Current research of cavernous transformation of portal vein for children / 国际外科学杂志

Cavernous transformation of portal vein accounts for about 40％ in children portal hypertension.Compared with other causes of portal hypertension disease cavernous transformation of portal vein presents early age of disease onset,high risk of bleeding and normal liver function.Because the pathology is relatively simple and most children have no other diseases,so a reasonable treatment of the disease has decisive significance.The current concept for diagnosis and treatment of the disease is different between home and abroad,Controlling upper gastrointestinal bleeding is the main purpose in out country.Reliving hypersplenism,improving liver blood supply and quality of life are much important abroad,The article aims to summarize latest foreign literature to introduce latest research for the disease abroad.

Microvascular Injury of the Peribiliary Plexus Associated with Transarterial Chemoembolization: A Study of Surgical Specimens

PURPOSE: We attempted to evaluate the relationship between transarteiral chemoembolization (TACE) and injury to the peribiliary plexus by evaluating the number of microvessels in the peribiliary plexus of surgical specimen. MATERIALS AND METHODS: Surgical specimens were obtained from 78 hepatocellular carcinoma patients and 22 patients with liver metastases. They were divided into 4 groups (Group 1; hepatocellular carcinoma without TACE [n=30], Group 2; hepatocellular carcinoma receiving preoperative TACE once [n=37], Group 3; hepatocellular carcinoma receiving preoperative TACE more than two times [n=11] and Group 4; metastatic carcinoma of the liver patients without a history of liver disease [n=22]). Immunohistochemical staining for factor VIII-related antigen was performed in all the specimens and the number of microvessels in the inner capillary layer and the outer venous layer of the bile duct (> 200 micrometer in diameter) was counted. RESULTS: The mean numbers of microvessels in the inner capillary layer were 4.50, 4.08, 1.64 and 2.05, and those in the outer venous layer were 25.23, 20.00, 18.36 and 12.32 for the 4 groups, respectively. The number of microvessels in group 4 was statistically fewer than that of group 1 (p<0.01). In the hepatocellular carcinoma patients, the number of microvessels was decreased as the number of TACE sessions was increased. CONCLUSION: The number of microvessels in the peribiliary plexus is increased in chronic liver disease patients. It may be from the increased portal pressure and flow stagnation in the sinusoidal and portal venules. TACE can have an effect on microvascular injury of the peibiliary plexus, and this can be a cause of bile duct necrosis and biloma.

Hepatic Perfusion Disorders: A Pictorial Review of CT and MR Imaging

The liver has a unique dual blood supply through the portal vein and the hepatic artery. There are several communications between these two vessels under various conditions such as in hepatic tumors, trauma and liver cirrhosis, vascular compromise, among others. When vascular compromise occurs, this dual blood supply system can cause changes in the volume of blood flow in individual vessels or even in the direction of blood flow. With rapid image acquisition and increased resolution available in multislice CT and MR imaging, hepatic perfusion disorders are now more frequently encountered than in the past. Familiarity with imaging findings of these perfusion disorders will be helpful in characterizing focal hepatic lesions and will also help to avoid false positive diagnoses.

Protective effect of emodin on hepatic ischemia-reperfusion injury in the rat liver / 中国普通外科杂志

Objective To study the protective effect of emodin on hepatic ischemia-reperfusion injury in the rat(liver). Methods Thirty Wistar rats were randomly devided into 3 groups:the sham-operatment group (Control group),the ischemia-reperfusion group (I/R group) and the emodin-treatment group (EMD group). By(clamping) the left and median lobes of the liver for 1 h and followed by 1 h of reperfusion,the(partial) (70%)(normothemic)(ischemia)-reperfusion injury model was established. The rats of emodin group received emodin [60mg/(kg?d)] by(oral) route for 3 days before ischemia. Blood and liver samples were obtained for(biochemical) and(histological) analysis 1 h after reperfusion. Some liver specimens were taken for flow cytometry(analysis) to assess the(mitochondrial)(membrane) potential (??m) . Rhodanmin123 and PI were used to label the cells.Results After reperfusion,(serum) levels of alanine transaminase(ALT) and liver contents of(malondialdehyde) (MDA) in the I/R group rats were increased significantly (P

Expression of toll-like receptor 2 in liver kupffer cells in hepatic ischemia/reperfusion injury in the mice / 中国普通外科杂志

Objective To observe the synthesis of TLR2 protein and mRNA expression in Kupffer cells(KCs). Methods BALB/C mice were used to make model of partial hepatic ischemia/reperfusion (I/R) injury. After injury, KCs were isolated with two-steps in situ perfusion technique. The synthesis of TLR2 protein was determined by flow cytometric analysis (FCM) and real time reverse transcription(polymerase) chain reaction (Real Time RT-PCR) was used to analyse its gene expression in KC. Results The expression of TLR2mRNA and synthesis of protein in KC were significantly higher in experimental group, compared with sham group (protein expression: 9.19?0.43 % vs 1.52 ?0.24%, P

Study of hepatic cellular injury due to hepatic ischemia in dogs / 中国普通外科杂志

Objective To investigate the ischemic injury of hepatic cell caused by hepatic artery occlusion.Methods The hepatic artery was occluded in 20 dogs via operation,while the portal vein remained patent.Specimens were gained from the right liver at four time points:before occlusion of the hepatic artery,20(minutes),40 minutes and 60 minutes after artery occlusion.Each specimen was examined by HE and BCL-2 by immunohistochemistry.The gray scale of BCL-2 in HE sections was detected.Results Hepatic cellular injury was obvious 20 minutes after occlusion of the hepatic artery.Irreversible hepatic cellular injury was(observed) 60 minutes after hepatic artery occlusion.The results showed that the gray scale of BCL-2 at every time point after hepatic artery occlusion were significantly different from that before hepatic artery occlusion(P

Protective effect of propofol delivered through portal vein on hepatic ischemia reperfusion injury in rabbits / 中国普通外科杂志

Objective To explore the protective effect of portal vein administration of propofol on hepatic ischemia reperfusion injury(HIRI) and its mechanism.Methods Thirty-two male rabbits were randomly allocated into four groups:Group A(sham operation group),the abdomen was only opened and closed;group B,the hepatic inflow was occluded for 30 min,and reperfused for 60 min;group C,the same managment as group B + propofol injected through jugular vein;group D,the treatment same as group B + propofol injected through portal vein.Drug injection was completed 20 min before hepatic inflow occlusion.Serum ALT and AST,and endothelin-1(ET-1) and nitric oxide(NO)in the hepatic tissue and blood,and the content of ATP in hepatic tissue were determined.Results The level of ET-1 in plasma and hepatic tissue was significantly increased in group B compared to group C and D(P

Protective effect of safflower solution on warm ischemia reperfusion injury of liver / 中国普通外科杂志

Objective To study the protective effect and mechanism of safflower solution on warm ischemia reperfusion injury(IRI) of liver in rats.Methods Male Sprague-Dawley rats were randomly divided as 4 groups: Group S(sham group);group I/R(IRI group);group IPC(ischemic preconditioning group);group SPC(safflower solution preconditioning group).The rats were sacrificed at 24 h after reperfusion,serum levels of ALT and AST were measured and HE staining of liver tissues were made to detect rat liver histological changes and grade liver IRI(Suzuki score);apoptosis were monitored by TUNEL;TNF-?,MIP-2 and ICAM-1 mRNA of liver were measured by RT-PCR;NF-?B gene products of liver were detected by Western blotting.The mean value of all the assay tests was compared.Results After 24 h reperfusion,compared with group I/R,the liver function(ALT and AST) in group SPC and group IPC was significantly improved(P

Selection of the method of hepatic vascular control during resection of liver carcinoma / 中国普通外科杂志

Objective To investigate the proper selection of methods of hepatic vascular control during(resection) of liver carcinoma.Methods Ninety-foury cases of liver carcinoma underwent hepatectomy using 4 different types of hapatic vascular control in our hospital.The operative time,amount of intraoperative blood loss,transfusion,and postoperative drainage,changes of postoperative liver function and complications were analyzed and compared between the 4 groups.Results Of the 94 cases,38(40.4%) underwent routine Pringle′s maneuver,34(36.2%) had selective hemihepatic vascular exclusion,18(19,1%) without(hepatic) inflow occlasion and 4(4.3%) had total vascular exclusion during hepatectomies.All tumors were entirely removed and operations were performed smoothly.Postoperative complications occurred 24 case-times and 2 patients(2.1%) died.Conclusions The selection of method of hepatic vascular control during(hepatectomy) for massive liver carcinoma should be comprehensively determined,based on the size and location of tumor,preoperative liver function,diffculty of hepatectomy and findings at intraoperative exploration.Proper method manner of hepatic vascular control is crucial for successful operation and uneventful recovery of the(patient).

Pseudolesion in Segment IV of the Liver on CT Arterial Portography

PURPOSE: To determine the incidence of pseudolesions seen in the posterior aspect of segment IV of the liveron CT arterial portography(CTAP), and to evaluate the findings of CT hepatic arteriorgraphy(CTHA) and celiacangiography. MATERIALS AND METHODS: We retrospectively analysed 450 cases of patients who had undergone CTHA,CTAP and celiac arteriorgraphy for the diagnosis and treatment of hepatic lesion, and evaluated the incidence andimaging findings of pseudolesions in segment IV of the liver, as seen on CTAP, CTHA and celiac arteriography. RESULT: In 28 of 450 patients(6.2%), pseudolesions of focal perfusion defect were seen in segment IV on CTarterial portography. Pseudolesions were seen on CTAP on 39 different section slices ; these were wedge-shaped in41% of cases(16/39), rectangular in 30.8%(12/39), ovoid-shaped in 23.1%(9/39), and half moon-shaped in 5.1%(2/39); they were from 1 to 3cm(average, 1.5cm) in anteroposterior diameter, from 1 to 3cm(average, 1.9cm) in width, andfrom 1 to 4cm(average, 1.9cm) in craniocaudal diameter. Twenty-seven patients underwent CTHAs ; hyperattenuationwas seen in 13(48.2%), isoattenuation in 12(44.4%), and hypoattenuation in two(7.4%). In 19 of 28 celiacangiograms(67.9%), the right gastric artery was seen to arise from the hepatic artery, and aberrant right gastricveins directly draining into the left lobe of the liver were seen in three(10.7%). CONCLUSION: The incidence ofpseudolesion seen in segment IV of the liver on CTAP was 6.2% (28/450), and in 3 of 28 cases(10.7%), celiacangiography showed aberrant right gastric venous drainage. For pseudolesions, CTHA showed variable attenuation,and this modality is less sensitive than CTAP for the detection of pseudolesion.

Effect of ischemic preconditioning on the apoptosis of hepatocytes and expression of regulating gene (bcl-2,Fas protiens) in rats / 中国普通外科杂志

Objective To explore whether hepatocellular ischemia reperfusion (IR) injury elicites the apoptosis of hepatocytes or ischemic preconditioning (IP) reduces the apoptosis (AP) of hepatocytes due to IR injury in the rat, and the effect of IP on AP regulating genes (bcl 2、Fas) protein expresssion. Methods Wistar rats were randomly divided into sham operation (SO) group, IR group and IP group. The latter two groups were futher divided into 3 subgroups respectively and subjected to 30 minutes of ischemia. IP was achieved by ischemia for 5 minutes, followed by reperfusion for 5 minutes before continuous block of the liver influe. The rats were killed after reperfusion for 1.5, 3 and 4.5 hours respectively, then liver tissues were sampled to examine the apoptosis and bcl 2 and Fas proteins. In SO group the rats were killed 3.5 hours after the operation and the liver tissues were sampled. Results Apotosis index of hepotocytes significantly in creased in IR groups compared with that in IP groups (P0.05). Expression of Fas protein was significantly increased in IR group and IP group than that in SO group (P0.05). Conclusions This study shows that: (1) IR injury may activate the apoptosis of hepatocytes by increasing Fas gene expression. (2) IP may decrease the apoptosis of hepatocytes by increasing bcl 2 gene expression.

Alteration of PtiO_2, PtiCO_2 and pHti in liver tissue during liver ischemia-reperfusion in rabbits / 中国普通外科杂志

Objective To study the causes, significance of alteration of PtiO 2, PtiCO 2 and pHti in liver tissue during liver ischemia reperfusion (I R). Methods After rabbits were anesthetized, liver ischemia was induced by complete occlusion of the hepatoduodenal ligment for 45 min, then the portal and arterial flow were released, and observed for 120 min for measuring the PtiO 2, PtiCO 2 and pHti in liver tissue and the pathology of the liver during ischemia reperfusion. Results After 15 min of hepatic vascular occlusion, PtiO 2 decreased to 4 mmHg, PtiCO 2 increased fast to (149.63?9.80) mmHg (P

Clinical study on the effect of normothermic liver ischemic preconditioning on the expression of apoptosis regulating genes / 中国普通外科杂志

Objective To explore the expression of apoptosis regulating genes C jun and bcl X L after normothermic liver ischemic preconditioning and its clinical significance. Methods 16 cases of liver cancer were randomly divided into ischemic reperfusion(IR) group and ischemic preconditioning (IP) group (8 cases in each). The samples of venous blood were drawn before IR or IP procedure and 30 minute after reperfusion for testing ALT, AST and LDH. Meanwhile, samples of liver tissue were taken for study of hepatocellular apoptosis, expressions of C-jun mRNA、 Bcl-X L mRNA and PCNA and morphologic changes. Results The levels of ALT、 AST、 LDH and AI in IR group were significantly higher than those in IP group (P

Changes of the levels of tumor necrosis factor and interleukin-8 in the blood and gastric mucosa and their mRNA expression after liver ischemia- reperfusion / 中国普通外科杂志

Objective To investigate the changes of the levels of TNF and IL 8 in blood and in gastric mucosa and their mRNA expression after liver ischemia reperfusion (I/R). Methods 130 rats were randomly divided into 3 groups: (1) sham operation group(control group, n=10);(2)liver ischemia reperfusion group (n=60), including ischemia for 20min and 40min, and reperfusion for 1h, 24h and 72h respectively; (3) liver I/R rats treated with famotidine group (n=60). ALT and AST were detected after operation, pathomorphological changes of gastric mucosa were studied by light microscope and transmission electronic microscope, the concentrations of TNF and IL 8 in blood and gastric mucosa were measured by radioimmunoassay (RIA), TNF mRNA and IL 8 mRNA were detected by in situ hybridization. Results After liver I/R,inflammatory damage appeared in gastric mucosa, TNF and IL 8 concertrations increased significantly(P

Small Arterioportal Shunt: A Pseudolesion Mimicking Hepatocellular Carcinoma in Angiography

PURPOSE: To document the findings of a small arterioportal(AP) shunt on hepatic angiography through the various diagnostic modalities, and to determine whether this shunt is related to hepatocelluar carcinoma. MATERIALS AND METHODS: During the hepatic angiography in 223 patients, a small AP shunt and subsequent focalparenchymal staining more than 1cm in diameter were found in 28 patients. We compared this angiographic abnormality using MR imaging(n=10), CTAP(n=12), iodized-oil CT(n=23), intraoperative ultrasonography(n=5) and follow-up hepatic angiography(n=11), as well as with conventional ultrasonography and CT scan. RESULTS: Arterioportal shunts noted on angiographic study matched with perfusion defects noted in CTAP(10/12) and also with the area of arterial enhancement seen on dynamic CT scan(3/4). In no case was a lesion found on MR and no Lipiodol uptake was seen on CT. There was no evidence of tumor growth around the AP shunts on follow-up angiographies, andno tumor was found during surgery. CONCLUSION: A small AP shunt was not related to the presence of a tumor. Ifthe hemodynamic changes resulfing from a small AP shunt are understood, confusion can be avoided in the interpretation of vascular imaging including CTAP and dynamic CT.

Expression of macrophage inflammatory protein-2 in liver injury induced by ischemia and reperfusion in rat / 中国普通外科杂志

Objective To study the expression and effect of macrophage inflammatory protein-2(MIP-2) in liver injury induced by ischemia/reperfusion(I/R). Methods Thirty-two rats were randomly divided into 4 groups(8 rats in each group):false operation (control) group and 3, 9, 24 hours reperfusion group.The expression of MIP-2 mRNA in hepatic tissue, MIP-2 protein in plasma, the neutrophil infiltration in liver tissue and serum ALT were measured. Results The expression of MIP-2 mRNA in the ischemic tissue was significantly higher than that in nonischemic tissue (P

Protective effect of ischemic preconditioning on liver ischemia/reperfusion injury in rats with cirrhosis / 中国普通外科杂志

Objective To investigate the protective effect of ischemic preconditioning(IP) on liver ischemia/reperfusion(I/R)injury in rats with cirrhosis.Methods Thirty-two SD rats with liver cirrhosis induced by carbon tetrachloride were randomly divided into IP group and Non-IP(NIP) group,according to whether an IP was performed before liver I/R injury or not.The function of liver, superoxide dismutase(SOD),glutathione peroxidase(GSH-PX),malonyldialdehyde(MDA),adenine nucleotide(ATP,ADP,AMP),energy charge(EC),nitric oxide(NO)in liver tissues,the changes in liver histology,and one-week survival rate after the test in both groups were compared.Results Compared with NIP group,the serum AST,ALT ,and LDH and the MDA contents significantly decreased(P

Study on the protective effect of liver and limbs ischemic preconditioning against liver ischemia/reperfusion injury in the rat / 中国普通外科杂志

Objective To investigate the protective effect of the first window(FW)of liver ischemic preconditioning(IPC),the second window(SW) of remote(leg) ischemic preconditioning(RPC) and conbined applications of liver and lges IPC to against liver ischemia/reperfusion(I/R) injury in the rat,and to investigate the mechanism of the protection.Methods Rats were randomly divided into five groups(n=8 each):(1) Sham group(S group),rats without IPC,(2) Rats with 5 min IPC(IPC group);(3) Rat wiht both liver and lower limbs IPC and repeated three times(RPC group);(4) IPC 24 h after RPC group;(5) IR without IP(I/R group);except S group,the rats were subjected to 60 min sustained liver ischemia followed by 180 min reperfusion.All ischemia rats were only subjected to 70% liver ischemia.Finally,blood and liver samples were obtained to determine the activity of ALT and AST,the expressions of TNF-? and HSP70 protein,and liver wet/dry weight(W/D) and pathology.Results All IPC group and RPC group and IPC+RPC group had obviously lower levels of ALT,AST,W/D,TNF-? than that of the I/R group(P0.05).Conclusions The FW of the IPC,the SW of the RPC and combined applications can lessen hepatic I/R injury.There is no significant difference in the protective intensity of the 3 motheds.The protective effects possibly are due to suppression of TNF-? production,induction of protein HSP70 expression and improvement of liver microcirculation.