Portal vein blood flow is very important for the normal function of transplanted liver. The author reviewed the management methods of different portal vein thrombosis classification in the liver transplantation (LT). The prognosis of LT in the patients with Yerdel 1–3 thrombosis is similar to that the patients without thrombosis. The portal vein reconstruction of the patients with Yerdel 4 thrombosis can be realized by varicose vein to portal anastomosis, renoportal anastomosis or cavoportal hemitransposition. When anastomosis is made at the proximal side of a spontaneous shunt between the portal and cava system, the blood shunted from portal system can be reintroduced into the donor liver, which is crucial for the management of Yerdel 4 thrombosis. The establishments of artificial shunt by distal splenic vein, mesenteric vein or “multiple to one” anastomosis are effective attempts to drain the blood from portal system to the donor liver. For more severe diffuse thrombosis of portal vein system, multivisceral transplantation, including liver and small intestine, should be considered. The cases of LT in the patients with complex portal vein thrombosis are increasing, however the prognosis remains to be determined after accumulation of the cases.
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 交流断流术加脾肾分流术联合治疗门静脉高压症的体会。方法 对我院1994～2000年采用断流术加脾肾分流术联合治疗的12例门静脉高压症患者资料进行回顾性总结与分析。结果 全组病例均获随访，除1例在术后15个月因肝癌死亡外，其余11例均健在，其中10例生活质量良好，并恢复原来工作，生存时间最短15个月，最长8年，中位生存时间4年。术后均无出血和肝性脑病发生。结论 应用联合术治疗门静脉高压症避免了单一断流术、分流术及脾切除术的缺点，具有术后再出血率低，患者生存质量高及远期生存率高等优点，是一种理想的术式。
目的观察特利加压素联合生长抑素治疗肝硬变门静脉高压食管胃底曲张静脉破裂出血的效果。 方法我院2008年3月至2012年8月期间收治的47例肝硬变门静脉高压食管胃底曲张静脉破裂出血患者入院时采用掷硬币法被随机分为特利加压素＋生长抑素组（n=24）和生长抑素组（n=23），分别给予联合用药或单独使用生长抑素，计算24 h止血率、总止血率、1周再出血率、1周死亡率，观察不良反应发生、尿量及腹水量情况。 结果特利加压素＋生长抑素组24 h止血率、总止血率和不良反应发生率明显高于生长抑素组（P＜0.05），1周再出血率明显低于生长抑素组（P＜0.05），2组1周死亡率比较差异无统计学意义（P＞0.05），特利加压素＋生长抑素组尿量明显多于生长抑素组（P＜0.05），盆腔腹水量明显少于生长抑素组（P＜0.05）。 结论特利加压素联合生长抑素用于肝硬变门静脉高压食管胃底曲张静脉破裂出血止血效果确切，可以明显降低死亡率；虽然其不良反应发生率略高，但均可以控制。
ObjectiveTo analyze the effect and incidence rate of major postoperative complications of pericardial devascularization in treatment of portal hypertension. MethodsEnglish and Chinese literatures about pericardial deva-scularization in treatment of portal hypertension were searched through Medline, Elsevier, PubMed, CNKI, and WanFang database, and meta analysis was taken in the process by using R-2.15 software. ResultsIn total of 671 literatures were searched and 23 were selected finally according to inclusion criteria and exclusion criteria.The results of meta analysis showed that, the effect of pericardial devascularization in treatment of portal hypertension were as follows:the incidence rate of rebleeding was 21%(95% CI: 0.18-0.24), the incidence rate of hepatic encephalopathy was 4%(95% CI: 0.02-0.06), the incidence rate of ascites was 29%(95% CI: 0.14-0.47), mortality of operation was 3%(95% CI: 0.02-0.04), mortality was 23%(95% CI: 0.15-0.33). ConclusionsThere is a certain incidence rate of complications of pericardial devascularization, of which the most common complication is rebleeding.So, it is necessary to do further improvement and development of pericardial devascularization.
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.
目的 探讨血吸虫病性肝硬变行脾切除术后再发大出血的外科治疗方法。 方法 回顾性分析1987年4月至1999年12月期间我院收治的经左胸行贲门周围血管离断术治疗脾切除术后再发大出血11例患者的临床资料。结果 急诊手术4例，2例死亡，其中1例手术后30 d死于肝功能衰竭，另1例于出院后2个月再发大出血而死亡。余2例及择期手术7例均无手术并发症和死亡率，随访6~8年，无出血再发。结论 对脾切除术后再发大出血病例行断流术，经左胸入路是一种可取的治疗方法。
【摘要】 目的 研究降钙素基因相关肽（calcitonin gene related peptide， CRGP）在肝硬化门静脉高压症患者食管下段胃底静脉曲张中的作用。 方法 以2005年1月－2010年8月46例肝硬化门静脉高压症不同程度食管下段胃底静脉曲张患者作为研究对象，并按食管下段胃底静脉曲张严重程度分为轻度曲张组、中度曲张组、重度曲张组，以30例行胃肠疾病手术无肝病患者作为对照。术中水柱法测定门静脉压力；酶联免疫吸附法测定门静脉血中CGRP含量。 结果 对照组及轻、中、重度曲张组门静脉压力分别为（14.8±2.1）、（30.5±2.5）、（44.3±3.2）、（47.6±3.8） cm H2O（1 cm H2O=0.098 kPa）。门静脉血中CGRP的含量分别为（45.4±5.4）、（69.2±7.2）、（93.6±8.7）、（98.2±9.4） pg/mL。对照组门静脉压力及CGRP含量明显低于其他3组（Plt;0.05），在轻度曲张组明显低于中度和重度曲张组（Plt;0.05），中度和重度曲张组之间差异无统计学意义（Pgt;0.05）。 结论 CRGP在肝硬化门静脉高压症食管下段胃底静脉曲张的发生和发展中起重要作用，CGRP可作为反映食管静脉曲张程度的一种有用指标。【Abstract】 Objective To investigate the role of calcitonin gene related peptide (CRGP) in pathogenesis of esophageal varices in portal hypertension with cirrhosis. Methods from January 2005 to August 2010, 46 patients with portal hypertension and cirrhosis at different degrees of esophageal varices were divided into mild varicose group, moderate varicose group and severe varicose group according to the severity of esophageal varices. The patients who underwent gastrointestinal surgery without liver disease were as the control. Portal vein pressure was detected by mercury during the surgery. The expression of CGRP was assayed by enzyme-linked immunosorbent assay. Results The portal pressure was (14.8±2.1), (30.5±2.5), (44.3±3.2), and (47.6±3.8) cm H2O (1 cm H2O=0.098 kPa) in the control group and the mild, moderate and severe varicose group, respectively. Those CGRP content in the portal vein was (45.4±5.4), (69.2±7.2), (93.6±8.7), and (98.2±9.4) pg/mL, respectively. CGRP content and portal vein pressure were the lowest in control group, which were significantly lower than those in the other three groups (Plt;0.05); which were also significantly lower in mild varicose group than those in the moderate and severe esophageal varices group (Plt;0.05), while no statistic difference between moderate and severe esophageal varices group was found (Plt;0.05). Conclusion CGRP plays an important role in the occurrence and development of portal hypertension with cirrhosis concurrent esophageal varices, and it may serve as a useful indicator reflecting the degree of esophageal varices.