Objective To evaluate the therapeutic effect of distal splenocaval shunt for portal hypertensive variceal rebleeding after periesophagastric devascularization.Method In this study 18 patients with recurrent bleeding after devascularization underwent distal splenocaval shunt.Clinical data and follow-up result were collected and analyzed.Result The free portal pressure decreased from (35.6 ±3.8) cm H2O before shunting to (26.9 ±2.7) cm H2O after shunting.The operative mortality was 0.Liver function after postoperative second day changed significantly comparing to preoperative levels and it recovered to pre-operative level after 7 days.The rate of rebleeding and ascites was 17％ and 44％ respectively.There were 2 patients suffering from postshunt hepatic encephalopathy and the 2-year survival rate was 94.4％.Conclusions Distal splenocaval shunt could still be performed in portal hypertensive patients with recurrent variceal bleeding after periesophagastric devascularization with a patent splenic vein.

Objective To explore the pathogenesis,diagnosis,therapy and prevention of portal vein thrombosis (PVT) after devascularization.Methods Data of 56 patients who underwent devascularization because of cirrhotic portal hypertension between Jan.2008 and Dec.2011 were retrospectively analyzed.Patients were divided into two groups according to whether or not to receive prophylactic anticoagulant therapy.There were 28 cases in each group.The causes of PVT was analyzed by Logit regression.Results Among all patients,9 patients developed PVT after operation (16％).The occurrence of PVT was 11％ in preventive anticoagulant treatment group,and that was 21％ in nonpreventive anticoagulant treatment group.Logit regression showed that there was no relationship in PVT with sex,age,preoperative platelet count and intraoperative ligation of splenic artery beforehand.There were apparent correlation in PVT with centrifugal-flow of portal vein and peak value of platelet count over ≥300 ×109/L.All patients discharged uneventfully after anticoagulant treatment.Conclusions The definite cause of PVT after devascularization is centrifugal-flow of portal vein and the peak value of platelet count over ≥300 × 109/L is a pivotal risk factor.The key point of therapy is early diagnosis and early anticoagulant treatment.

Objective To evaluate the operative safety of difficult splenectomy.Methods The clinical data of 126 splenectomy cases from January 2005 to December 2011 were analyzed retrospectively.Results All patients were cured and discharged.There was no mortality and pancreatic leakage,no gastric and colonic injury.The postoperative complications occurred in 14 patients including intra-abdominal hemorrhage in 5 cases,pulmonary complications in 7 cases (left pleural effusion and left subphrenic abscess),splenic venous thrombophlebitis in 11 cases and massive ascites in 10 patients.After splenectomy splenic and portal vein thrombi rate in HBV-related cirrhosis was 7％ (6/84) and that was 50％ (6/12) in schistosoma-related cirrhosis (t =13.4,P ＜ 0.01).Conclusions Careful evaluation before operation,skillful technique during operation are determinants for the safety of complex splenectomy.

Objective To investigate the effect of early embryonic mouse pancreatic tissue transplantation in the treatment of mouse experimental diabetes.Methods C57BL/6 mouse models of streptozocin-induced diabetes mellitus were established and then randomly divided into two groups:transplantation group,in which,five to seven pieces of pancreatic tissue of mice at embryonic 16.5 days were transplanted into mouse renal capsule,and sham-operated (SO) control group,in which,0.05 ml RPMI1640 culture medium was injected into mouse renal capsule.When blood glucose level of the transplantation group mouse was ≤ 11.2 mmol/L,the endocrine function of embryonic pancreatic tissue transplanted was detected by IPGTT and IPITT methods and then the transplanted graft was removed for observing the blood glucose surge.In vitro,levels of insulin secretion were measured in serum,E16.5 pancreatic tissue and graft (3.3 mmol/L and 16.7 mmol/L) glucose stimulation by ELISA.Histology and immunohistochemistry were observed before or after pancreatic tissue transplantation to detect insulin and glycagon production.Results (1) The glucose level decreased significantly in the TX group after 4-6 weeks of transplantation (13.4 ± 6.5 vs 28.9 ± 2.5,P ＜ 0.05),and the body weight gaining (P ＜ 0.05).Compared to SO group,glucose level decreased significantly (P ＜ 0.001).The graft can modulate insulin secretion; (2) Insulin can be detected in E16.5 embryonic mouse.Insulin and glycagon were produced more in TX group than pretransplantated pancreatic tissue.Conclusions E16.5 embryonic mouse pancreatic tissue transplantation effectively controls serum glucose level and restore the nondiabetic pattern of weight gaining in diabetic mouse.

ObjectiveTo systematically evaluate the therapeutic effect of gastroesophageal devascularization( GD),portasystemic shunt( PSS),devascularization plus portasystemic shunt ( GD + PSS) for the treatment of 4250 cirrhotic portal hypertension cases reported in Chinese literature. MethodsThe literatures about the effect of gastroesophageal devascularization,portasystemic shunt,devascularization plus portasystemic shunt on portal hypertension were collected from Wanfang databases, China National Knowledge Infrastructure(CNKI) from 1980 to 2011.RevMan 4.2 and SPSS 13.0 were used for data analysis. ResultsIn this study 17 reports were enrolled into the meta-analysis.The results of the mta-analysis showed that long term survival rate in the group of GD plus PSS was higher than that in group of GD [OR=1.73,95％CI (1.23,2.44),P ＜0.01].That in group of PSS was similar with the group of GD [ OR =0.87,95 ％ CI (0.63,1.20),P =0.40 ].That of group GD plus PSS was similar with the group of PSS [ OR =1.73,95％ CI (0.95,3.13),P =0.07 ].For recurrent variceal bleeding rate,that in group of PSS was lower than that in the group of GD[ OR =0.46,95％ CI (0.35,0.61 ),P ＜0.01 ].That in the group of GD plus PSS was lower than that in the group of GD [ OR =0.25,95％ CI (0.18,0.35),P ＜ 0.01 ].The group of GD plus PSS was similar to that of group of PSS [ OR =0.72,95％ CI ( 0.40,1.29 ),P =0.27 ].Encephalopathy rate was higher in the group of PSS than the group of GD [ OR =3.57,95％ CI (2.43,5.23 ),P ＜0.01 ].That in group of GD plus PSS was lower than that in the group of PSS[ OR =0.37,95％ CI (0.20,0.69),P ＜0.01 ],while that in GD plus PSS was similar to the group of GD[ OR =1.58,95％ CI (1.02,2.43),P =0.04 ].ConclusionsThe only significant factor influencing the long term result in Chinese patients with portal hypertension is preoperative liver function.The three types of operation have different benefits and disadvantages.

Objective To study the efficacy of the orthotopie liver transplantation for hilar cholangiocarcinoma and analyse relevant factors.Methods A retrospective study was conducted in 10 cases of hilar cholangiocarcinoma treated with orthotopic liver transplantation from 2002 to 2010.Results The male:fe5 and 8 years were 70.0%and 60.4%.50.9%and 50.9%,respectively.No tumor survival rates for 1,3,5 and 8 year were 65.3%,58.7%,50.9%and 50.9%,respectively.Operative time was(306.7±38.1)min.The average blood loss was(659.4±300.6)mL.Multiple regression analysis showed that positive lymph nodes(P=0.0092)positive surgical margin(P=0.0028)and neural invasion(P=0.021)were the most important factor affecting hilar cholangiocarcinoma recurrence after liver transplantation.Conclusions Orthotopic liver transplantation for hilar cholangiocarcinoma is an effective means.Intraoperative radical resection will receive a good effect.Resection margin and lymph node-positive are the most important factors affecting long-term survival.

Objective To explore the potential benefits of liver resection for patients with liver metastasis of pancreatic neuroendocrine tumors(PNETs).Methods We searched CNKI,CBM,MEDLINE,The Cochrane Library,EMBASE until Aug.2012 for identifying randomized trials.Randomized clinical trials(irrespective of language,blinding,or publication status)were collected to compare liver resection alone versus other unresected interventions(radiofrequency ablation,chemotherapy,hepatic arterial embolization,or drugs et al)in patients with liver metastasis from PNETs.Two authors independently identified trials for inclusion.The primary outcome was survival,treatment-related mortality(30-day mortality)and relief of symptoms.RevMan 5.1 software was used for Meta analysis.Results There was no meta-anlaysis,RCT,QRCT showing the clinical effect of operation for the treatment of pancreatic neuroendocrine tumor with liver metastasis.Only 6 cohort studies found were eligible and analyzed,involving 1020 patients.Compared with unresected treatment,the 3-year survival rate[OR =0.24,95％ CI (0.11,0.53),P =0.0004],the 5-year survival rate [OR =0.16,95 ％ CI (0.12,0.22),P ＜ 0.00001] and median survival time (109.5 ± 19.02 vs 31.2 ± 5.97 months,P ＜ 0.01) were significantly increased in liver resection alone.The symptom relief rate was substantially higher in the surgical group than in the non-surgical group(98.3 ±2.8 vs 62.5 ± 22.0,P ＜ 0.05).Perioperative mortality rate was lower in surgical group.Conclusions Surgical resection is the preferred treatment of PNETs in patients with liver metastasis.Surgery is safe and effective.Survival time is significantly extended and symptom relief rate significantly improves.Due to lack of randomized controlled trial (RCT),surgical resection for treatment of liver metastasis of PNETs requires further more randomized control study.

Objective To explore the isolation technique of embryonic pancreatic tissues in mice and to identify the isolated embryonic pancreatic tissue by morphology and endocrine function test.Methods Pancreatic tissues from embryonic(E) 11.5-16.5 d C57BL/6 mouse embryos were surgically isolated under the stereomicroscope.E12.5 d,E14.5 d,E16.5 d embryonic pancreas tissues were identified by conventional HE staining,immunohistochemistry and immunofluorescence.The endocrine functions of embryonic pancreatic tissues were measured by glucose stimulation test.Results Embryonic pancreatic tissues of mice over embryonic 12.5days can be easily isolated.Embryonic pancreatic tissues of mice younger than embryonic 12.5 days were hard to achieve and these pancreatic tissues could only be isolated according to the relationship with the adjacent organs.Histological and ELISA examinations showed that early embryonic pancreatic tissues could express and secrete insulin and the insulin level was gradually increased with developmental time.Conclusion A good command of the knowledge of the development and anatomy of mouse embryo help improve isolation of embryonic pancreas,which provides therapeutic potential for embryonic pancreatic tissue transplantation.

The surgical treatment for portal hypertension (PHT) aims to control and prevent the gastroesophageal variceal bleeding.The choices of surgical timing and procedures are dependent on the liver reserve function.Except for Child-Pugh classification and model for end-stage liver disease scoring system,the future liver remrant and pre-albumin are the important evaluation indexes,meanwhile,the choice of surgical procedures would be dependent on portal hemodynamics that can reduce incidence of rebleeding of postoperative hepatic encephalopathy.Hepatic venous pressure gradient is the most important objective index forecasting bleeding risk and severity of PHT.

ObjectiveTo evaluate the therapeutic effect of gastroesophageal devasculariztion on cirrhotic portal hypertensive bleeding.MethodsClinical data of 85 cirrhotic patients with portal hypertentsive bleeding undergoing gastroesophageal devascularization were retrospectively analyzed. Results The following-up rate was 78％. The 1-yr,3-yr and 5-yr survival rate was 95％, 88％and 82％respectively.There was significant difference in survival time after devascularization between patients of Child-Pugh A and Child-Pugh B.For the whole group the 1-yr,3-yr and 5-yr recurrent bleeding rate was 6％,16％ and 28％ and postoperative hepatic encephalopathy was 7％.ALT,AST and ALB recovered to pre-operative level on post-operative day 7.ConclusionsGastroesophageal devascularization was an effective therapy in treating portal hypertensive variceal bleeding.Liver function remains a significant factor influencing long term survival.