL increased significantly. Conclusions:Transfection of survivin ASODN can inhibit the IH of vein graft, which may be effecteol by the inhibition of expression of survivin and enhancement of VSMC apoptosis.

Abstract:Abstract:Objective:To study the changes of intrahepatic shunt flow(IHSF) and functional hepatic blood flow(FHBF) after liver ischemia reperfusion in rats. Methods:12 healthy male SD rats were anaesthetized and heparinised.The right carotid artery,jugular vein and two distal ileocolic veins were cannulated for blood transfusion,volume compensation,drug infusion,and blood sampling respectively. Rats were randomly divided into 2 groups. Group 1 was the sham operation control group. Group 2 rats was ischmic/reperfusion(I/R) group, subjecting to 45min liver lobar ischemia and 60min reperfusion.Both groups received infusion of D-sorbitol(10mmol/l,0.2mL/min) via portal venous,and blood samples(1mL) were drawn simultaneously from the carotid,portal venous,and hepatic venous catheters.Portal venous flow(PVF) and hepatic arterial flow(HAF) were measured via flow probes.Hepatic sorbitol uptake rate, FHBF and IHSF were calculated. Results:There were no significant differences between the two groups in PVF,HAF and total hepatic blood flow(THBF). Compared to control group, hepatic sorbitol uptake rate as well as FHBF were decreased and IHSF was increased in I/R group(P<0.01). Conclusions:After liver ischemia reperfusion in rats, intrahepatic portal systemic shunts were opened and FHBF was reduced.

Abstract:Abstract:Objective:To explore the correlation between up-regulation of cyclooxygenase-2(COX-2) expression and hepatocellular carcinoma (HCC) angiogenesis. Methods:The expression of COX-2，vascular endothelial growth factor (VEGF)、basic fibroblast growth factor (bFGF) and angiopoientin-2 (Ang-2) were examined in eighty matched sets of HCC specimens using immunohistochemistry and reverse transcription- polymerase chain reaction(RT-PCR). Results:In HCC, the expression rate of COX-2，VEGF，bFGF and Ang-2 was 75.0%，62.5%，60.0% and 61.25%, respectively. Immunohistochemical staining scores of VEGF、bFGF and Ang-2 were 5.98±1.16, 4.57±0.26 and 5.87±0.12, respectively in strongly postive group of COX-2; and were 3.30±0.22，2.61±0.16 and 2.63±0.13, respectively in moderately weak postive group of COX-2. The expression rates of VEGF，bFGF and Ang-2 were 100.0%(95/95)，94.29%(33/35) and 97.14%(34/35), respectively in strongly postive group of COX-2; and were 60.0%(15/25)，60.0%(15/25) and 60.0% (15/25), respectively in moderately weak postive group of COX-2. There was significant difference in HCC angiogenesis between the two groups (P<0.01), and COX-2 expression was significantly correlated with VEGF，bFGF and Ang-2(r=0.857，0.706，0.901，respectively and all P<0.01). MVD was 73.18±12.43 and 33.42±7.52 in strongly postive group of COX-2 and moderately weak postive group of COX-2, respectively(P<0.01),and COX-2 was significantly correlated with HCC MVD(r=0.812，P<0.01). Conclusions:Up-regulation of COX-2 expression correlates with tumor angiogenesis in HCC.

Abstract:Abstract:Objective:To investigate the expression of Skp2 and C-myc in hepatocellular carcinoma and its relationship with clinicopathologic characteristics. Methods:The expression of skp2 and C-myc was evaluated in hepatocellular carcinoma tissues of 48 patients, liver cirrhosis tissues of 20 cases, and normal liver tissues of 16 patients by immunohistochemistry(PV9000 two steps methods).Results:The expression rate of skp2(33.3%) in hepatocellular carcinoma tissues was significantly higher than that in liver cirrhosis tissues(negative expression)( P=0.008)and normal liver tissues(negative expression)( P=0.020).The expression of skp2 was correlated with histological differentiation and metastasis(P﹤0.001 and P=0.017),but not with tumour size(P=0.058)，and it was not expressed in highly differentiated hepatocellular carcinomas. The expression rate of C-myc protein in hepatocellular carcinoma tissues(58.3%) was significantly higher than that in liver cirrhosis tissues(15%)(P=0.001) and normal tissues(negative expression)(P<0.001). The expression of C-myc was correlated with histological differentiation(P<0.001), metastasis(P=0.023), and tumour size(P=0.007).The expression of skp2 in hepatocellular carcinoma was positively correlated with the expression of C-myc(r=0.508, P<0.001). Conclusions:C-myc gene may be closely related to the occurrence and development of hepatocellular carcinoma. The expression of skp2 indicates a poor prognosis. The expression of skp2 in hepatocellular carcinoma may be positively modulated by the activation of C-myc gene.

Abstract:Abstract:Objective:To study the characteristics of hepatic artery anatomy and master the method of arterial repair, especially the method and technology of repair of anomalous donor arteries. Methods:Sixty-four human liver arteries were dissected and repaired, and 31 of these were used in liver transplantation. Results:Twelve of 64 cases had anatomical anomaly of hepatic artery (12/64,18.75%). Five of 24 fetal liver donors(20.83%) had anatomical anomaly of hepatic artery, one arose from the superior mesentery artery as a replaced right hepatic artery, 3 from accessory right hepatic artery, and in 1 case the hepatic artery arose from superior mesentery artery directly. Seven adults had hepatic artery anomalies:2 cases of right hepatic artery being replaced by artery derived from SMA, 2 cases of left hepatic artery deriving from left gastric artery and 3 cases of accessory right hepatic artery derived from SMA.In 31 hepatic transplantations, 4 grafts with anatomical anomaly of right hepatic artery were used. Conclusions:Reconstruction of hepatic artery plays an important role in hepatic transplantation. Avoidance of injury to aberrant hepatic avteries during removal of donor liver is a key to ensure successful arterial repair.During repair of very small accessory hepatic arteries, ligation or repair of the artery may be determined after observation of backflow from collateral vessels.

Abstract:Abstract:Objective:To assess whether clustered radiofrequency ablation(RFA) would lead to hematogenous dissemination of malignant cells in patients with primary hepatocellular carcinoma (PHC).Methods:In 33 patients with PHC, the expression of AFPmRNA in peripheral blood before and after RFA treatment was detected by RT-PCR.Results:Before RFA treatment,peripheral blood AFPmRNA was positive in 18 PHC patients(56.3%),and in the remaining 14 patients was negative(43.7%).However,positive expression of peripheral blood AFPmRNA was detected in 12 patients(37.5%) after RFA treatment.No significant difference of AFPmRNA expression was found before and after RFA tereatment(P>0.05).Conclusions:RFA treatment of PHC patients does not lead to hematogenous tumor dissemination.

Abstract:Abstract:Objective:To study the therapeutic effect of liver resection for spontaneous rupture of primary hepatocellular carcinoma (SRHCC). Methods:The clinical data of 15 patients with ruptured SRHCC treated by liver resection were retrospectively analysed. Results:In this group there were 12 males and 3 females. Eight underwent emergent hepatectomy, 2 cases had second stage surgery at 40 days after initial operation to control bleeding and 5 cases had operation after 40 days of conservative treatment.Operation included partial right hepatectomy in 8 patients, median lobectomy in one patient, left lateral lobectomy in 2 patients, left median lobectomy in 2 patients, left hemihepatectomy in 1 patient, right tumor resection in 1, and left tumor resection in one patient. One of 5 patients with Child grade B liver function died of liver failure at 5 days after operation. The operative mortality was 6.7%. Twelve of the 14 patients who surrived were followed up. The median postoperative survival time was 18 months. The 1-, 3- and 5- year survival rates were 58.3%, 25%, 16.7%, respectively.One patient has been alive and free of tumor for 6 years and 2 months. Conclusions:Liver resection is the best treatment for ruptured SRHCC and should be performed when possible. Hepatic resection for SRHCC can result in a long survival time.