Objective To approach the prognosis after liver transplantation （LT） of liver function for Child grade A in patients with portal hypertension， and to compare with periesophagogastric devascularization with splenectomy （PDS）. Methods The data of 195 portal hypertension cases with Child A caused by hepatitis B cirrhosis who received surgical treatment of PDS （152 cases） or LT （43 cases） in division of liver transplantation center of West China Hospital of Sichuan University from 1999 to 2011 were retrospectively analyzed. The pre-， intra-， and postoperative variables in two groups that including patients’ age， score of Child， score of model for end-stage liver disease （MELD）， total bilirubin （TB），creatinine （Cr）， international normalized ratio （INR）， albumin （Alb）， complications of portal hypertension， amount of intraoperative bleeding and blood transfusion， operative time， and in the ICU and hospital stay time were compared. The postoperative outcomes were statistically analyzed including severe postoperative complications， short-term and long-term survival rates. Results Compared with PDS group， the amount of intraoperative bleeding and blood transfusion of LT group were morer （P＜0.05）， the operative time， in the ICU and hospital stay time of LT group were longer （P＜0.05）. The rate of severe postoperative complications in LT group was higher than that in PDS group 〔18.60% （8/43） vs. 1.97% （3/152），P＜0.05〕. The levels of TB and Cr during the postoperative period in LT group were higher than that in PDS group （P＜0.05）. Although the INR on day 1 after operation in LT group was higher than that in PDS group （P＜0.01）， but the difference disappeared soon on day 7 after operation in two groups （P＞0.05）.The 1-， 3-， and 5-year survival rates of the LT and PDS groups were 90.3%， 86.5%， 86.5%， and 100%， 100%， 100%， respectively， significant difference were observed in both short-term and long-term survival rates between the two groups （P＜0.05）. Conclusion LT offered no significant survival benefit to patients with portal hypertension and Child A due to hepatitis B cirrhosis， whereas PDS could be an effective treatment.
目的 总结肝硬变状态下腹腔镜胆囊切除术（LC）治疗胆囊疾病的经验。方法 回顾性分析30例肝硬变合并胆囊疾病患者行LC的临床资料。结果 30例患者中肝功能Child-Pugh A级8例，B级11例，C级11例。LC术后6例(20.0%)发生并发症，其中Child-Pugh B级2例,C级4例。治愈29例（96.7%）； 死亡1例(3.3%)，死亡者为Child-Pugh C级。结论 存在肝硬变时,肝功能Child-Pugh A及B级者行LC比较安全,C级风险较大,应列为手术禁忌。
在以往的时日里，对于肝硬变门静脉高压症的治疗常常争论于是以内科治疗为主还是外科治疗为主; 若进行外科治疗，是以断流还是分流手术为首选，抑或联合手术； 若选定了某种术式，是行预防性干预还是不得已而为之的急诊干预，凡此种种，尚可举之。但是时至今日，该领域在观念和技术上已经有了很大的变革与进步。对此，我们的关注及思考也随之发生变化，现不揣冒昧，敞开所想，予以探讨……
Objective To explore the correlation between liver volume variation of posthepatitic cirrhosis patients and the severity of the disease. Methods One hundred and eleven patients with normal livers and 74 posthepatitic cirrhosis patients underwent volume CT scan. The relation between normal liver volume and body height, body weight and body surface area was studied by linear regression and correlation method, the standard liver volume equation was deduced. The change ratio of liver volume in cirrhotic patients was calculated and compared with Child classification. Results The mean normal liver volume of Chinese adults was （1 225.15±216.23） cm3, there was a positive correlation between liver volume and body height, body weight 〔liver volume (cm3)=12.712×body weight (kg)+450.44〕 and body surface area 〔liver volume (cm3)=876.02×body surface area (m2)-297.17〕. The mean liver volume of Child A, B and C patients were （1 077.77±347.01） cm3, (1 016.35±348.60) cm3 and (805.73±208.85) cm3 respectively. The liver volume and liver volume index was significantly smaller in Child C patients than those in Child A and B patients (P＜0.05); while liver volume change ratio was higher in Child C patients (P＜0.05). Conclusion Liver volume variation of cirrhotic patients can be quantitatively assessed by 16 slices helical CT volume measurement and standard liver volume equation. The change of the liver volume is correlated with the severity of liver cirrhosis.
【Abstract】ObjectiveTo investigate the influence of CO2 pneumoperitoneum on intestinal mucosa permeability in rats with liver cirrhosis. MethodsFifty rats were randomly divided into following groups: control group (n=5), cirrhosis group(n=5) and pneumoperitoneum group (n=40); the pneumoperitoneum group was further divided into 8 mm Hg group(n=20) and 13 mm Hg group (n=20). Four time points were chosen, including 0.5, 2, 6, and 12 hours after the end of pneumoperitoneum. After rat models with cirrhosis were established successfully, the abdominal cavity was insufflated with CO2 and maintained under the pressures of 8 mm Hg and 13 mm Hg respectively for two hours. The portal venous blood was collected and the levels of Dlactic acid and endotoxin were measured. ResultsThe levels of endotoxin and Dlactic acid in cirrhosis group were much higher than those of control group（P＜0.05）. The levels of serum endotoxin and Dlactic acid in pneumoperitoneum group were higher than those of cirrhosis group(Plt;0.05) regardless of pressure and time point. The endotoxin level in 13 mm Hg group was higher than that of 8 mm Hg group on different time points (F=5.466, P＜0.05), but there was no difference in Dlactic acid level between both of them（F=0.415,Pgt;0.05）.ConclusionThe intestinal mucosa permeability is increased in rats with liver cirrhosis. It can be further increased under CO2 pneumoperitoneum with certain pressure and time and in a pressuredependent manner. The permeability can decrease after removal of pneumoperitoneum.
【摘要】目的 探讨肝硬变门静脉高压症患者术前肝脏备功能的评估方法。方法 用Logistic多元回归法分析了78例门静脉高压症行断流术患者术后出现肝功能不全的相关因素，从中筛选与肝功不全关系最密切的危险因子。结果 术后发生肝功不全影响最大的因素依次为： 肝性脑病（EN）、血浆吲哚氰绿潴留试验（ICGR15 min）及门静脉充血指数（PCI）等，而术前的血清总胆红素（TBIL）、白蛋白（A）、凝血酶原时间（PT）、门静脉内径（dp）、门静脉流速（Vp）及门静脉流量（Qp）等因素，在多元回归中所占比例不大。结论 综合分析术前患者临床指标和肝功能实验室检查有助于评价肝硬变患者肝储备功能，预测手术风险及术后转归。
ObjectiveTo introduce the technique of threedimensional portal venography of multidetector row spiral CT and its clinical application in the evaluation of the portosystemic collateral shunts of liver cirrhosis. MethodsAll relevant literatures were retrospectively reviewed on the application of twodimensional and threedimensional reconstruction techniques such as MIP, SSD, VRT of multidetector row spiral CT to demonstrate the collateral vessels of liver cirrhosis.ResultsThe distribution, pathway and anatomy of portosystemic collateral vessels were well shown by multidetector row spiral CT portal venography. Conclusion Multidetector row spiral CT portal venography provides excellent depiction of the anatomic characteristics of the collateral shunts and enables the continuous tracing of vascular structures, thus it is very helpful in the imaging evaluation of the collateral vessels of liver cirrhosis.
ObjectiveTo investigate the possible mechanism affecting liver cirrhosis by splenectomy. MethodsBy subcutaneous administration of 20% carbon tetrachloride(CCl4), liver cirrhosis models were established in splenectomy and nonsplenectomy groups. After HE staining, special staining and immunohistochemical staining, mast cell, Kupffer’s cell and Ito cell were counted under optical microscope. Liver pathological sections and the dynamic changes of these cells in mice were studied respectively in comparison with the normal group.ResultsThe incidence of liver cirrhosis in nonsplenectomy group was significantly higher than that in splenectomy group after the 16th injection of CCl4 (P＜0.05). The count of mast cell was much higher than that in splenectomy group after the 4th and the 8th injection (P＜0.05). Kupffer’s cell and Ito cell significantly increased after the 12th and the 16th injection in nonsplenectomy group compared with splenectomy group (P＜0.05). ConclusionSplenectomy may decline the incidence of hepatic cirrhosis caused by multifactors. In the early stage, splenectomy influences the migration, maturation and accumulation of mast cell. In the middle and late stage, it influences the proliferation of Kupper’s cell and cytokine secretion, thus the Ito cells are activated and proliferation is inhibited, in which extracellular matrix decreases in amount and the degree of hepatic fibrosis is reduced.
Objective To study the value of the clinical application of stereography and measurement of liver volume in cirrhotic patients with portal hypertension. Methods By use of the personal computer and the software of threedimensional reconstruction and measurement system of liver faultage photograph, the liver volume in vivo was successfully measured and the threedimensional image of the liver rebuilt in 46 posthepatitic cirrhotics who were selected for orthotopic liver transplantation and in 30 noncirrhotic controls, and comparison with the reference volume of recipient liver was obtained by means of water deplacement after transplantation. Results The liver volume of cirrhotic patients with portal hypertension measured by software and water deplacement was (983.33±206.11) cm3, and (904.93±209.56) cm3 respectively. Comparison by means of linear regression analysis between volume measurement on threedimensional reconstruction software and reference volume showed a nearly ideal correlation coefficient(r=0.969,P＜0.01), the average error was 8.66%.The average of liver volume in controls was (1287.00±96.18) cm3, and was positively correlated to the height，weight and body surface area (r=0.845,0.833,0.932 respectively,P＜0.01)，and was different from that of cirrhotics. Liver volume of cirrhoitic patients with portal hypertension was related to their ChildPugh classification. The liver volume of patients in Child C group was significantly smaller than that of patients of Child B group, and was significantly correlated with Alb （r=0.496, P＜0.01） and TBIL（r=-0.493, P＜0.01）,PT(r=-0.517, P＜0.01), but was not significantly correlated with ALT（r=0.206，Pgt;0.05）,portal pressure（r=-0.093，P=0.539） and portosystemic shunt index (r=0.044，P=0.769). Conclusion The volume measurement of the liver by the threedimensional software is relatively accurate. Liver volume of cirrhotic patients with portal hypertension was significantly related to their liver function,and can reflect the liver reserve function.