We had performed transjugular intrahepatic portosystemic stent shunt (TIPSS) in one hundred and three patients with advanced liver cirrhosis and portal hypertension from July,1993 to January, 1995. TIPSS was carried out successfully in ninty-eight out of 103 cases and the technical success rate was 95.2%. Acute variceal bleeding was immediatly controlled and portal pressure reduced by an average of 1.36±0.02 kPa after TIPSS. The disappearance of gastric cornoary and esophageal varices, the shrinkage of spleen and the reduction of ascite were observed . Three patients died of acute liver failure and one died of variceal redbleeding within 30 days of treatment. Mild encephalohthy was obserbed in 10 cases with TIPSS. At follow-up of 1～22 months, variceal rebleeding and ascite were observed in 6 patients and stenosis of shunt was evident is 12.5% of cases by the subsequent doppler sonography. According to this result, TIPSS is an effective method for the treatment of portal hypertension.
ObjectiveTo investigate the risk factors of postoperative portal vein thrombosis (PVT) after devascu-larization in patients with cirrhotic portal hypertension. MethodsThe clinical data of 40 patients with cirrhotic portal hypertension treated with splenectomy and gastric pericardial devascularization were retrospectively analyzed to investigate the related risk factors. ResultsA total of 12 of the 40 patients suffered from PVT (30.00%). The results of multivariate analysis showed that portal vein diameter, postoperative portal vein velocity, platelet count at 2 weeks postoperatively, and postoperative portal vein pressure were the factors influencing the incidence of PVT after devascularization. Patients with the greater portal vein diameter and platelet count at 2 weeks postoperatively, the lower postoperative portal vein velocity and postoperative portal vein pressure, had higher ratio of PVT (P < 0.05). ConclusionPortal vein diameter, portal vein blood flow velocity, platelet count, and postoperative portal vein pressure were the main risk factors for PVT after surgery in patients with cirrhotic portal hypertension.
Anatomical venous distribution around the lower esophagus, gastric cardia and fundus in 100 adult cadavers had been observed. The results showed that the occurrence rate of the left gastric and the right gastric veins were 96% and 92% respectively. Venous distribution in the lesser curvature of the stomach can be classified into five types: the left gastric vein type, the right gastric vein type,the left gastric vein dominant type, the right gastric vein dominant type, and the balance type (of the left and the right gastric veins). The retrogastric veins were found in 73.6% of 100 cadavers showed portacaval anastomoses. From March 1976 to March 1992, we had treated with transthoracic interruption of portoazygous circulation, 52 cases of portal hypertension resulting in bleeding du to rupture of esophageal and venriculi fundus varices ( male 43, female 9). Among the 41 emergency operations, 2 cases died (4.9%), and bleedings were controlled by emergency surgery in 92.6% of cases. 44 of the 50 cases (88%) were followed up. The recurrence of bleeding occured in 5 cases, with a long-term bleeding rate of 11.4%. The authors suggest that anatomical factors might be the reason of inadequacy of portaoazygous interruption, and claim the advantages of transthoracic interruption of portoazygous circulation.
Objective To evaluate the feasibility of X-ray guided access to the extrahepatic segment of the main portal vein (PV) to create a transjugular extrahepatic portacaval shunt (TEPS). Methods 5F pigtail catheter was inserted into the main PV as target catheter by percutaneous transhepatic path under ultrasound guidance. The RUPS-100 puncture system was inserted into the inferior vena cava (IVC) by transjugular path under ultrasound guidance. Fluency covered stent was deployed to create the extrahepatic portacaval shunt after puncturing the target catheter from the IVC under the X-ray guidance, then shunt venography was performed. Enhanced CT of the abdomen helped identify and quantify the patency of the shunt and the presence of hemoperitoneum. Results The extrahepatic portacaval shunts were created successfully by only 1 puncture in 6 pigs. No extravasation was observed in shunt venography. One pig died of anesthesia on the day of operation. The extrahepatic portacaval shunts were failed in 2 pigs 3 days after the operation (one was occluded and the other one was narrowed by 80%). The extrahepatic portacaval shunts were occluded 2 weeks after the operation in the remaining 3 pigs. The shunts were out of the liver and no hemoperitoneum was identified at necropsy in the 6 pigs. Conclusion TEPS is technically safe and feasible under the X-ray guidance.
Objective To investigate the effect of vitamin K1 in the function of blood coagulation state, intraopera- tive blood loss, and hemoglobin content of liquid in postoperative drainage in patients with cirrhosis combined with portal hypertension before and after splenectomy combined with the hydrodynamic vein cut-out surgery. Methods In total of 143 cases of cirrhosis combined with portal hypertension who treated in our hospital from January 2010 to October 2015 were prospectively collected, and randomly divided into 3 group, including 51 cases of vitamin K1 group, 45 cases of carbazochrome sodium sulfonate group, and 47 cases of control group. Drug was used form 1 week before surgery to 5 days after surgery (vitamin K1 group: vitamin K1, 0.03 g, intravenous drip; card collaterals sodium sulfonic group: card collaterals sulfonic sodium, 80 mg, intravenous drip; control group: normal saline, 250 mL, intravenous drip). Prothrombin time of patients in 3 groups was detected at 1 week before surgery, 3 days before surgery, 1 day before surgery, 1 day after surgery, 3 days after surgery, and 5 days after surgery; hemoglobin content of liquid in postoperative drainage was detected on 1, 3, and 5 days after surgery. Results In terms of prothrombin time, there was no significant difference at 1 week before surgery and 5 days after surgery (P>0.05); prothrombin time of vitamin K1 group was lower than those of carbazochrome sodium sulfonate group and control group on 3 days and 1 day before surgery (P＜0.05), but there was no significant difference between carbazochrome sodium sulfonate group and control group on 3 days and 1 day before surgery (P>0.05); prothrombin time of vitamin K1 group and carbazochrome sodium sulfonate group was both lower than that of control group on 1 day and 3 days after surgery (P＜0.05), but there was no significant difference between carbazochrome sodium sulfonate group and vitamin K1 group on 1 day and 3 days after surgery (P>0.05). In terms of intraoperative blood loss, intraoperative blood loss of vitamin K1 group was lower than those of carbazochrome sodium sulfonate group and control group (P＜0.05), but there was no significant difference between carbazochrome sodium sulfonate group and control group (P>0.05). In terms of hemoglobin content of liquid in postoperative drainage, it was lower in vitamin K1 group and carbazochrome sodium sulfonate group than that of control group on 1 day and 3 days after surgery (P＜0.05), but there was no significant difference among 3 groups on 5 days after surgery (P>0.05). Conclusion Vitamin K1 is helpful to improve function state of blood coagulation before and after surgery in patients with cirrhosis combined with portal hypertension (from 1 week before surgery to 3 days after surgery), and reduce the intraoperative blood loss; carbazochrome sodium sulfonate can improve function status of postoperative blood coagulation to 3 days after surgery and postoperative blood loss, but has no obvious improvement in the function status of preoperative blood coagulation and introperative blood loss.
Objective To explore the influence of cirrhotic portal hypertension and its complications on liver transplantation. Methods The literatures of the recent years on influence of hepatic cirrhotic portal hypertension on liver transplantation were reviewed. Results Splenomegaly, hypersplenism, portal vein thrombosis, portosystemic shunt and collateral flow in cirrhotic patients will increase the difficulty of liver transplantation and lead to more postoperative complications. Appropriate handling of these conditions can achieve a higher success rate of liver transplantation. Conclusion Correct management of end-stage cirrhotic portal hypertension and its complications can expand the indications of liver transplantation and improve long-term survival rates.
To investigate the mechanisms of splanchnic hyperdynamics in portal hypertension (PHT), angiotensin Ⅱ(A-Ⅱ) receptor maximal binding capacity (Bmax) and dissociation constants (Kd) of splanchnic blood vessels in rats with prehepatic PHT were studied by radioligand binding analysis. The results showed that the A-Ⅱ receptor Bmax in the superior mesenteric artery and portal vein of PHT animals (206.9±39.3 fmol/mg protein and 31.5±9.2 fmol/mg protein respectively) was all significantly lower than that of the controls (297.2±44.7 fmol/mg protein and 53.4±12.1 fmol/mg protein respectively, Ｐ＜0.01). The A-Ⅱ receptor Kd in the superior mesenteric artery was markedly increased in PHT animals (1.03±0.11 nmol/L) compared with that in controls (0.88±0.08 nmol/L, Ｐ＜0.05). In the portal vein, the A-Ⅱ receptor Kd in PHT animals was slightly higher than in controls, but no significant difference was observed between the two groups. These results suggest that the vascular hyporesponsiveness to A-Ⅱ in PHT is caused partially by a reduction in number and a decrease in affinity of vascular A-Ⅱ receptors, and these changes may possibly lead to the formation of hyperdynamic circulation.
ObjectiveTo summarize the recent development of surgical treatment for portal hypertension with hypersplenism. MethodsThe related literatures on various operation treatment of hypertension with hypersplenism at home and abroad in recent years were collected and reviewed. ResultsThere are many operation treatment methods of hypertension with hypersplenism, includes the pericardial devascularization, subtotal splenectomy, partial splenic embolization, spleen radiofrequency ablation, splenic artery ligation, distal splenorenal shunt, and so on. The different operation methods each has its advantages and disadvantages, but there are a certain percentage of the incidence of complications. At the same time, due to the limited understanding of the function of the spleen in portal hypertension, the treatment of "resecting" or "reserving" spleen has always been the hot spot of the academic dispute. ConclusionFor what kind of operation method is the most suitable for the treatment of hypertension with hypersplenism is no fixed conclusion.
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．
Objectives To systematically review the efficacy of polytetrafluoroethylene (PTFE) covered stent grafts vs. bare stent grafts in transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension. Methods PubMed, EMbase, The Cochrane Library, and ClinicalTrial.gov were searched online to collect randomized controlled trials (RCTs) and cohort studies of PTFE-covered stent grafts vs. bare stent grafts for portal hypertension from inception to Jan 11th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software. Results A total of 4 RCTs and 11 cohort studies involving 2 422 patients (1 070 PTFE-covered stent grafts patients and 1 352 bare stent grafts patients) were included. The results of meta-analysis showed that compared with the bare stent grafts group, the PTFE-covered stent grafts group had higher patency rate of intrahepatic shunt (HR=0.38, 95%CI 0.31 to 0.47, P<0.000 01) and survival rate (HR=0.59, 95%CI 0.44 to 0.79,P=0.000 5), lower postoperative complications rate (including gastrointestinal bleeding and refractory ascites) (HR=0.44, 95%CI 0.33 to 0.58, P<0.000 01) and encephalopathy rate (HR=0.76, 95%CI 0.57 to 0.99,P=0.05). Conclusions Current evidence shows that compared with the bare stent grafts, the PTFE-covered stent grafts could effectively improve patency rate of intrahepatic shunt and survival rate with less postoperative complications rate and encephalopathy rate. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.