Objective To evaluate the therapeutic effect of selective paraesophagogastric devascularization withoutsplenectomy in treatment of portal hypertension with upper gastrointestinal hemorrhage. Methods The clinical data of 27 patients who received selective paraesophagogastric devascularization without splenectomy from 2008 to 2011 were retrospectively analyzed. The hemogram， hepatic function， perioperative compliations， and free portal pressure （FPP） were observed. The patients were followed-up and the re-bleeding rate and survival rate were observed. Results The FPP decreased significantly（P＜0.05） after operation. The complication rate was 33.3%（9/27） after operation， including2 cases（7.4%） stress ulcer bleeding， 1 case （3.7%） acute bleeding portal hypertensive gastropathy， 1 case （3.7%） deep venous thrombosis， 1 case （3.7%） acute lung injury， 1 case （3.7%） death of hepatic encephalopathy， 3 cases（11.1%） new onset portal vein thrombosis. Twenty-four patients were followed up for an average of 27 months （8-57 months）. The overal survival rate was 92.6% （25/27）. Conclusion Selective paraesophagogastric devascularization without splenectomy is an effective method for treatment of portal hypertension with upper gastrointestinal hemorrhage.
ObjectiveTo investigate the feasibility and safety of spleen-preserving distal pancreatectomy (SpDP), and to discuss the indications and techniques of SpDP. MethodsThe clinical data of seven patients underwent SpDP between January 2004 and December 2007 in Xinhua Hospital were analyzed retrospectively. ResultsOut of the seven cases, one case received the SpDP combined with partial splenic vessel resection, while the other cases received the SpDP with splenic vessel preservation. The operation time was (2.93±0.38) h and the intraoperative blood loss was (392.86±109.65) ml. Only one case suffered from pancreatic fistula, who finally recovered after medicine therapy and percutaneous drainage. There was no other complication or operative mortality. The postoperative platelet count was (273±43.76)×109/L and the postoperative hospital stay was (17.86±8.07) d. For six cases of patients, no recurrence and metastasis was found after the followup (49.2±14.4) months （30-72 months）. ConclusionSpDP is a safe and feasible procedure, which is worthy for selected cases such as benign neoplasm of the body and tail of the pancreas.
Objective To improve the diagnosis and treatment of complications following spleen transplantation. Methods Five cases of spleen transplantation performed to treat severe hemophilia A were analyzed retrospectively .Results Hemorrhage was found in 2 cases that one was from small vessels of spleen porta and the other one was retroperitoneal hemorrhage. Acute rejection was diagnosed in early stage to all in which it happened to 1 case within 5 days, happened to 3 cases from the fifth day to the tenth postoperative day and happened to 1 cases after the tenth day. Infection was found in 2 patientsone with incision infection and the other with infection retroperitoneal infection. All but one who died from hydrocephalus recovered as a result of timely diagnosis and treatment.Conclusion It is of great significance to the recipients with transplanted spleen that the complications are detected comprehensively and treated in time.
Objective To probe into the significance of tuftsin in patients with liver cancer. MethodsThe serum tuftsin level of 12 patients with liver cancer before and after the resection，20 cirrhostic and 20 normal controls were measured by radioimmunoassay (RIA). ResultsTuftsin level in preoperative group （449±106） ng/ml was much lower than that in postoperative group (588±129) ng/ml，cirrhotics group (580±187) ng/ml and control group (703±128) ng/ml (P＜0.01). The tuftsin level in postoperative group was also quite lower than that in control group (P＜0.01). Conclusion We should try our best to excise the liver cancer so that a higher tuftsin level might be obtained which can activate NK cell and T cell.
Objective By using small interfering RNAs ( siRNAs) specific for spleen tyrosine kinase ( Syk) , to evaluate the role of Syk in maturation of bone marrow-derived dendritic cells. Methods The fragments of 21-23 bp siRNAs specific for mice Syk were chemo synthesized and transfected into the asthmatic murine bone marrow-derived dendritic cells ( BMDCs) by Lipofectamine 2000 transfection system for 48 hours. Then BMDCs were co-cultured with T cells from the normal mice spleen for 48 hours. The cytokines including IL-4, IL-13, IL-2 and INF-γin supernatant were detect by ELISA. The expression of Syk protein was measured by Western Blot to determine whether the Syk gene was silenced. Results The expression of Syk protein was obviously decreased in the siRNA-interference group. The secretions of IL-4 and IL-13 were significantly inhibited by siRNA interference ( P lt; 0. 05) , but the secretions of IL-2 and INF-γwere not interfered signficantly ( P gt;0. 05) . Conclusion Syk specific siRNA fragments can block the antigen presentation function of dendritic cells and block the activation and differentiation of T cells.
OBJECTIVE: To evaluate the histological characteristics of xenogeneic graft-versus-host disease (GVHD), and to differentiate it from the allogeneic GVHD. METHODS: The original articles related to the characteristics of xenogeneic GVHD and the relationship between xenogeneic GVHD and allogeneic GVHD were widely reviewed in the past decade. RESULTS: Xenogeneic GVHD was different from allogeneic GVHD in the speed of development, position and features of pathological changes, due to the incompatibility of common simulative signals, adhesive molecules and difference of antigens. Xenogeneic spleen transplantation could induce xenogeneic GVHD. CONCLUSION: Xenogeneic GVHD can be used as a model to mimic rejection in xenotransplantation and to evaluate the compatibility of xenotransplantation.
ObjectiveTo study the clinical role of spleen/remnant liver volume ratio in evaluating liver reserve function after surgical treatment for liver cancer. MethodsTo calculate the ratio of spleen volume/remnant liver volume after tumor excision with imaging method and immersion method; to analyze the relationships between spleen/remnant liver volume ratio and liver function score after operation as well as hospital stay. ResultsLiver function ChildPugh score was related mainly with spleen/remnant liver volume ratio (t=7.831, P=0.000), which was proved by multiple regression analysis. The median hospital stay of the group with spleen/remnant liver ratio ≤0.9 was 14 d （12-16 d）, which was less than that (22 d, 15-29 d) of the other group with the ratio gt;0.9 (P=0.000). ConclusionsSpleen/remnant liver volume ratio can predict effectively recovery ability of patients after operation for liver cancer， and assess correctly the reserve function of liver. When the ratio is less than or equal 0.9, the operation is safe.
【Abstract】ObjectiveTo explore the appropriate surgical management of the primary hepatocellular carcinoma with hypersplenism. MethodsOf 67 patients who has primary hepatocellular carcinoma with hypersplenism, 17 cases had hepatectomy combined with splenectomy, 7 cases had hepatectomy only, and the other 43 patients were treated with hepatic artery embolization and splenic artery embolization. ResultsThe symptoms of hypersplenism disappeared and the hemogram became normal 30 d after operation in 17 patients who had hepatectomy combined with splenectomy, but worsened in 7 patients who only had simple hepatectomy and 6 cases of those patients were treated with splenic artery embolization 3-7 months after operation. In 43 patients treated with hepatic artery embolization and splenic artery embolization, 79%（34/43）had improved hypersplenism symptoms and the hemogram became normal. ConclusionThe treatment of primary hepatocellular carcinoma with hypersplenism should be strived for hepatectomy combined with splenectomy. If the liver mass cannot be resected, hepatic artery embolization and splenic artery embolization should be chosen.
【Abstract】ObjectiveTo investigate the effects of liver transplantation on splenic function in rats with hepatic cirrhosis. MethodsHepatic cirrhosis model was established in rats by subcutaneous injections of carbon tetrachloride. Liver transplantation model was established with twocuff technique. Spleen index, morphological changes of spleen were observed before and after liver transplantation in hepatic cirrhosis rats. Spleen T lymphocyte subgroups before and after liver transplantation were also assayed by immunofluorescence staining and flow cytometry. ResultsBefore liver transplantation, spleen index was increased from (2.42±0.11) mg/g to (3.62±0.14) mg/g， P＜0.01; pathological examination of spleen samples showed that the areas of white pulp were decreased from (23.47±2.30)% to (7.70±2.01)%， P＜0.01， and the areas of spleen trabecula were increased from (1.75±0.61)% to (4.46±0.71)%， P＜0.01. Meanwhile, the ratio of CD4/CD8 of spleen T lymphocyte subgroups was decreased from 2.67±0.15 to 1.18±0.15, P＜0.01. After liver transplantation, spleen index was decreased from (3.62±0.14) mg/g to (2.62±0.11) mg/g， P＜0.01; pathological examination of spleen showed that the areas of white pulp were increased from (7.70±2.01)% to (15.07±1.97)%， P＜0.01, and those of spleen trabecula were decreased from (4.46±0.71)% to (3.11±0.51)%， P＜0.05. Meanwhile, the ratio of CD4/CD8 of spleen T lymphocyte subgroups was increased from 1.18±0.15 to 2.32±0.11, P＜0.01. ConclusionImpaired function of spleen resulting from liver function damage can be improved in rats with hepatic cirrhosis after liver transplantation.
Objective To study the effect of splenectomy on the anti-tumor immunity in rats with induced hepatocellular carcinoma (HCC). Methods At the second and fourth month of the induced HCC, the NK cell activity, TNF-α level and total lymphcyte in blood were measured in the group of splenectomy and the control group. Results There were no different in the total lymphcyte and TNF-α in the blood in two groups, but there were significant difference in the NK cell activity between the group of splenectomy and the control group (Ｐ＜0.05). Conclusion There are some change in the anti-tumor immunity after splenectomy in rats, in which NK cell activity is at low level continuously. TNF-α isn′t affected after the second month after splenectomy.