Esophagogastric variceal hemorrhage caused by portal hypertension is common and severely threatens the patients' health.The conventional surgical treatment plays an important role in portal hypertension.Although surgical treatment is strongly challenged by the pharmacological treatments,endoscopic treatments and radioactive intervention therapies,the role in portal hypertension treatment is still unshakable and irreplaceable,and is also not the disappearing surgery.The multidisciplinary treatment modalities have also brought new impetus for the individualization and precision treatment of portal hypertension.The developments of new clinical guidelines and consensuses,new techniques and novel conceptions have promoted the treatment of portal hypertension to a standard procedure.

Objective　To determine whether the important apoptosis-related genes of p53 and bcl-2 participate in the regulation of apoptosis of human liver cancer cells by establishing the model of apoptosis of human liver cancer cells induced by mitomycin C (MMC). Methods　The selected human liver cancer cell line HepG2 was treated with 8mg/ml MMC. The morphological changes of the cells were observed using fluorescent and electron transmission microscopy and the DNA fragments of the cells analyzed by agarose gel electrophoresis to testify cell apoptosis. The expression of p53 and bcl-2 genes was detected by flow cytometry. Results　The morphological observation and biochemical examination showed that MMC induced the HepG2 cells to undergo apoptosis. After administration of MMC, the expression of p53 gene changed obviously while that of bcl-2 gene was not apparent. Conclusion　p53 plays an important role in the regulation of apoptosis induced by MMC in HepG2 cells. This regulation may be an early event in apoptotic signal pathway. Meanwhile, the apoptosis of the cells is p53-dependent. However, bcl-2 gene may not participate in the control of this apoptosis.

Objective To explore the relationship between the changes in activity of caspase-8 and apoptosis of HepG2 cells induced by 5-fluorouracil(5-Fu). MethodsThe HepG2 cells were treated with 5-Fu. The caspase-8 activity was detected using caspase-8 Fluorescent Assay Kit. The apoptotic rates of HepG2 cells induced by 5-Fu with or without the caspase-8 inhibitor IETD-FMK were measured by flow cytometry. ResultsAfter treatment with 10 -2mol/L 5-Fu, the caspase-8 activity in HepG2 cells increased gradually and reached the peak at 16 h. With the concentration of 5-Fu increasing, the caspase-8 activity also elevated, the group of high concentration was significantly higher than that of low concentration(P

Objective To summarize the diagnosis and treatment experiences of focal nodular hyperplasia (FNH).Methods The clinical data of 48 patients with FNH who were admitted to the Xiangya Hospital from February 2010 to August 2014 were retrospectively analyzed.All the patients received complete serologic tests,abdomen B ultrasound,computed tomography (CT) and magnetic resonance imaging (MRI) examinations.The pathological examinations were done on the patients undergoing surgical treatment.The surgical treatment was done on the unconfirmed FNH patients according to location of space-occupying lesions.The conservative treatment was done on the confirmed FNH patients without clinical symptoms.All the patients were followed up via outpatient examination and telephone interview up to September 2014,and the follow-up included the history review,clinical symptoms and medical examinations.Results Forty-seven patients had normal liver function and 1 had high level of total bilirubin (TBil).The serum tumor markers including AFP,CEA and CA19-9 in all the patients were negative.Fifty-five foci were detected by imaging examination,41 foci were single mass and 7 foci were multifocality.Forty-eight patients were definitively unconfirmed with FNH by B ultrasound.The results of CT examinations in 38 patients showed as follows:low density was in 31 patients and isodensity in 7 patients,including striped and radiated low density showing in the center of tumor in 20 patients and 3 patients with the confirmed FNH.The results of MRI examinations in 10 patients showed as follows:3 patients were confirmed as with FNH; all the 10 patients showed rather homogeneous enhancement in arterial phase; 5 patients were accompanied with radiated foci in the center of tumor,and showed high signal on T2WI,no enhancement in early arterial phase and enhancement in delayed arterial phase.The central scar showed low signal on T1WI and high signal on T2WI.Two patients were confirmed as with FNH by percutaneous trans-hepatic histopathological examinations.Forty patients without the confirmed FNH underwent surgical treatment,including 31 undergoing open hepatectomy and 9 undergoing laparoscopic hepatectomy.No patients had cirrhosis of liver.During operation,47 foci were detected,16 of which located at the left lobe of liver and 31 of which located at the right lobe of liver.Local tumor resection of liver was carried out on 30 patients,right hemihepatectomy or extended right hepatectomy on 7 patients,left hemihepatectomy on 3 patients and combined treatment of cholecystectomy on 12 patients.The operation time,volume of blood loss and diameter of foci were (78-255) minutes,(80-720) mL and (4.6 ± 1.6) cm (range,1.5-11.5 cm).Forty patients were confirmed as with FNH by pathological examination,and 8 patients were cured by conservative treatment.All the 48 patients were followed up for 21 months (range,1-56 months) and survived well without recurrence and complications.Conclusions The clinical symptoms of FNH are atypical and unobvious.The preoperative enhanced CT and MRI examinations can help improve the diagnosis and differential diagnosis of FNH.The surgical treatment could be performed on the patients with significant clinical symptoms and without definitive diagnosis,and the patients with definitive diagnosis should be treated by conservative treatment with the good prognosis.

Objective To explore the methods of decreasing pancreatic fistula rates after pancreaticoduodenectomy. Methods This paper was made on the review of recent literatures about preventing pancreatic fistula after pancreaticoduodenectomy. Results Pancreatic fistula is still one of the main common complications of pancreaticoduodenectomy. Pancreatic stamp is managed mostly by pancreato enteric or pancreato gastric anastomosis. Ligation of the pancreatic duct and total pancreatectomy have reduced gradully. It is still undertermined that perioperative somatostatin can prevent pancreatic fistula. Conclusions The key point of deteasing pancreatic fistula rate of pancreaticoduodenectomy is to master all sorts of ways in managing the pancreatic stump.

Objective To summrize the effects of various treatment methods,including operation,transcatheter arterial embolization(TAE),and percutaneous ethanol injection(PEI) on hepatic cavernous hemangioma(HCH),in order to select an optimal therapy strategy for HCH.MethodsClinic data of 47 patients with 58 hepatic hemangiomas treated in our hospital in recent 10 years were analyzed retrospectively.Results There were 26 males and 21 females with mean age 42?2 5 years(10～72 years old)in this series.The diameters of these lesions were 3～21 5cm(mean diameter 8 5?1 8cm).Of them,obvious symptoms appeared in 39 patients,malignancy could not excluded in 6,and the size of HCH increased rapidly in 2.Operations were performed in 40 patients,including 2 patients failed to PEI;TAE was conducted in 7cases.There was no mortality or major morbidity occurred in the operative patients,except right pleual effusion in one case and subdiaphragmatic fluid collections in another case(2/40).Neither is mortality nor morbidity seen in the TAE treated case.Conclusions Operation is an effective procedure for HCH.But for more diffuse lesions or lesions located in special region,TAE is a more favorable alterative selection.Because PEI has risk of hemorrhage and hardener injection under ultrasonography guide has uncertain outcome,so it should be chosen cautiously.

ObjectiveTo study the effect of age on the perioperative and long-term outcome of hepatic resection for hepatocellular carcinoma. MethodsFifty two cases of elderly patients with hepatic resection for hepatocellular carcinoma were analysised retrospectively. ResultsThe morbidity rate and in-hospital duration in elderly group were 32.7% and (29.94.3)d respectively, higher than 18.6% and (24.76.1)d in non-elderly group (P

Objective To study the expression of integrin ?v subunit(?v) in hepatocellular carcinoma(HCC )and its effect. Methods With the method of immunohistochemistry, specimens from 43 HCC patients and 6 control patients were studied. The relationship between the ?v expression and pathological features,microvessel density(MVD) was evaluated.Results The difference of the expression of ?v in tumor cells between HCC with satellite lesions and without it was significant(H=9 008, P =0 003).The MVD of HCC with positive and negative expression of ?v in endothelia was 151?54 and 115?39 respectively,difference of which was significant( t =2 503, P =0 016).Conclusions Integrin ?v subunit may play an important role in the angiogenesis, invasiveness and metastasis of hepatocellular carcinoma.

ObjectiveTo investigate the relationship between metabolic abnormalies of thyroid hormone and intestinal barrier disfunction and the potential protective effects of exogenous thyroid hormone in sepsis. MethodsMurine septic model was established through cecal ligation puncture. Triiodothyronine (15??g/kg) was given to the septic rats to correct the low T 3 syndrome. ResultsThere was significant negative correlation between the seral concentration of free T 3 or free T 4 and MDA concentration in the tissues of small intestines. The insulting degree of the intestinal barrier in the treatment group were much milder than that of the sepsis group. ConclusionsThere were significant correlation between the metabolic abnormalies of thyroid hormone and the oxic insults of the intestinal barriers in sepsis. Providing the thyroid hormone for the septic rats could protect the intestinal barriers and improve the prognosis of sepsis.

Objective This study was to investigate the effect of exogenous thyroid hormone on serum NO and iNOS activity of intestinal mucosa in septic rats. Methods Septic model was established by cecal ligation puncture(CLP) in male SD rats. Triiodothyronine(T 3) was administered intraperitoneally to correct the low T 3 syndrome of septic rats. Blood was collected to examine serum NO and thyroid hormone concentration. Intestinal mucosa iNOS activity was assayed using immunochemical stain. Results Mortality rate in the prevention group was significantly lower than the septic group(Log rank=3.85, P