Portal vein thrombosis is a common though serious complication after splenectomy in patients with liver cirrhosis and portal hypertension.Its pathogenesis may be primarily associated with the coagulation mechanism and the changes of hemorheology.The clinical presentations of portal vein thrombosis after splenectomy depend on the course of disease,as well as site and degree of obstruction.The principle of treatment is to improve microcirculation,relieve the platelet aggregation and prevent further progress of the thrombosis.But in clinical settings,signs and symptoms of portal vein thrombosis were generally atypical.Any misdiagnosis or delayed treatment may expose the patients under risk.This article focuses on the risk factors,potential mechanisms and recent progress on the prevention of post-splenectomy portal vein thrombosis.

Organ transplantation is the first effective treatment for end-stage organ failure. However, early acute rejection after organ transplantation is often an important factor leading to transplantation failure. In order to reduce the incidence of rejection after organ transplantation, it is often necessary to use potent immunosuppressants to induce the immune system of recipients before or during transplantation. As a common method of covering immunosuppressive therapy in the early stage of organ transplantation, antibody immunoinducers can significantly reduce the occurrence of early acute rejection after organ transplantation, and delay or reduce the application of calcineurin inhibitor drugs, which is conducive to protecting renal function, promoting graft function recovery and long-term survival of recipients. This article reviews the application of antibody inducers in solid organ transplantation.

Objective To analyze the perioperative complications and prognosis of surgical treatment of pancreatic ductal stones.Methods 60 patients diagnosed to have pancreatic ductal stones and were admitted into our hospital from January 2009 and December 2014 were enrolled into this retrospective study.There were 47 males and 13 females.The average age was (44.1 ± 12.0).Results All patients underwent surgical operation and there was no perioperative death.Perioperative complications occurred in 7 patients (11.7％), including pancreatic fistula in 4 patients, delayed gastric emptying in 1 patient, abdominal infection in 1 patient, anastomotic bleeding in 1 patient.Eight patients developed elevated amylase levels.The fasting time was 3.4 ± 1.2 days and the hospital stay was 10.0 ±4.0 days.The follow-up rate was 88.3％ (53/60), at a mean follow-up of 27 months.In 51 patients who presented with abdominal pain, 43 patients (84.3％) had complete pain relief and 7 patients (13.7％) had partial pain relief.In 14 patients with preoperative diabetes mellitus, 1 patient had improvement and 2 patients recovered from diabetes.Two additional patients were diagnosed to have diabetes two years after the operation.Of the 2 patients who were shown to have pancreatic cancer on histopathological study, 1 patient was lost to follow-up while another patient died at 27 months after the operation.The patients diagnosed to have epithelial dysplasia were followed-up and none developed pancreatic cancer.Conclusions The relationship between chronic pancreatitis and pancreatic ductal stones was very close.Chronic pancreatitis also caused exocrine and endocrine dysfunction.Surgical operation plays an important role in symptomatic relief and in delaying pancreatic dysfunction.

Objective To investigate the infection characteristics and drug resistance of methicillin resistant Staphylococcus aureus after liver transplantation.Methods Retrospectively analyzed the clinical data of 170 patients who underwent liver transplantation in Beijing Chaoyang Hospital,Capital Medical University between January 2011 and April 2016.The incidence,pathogenic characteristics,distribution and drug resistance of methicillin resistant Staphylococcus aureus were analyzed.Results In this research,the methicillin resistant Staphylococcus aureus infection occurred in 23 cases after liver transplantation,and the incidence rate was 13.53％ (23/170).There were 27 strains of pathogens had been isolated,and 74.07％ (20/27) of pathogens were isolated from peritoneal drainage fluid.The most common methicillin resistant Staphylococcus aureus were Staphylococcus haemolyticus,Staphylococcus epidermidis and Staphylococcus hominis,accounting for 29.63％ (8/27),22.22％ (6/27) and 14.81％ (4/27).Drug sensitivity results indicated that the methicillin resistant Staphylococcus aureus were completely resistant to Penicillin,Oxacillin and Methicillin antibiotics.And the pathogens were extensively drug-resistant to Ciprofloxacin,Levofloxacin and Moxifloxacin,the resistance rates were 63％ (15/24),63％ (15/24) and 58％ (14/24).But the pathogens were sensitive to Teicoplanin,Vancomycin and Linezolid,and there have not been detected drug-resistant bacteria.Conclusions The infection of methicillin resistant Staphylococcus aureus is one of the most common pathogens after liver transplantation.Routine prophylactic antibiotics are not useful for the treatment,however,Teicoplanin,Vancomycin and Linezolid can be used as the first choice of treatment.

Objective:To explore the influence of fatty liver donor on the prognosis of benign liver disease liver transplantation.Methods:The clinical data of 229 recipients and donors who underwent liver transplantation at Beijing Chaoyang Hospital affiliated to Capital Medical University from January 2015 to December 2019 due to benign liver diseases were retrospectively analyzed. According to the degree of fatty degeneration of the donor liver, the patients were divided into non-fatty liver group( n=168), mild-medium fatty liver group( n=43), and severe fatty liver group( n=18). First, the overall prognosis after liver transplantation was analyzed, the general data of the donor and recipient were compared, and the perioperative complications of the three groups were compared. Finally, survival analysis was performed to compare the long-term prognosis of the three groups. Measurement data with the normal distribution were represented as ( Mean± SD), comparisons among groups were analyzed using t test. Comparisons of counting data between groups were analyzed using chi-square test. The theoretical frequency was less than 1. Fisher exact probability method was used, and variance analysis was used for the comparison among the multiple groups. Results:The overall 1-year, 3-year, and 5-year survival rates of the patients were 86.9%, 70.7%, 70.7%, respectively, and the average survival time was 53.1 months. The general data of donors and recipients were not significantly different among the three groups. The probability of perioperative transplanted liver failure, delayed liver function recovery, and acute kidney injury in recipients with severe fatty liver was significantly higher than that of mild to moderate fatty liver group and non-fatty liver group ( P<0.05). The results of survival analysis showed that the 1-year, 3-year, and 5-year survival rates of the non-fatty liver group were 90.5%, 71.7%, 71.7%, the mild-moderate group were 88.4%, 76.7%, 64.0% and the severe fatty liver group were 61.1%, 49.4%, 49.4%, the survival rate of patients with severe fatty liver was significantly lower than that of the other two groups ( P<0.05). Conclusion:Donor weight-grade steatosis leads to a higher incidence of transplanted liver failure, delayed liver function recovery, acute kidney injury, and worse long-term prognosis.

Objective To explore the clinical effect of radio-frequency ablation in the treatment of advanced pancreatic cancer.Methods Retrospectively analyzed the clinical data of 28 cases of radio-frequency ablation in the treatment of advanced pancreatic cance between January 2008 and December 2012 in 304 hospital.And choosed made 140 cases patients who only underwent the conservative treatment as the control group at the same period.Then compared the data of two groups patients.Results The mean tumor diameter was (4.8 ± 1.6) cm.The average radio-frequency time was (17.7 ± 4.3) minutes.There was no patient occurred of pancreatic fistula or postoperative bleeding,and no patient dead.Peri-operation pain relief rate was 88.9％.Twenty-three patients were followed up,and the follow up rate was 82.1％.The patients' survival rate who underwent radio-frequency ablation of 1 month,6 months and 1 year were 95.7％,65.2％ and 38.2％.The average survival time was (14.6 ± 2.2) months.And the data was significantly higher than that of the control group patients (97.4％,45.3％,19.1％,P =0.0306).Conclusions The radio-frequency ablation was one of an effective treatment method for the advanced pancreatic cancer patients.It can prolong the survival time of pancreatic cancer patients and alleviate the patient's pain.

Pancreatic cancer is a common malignant tumor of the digestive system with high degree of malignancy and difficulty in diagnosis.Patients with unresectable pancreatic cancer can regain the opportunity to receive surgical treatment with a combination of treatments known as conversion therapy. FOLFIRINOX regimen (Oxaliplatin+ Irinotecan+ 5-Fluorouracil+ Calcium folate) is an effective convesion therapy for unresectable pancreatic cancer, increasing surgical resection rate and prolongation of survival.This review aims to review the application of the FOLFIRINOX regimen in conversion therapy of unresectable pancreatic cancer.

Choledochojejunostomy is used in biliary diseases and part of the pancreas disease after surgical treatment of biliary reconstruction, the process of healing of biliointestinal anastomosis, involves a variety of inflammatory factors and different regulatory pathways, and eventually scarring is inevitable. Excessive scar response will result in anastomotic scar stricture, which will have to be treated..At present, interventional therapy is the main method to treat the scar stricture of biliointestinal anastomosis.On the whole, the treatment of bilioenteric anastomotic scar is relatively lagging behind, and there are many potential early treatment options worthy of attention, in order to better prevent and treat scar.The purpose of this article is to review the mechanism and treatment of choledochojejunostomy and anastomotic scar formation.

Liver transplantation has been developed for nearly 60 years, and the operation technology has been improved day by day. However, the rejection is still one of the key factors that restrict the long-term survival of the graft and patients. Immune tolerance refers to the state of specific immune non response or low response after the immune system contacts the antigen, which is the most ideal state after organ transplantation, and the liver, as an immune immunity organ, is also the most easy to induce immune tolerance state. At present, a large number of experimental studies have confirmed that immune tolerance is related to a variety of cellular and molecular mechanisms after liver transplantation, but the realization of clinical transformation remains to be further studied. In this paper, the current research status of immune tolerance after liver transplantation was reviewed to explain its possible mechanism and induction methods.

Portal vein gas refers to the accumulation of gas in the main portal vein and its tributaries caused by various reasons. It is often found in acute abdomen patients caused by intestinal obstruction and ischemia. CT is an important examination for the definite diagnosis. In recent years, with the deepening understanding of the pathogenesis of portal vein gas and the development of radiological imaging technology, portal vein gas is no longer considered as the indication of surgical exploration in acute abdomen patients. However, once it is found, intestinal ischemia and necrosis should been evaluated carefully in patients. According to the etiology, vital signs and auxiliary examination, the treatment decision can be made to avoid improper selection of treatment plan and delay the treatment opportunity. For patients with intestinal necrosis, surgical treatment should be active. This paper reviews the current situation of diagnosis and treatment of portal vein gas in adult acute abdomen patients.