Transjugular intrahepatic portosystemic shunt (TIPS) has been developed for two decades in order to treat portal hypertension accompanying with upper gastrointestinal hemorrhage and refractory ascites.TIPS may cause the development of hepatic encephalopathy (HE).TIPS induces portalsystemic shunt and leads to hemodynamics chaos. Hepatic encephalopathy belongs to the complications of the portal hypertension. There are many possible predictors of the post-TIPS HE. The relationship between TIPS and HE was reviewed.

The therapeutic management of hepatic portal hypertension in patients with cirrhosis is still a challenge. At present surgical devascularization and shunting play the important roles in treatment of portal hypertension. While some cirrhotic patients can not bear the stress of operation and anesthesia because of inadequat potential hepatic function. So the mortality of operation is very high. With the development of endoscopy,radiological techniques and new materials and equipments, the mini invasive treatments become more important. This review summarizes the current advances of mini invasive treatments of portal hypertension in cirrhosis.

Objective Transcatheter thrombolysis is an important method for early recanalization of acute superior mesenteric venous thrombosis (SMVT), which is conducted mainly through percutaneous transhepatic , transjugular intrahepatic, or superior mesen-teric artery approach .This study is to assess the feasibility , effectiveness and safety of catheter-directed thrombolysis via the superior mesenteric vein and artery for acute SMVT . Methods We retrospectively reviewed 8 cases of acute extensive SMVT treated by tran-scatheter thrombolysis via superior mesenteric vein and artery in our institute .We collected and analyzed the general information , case history, etiology, risk factors, imaging characteristics, treatment procedures, complications, and follow-up data of the patients summa-rized the experience in the treatment of acute extensive SMVT by catheter-directed thrombolysis . Results Technical success was a-chieved with substantial symptoms improvement after thrombolytic therapy in all the cases .The local urokinase infusion via the superior mesenteric artery and vein was performed for (6.13 ±0.83) and (12 ±2.51) d.Four patients required delayed localized bowel resection of (1.63 ±0.48) m, with satisfactory recovery after intensive care and organ function support .Contrast-enhanced CT scan and portogra-phy demonstrated complete thrombus resolution in all the patients before discharged after a hospital stay of (19.25 ±4.89) d.Minor bleeding at the puncture site occurred in 2 cases and sepsis developed in another 2 postoperatively .No recurrence and complications were ob-served during the follow-up of (12.13 ±0.99) mo. Conclusion For acute extensive SMVT , catheter-directed thrombolytic therapy via superior mesenteric vein and artery can accelerate thrombus resolution , stimulate collateral vessel development , reverse extensive intestinal is-chemia, avert bowel resection , localize infarcted bowel segment to pre-vent short bowel syndrome , and effectively speed up the recovery and significantly increase the survival rate of the patients .

Objective To investigate the clinical results of combined TIPSS and azygoportal disconnection for portal hypertension in controlling and preventing esophageal variceal bleeding. Methods From Oct. 1996 to Dec. 2001, 60 patients with portal hypertension were admitted to our department because of variceal bleeding and submitted to the treatment with the combination TIPSS and azygoportal disconnection. According to Child Pugh classification, 11 patients were in class A, 37 in class B, and 12 in class C. 41 patients showed mild ascites and 8 with severe ascites. The mild and severe esophageal varices were proven by upper digestive barium meal. The procedure was divided into two stages; first, TIPSS procedure with the stent of diameter 0.8cm and length 6-7cm was successfully inplanted in all patients, second, all patients underwent azygoportal disconnection two weeks later after TIPSS. Results After the combination TIPSS and azygoportal disconnection, the recent complications included three cases with bleeding at operative fields, one case with infradiaphagmatic abscess and seven with slight encephalopathy. No rebleeding of esophageal varices and death occurred during the treatment. During the follow up of 1-5 years, the rates of shunt occlusion, rebleeding and death were 11.9%, 3.5% and 7.0% respectively. Conclusions The combination TIPSS and azygoportal disconnection is an efficient therapeutic methods for portal hypertension.

Objective To determine the effect of different surgical modalities on hemodynamics,systemic major organ injury and survival rate following superior mesenteric artery (SMA) injury in an attempt to search a modality that conforms to principles of damage control surgery (DCS).Methods SMA was exposed in 30 domestic hybrid pigs,leaving the blood flow blocked using non-invasive vessel forceps.The animals were divided into control group,primary anastomosis group (anastomosis group) and temporary intravascular shunt (TIVS) group according to random number table.TIVS group was further divided into three subgroups:shunting for 6 hours group (TIVS-6 h group),9 hours group (TIVS-9 h group) and 12 hours group (TIVS-12 h group).At each time point,the angiography was performed for evaluation of shunt patency; hemodynamic parameters were detected,terminal ileum and SMA samples were harvested for pathological analysis.Results All groups suffered extreme physiological conditions including hypothermia,severe acidosis,hypotension,low cardiac output and low oxygen supply.Less requirement of resuscitation fluid,faster restoration of SMA blood flow,earlier clearance of lactate,milder intestinal ischemia-reperfusion injury and higher survival rate were observed in TIVS-6 h and TIVS-9 h groups,compared with anastomosis group.Patency rate in TIVS-6 h,9 h and 12 h groups was 100％,50％ and 0％ respectively.Pathologic outcome of intestine revealed diffuse intestinal necrosis in TIVS-12 h group and reversible intestinal ischemia-reperfusion injury in TIVS-6 h and 9 h groups.Conclusion For SMA injury in severe hemodynamic disarrangement and jeopardized condition,TIVS shortens intestinal ischemia time,maintains systemic hemodynamic stability,relieves intestinal injury,improves early survival rate and keeps long-term intestine patency when compared with primary vascular anastomosis.

The blood level of tumor necrosis factor (TNF) was measured by the method of TNF cytotoxic activity in 20 patients with abdominal infection, 10 patients with gastrointestinal cancer and 30 normal subjects. The results showed that the blood level of TNF in patients with abdominal infection was significantly higher than that in normal subjects and in patients with gastrointestinal cancer. The blood level of TNF in serious abdominal infection was remarkably higher than that in moderate abdominal infection. The blood level of TNF in both group of patients was obviously declined after the infection had been controled. The blood level of TNF in the patients died from abdominal infection was constant during treatment. Therefore, the blood level of TNF is an important index of abdominal infection and has important clinical value in evaluating the seriousness of abdominal infection and predicting the development of infectious disease.

Objectives The purpose of this study was to compare the effect of somatostatin and octreotide on portal vein pressure in portal hypertensive patients.KG*2MethodsWT5”BZ Portal pressure in 12 patients with portal hypertension after TIPS was measured directly by means of a cathater placed in portal vein after infusion of somatostatin (6 mg/24h) or octreotide(0 6 mg/h). The drugs was infused intravenously and alternatively in each individual patient on day 1 or day 3 after TIPS. Portal pressure was assessed at baseline and at 1、2、4、6、8、12、24、30、36 hours after infusion of each drug.KG*2ResultsKG1The average decrease of portal pressure was 9 4?1 0 cm H 2 O and 5 0?1 0 cm H 2 O respectively after the intravenous infusion of somatostatin or octreotide( P

Objectives: To investigate the effect of growth hormone on liver protein synthesis in patients with portal hypertension following TIPS. Methods: Ten patients with liver cirrhosis and portal hypertension were injected with rhGH (8 U/day) for 7days after TIPS. The serum levels of Alb, PA and FN were detected before and days 3 and 7 after TIPS and use of rhGH. Plasma insulin like growth factor 1 (IGF 1) was also measured by immunoradiological method. Results: As compared with the day before TIPS and rhGH, the levels of IGF 1, Alb , PA and FN were significantly increased on the 7th day after TIPS and rhGH treatment( P

Objective: To evaluate the effectiveness of bowel nutritional rehabilitation therapy in patients with gut dysfunction caused by acute mesenteric artery occlusion. Methods: Two patients with acute mesenteric artery occlusion received management of revascularization by operative and nonoperative approach. Viability dusky bowel was leaved in one patient. Second look laparotomy was performed to access the viability of the bowel in another patient. The patients remained gut dysfunction and received bowel nutritional rehabilitation therapy early after operation. Results: The gut function of the patients recovered and had normal diet after bowel nutritional rehabilitation therapy. Conclusions: The gut dysfunction caused by acute mesenteric artery occlusion should be treated with bowel nutritional rehabilitation early.

The present paper respectively analyzed the results of deep vein ascending phlebography in examining 105 cases(136 extremities)of the lower extrimity venous ulcer. This study showed that communicating branch incompetence eccompanied with deep vein incompetence in 99 lower extremities (72 8%);communicating branch incompetence without deep vein incompetence in 32 lower extremities(23 5%);and saphenous incompetence without communicating branch incompetence in five lower extremities (3 7%). According to the results of phlebography, the pathogenesis of the leg venous ulcer and the selection of operation were discussed in the paper.