model control group. CONCLUSION: Both heterologous bone marrow stem cell transplantation and vascular endothelial growth factor injection can promote the formation of retroperitoneal blood vessel in rats with portal hypertension, and the conbination of them can effectively relieve portal venous pressure.

Objective To investigate the indications for interventional therapy of Budd-Chiari syndrome((B-CS)) and surgical treatment after stent failure. Methods A retrospective analysis of the clinical data of 21 patients with mistakes in treatment of B-CS by stent placement in inferior vena cava(IVC).Results (Among) the 21 cases with mistakes, the indications were inappropriately selected in 6 cases, the main hepatic vein was obstructed by the stent in 1 case, dilated accessory veins were occluded in 10 cases, the stent was (displaced) in 3 cases, and the stent failed to unfold in 1 case. Nineteen cases were converted to operation; of these patients, a shunt was performed in 18 cases, and radical excision of diaphragmatic web of IVC was done in 1 case. Operation was successful in all 19 cases. After shunt procedure in the 18 cases, the free portal pressure significantly decreased(P

Objective To investigate the diagnosis and treatment of obstructive jaundice (OJ) caused by hepatocellular cacinoma (HCC) invasion to bile duct. Methods The diagnosis and treatment of 16 cases of OJ caused by HCC in our hospital from January 1989 to December 1998 were retrospectively analysed. Results Correct diagnosis was made in 2 cases and misdiagnosis in 14 cases preoperatively. 14 cases were operated on, including hepatectomy, enucleation of the tumor in the common bile duct (CBD) and T tube drainage in 2 cases; enucleation of the tumor in CBD and internal stent of T tube drainage in 11 cases; tumor biopsy and T tube drainage in 2 cases; one case died without operation. 15 cases were followed-up for 1 to 14 months postoperatively. The results demonstrated that 14 patients died within 6 months, and only 1 case remained alive for 14 months after operation. Conclusions The correct diagnosis of this disease could be made for the patients with jaundice accompanied with positive of HbsAg and AFP, local lesions in the liver and the dilated bile duct. B-US, CT, PTC and ERCP are the main examination methods for the diagnosis. The best treatment of this kind of HCC is to remove the hepatic tumor and to recanalize the affected bile ducts.

Objective　To investigate the diagnosis and treatment of obstructive jaundice (OJ) caused by hepatocellular cacinoma (HCC) invasion to bile duct. Methods　The diagnosis and treatment of 16 cases of OJ caused by HCC in our hospital from January 1989 to December 1998 were retrospectively analysed. Results　Correct diagnosis was made in 2 cases and misdiagnosis in 14 cases preoperatively. 14 cases were operated on, including hepatectomy, enucleation of the tumor in the common bile duct (CBD) and T tube drainage in 2 cases; enucleation of the tumor in CBD and internal stent of T tube drainage in 11 cases; tumor biopsy and T tube drainage in 2 cases; one case died without operation. 15 cases were followed-up for 1 to 14 months postoperatively. The results demonstrated that 14 patients died within 6 months, and only 1 case remained alive for 14 months after operation. Conclusions　The correct diagnosis of this disease could be made for the patients with jaundice accompanied with positive of HbsAg and AFP, local lesions in the liver and the dilated bile duct. B-US, CT, PTC and ERCP are the main examination methods for the diagnosis. The best treatment of this kind of HCC is to remove the hepatic tumor and to recanalize the affected bile ducts.

Objective To set up CEAP system for the diagnosis of portal hypertention.Methods Based on CEAP system from American Venous Forum,the clinical and pathologic classification of Budd-Chiari syndrome from Xu,the clinical and pathologic data of 251 cases of portal hypertension were analyzed retrospectively.Results According to the results of imaging examination [(Doppler ultrasound,percutaneous splenoportography,selective angiography of mesenteric artery,multi-slice spiral CT(MSCT) three dimensional(3D) reconstruction],clinical and pathological data,CEAP system for the diagnosis of portal hypertention was defined as follows: Clinical manifestation(C) including mild and severe types;Etiology(E)(congenital,primary,secondary);Anatomy(A) consists of liver,inferior vena cava,hepatic veins,and portal vein system;Pathophysiology(P) could have liver fibrosis/cirrhosis,obstruction,thrombosis,intrahepatic collateral circulation and tumors.Conclusions CEAP system for correct diagnosis,classification as well as the individual treatment is of great practical importance,and could be wide application.

Objective To investigate the treatment of severe Budd-Chiari syndrome (BCS) . Methods The clinical data of 95 patients with severe BCS from November 1994 to June 1999 were retrospectively analyzed . Results Mesocaval C shunt with artificial graft was performed in 51 cases , splenojugular shunt with artificial graft in 23 cases ,mesojuglar shunt with artificial graft in l case , percutaneous transhepatic recanalization and dilation and/or stent placement of main hepatic vein (MHV) in 10 case, and combined PTA and stent placement of inferior vena cava (IVC) and mesocaval shunt in 10 cases . 5～60 months follow-up showed excellent result in 65 patients , good results in 25 and 5 cases dead. Conclusions Good results could be obtained by most of the severe BCS patients treated by different procedures according to the pathological changes of IVC and main hepatic vein.

Objective To investigate the indication,feasibility and clinical effectiveness of stage management of Budd-Chiari syndrome(B-CS). Methods From Feb 2007 to June 2009,32 cases of Budd-Chiari syndrome(9 cases of type Ⅰ,17 cases of type Ⅲa,6 cases of type Ⅲ b)were admitted.Inferior vena cava hypertension(IVCHT)and portal hypertension(PHT)co-existed in all the patients.According to the clinicopathologic classification and hemodynamic compensation,these patients underwent single stage treatment(snrglcal procedure or radioactive intervention)or two-stage management(one.stagesurgical procedure/radioactive intervention plus two-stage surgical procedure/radioactive intervemion).Results Recovery was achieved in all patients without mortality.The main complications were Dleural effusion in 3 cases,acute heart failure in 2 cases and celiac lymphatic leakage in 1 case respectively.which were cured after medical treatment.In 4 months to 2 years follow-up,no recurrent cases were identified and all the patients were in good condition. Condusions Stage management of Budd.Chiari svndrome canalleviate the perioperative risk and clinical effectiveness can be achieved.The hemodynamic compensation is the basis on which stage management is adopted.

Objective To study the effect of small diameter graft (0.8 cm) splenocaval or mesocaval shunts combined with pericardial devascularization in the treatment of portal hypertensive variceal bleeding. Methods Splenocaval shunts were performed in 14 patients and mesocaval shunts were done in 24 patients, in combination with pericardial devascularization. Results The average decrease of free portal pressure was 6.6±1.2 cm. There was no significant changes in liver function postoperatively (P>0.05). Platelet counts and leukocyte counts were back to normal in splenocaval shunt patients postoperatively (P< 0.05). Operative mortality was 3%. Pyrexia developed in 4 patients, intractable ascites in 1 patient, chylons ascites in 1 patient, hepatic encephalopathy in 1 patient, intraabdominal infection in 1 patient and stress ulceration in 1 patient. All patients recovered after expectant treatment except one who died from severe intraabdominal infection. 35 patients received follow-up between 6 months and 3 years, total effective rate was 89%, 2 patients died from recurrent variceal bleeding, the shunt potency rate was 80% in 1 year and 75% in 3 years. Esophagogastric varices disappeared or alleviated as shown by endoscopy in 25 patients on 6 months postoperatively. Conclusions Small diameter portosystemic graft shunts combined with poricardial devascularization is an effective therapy for bleeding esophagogastric varices with a low rate of hepatic encephalopathy. Splenocaval shunt alleviates hypersplenism concurrently.

Objective To evaluate covered stent placement in the treatment of iliac artery rupture in the process of iliac artery angioplasty.Methods Clinical data of 9 patients' iliac artery rupture in the process of iliac artery angioplasty were retrospectively reviewed.Results Covered stent was successfully placed in all cases.The patency of involved iliac artery was identified in 8 cases by angiography and there was no contrast extravasation.Type Ⅰ endoleak occurred in one patient in the proximal end of the stent graft and iliac artery graft replacement was done by open surgery immediately.Postoperatively clinical symptoms were relieved in all these 9 patients.One case lost to follow up.8 patients were followed up for 14 to 45 months,average (22 ±9) months.Stenosis on the distal end of the covered stent (external iliac artery)was found in one patient who underwent external iliac artery balloon-expandable stent angioplasty.One patient with artificial vessel placement was symptoms free with patency of the involved artery as reviewed by ultrasonography on 18 month followed up.Conclusions When iliac artery rupture in the process of iliac artery angioplasty should develop,the first choice is immediately covered stent placement therapy,while open surgery remains as the last resort.

Objective To investigate the role and implication of Engrailed-2 (EN2) in human hepatocellular carcinoma (HCC) and the effect of silencing EN2 genes on the proliferation and invasion of HepG2 cells by RNA interference.Methods Immunohistochemistry was used to detect the expression of EN2 in the HCC tissues and corresponding non-cancerous adjacent liver tissues in 126 patients with HCC.The expressions of EN2 and the relationship between EN2 expression and clinicopathological features and prognosis were analyzed using the Chi-square test.The survival curve was drawn using the Kaplan-Meier method and the survival was analyzed using the log-rank test.EN2-small interfering RNA (siRNA) was transfected into HepG2 cell lines mediated by LipofectamineTM 2000,and the expression of EN2 were detected by Western blotting assay.The cell proliferation and invasion were measured by methyl thiazol tetrazolium (MTT) and Transwell assays.Results EN2 positive expression rate was high (62.7％) in HCC tissue but low in the corresponding peritumoral tissue (23.5％,P ＜ 0.01).The high expression of EN2 was strongly correlated with tumor size,metastasis and AJCC TNM stage.The cumulative 5-year survival rate was 33.9％ in the low EN2 expression group,whereas it was 5.1％ in the high EN2 expression group (P ＜ 0.01).Expression of EN2 in EN2 siRNA group was significantly lower than that in control siRNA group and control group (P ＜ 0.05),respectively.The cell proliferation and invasion ability were significantly reduced in the EN2 siRNA group.Conclusion The expression of EN2 is highly up-regulated in HCC tissues and down-regulation of EN2 could inhibit proliferation and invasion of HepG2 cells,which indicating that EN2 is involved in the process of HCC carcinogenesis and progression and may serve as a biomarker for predicting prognosis of HCC patients.