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Objective To explore the indications,surgical techniques and clinical effects of laparoscopic splenectomy on patients with portal hypertension. Methods Analysis the clinical data of 32 patients of portal hypertenision with laparoscopic splenectomy and open splenectomy from March 2006 until June 2009. Results The effectiveness of the procedures for portal hypertension was evaluated.Among 16 patients with LS, 2 patients were converted to open surgery. There is no significant difference with operatative time, blood loss and hospital fees between the two groups, the laparoscpy group had the shorter mean hospitalization, fasting and draining time. Conclusions If there are enough preparation preoperation, skillful laparoscopic technique and micromesh manipulation during operation,laparoscopic splenectomy is a minimally invasive and safe technique in the patients with lower-grade to medium varicose veins.
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Objective To evaluate the safety and feasibility of total laparoscopic hepatectomy for liver neoplasms.Methods Laparoscopic hepatectomy in 15 patients with liver neoplasms were completed by combined application of ultrasound scalpel,Ligasure and vascular clip without blockage of liver blood flow,including 9 cases of hepatic cavernous hemangioma,whose diameters were from 5.0 cm to 15.0 cm,3 cases of hepatic cyst with fibrosis,located in left lateral hepatic lobe,3 cases of primary hepatic carcinoma,whose diameters were from 1.0 cm to 5.0 cm and the hepatic functions were all Child A.Results Laparoscopic hepatectomy was completed successfully in all 15 cases with no conversion to open laparotomy,including 6 cases of left lateral hepatectomy,9 cases of irregular hepatectomy.The mean operative time was 110 min,blood loss during operation was from 30 ml to 500 ml,the average was 251 ml.The mean postoperative hospital stay was 6.5 d.The mortality rate was 0%.No severe complications occurred except 1 case of small amount bleeding which stopped itself.Conclusion Total laparoscopic hepatectomy is a feasible,safe and minimal invasive approach for patients with liver neoplasms within segment Ⅱ、Ⅲ、Ⅳa、Ⅴ、 and Ⅵ.
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Objective To explore the effect of glutamine on immune function of rat with obstructive jaundice and its possible mechanism. Methods Fifty male Wistar rats were randomly divided into three groups: Control group (n=10), obstructive jaundice group (n=20) and glutamine treatment group (n=20). The serum concentration of TNF-?, IL-10 was detected by using radioimmune method. Liver function was measured through automated biochemistry analyzer. The animal model of obstructive jaundice was established by ligating the rat's common bile duct. Bacteria cultures were performed with the rat's tissues of lung, spleen, liver and kidney respectively. Resu- lts Compared with control group, obstructive jaundice group showed statistically lower serum level of TNF-?, and statistically higher serum level of IL-10, TBIL, ALT and AST during the first and the second week after ligation of common bile duct. During the first and second week after administration of glutamine, the serum TNF-? of glutamine treatment group was statistically higher than that in control group and obstructive jaundice group. Meanwhile, glutamine treatment group showed statistically lower serum level of IL-10, TBIL, ALT and AST than obstructive jaundice group. There were statistically less bacteria translocations in glutamine treatment group than those in obstructive jaundice group. Conclusion Glutamine can increase the immune function by changing serum concentration of TNF-?, IL-10 and decrease the bacteria translocation.
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Objective To evaluate pericardial devascularization with splenectomy (PCDV) for the treatment of cirrhotic portal hypertension. Methods From January 1994 to December 2004, 177 patients were treated by PCDS, among them posthepatitic cirrhosis was identified in 170 cases, and alcoholic cirrhosis in 7. One hundred and thirty two patients were operated on electively, 25 prophylactically, and 20 emergently. Results The bleeding control rate was 95% , the overall operative mortality rate was 4. 5%. The main causes of death were upper gastrointestinal bleeding, hepatic failure and intra-abdomimal hemorrhage. The mean follow-up time was 3. 6 years. The 5-year survival rate was 90%. The 5-year recurrent bleeding rate was 5. 1% , The rate of postoperative hepatic encephalopathy was 5. 1%. Conclusions This procedure has the advantage of high successful rate of bleeding control, low complication rate, and long term survival.