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.
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.
ObjectiveTo evaluate the value of individualized preoperative simulation in transjugular intrahepatic portosystemic shunt (TIPS).MethodsThin slice scan data of 39 patients with supine upper abdomen were obtained, three dimensional structures of bone, liver, portal vein, inferior vena cava and hepatic vein in CT scan area were reconstructed in Mimics software. According to the size of interventional instruments, a virtual RUPS-100 puncture kit and an VIATORR stent were established in 3D MAX software. Computer simulations were performed to evaluate the route from the hepatic vein puncture portal vein and stent release position. The coincidence of simulation parameters with actual surgical results was compared.Results① The time of preoperative simulation was controllable. The total simulation time was 70–110 minutes (after summing up the previous experience). Preoperative simulation in daily work would not affect the progress of treatment. ② There were 4 cases of puncturing bifurcation of portal vein, 22 cases of puncturing left branch and 13 cases of puncturing right branch during operation (24 cases of puncturing left branch and 15 cases of puncturing right branch by preoperative simulation plan). The overall coincidence rate was 89.7% (35/39). ③ Preoperative simulations were performed using 8 mm×6 cm/2 cm size VIATORR stents, and the stents used in the actual operation were the same as the simulation results. ④ Preoperative simulation and post-operative retrospective simulation could shortened the teaching and training time and enhanced the understanding of surgical intention and key steps.ConclusionPreoperative simulation based on patient's individualized three-dimensional model and virtual interventional device could guided the actual operation of TIPS more accurately, and had practical value for improving the success rate of operation and training young doctors.
门静脉高压症是慢性肝病的主要合并症之一，它所导致的食管胃底静脉曲张破裂出血死亡率可达30%～50%，是肝硬变患者的主要死亡原因。1概述自1945年Whipple等人倡导门体分流手术治疗门静脉高压症以来，各国学者作出了不懈努力，探求对这种顽症的治疗手段。最近20～30年在治疗方法上出现了许多革新，如内窥镜下曲张静脉硬化剂注射、曲张静脉套扎、门体静脉选择性分流（远端脾肾分流）等。应用β受体阻滞剂心得安来预防或治疗门静脉高压症引起的上消化道出血取得了肯定的疗效。小口径人工血管门静脉下腔静脉搭桥分流减少了门体分流手术后脑病的发生率，而复发出血率几乎可与传统门腔分流术相比。经颈内静脉肝内门体分流术（TIPSS）治疗急性上消化道出血的疗效十分肯定，尤其适用于手术风险大、肝功能差者。肝脏移植作为治疗终末期不可逆性肝病的成熟手段，近年来也越来越多地应用于肝硬变门静脉高压症的治疗，与其它各种治疗手段相比，肝移植可算是对门静脉高压症治疗的一种革命性的变化，一个成功的肝移植一劳永逸地解决了门静脉高压症产生的根源，使门静脉高压症得到根治。
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.
Pancreatic sinistral portal hypertension (PSPH) is a clinical syndrome resulting from pancreatic disease that blocks splenic vein return, which includes acute and chronic pancreatitis, pancreatic tumors, and iatrogenic factors related to pancreatic surgery. Most PSPH patients present with isolated gastric varices, splenomegaly and hypersplenism, with normal liver function, and upper gastrointestinal bleeding caused by varices in the fundus of the stomach is the most serious clinical manifestation. The treatment of PSPH can be divided into the treatment of portal hypertension in the spleen and stomach region, including close follow-up, medication, endoscopic therapy, splenic artery embolization and splenectomy, etc. The primary diseases of pancreas are mainly treated for acute pancreatitis, chronic pancreatitis and pancreatic tumor. In particular, PSPH related to pancreatic surgery should be concerned.
Objective To summarize the effect of the splenectomy in patients with portal hypertension on the occurrence and recurrence of hepatocellular carcinoma. Methods The related literatures about the splenectomy in patients with hepatocirrhosis combined with portal hypertension or patients with hepatocellular carcinoma combined with portal hypertension in recent years were reviewed. Results At present, most academics considered that, for patients with hepatocirrhosis combined with portal hypertension, splenectomy could reduce the occurrence of hepatocellular carcinoma. For patients with hepatocellular carcinoma combined with portal hypertension, splenectomy+hepatectomy didn’t increase the perioperative mortality, and it could reduce the recurrence rate of hepatocellular carcinoma. Conclusion Splenectomy for patients with portal hypertension is safe, and it can inhibit the occurrence and progress of hepatocellular carcinoma, however, the specific mechanism remain needs further study.
ObjectiveTo summarize research progress of vascular physiological function of epoxyeicosatrienoic acid and its impact on pathogenesis of cirrhotic portal hypertension. MethodLiteratures about recent studies on epoxyeicosatrienoic acid in different organs and different animal models including cirrhotic portal hypertension were reviewed according to the results searched from PubMed and Wanfang databases. ResultsEpoxyeicosatrienoic acid in the different organs and the different animal models showed the complex functions, and it might affect the development of cirrhosis portal hypertension disease through its vascular physiological function. ConclusionIncreasing or decreasing epoxyeicosatrienoic acid might affect development of cirrhosis portal hypertension disease, which could provide a new method for treatment of cirrhosis portal hypertension.
Objective To investigate the clinical feature and misdiagnosis of 128 patients with Wilson’s disease and proposed the points of diagnosis for this disease. MethodsOne hundred and twenty eight patients with Wilson’s disease from Jan. 1983 to Apr. 2000 of our hospital were reviewed. Their clinical feature and diagnosis condition, such as the first onset symptoms, misdiagnosis conditions and hypersplenism were studied. Results①The first onset symptoms: 64 showed liver dysfunction and 52 presented manifestation of central nerves system (CNS) (Pgt;0.05). ②The age of liver dysfunction was significantly younger (13 years) than that of CNS involved patients (23 years, P＜0.05). ③Patients with the liver damage had enlarged liver (3 cm below the right rib) and hypersplenism and 12 patients had to receive splenectomy. ④Gastroscopy or barium meal showed that esophageal varicose rate was 30.8%（12/39） and 7 patients had large upper gastrointestinal bleeding. Conclusion The age of liver involved patients is significantly younger than that of the CNS involved patients. The liver cirrhosis, hypersplenism and portal hypertension are very common complications of Wilson’s disease and some prevention and cure measures should be taken for these complications.
目的 交流断流术加脾肾分流术联合治疗门静脉高压症的体会。方法 对我院1994～2000年采用断流术加脾肾分流术联合治疗的12例门静脉高压症患者资料进行回顾性总结与分析。结果 全组病例均获随访，除1例在术后15个月因肝癌死亡外，其余11例均健在，其中10例生活质量良好，并恢复原来工作，生存时间最短15个月，最长8年，中位生存时间4年。术后均无出血和肝性脑病发生。结论 应用联合术治疗门静脉高压症避免了单一断流术、分流术及脾切除术的缺点，具有术后再出血率低，患者生存质量高及远期生存率高等优点，是一种理想的术式。