42 Wistar rats were divided into three groups at random, liver cirrhosis (LC), portal vein stricture (PVS) and sham operation (SO) group. The changes of barrier capability of gastric mucosa in portal hypertensive rats were observed. The results demonstrated: the splanchnic blood flow of the portal hypertensive rats increased, as compared with the normal control group (Ｐ＜0.001), but actually gastric mucosa was under the condition of ischemia. Mucosa of gastric wall glycoprotein and PGE2 of gastric mucosa decreased, as compared with the normal control (Ｐ＜0.01); and more seriously decreased in cirrhotic portal hypertensive rats, there was no significant difference about amount of the basal acid secretion (BAS) among the three groups, but the amount of H＋ backdiffusion (H＋BD) was obviously increased, as compared with the normal control group (Ｐ＜0.001). The amount of H＋BD of cirrhotic portal hypertensive rats was the highest among this three groups. The results suggest that the barrier capability of gastric mucosa with portal hypertension is lower than that of the normal control group and much lower with cirrhotic portal hypertensive rats. The portal hypertensive gastropathy is associated with the lower capability of defense of gastric mucosa. The condition of liver function contributes to the change of barrier capability of gastric mucosa.
Objective To explore the methods， clinical effects， and application value of laparoscopic splenectomy combined with pericardial devascularization. Methods The clinical data of 23 patients with liver cirrhosis and portal hypertension who performed laparoscopic splenectomy combined with pericardial devascularization between july 2009 and july 2012 in our hospital were analyzed retrospectivly. Results In 23 cases， 2 cases were converted laparotomy due to bleeding， 21 cases were successfully performed laparoscopic splenectomy combined with pericardial devascularization. The operative time was 230-380 minutes （average 290 minutes）. The intraoperative blood loss was 300-1 500 mL （average 620 mL）. The postoperative fasting time was 1-3 days （average 2 days）. The postoperative hospital stay was 8-14 days （average 10 days）. Conclusion Laparoscopic splenectomy combined with pericardial devascularization is a feasible， effective， and safe procedure as well as minimally invasive hence is applicable for patients with portal hypertension and hypersplenism．
目的:探讨门静脉高压症(Portal hypertension,PHT)合并胆石症的合理处理方式。方法:回顾分析2003年9月于2008年9月64例PHT合并胆石症患者不同方式手术治疗的结果。根据手术方式不同将64例患者分为三组。A组:仅行胆道手术(n=20);B组:在行PHT手术的同时行胆道手术(n=20);C组:在行PHT手术时对胆囊或胆道结石未作处理(n=24)。结果:死亡率A组10%,B组28.5%,C组4.3%。并发症:A组40%,B组70%,C组25%。结论:PHT合并胆石症无论仅行胆道手术或同期行PHT手术和胆道手术,手术死亡率和术后并发症均显著增加,尤以同期手术为明显。根据患者情况选择正确的手术方式,可有效降低手术风险。
目的探讨脾静脉高压的临床特征及诊断依据。方法 回顾性分析6例脾静脉高压病例的临床症状、体征、影像学检查及术中发现等资料。结果 临床症状主要表现为呕血和便血； CT扫描3例脾静脉狭窄，3例脾静脉显示不清； 术中测定门静脉压力，切脾前左侧为2.94±0.2 kPa(35.0±2.1 cmH2O)，高于右侧的1.96±0.2 kPa(20.0±2.3 cmH2O)，切脾后左侧为2.06±0.1 kPa(21.0±1.3 cmH2O)，右侧为1.76±0.1 kPa(18.0±1.4 cmH2O)，二者无明显差异。术中探查脾静脉，5例脾静脉栓塞，1例狭窄。结论 术前CT增强扫描，术中测定左右半门静脉压力以及术中发现脾静脉栓塞或狭窄，可以诊断脾静脉高压。
Objective To explore the causes and treatment of rebleeding after operation on portal hypertension patients. Methods The clinical data of 41 rebleeding cases underwent the operational between January 2000 and December 2009 in Peking Union Medical College Hospital were retrospectively analyzed. Results All 13 cases who got rebleeding after shunt operation received lienectomy, but for those who got rebleeding after lienectomy, 23 patients received Phemister or modified Phemister or expanded lienectomy and 5 patients received shunt operation. Surgical related complications occurred in 7 cases (17.1%) at 2 weeks after operation, including abdominal bleeding (3 cases), gastrointestinal bleeding (2 cases), and intractable ascites (2 cases). After the follow-up of 3-60 months (mean 39 months), all patients were still alive. During the follow-up, 3 cases of recurrent esophageal varices were observed and one of them got rebleeding.Conclusion The majority of rebleeding after lienectomy tend to be ascribed to the wrong operations chose, while bad operation skill often contribute to the rebleeding after shunt operation, suggesting ideal therapeutic effect for rebleeding can benefit from appropriate operation choose.
【Abstract】Objective To explore the dynamic expression of TNF-α and VEGF in the development of esophageal varices in rats with portal hypertension. Methods Sixty male SD rats were randomly divided into the experimental group and the control group. In the experimental group, a two-stage ligation of portal vein plus ligation of the left adrenal vein was performed.After establishment of the model, the expression of TNF-α、VEGF and PCNA in the lower esophagus was detected with immunohistochemical SP technique on 7 d、14 d、21 d and comparision of these data with control group was performed respectively. In the control group, a sham-operation was performed, was also divided.Results The portal venous pressure in the experimental group was significantly higher than that of the control, so did the vessel number and the total vascular area of the submucosal veins in the lower esophagus. Compared with the control subgroups, the expression of TNF-α and VEGF on the 21 d subgroup was ber, while PCNA was ber on the 14 d and 21 d. Conclusion In the development of esophageal varices of portal hypertension, VEGF possibly plays a role in the varices developemt, and TNF-α may be responsible for the damage of esophageal mucosa.
ObjectiveTo evaluate long-term therapeutic effect of esophagogastric devascularization without splenectomy in treatment of portal hypertension with esophagogastric varices hemorrhage. MethodsThe patients who took esophagogastric devascularization without splenectomy from 2008 to 2013 were followed-up in clinic or through phone. The remission of esophagogastric varices, rebleeding, survival and long-term postoperative complications were observed. ResultsA total of 32 patients were taken esophagogastric devascularization without splenectomy in Peking University People's Hospital from 2008 to 2013. One patient died during the perioperative period. Twenty-three patients were followed-up for 10-81 months with an average 45.5 months, of whom 7 patients had rebleeding, 5 patients died, 3 patients had new onset portal vein thrombosis, 2 patients had esophageal anastomotic strictures. ConclusionEsophagogastric devascularization without splenectomy is an effective method in treatment of portal hypertension with esophagogastric varices hemorrhage in selected patients.