Abstract:Abstract:Objective：To study the value of modified splenopneumopexy in the treatment of Budd-Chiari syndrome（B-CS）. Methods：The clinical data of 126 patients with BCS treated by modified splenopneumopexy were analysed retrospectively. Results：In this series, the postoperative complication rate was 7.94%（112/126）, the perioperative mortality rate was 1.60%(2/126); and 86 cases were followed up for 9 months to 18 years, the mean time was （7.8±1.2）years, the effective rate was 83.7%（72/86）. Among them, 22 patients followed up by color Doppler ultrasound, and 16 patients by percutaneous splenoportography(1 month~6 years after operation), which showed the collateral circulation of various diameters and numbers between the spleen and lung was formed. In 8 cases the operation was ineffective or B-CS recurred. Six cases died, two of them died of hepatoencephalopathy 2 and 3 years after operation respectively, two of upper digestive tract rebleeding, and 2 of hepatocellularcarcinoma. Conclusions：Splenopneumopexy can decrease portal vein pressure, relieve hypersplenism and ascites, and control(or prevent) upper digestive tract bleeding. Splenopneumopexy is a valuable and worthy operation for B-CS, and can be widespread application.

Abstract:Abstract:Objective：To explore the diagnosis and treatment of regional pancreatic portal hypertension.
Methods：The clinical data of 11 cases of regional pancreatic portal hypertension were analysed retrospectively.
Results：The 11 cases presented with gastric varices, splenomegaly, and pancreatic disease, but liver was normal. All cases underwent surgery ,including splenectomy in 9 cases, splenectomy and distal pancreatectomy in 1 case, and other operation in 1 case. No serious complication was found postoperatively. Ten cases were followed up, no re-bleeding occurred postoperatively. Conclusions：Regional pancreatic portal hypertension can be diagnosed correctly preoperatively and treated effectively.

Abstract:Abstract:Objective：To study the extrahepatic hemodynamic changes in portal system after DSRS+SPD and after DSRS+SPD+Disconnection in dogs. Methods：The FPP, POPP and MAP levels before operation, after DSRS+SPD and DSRS+SPD disconnection operation were measured; and the portal-system shunt(PSS) was calculated postoperatively. Results：After DSRS+SPD, FPP decreased（0.07±2.41）mmHg(P>0.05),POPP decreased(19.10±10.45)mmHg(P<0.01), MAP decreased (31.35±22.18)mmHg (P<0.01),PSS increased (4.53±4.09)% (P<0.01). After DSRS+SPD+Disconnection,FPP decreased (1.82±1.38)mmHg (P>0.05),POPP increased (11.14±8.85)mmHg (P<0.01), MAP decreased(9.83±7.59)mmHg (P>0.05),PSS decreased (6.72±4.55)% (P<0.01). Conclusions：There are two systems in the portal system, namely, gastrosplenic (GS) system and portomesenteric (PM) system, and between the two systems there is a functional barrier. DSRS+SPD+Disconnection operation can strengthen this barrier.

Abstract:Abstract:Objective：To study the application effect of fibrin sealant(FS) during operation for late-stage portal hypertension caused by schistosomiasis. Methods：From Jun,2003 to Jun,2005, 92 cases of late-stage portal hypertension caused by schistosomiasis treated by portal-systemic disconn-ection(PSD) operation were divided into two groups, namely PSD group and PSD+FS group. The early complications such as fever and exudate in splenic fossa, as well as long term complications such as recurrent bleeding, hypertensive gastropathy were compared in the 2 groups, and encephalopathy were compared between 64 cases of patients with FS and 28 cases of patients without FS. Results：The patients undergoing PSD+FS showed decreased the exudate in splenic fossa and fever(P<0.05, respectively). Recurrent bleeding rate was 1.6% in PSD+FS group and 14.3% in PSD group(P<0.05), and portal hypertensive gastropathy was 29.7% in PSD+FS group and 64.3% in PSD group(P<0.01), but the occurrence rate of hepatic encephalopathy was no different in the 2 groups(P>0 05). Conclusions：FS application during operation is effective in attenuating early and long term operative complications of portal hypertension caused by schistosomiasis, and improving outcome of surgical treatment.

Abstract:Abstract:Objective：To explore the method of endovascular therapy for complicated aortic dissections. Methods： The clinical data of 25 patients with complicated aortic dissections were analysed retrospectively. Results： The patients′ ages ranged from 31-72 years with a mean of 50.2 years. Among the 25 cases, 6 cases had severe ischemia of mesenteric artery, 5 cases had renal artery ischemia, 4 cases had severe ischemia of both legs, 3 cases had renal arteries ischemia combined with superior mesenteric artery ischemia, 2 had complicated aortic dissection combined with AAA, and in 5 cases the true aortic lumen was totally compressed by the false aneurysmal lumen. All patients underwent endovascular therapy, and the instant technique was successfully performed in all patients. Endoleak occurred in 3 cases after the stent-graft deployment, it stopped spontaneously in 2 of them 7 days later, and 1 case with endoleak waiting for treatment. In the other 22 patients, angiography after the operation showed that all the diseased area were sealed completely, and the viscera arterial blood supply was restored mainly via the true lumen. All the patients were cured and discharged. Conclusions：In the management of complicated aortic dissections, endoluminal technique is simple, less traumatic, safe and has less complications as compared to the traditional operation. Improvement of the endoluminal technique is essential for successful treatment of these complicated cases.

Abstract:Abstract:Objective：To summarize our experience in treating abdominal aorta saddle embolism (ASE). Methods：The clinical data of 21 cases of abdominal ASE were treated with Fogarty catheter and other methods during January 2000 to July 2006 were retrospectively assessed. Results：After the blood flow was restored by operation, 4 died in the postoperative early stage because of sudden cardiac asystole due to hyperkalemia; in the late stage, 6 died of multiple organ dysfunction syndrome socondary from acute renal failure(ARF). Eleven patients were cured. Of them, bilateral lower extremites were salvaged in 5 patients; and 6 patients received amputation. Ten patients were followed up, and the blood supply of the salvaged legs was good. Conclusions：Early diagnosis and embotism removal are the key points to decrease the mortality and amputation rate of ASE. The intra-operative and post-operative prevention and management of hyperkalemia and ARF are important for reduction of mortality.

Abstract:Abstract:Objective：To summarize our experience in the treatment of 26 cases of infra-renal abdominal aortic aneurysm(AAA). Methods：Clinical data of 26 patients with infra-renal AAA treated with open surgical repair in recent 5 years were retrospectively reviewed. The diagnosis of AAA in all the patients was confirmed by imaging examination.21 patients were operated electively.Of them 5 patients whose aneurysms ruptured before operation underwent emergency surgery.All of the 26 cases were treated by aneurysmectomy and prosthetic grafting. Results：Among the five patients whose aneurysms ruptured before operation,two died in perioperative period.There was no operative mortality in the other cases. The overall mortality rate was 7.7%, and the mortality rate of emergency operation was 40.0%.Tweenty-four patients were followed-up for 1 year to 5 years.The 1,3,and 5-year survival rates were 96%,88%and75% respectively.No death was caused by aneurysm or the operation during follow-up. Conclusions：CT angiography is a credible method in the diagnosis of AAA.The aneurysm diameter is not an absolute operative indication.Risk factors of open operation of AAA are old age,severe cardiopulmonary diseases, and renal dysfunction.Open surgery is still the primary treatment of AAA.

Abstract:Abstract:Objective： To investigate the method of diagnosis and treatment of patients with intestinal bleeding after aortic reconstruction. Methods：The clinical data of 6 patients who had intestinal bleeding after aortic reconstruction from 1995 to 2006, including the etiology, clinical manifestations, imaging data, diagnosis and operative findings, were analysed retrospectively. Results：All cases underwent repair of aortoenteric fistulas and partial enterectomy after aortic occlusion under general anesthesia. The cause of intestiral bleeding in all cases was abdominal aorto-enteric fistula. One case died from multiple organ system failure on the 11th day after operation. Five cured cases were followed-up for 1~10 years. The results showed that 3 cases were alive longer than 5 years and 2 cases died from acute myocardiac infaction and intracerebral hemorrhage more than 1 year after operation respectively. Conclusions：The correct diagnosis of aortoenteric bleeding may be confirmed by combining clinical manifestation with imaging data. Repair of the aortoenteric fistula is a rational and reliable method in treating this complicated illness.

Abstract:Abstract:Objective：To study the effect of antisense RNA retroviral vector of mTOR on the proliferation of vascular smooth muscle cells (VSMC). Methods：The conservative region of mTOR gene was inserted into pLXIN reversedly, then the vector was packaged in PT67 cells by transfection with lipofectamine and transfected to VSMC. The efficiency of antisense inhibition was verified，and the changes of p70S6k and 4E-BP1 were also determined at the same time. The proliferation activity was determined by flowcytometry and MTT. Results：After the vector was successfully transfected to the cells. pLXIN-A-mTOR vector could efficiently decrease mRNA and protein expression of mTOR and p70S6k of the cell, while the expression of 4E-BP1 increased significantly. The cell cycle and proliferation activity of VSMC was also stunned in phase G1. Conclusions：The mTOR antisense retroviral vector, pLXIN-A-mTOR, has been constructed successfully, which can significantly inhibit the proliferation of VSMC.

Abstract:Abstract:Objective：To identify the anticoagulation effect of pcDNA3.1 transfected exogenous human throbomodulin molecule (hTM) on umbilical vein endothelial cells (HUVECs). Methods：The pcDNA3.1/hTM plasmid was transduced into HUVECs by cationic liposome. Expression of hTMmRNA and hTM protein was detected by RT-PCR and immunohistochemistry,respectively. Results：The expression of hTMmRNA in HUVECs transduced with pcDNA3.1/hTM was 1.7 times higher than cells without transfected PcDNA3.1/hTM. Immunogistochemical examination showed about 10% cell tranfected with PcDNA3.1/hTM and high-level hTM protein was detected on positive cells. Conclusions：The pcDNA3.1/hTM plasmid could be transfected into endothelial cells by cationic liposome and the exogenous hTM protein had complete anticoagulation biological activity.

Abstract:Abstract:Objective：To explore the mechanism of the activation of Toll-like receptor 2 in alveolar macrophage and its significances in hepatic ischemia/reperfusion(HIR) associated lung injury in mice. Methods：Wild type mice（C3h/Heouj）and TLR4-deficient mice(C3h/HeJ) were used in a model of hepatic ischemia/reperfusion. Alveolar macrophages were collected at the time point of 1h, 6h and 12h after HIR by means of bronchoalveolar lavage (BAL),and the expression of TLR2/4 mRNA was detected with Real-Time PCR. The level of endotoxin and TNF-α in BAL fluid were measured. The concentration of MPO, the ratio of wet/dry weight of lung tissue, and lung histological scores were used to assess the degrees of lung injuries. Results：The expressions of TLR2/4 mRNA in HIR group of C3h/Heouj mice were up-regulated at the all three time points after HIR. The level of TLR2mRNA was increased sustainedly and TLR4 markedly increased at 6h(P<0.01). At the same time TNF-α concentrations in BALF were increased(P<0.01) and lung injuries were aggravated which was indicated by the level of MPO, the ratio of wet/dry weight of lung and lung histological scores. But in TLR4-deficient(C3h/Hej) animals, the activations of TLR2 after HIR were only slight increased. TNF-α levels were significantly decreased compared to wild type mice at three time points after reperfusion(P<0.01), and lung injuries were milder than that in wild typy mice(P<0.05). Conclusions：Toll-like receptor 2 on alveolar macrophage can up-regulate TLR4 expression after HIR, which can aggravated the injury of the lung.

Abstract:Abstract:Objective：To explore the effect of HBV X gene in the expression of RhoC gene in HEPG2 cell line. Methods：The whole-length X gene was directly cloned to pcDNA3.1 vector.The recombinant vector(pcDNA3.1-X) was transfected into HEPG2 cells after selection with hygromycin,steady clones(HEPG2-X cells) were obtained.The expression of RhoC protein was analysed with immunohistochemical stain. Results：The recombinant plasmid could steadily express X protein efficiently, and the expression of RhoC protein in HEPG2-X cell was enhanced. Conclusions：HBV X gene can enhance the expression of RhoC protein in vitro. It may be related to invasiveness and metastasis of hepatocellular carcinoma.

Abstract:Abstract:Objective：To study the inhibit effect of survivin short hairpin RNA on the survivin mRNA and protein expression of gallbladder carcinoma cells. Methods：Human gallbladder carcinoma cells(GBC-SD) were transfected with recombinant plasmid. RT-PCR and Western blot were used to analyze the changes in expression levels of survivin mRNA and protein. Results：The size of the PCR product was 350bp. DNA sequencing showed that the sequence of recombinant vector pshRNA-survivin was successfully constructed and suppressed the expression of (GBC-SD) survivin mRNA. Conclusions：The recombinant plasmid constructed can inhibit the expression of survivin mRNA in transfected cells. This provides a new method and material for the biological therapy of cancer.

Abstract:Abstract:Objective：To explore the methods and the effect of the surgical treatment of patients with chronic ischemia of extremities. Methods：In recent 6 years, the clinical data of 75 patients, including 7 upper extremities and 71 lower extremities with chronic ischemia, treated surgically were reviewed retrospectively. The surgical treatment included: traditional operation in 65 cases, interventional surgery in 4 cases and stem cell transplantation in 6 cases. Results：Sixty-three patients(66 extremities) were followed up from 2 to 56 months after the surgical treatment, and the result showed that 9 extremities of 8 patients were amputated within 1 year（13.6%）. In the other cases（83.3%）, the ischemic symptoms were relieved or disappeared, the ulcer healed or the amputating level had lowered（3.0％）．The effective rate of the surgical treatment was 86.3％.Conclusions：The appropriate surgical treatment of chronic ischemia limbs should be choiced based on the ischemic state of the limb，and a satisfactory result can be obtained in most patients．

Abstract:Abstract:Objective：To explore the causes of complications of varicose venous diseases of lower limbs treated by endovenous laser and methods of prevention and treatment.
Methods：Clinical materials of laser treatment of 420 patients (525 limbs) with greater saphenous vein(GSV) varices were studied retrospectively. Of them, 324 cases(422limbs) were simple GSV varicosis, and 96 cases(103 limbs) coexistented primary deep venous insufficiency(PDVI) of lower limbs. There were 263 limbs treated with laser therapy only, 159 limbs treated with laser combined with stab-avulsion of venectasias in the calf , 25 limbs treated with laser and insertion of superficial femoral vein ring and 78 limbs treated with laser and stab-avulsion of venectasias combined with insertion of superficial femoral vein ring.
Results：Complications related to laser therapy occurred in 331 limbs（63.1%）, which consisted of skin petechiae in 268 limbs（51.1%）, saphenous nerve injury in 198 （37.7%）, superficial thrombophlebitis in 33（6.3%）and mild skin burn in 26（5.0%）. There were no patients with infected incisions or deep venous thrombosis of the lower limbs. In this group, 380 patients(90.5%) were followed-up from 3 to 40 months postoperatively. Postoperative recurrence were diagnosed in 27 limbs（6.4%）with simple GSV varicosis and in 8 limbs(7.8%) with PDVI.
Conclusions：The prevention and treatment of the complications caused by laser therapy should be highly kept in mind,so as to express the safe and micro-traumatic features of the endovenous laser for treatment of varicose venous diseases of lower limb.

Abstract:Abstract:Objective：To compare the clinical curative effect and the pros and cons of microwave intracavitary minimally invasive treatment and traditional operation for varicose veins in lower extremities. Methods：Treatment group:The varicosities of greater saphenous vein were treated by microwave coagulation intracavitary treatment together with injection coagulation treatment of its tributaries. Control group:The varicosities of greater saphenous vein were treated by traditional operation. Results：Treatment group was better than control group in improvement of symptoms, cosmetic effect of diseased limb, operation time, amount of blood loss, length of hospital stay, and complications of operation. Conclusions：Microwave coagulation intracavitary treatment of varicose veins in lower extremities has more advantages, such as minimally invasive, little pain, quick recovery, good cosmetic effect, better result, fewer complications, and simplicity of operation.

Abstract:Abstract:Objective：To study the clinical prognosis and opportune time for surgical treatment of patients with asymptomatic cholecystolithiasis. Methods：The 10-year B-ultrasound followup observations and the method of treatment of 200 cases of asymptomatic cholecystolithiasis patients were summarized and evaluated. Results：Two cases (1.0%)died of other causes in the 10-year followup period. In 134 patients(67.0%), who did not develop symptoms, 4 patients had prophylactic cholecystectomy, and 130 cases were treated non-operatively. Among them, 64(32.0%) cases who suffered biliary cholic or other biliary complications,49(76.6% of patients with symptoms ) cases underwent cholecystectomy, and 15 cases were treated non-operatively. Conclusions：Some patients with asymptomatic cholecystolithiasis may selectively undergo preventive cholecystectomy to reduce complications.

Abstract:Abstract:Objective：To compare the effect, advantages and disadvantages of single-layer eversion choledochojejunostomy and posterior wall single-layer inversion and anterior wall single-layer eversion choledochojejunostomy. Methods：Patients who undergoing choledochojejunostomy were randomly divided into 2 groups:observation group, 95 cases, had single-layer eversion choledochojejunostomy; Control group, 92 cases, had posterior wall single-layer inversion and anterior wall single-layer eversion choledochojejunotomy. The anastomotic stoma size, time to perform the anastomosis, post-operative complications and outcome of the 2 types of operation were compared and analyzed. Results：The time to perform the anastomosis and the post-operative outcome of the observation group were better than those of the control group(P<0.05), but post-operative complications between the 2 groups were not statistically different. Conclusions：Single-layer eversion choledochojejunostomy is easy to perform, the operative time is short, and is a safe, reliable and rational anastomotic procedure.

Abstract:Abstract:Objective：To evaluate the effect of pull-through and double stapling technique for sphincter preservation operation in super-low rectal carcinoma. Methods：The resection through pull-through and double stapling technique for sphincter preservation approach was performed on 46 patients with super-low rectal carcinoma from December 1997 to December 2005. The distance between the anal verge and the lower margin of the tumor was 4～ 7 cm（averaged 5.5 cm），including 26 patients in Dukes A stage，16 Dukes B and 4 Dukes C.Results：Fecal continences were preserved successfully in all patients．Only one got anastomosis leak（2.2％）after operation，and 4 cases had anastomotic narrowing（8.7％）within 1 year.At a median follow-up of 54 months，two patients had local recurrences（4.3％）. The 5 year survival rate was 81.3％. There was no urinary dysfunction in this series.The successful rates of sexual function after surgery were respectively as follows:man 82.4% and woman 83.3%. Conclusions：Pull-through and double stapling technique for sphinceter preservation operation was feasible and safe ，provide a original operative style for super-low rectal carcinoma.