ABSTRACT
Objectives To evaluate modified transthoracic esophageal transection (modified Walker's procedure) for management of postoperative rebleeding of portal hypertension.Methods Since 1983,we adopted modified Walker's operation to make low esophageal transection and transect intraabdominal recurrent varix of the coronary vein in the treatment of esophageal variceal rebleeding in portal hypertensive patients who had received previous surgeries aiming at portal hypertension.Results In 53 cases of postoperative rebleeding of portal hypertension,49 cases underwent elective operation with no mortality,4 cases received emergency surgery,one died post-operatively due to hepatic failure.The postoperative control rate of recurrent bleeding was 100％,and the overall postoperative mortality was 2％.The longest postoperative survival time was 24 years,and the 5-year survival rate was 77％.There were no postoperative recurrent hemorrhage and hepatic encephalopathy.Conclusions Modified transthoracic esophageal transection (modified Walker's procedure) is easy to perform,good at saving operative time,with a reliable immediate hemostatic effect and long-term control of variceal hemorrhage,hence is a effective remedy operative method for postoperative rebleeding of portal hypertensive patients after failed previous operations.
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ObjectiveTo evaluate the therapeutic effect of combined portoazygous devascularization and shunt on portal hypertension. MethodsThe data of 56 cases of portal hypertension treated with portoazygous devascularization and shunt from April 1987 to April 1999 was summarized. ResultsThere was no death in 54 patients receiving selective operation;of 2 cases receiving emergency operation, one died. Among 49 followed-up cases, there was one rebleeding,2 hepatic encephalopathy, and one died of liver failure 4 years after opeation. The mean portal pressure before and after operation was(3.42±0.46) kPa and (2.50±0.35) kPa, respectively. ConclusionCombined portoazygons devascularization and shunt not only decreases portal pressure but preserve hepatic blood flow to some extent.
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Objective: To discuss the feasibility of immune tolerance in rat small bowel trans-plantation induced by immature dendritic cells isolated from SD and Wistar rat. Methods: Dendritic cells isolated from liver or bone marrow of inbred strain Wistar and SD rat were cultured for five to nine days. A week before operation, the recipient rats were injected 2?106 inmature DCs from vena dorsalis penis and observed. The models of heterotopic small bowel transplantation (SBT: SD→ Wistar)were established. Acute immuno- rejection levels were evaluated by HE. Results: Varying degrees of rejection were observed in 3, 5, 7 days after operation. Conclusion: Immature DC can induce allogenic immunological tolerance of rat small bowel transplantation.
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ObjectiveTo study the effects on hemodynamics of portal venous system of splenorenal shunt plus pericardia devascularization (SRS+PCDV), and evaluate the clinical significance of this operative procedure.MethodsThe hemodynamic parameters of portal venous system by Doppler color-flow imaging (DCFI) of 99 patients with portal hypertension (PH) were measured before and after operation.Results(1)In SRS group the postoperative portal venous flow (PVF), free portal pressure(FPP) decreased by (57?9)%, (52?5)% respectively (P0.05).(3)In SRS+PCDV group PVF,FPP decreased by (36?8)%, (34?10)% respectively(P