Objective To investigate the development and influence factors of collateral circulation between spleen and lung in patients with portal hypertension after modified splenopneumopexy.Methods Data of 59 patients from January 2009 to December 2014 were analyzed,and the development of collateral circulation between spleen and lung after surgery were evaluated with ultrasound.Patients were divided into obvious collaterals group (maximum collateral diameter ≥ 2 mm,n =43) and non-obvious collaterals group (maximum collateral diameter ＜ 2 mm,n =16) according to ultrasound examination 3 months after surgery.Gender,age,type of disease,Child-Pugh classification,free portal pressure,portal vein diameter,splenic vein diameter,splenic artery diameter,splenic length,ejection fraction,forced vital capacity rate of one second (FEV1％),whether partial splenectomy was performed,and management of splenic upper pole were recorded and analyzed between the two groups.Results 3 months after surgery obvious collateral circulation could be observed in 43 patients,6 months after surgery the number increased to 53 (x2 =4.526,P ＜ 0.05).Splenic length (t =2.092) and FEV1％ (t =2.233) were significantly higher in obvious collaterals group (all P ＜ 0.05),and there were no statistical differences in gender (x2 =0.092),age (t =-1.254),type of disease (x2 =1.565),Child-Pugh classification (Z =-1.821),free portal pressur (t =0.912),portal vein diameter (t =0.008),splenic vein diameter (t =-0.485),splenic artery diameter (t =0.397),ejection fraction (t =-0.852),whether partial splenectomy was performed (x2 =0.002),and management of splenic upper pole (x2 =1.731) between the two groups (all P ＞ 0.05).Conclusions Obvious collateral circulation can develop between spleen and lung in patients with portal hypertension after modified splenopneumopexy,and the development of collateral circulation is associated with splenic length and FEV1％.

Objective To investigate the feasibility and safety of catheter thrombolysis in the treatment of Budd-Chiari syndrome (B-CS) with inferior vena cava(IVC) thrombosis.Methods A retrospective analysis of the clinical data of 21 cases of B-CS with IVC thrombosis in the First Affiliated Hospital of Zhengzhou University from January 2011 to September 2014 was conducted.They were divided into 2 groups,12 cases of fresh thrombus group,while 9 cases of old thrombus group.All cases were couducted with catheter directed thrombolysis through the right femoral vein,then regularly with color doppler examination,evaluating thrombolytic effect.When thrombus disappearing,intervention or (and) operation treatment was conducted,then postoperative following-up.Results There were 16 cases in which thrombus dissolving completely within 15 days(9 cases of fresh thrombus and 7 cases of old thrombus,P =0.536).In 1 case,thrombosis dissolved completely 20 days later.There were 3 cases combined with pre-dilating technology (thrombosis dissolved completely).When thrombosis completely dissolved,the mean catheterization time of fresh thrombus group was (10.78 ± 2.97)d,while the old thrombus group was (14.13 ± 3.41)d(P =0.06).The short-term (less than 15 days) dissolution rate was 76.19％ (16/21),and the total efficiency rate was 90.48％ (19/21).Complications occurred in 4 cases.The incidence of severe complications was 4.76％ (1/21).Postoperative follow-up with Color Doppler ultrasound in 1 to 12 months,1 case recurred after 5 months.The rest did not recurred.the recurrence rate was 4.76％ (1/21) within following up time.Conclusions The catheter thrombolysis is an important link in the treatment of B-CS with thrombosis of IVC,which is simple,safe and effective,with low incidence of complications.It can be used as the preferred treatment for this type of B-CS.

Objective To investigate the application value of clinical typing in the treatment of BuddChiari syndrome (BCS).Methods The retrospective corss-sectional study was adopted.The clinical data of 95 patients with BCS who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2012 to September 2015 were collected.Based on patients' compensation and clinical symptoms,3 clinical typing and 8 subtypes of BCS were proposed,and each subtype was treated with corresponding strategies.Observation indices included (1) the clinical typing of BCS,(2) selection of treatment,(3) treatment effect,(4) follow-up situations.Follow-up using telephone interview and outpatient examination was performed once within 3 months after the first treatment and then once every 6 months up to December 2015 or death,loss to follow-up and experienced decompensation.During follow-up,color Doppler ultrasound and blood bio-chemistry test were performed regularly,and CT angiography was also conducted when necessary.Count data were presented as the case or percentage.The survival rate was calculated using Kaplan-Meier method and the survival curve was drawn.Results (1) BCS clinical typing of 95 patients:4 were detected in type Ⅰ (3 in type Ⅰ a and 1 in type Ⅰ b),7 in typeⅡ (4 in type Ⅱa and 3 in type Ⅱb),and 84 in type Ⅲ(43 in type Ⅲa,4 in type Ⅲb,32 in type Ⅲc,and 5 in type Ⅲd).(2) Selection of treatment in 95 patients:① among the 3 patients with type Ⅰ a,2 of them received inferior vena cava balloon angioplasty while 1 patient had to give up the operation due to failure in opening the occlusion.This patient underwent close observation and follow-up afterwards.② The patient with type Ⅰ b underwent cavity-antrum artificial blood vessel bypass operation due to failure in opening the occlusion.③Among the 4 patients with type Ⅱ a,one of them underwent hepatic vein balloon angioplasty.The other 3 patients underwent close observation and follow-up because of failure in intervention therapy,such as segmental occlusion of hepatic vein or difficulty in finding the hepatic vein.④ Among the 3 patients with type Ⅱ b,due to the history of upper gastrointestinal bleeding,2 patients received modified spleen-lung fixation and intestine-cavity blood vessels bypass,respectively,and 1 patient received intestine-cavity artificial blood vessels bypass due to severe peritoneal effusion.⑤ Among the 43 patients with type Ⅲ a,35 patients underwent inferior vena cava balloon angioplasty due to failure in hepatic vein intervention therapy (6 of them received firstly thrombolysis treatment due to combined thrombosis.Four patients received inferior vena cava and hepatic vein balloon angioplasties.Another 4 patients received close observation and follow-up due to failure in both inferior vena cava and hepatic vein intervention therapy.⑥Among the 4 patients with type Ⅲ b,2 underwent inferior vena cava balloon angioplasty and intestine-cavity artificial blood vessel bypass.The other 2 patients only received modified spleen-lung fixation because of failure in inferior vena cava intervention therapy.⑦ Among the 32 patients with type Ⅲ c,3 underwent inferior vena cava and hepatic vein balloon angioplasties,and 27 patients underwent only inferior vena cava balloon angioplasty due to failure in hepatic vein intervention therapy (7 of them received balloon angioplasty following thrombolysis treatment due to combined thrombosis).On account of failure in both inferior vena cava and hepatic vein intervention therapy,2 patients underwent resection of lesion membranes and cavity-antrum artificial blood vessel bypass,respectively.⑧ Among the 5 patients with type Ⅲ d,1 underwent inferior vena cava balloon angioplasty and intestine-cavity artificial blood vessel bypass,and 4 underwent only modified spleen-lung fixation due to failure ininferior vena cava intervention therapy.(3) Treatment efficacy:of 95 patients,8 received followup observation,and 87 patients recovered to varied extent after interventional therapies and operations,with symptomatic relief of leg edema,ulcer,peritoneal effusion and esophageal varicosity.Eighty-seven patients went through the perioperative period safely,and no death occurred.The incidence of postoperative complications was 10.3％ (9/87).The complications mainly include venous thrombosis in lower limbs during catheter-directed thrombolysis therapy,pleural effusion,pneumatosis,and peritoneal effusion after surgery,all of which were cured after symptomatic treatment.(4) Follow-up results:87 were followed up for 3-42 months with an average time of 19 months.During the follow-up,5 patients (1 in type Ⅰ a and 4 in type Ⅲa) received recanalization surgery because of the reocclusion after the inferior vena cava balloon angioplasty,and no decompensation occurred.However,decompensation was found in 11 patients (disease progression in 4 patients and symptom relapse in 7 patients).The survival rates of patients without decompensation at 0.5,1.0,2.0 and 3.0 years after the first treatment were 96.5％,95.0％,83.4％ and 80.5％,respectively.Conclusion According to patients' compensation and clinical symptoms,clinical typing of BCS and treatment strategiesis are determined,and it will provide a satisfactory clinical efficacy.

Prevention and control about the situation of 2019 coronavirus disease (COVID-19) are grim at present. In addition to supporting the frontline actively, medical workers in general surgery spare no efforts in making good diagnosis and treatment of specialized diseases by optimizing treatment process, providing medical advice online, mastering indications of delayed operation and emergency operation reasonably, etc. Budd-Chiari syndrome is a complex disorder, and severity of the disease varies, serious cases can be life threatening. While fighting the epidemic, medical workers should also ensure the medical needs of patients. However, instead of continuing the traditional treatment, a new management system should be developed. Based on the characteristics of Budd-Chiari syndrome patients in China and our experience, we divide the patients into ordinary and critical cases, and treatment strategies suitable for the epidemic period of COVID-19 are put forward for reference and discussion by physicians.

Objective:To investigate the clinical treatment options for cavernous transformation of portal vein (CTPV).Methods:Data of 65 CTPV patients receiving invasive treatment and followed up at the First Affiliated Hospital of Zhengzhou University between Apr 2011 and Apr 2021 were collected. Patients were divided into four groups based on different treatment option, 24 patients were treated with transjugular intrahepatic portosystemic stent-shunt (TIPS) and 11 patients with splenopneumopexy, while 22 patients underwent splenectomy and devascularization , 8 were treated by endoscopic variceal ligation . The difference of postoperative upper gastrointestinal bleeding and hepatic encephalopathy between the four groups were analyzed,Results:There were no difference between four groups in sex, age, preoperative serum aspartate aminotransferase, total bilirubin, albuminand Child-Turcotte-Pugh grade. The incidence of hepatic encephalopathy in the TIPS group was 33.3%±9.6%、46.5%±10.3% and 64.4%±13.1% in half year, 1 year, and 3 years , respectively. Postoperative hepatic encephalopathy rate was higher in TIPS group( χ2=31.191, P=0.000). Three patients in the TIPS group developed upper gastrointestinal hemorrhage within 6 months after the operation, and postoperative upper gastrointestinal bleeding rate was higher in splenopneumopexy group( χ2=7.542, P=0.006), Conclusion:The clinical treatment options for CTPV patients are complicated ,we should make individual treatment options depend on the etiology, clinical symptoms and site of blood flow obstruction.

Objective To investigate the distribution and drug resistance characteristics of pathogens in donors and recipients undergoing simultaneous pancreas-kidney transplantation (SPK). Methods Clinical data of 231 pairs of donors and recipients undergoing SPK were analyzed retrospectively. The pathogens of samples from donors and recipients were identified by VITEK-2 analyzer, and drug sensitivity test was performed by K-B method. The source distribution and composition ratio of pathogens in donor and recipient samples, distribution characteristics of multi-drug resistant organism, infection of recipients and drug resistance characteristics of pathogens were analyzed. Results A total of 395 strains of pathogens were cultured from 1 294 donor samples, and the detection rate was 30.53%. Gram-negative bacteria mainly consisted of klebsiella pneumoniae, Gram-positive bacteria mainly comprised staphylococcus aureus, and fungi primarily included candida albicans, respectively. In total, 2 690 strains of pathogens were cultured from 10 507 recipient samples, and the detection rate was 25.60%. Gram-negative bacteria mainly consisted of pseudomonas maltophilia, Gram-positive bacteria primarily comprised enterococcus faecalis, and fungi mainly included candida albicans, respectively. Among 395 pathogens of donors, 15 strains of methicillin-resistant staphylococcus aureus (MRSA), 16 strains of extended-spectrum β-lactamase (ESBL) positive drug-resistant bacteria, 8 strains of carbapenem-resistant pseudomonas aeruginosa (CR-PA), 21 strains of carbapenem-resistant acinetobacter baumannii (CR-AB), 2 strains of carbapenem-resistant enterobacteriaceae (CRE) and 1 strain of multiple-drug/pan-drug resistant pseudomonas aeruginosa (MDR/PDR-PA) were identified. Among 2 690 strains of recipient pathogens, 73 strains of ESBL positive drug-resistant bacteria, 44 strains of CR-PA, 31 strains of CR-AB and 3 strains of MDR/PDR-PA were detected. One recipient developed donor-derived infection, 69 cases of pneumonia, 52 cases of urinary tract infection, 35 cases of abdominal infection and 2 cases of hematogenous infection were reported within postoperative 1 year. Gram-negative bacteria were resistant to certain antibiotics. Gram-positive bacteria were sensitive to vancomycin. Fungi were sensitive to amphotericin B. Conclusions Gram-negative bacteria are the main pathogens of SPK recipients, which are resistant to certain antibiotics. Empirical use of antibiotics can be delivered before culture results are obtained. Subsequently, sensitive antibiotics should be chosen according to the culture results to improve the survival rate of SPK recipients.

Objective To explore the clinical significance of large spontaneous portosystemic shunts (L-SPSS) in Budd-Chiari syndrome (B-CS).Methods Clinical data of 382 B-CS patients treated at the First Affiliated Hospital of Zhengzhou University from Apr 2012 to Dec 2018 were analyzed retrospectively and we included 32 patients with B-CS complicated L-SPSS (diameter ＞ 8 mm).65 patients without L-SPSS were selected randomly to form the control group.The correlation between L-SPSS and liver function,upper gastrointestinal bleeding,ascites,hepatic encephalopathy,inferior vena cava thrombosis,portal vein diameter and splenic vein diameter were analyzed.Results TBil,Child-Pugh scores,incidence of hepatic encephalopathy,ascites and inferior vena cava thrombosis in the B-CS complicated L-SPSS group were higher than that in the B-CS without L-SPSS group.The percentage of Child-Pugh grade B and C patients in the B-CS complicated L-SPSS group were also higher than that in the B-CS without L-SPSS group.The level of ALB and hepatic volume per unit surface area were both significantly less in the experimental group.(P ＜0.05).There were no statistics differences in incidence of upper gastrointestinal bleeding and MELD scores between the two groups (P ＞ 0.05).Conclusions For those B-CS patients complicated L-SPSS,hepatic encephalopathy and ascites are more frequent,and they usually have poorer liver function.

Objective:To analyze the association of pre-transplant risk factors with diabetes mellitus after renal transplantation and examine the significance of preventing the occurrence in kidney transplantation recipients.Methods:A total of 290 kidney transplantation recipients were retrospectively reviewed at our transplantation center from August 2018 to May 2020.Diabetes mellitus after renal transplantation was employed as a primary outcome index.Multivariate Logistic regression model was utilized for constructing A (without adjusting for covariates)、B(covariates include: gender, dialysis mode, type of donation)and C(covariates include: gender, dialysis mode, type of donation, calcineurin inhibitor, antiproliferative drugs, primary disease, fasting blood glucose, 1 h postprandial blood glucose, fasting C peptide, 1 h and 2 h postprandial C peptide, fasting C-peptide index, 1 h postprandial C-peptide index, albumin, triglycerides, total cholesterol)to evaluate the relationship between diabetes mellitus after transplantation and age, body mass index, 2 h postprandial blood glucose(2 h-PG), HbA1c, and 2 h postprandial C-peptide index(2 h-CPI).Results:In model A, age [odds ratio(OR)1.1, 95% confidence interval( CI)1.0~1.1], BMI(OR 1.2, 95% CI 1.0~1.3), 2 h PG(OR 1.2, 95% CI 1.1~1.4), HbA1c(OR 2.7, 95% CI 1.5~4.9), 2 h-CPI(OR 0.7, 95% CI 0.5~1.0), model B/C had similar results with A. Age, BMI, 2 h PG and HbA1c were all risk factors for diabetes mellitus after transplantation while 2 h-CPI was a protective factor.Quartile stratification was analyzed by regression model.And trend test was significant( P<0.05). Conclusions:Age, BMI, 2 h PG, HbA1c and 2 h-CPI are correlated with diabetes mellitus after kidney transplantation.

Modern surgical technology develops rapidly, and surgical methods and therapeutic ideas are changing constantly, which greatly improve the surgical safety and the therapeutic effect of patients. However, no matter how advanced the surgical techniques develop, correct and reasonable selection and control of surgical indications are always the basic issues of surgery, as well as the basic quality of surgeons throughout the career. Surgeons should strictly control surgical indications, improve the theoretical knowledge and technical level, and avoid adverse factors interfering with surgical decision-making; possess the courage to perform high-risk operations in accordance with the indications, strengthen doctors′ sense of responsibility and vocation; reasonably select surgical methods, grasp the balance between "conventional open surgery" and "laparoscopic minimally invasive surgery" ; and rationally view the advantages of non-surgical methods, pay attention to interdisciplinary integration to create conditions for the implementation of surgery. Only this can surgeons keep our original intention, and maximize the benefit of patients from the treatment.

Objective:To summarize the clinical characteristics and risk factors of acute rejection(AR)of transplanted pancreas and kidney after simultaneous pancreas-kidney transplantation(SPK)and explore the effects of AR on the survival of transplanted pancreas, kidney and recipients.Methods:From September 2016 to July 2022, the relevant clinical data were retrospectively reviewed for 218 recipients undergoing SPK.According to whether or not AR occurred after SPK, they were assigned into two groups of AR(n=53)and non-AR(n=165). The relevant clinical data were compared for two groups of donors and recipients and the risk factors of AR analyzed by binary Logistic regression.Kaplan-Meier method was employed for comparing the survival rates of recipients/transplanted pancreas and kidneys in two groups.Results:A total of 53 cases(24.3%)developed ARs of transplanted pancreas(n=31, 14.2%)(5 of 2 ARs), transplanted kidney(n=15, 6.9%)(1 of 2 ARs)and transplanted pancreas & kidney AR(n=11, 5.0%)(2 of 2 ARs). Tacrolimus blood levels in AR and non-AR groups were(5.8±1.2)and(6.3±1.6)μg/L and failed to attain targets in 36(67.9%)and 78(47.3%)cases.During follow-ups, the incidence of pneumonia and urinary tract infections in AR group versus non-AR group were[43.4%(23/53)vs.27.3%(45/165)and 39.6%(21/53)vs.18.8%(31/165)]and the differences were statistically significant( P=0.028 & 0.002). The results of multifactorial regression analysis revealed that sub-optimal blood level of tacrolimus was an independent risk factor for an occurrence of AR in grafts of SPK recipients( OR=2.254, 95% CI: 1.167-4.353, P=0.016). Comparisons of 1/5-year postoperative survival rates between recipients in AR and no-AR group(98.1% vs.93.9% and 92.1% vs.92.4%)indicated that the differences were not statistically significant( P=0.233 & 0.806). Through comparing 1/5-year survival rates of transplanted pancreas in AR and non-AR groups(94.3% vs.100%, 89.4% vs.98.6%), the differences were statistically significant( P=0.003 & 0.004). And 1/5-year survival rates of transplanted kidneys in AR and non-AR groups(92.5% vs.100% and 90.2% vs.100%)were compared and the differences were statistically significant(all P<0.001). Conclusions:The incidence of AR is higher in transplanted pancreas and kidney after SPK.And the incidence of pneumonia and urinary tract infection is higher in AR group than that in non-AR group.Sub-optimal blood level of tacrolimus is an independent risk factor for the occurrence of AR.The 1/5-year survival rates of transplanted pancreas and transplanted kidney are lower in AR group than those in non-AR group.It has some effect on the survival of transplanted pancreas and kidney.