肝硬化螺旋CT门脉系血管成像的临床意义

SCTA是一种新的微创血管成像术,近年逐渐应用于临床,笔者对正常对照组和肝硬化患者门脉系进行SCTA检查,旨在探讨SCT对门脉系血管成像的可行性,评价肝硬化及门静脉高压时该系统血管成像的临床诊断价值和意义。 1

胰源性门静脉系节段性阻塞的螺旋CT表现

目的 探讨胰源性门静脉系节段性阻塞 (PSOPS)的CT征象。材料与方法 回顾性分析 3 3例PSOPS患者的螺旋CT表现 ,同时以 2 0例无门静脉系阻塞的病例作对照。 3 3例PSOPS中 ,包括脾静脉阻塞 (SVO) 2 7例和肠系膜上静脉阻塞 (SMVO) 6例。结果 在SVO中 ,胃左静脉、胃短静脉、胃网膜静脉、胃结肠干曲张或扩张的比例分别为 70 %、78%、83 %、5 6%。在SMVO中 ,胃结肠干、结肠右上静脉扩张比例均为 67%。结论 PSOPS有较特征性的侧支循环静脉开放 ,这些侧支静脉对PSOPS的CT诊断和临床治疗有重要意义。

Improved Method for Pancreaticoduodenal Transplantation in Rat Model

Objective: To improve the method of pancreaticoduodenal transplantation and to establish a more physiological rat model. Methods: SD rats served as donors and recipients. The vein was reconstructed by end-to-side anastomosis between the donor portal vein and the recipient superior mesenteric vein, and arterial reconstruction was carried out by end-to-side anastomosis of the donor to the recipient abdominal aorta. Enteric drainage was performed by side-to-side anastomosis between the duodenum of donors and that of recipients. Results: Fifty experiments were performed. The successful rate of transplantation which restored the recipients euglycemia were 78%. Conclusion: This model of pancreaticoduodenal transplantation in rats was stable and reliable, which was in accordance with the trend of clinical pancreas transplantation and could be applied for further scientific research.

Wall shear stress in portal vein of cirrhotic patients with portal hypertension

AIM To investigate wall shear stress(WSS) magnitude and distribution in cirrhotic patients with portal hypertension using computational fluid dynamics. METHODS Idealized portal vein(PV) system models were reconstructed with different angles of the PV-splenic vein(SV) and superior mesenteric vein(SMV)-SV. Patient-specific models were created according to enhanced computed tomography images. WSS was simulated by using a finite-element analyzer, regarding the blood as a Newtonian fluid and the vessel as a rigid wall. Analysis was carried out to compare the WSSin the portal hypertension group with that in healthy controls.RESULTS For the idealized models, WSS in the portal hypertension group(0-10 dyn/cm2) was significantly lower than that in the healthy controls(10-20 dyn/cm2), and low WSS area(0-1 dyn/cm2) only occurred in the left wall of the PV in the portal hypertension group. Different angles of PV-SV and SMV-SV had different effects on the magnitude and distribution of WSS, and low WSS area often occurred in smaller PV-SV angle and larger SMV-SV angle. In the patient-specific models, WSS in the cirrhotic patients with portal hypertension(10.13 ± 1.34 dyn/cm2) was also significantly lower than that in the healthy controls(P < 0.05). Low WSS area often occurred in the junction area of SV and SMV into the PV, in the area of the division of PV into left and right PV, and in the outer wall of the curving SV in the control group. In the cirrhotic patients with portal hypertension, the low WSS area extended to wider levels and the magnitude of WSS reached lower levels, thereby being more prone to disturbed flow occurrence.CONCLUSION Cirrhotic patients with portal hypertension show dramatic hemodynamic changes with lower WSS and greater potential for disturbed flow, representing a possible causative factor of PV thrombosis.

Contrast-enhanced endoscopic ultrasonography

Contrast agents are increasingly being used to characterize the vasculature in an organ of interest,to better delineate benign from malignant pathology and to aid in staging and directing therapeutic procedures.We review the mechanisms of action of first,second and third generation contrast agents and their use in various endoscopic procedures in the gastrointestinal tract.Various applications of contrast-enhanced endoscopic ultrasonography include differentiating benign from malignant mediastinal lymphadenopathy,assessment of depth of invasion of esophageal,gastric and gall bladder cancers and visualization of the portal venous system and esophageal varices.In addition,contrast agents can be used to differentiate pancreatic lesions.The use of color Doppler further increases the ability to diagnose and differentiate various pancreatic malignancies.The sensitivity of power Doppler sonography to depict tumor neovascularization can be increased by contrast agents.Contrast-enhanced harmonic imaging is a useful aid in identifying the tumor vasculature and studying pancreatic microperfusion.In the future,these techniques could potentially be used to quantify tumor perfusion,to assess and monitor the efficacy of antiangiogenic agents,to assist targeted drug delivery and allow molecular imaging.

Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

AIM: To summarize our methods and experience with interventional treatment for symptomatic acute-sub-acute portal vein and superior mesenteric vein throm-bosis (PV-SMV) thrombosis. METHODS: Forty-six patients (30 males, 16 females, aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were ac-curately diagnosed with Doppler ultrasound scans, com-puted tomography and magnetic resonance imaging. They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutane-ous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization). RESULTS: The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased signif icantly. Symptoms in these 45 patients were improved dramatically without severe operationalcomplications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment. In 3 patients with interventional treatment, thrombi reformed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful. CONCLUSION: Interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acutesubacute PV-SMV thrombosis.

Acute extensive portal and mesenteric venous thrombosis after splenectomy:Treated by interventional thrombolysis with transjugular approach

AIM:To present a series of cases with symptomatic acute extensive portal vein(PV)and superior mesenteric vein(SMV)thrombosis after splenectomy treated by transjugular intrahepatic approach catheter-directed thrombolysis. METHODS:A total of 6 patients with acute extensive PV-SMV thrombosis after splenectomy were treated by transjugular approach catheter-directed thrombolysis. The mean age of the patients was 41.2 years.After access to the portal system via the transjugular approach,pigtail catheter fragmentation of clots, local urokinase injection,and manual aspiration thrombectomy were used for the initial treatment of PV-SMV thrombosis,followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV,which was performed for three to six days. Adequate anticoagulation was given during treatment, throughout hospitalization,and after discharge. RESULTS:Technical success was achieved in all 6 patients.Clinical improvement was seen in these patients within 12-24 h of the procedure.No complications were observed.The 6 patients were discharged 6-14 d(8±2.5 d)after admission.The mean duration of follow-up after hospital discharge was 40±16.5 mo.Ultrasound and contrast-enhanced computed tomography confirmed patency of the PV and SMV,and no recurrent episodes of PV-SMV thrombosis developed during the follow-up period. CONCLUSION:Catheter-directed thrombolysis via transjugular intrahepatic access is a safe and effective therapy for the management of patients with symptomatic acute extensive PV-SMV thrombosis.

Ischemic colitis secondary to inferior mesenteric arteriovenous fistula and portal vein stenosis in a liver transplant recipient

Arteriovenous fistula （AVF） involving the inferior mesenteric vessels is rare, and the affected patients usually present with abdominal pain, mass, or features of established portal hypertension. Colonic ischemia is a less common and more serious manifestation of AVE We report a case of ischemic colitis secondary to inferior mesentedc AVF in a patient who underwent a previous liver transplantation, subsequently developed portal vein stenosis, and then presented with acute lower gastrointestinal bleeding. He underwent percutaneous transhepatic placement of a portal vein stent and left colectomy.

Realization of Two-Qutrit Quantum Gates with Control Pulses

We investigate the realization of 2-qutrit logic gate in a bipartite 3-level system with qusi-Ising interaction. On the basis of Caftan decomposition of matrices, the unitary matrices of 2-qutrit are factorized into products of a series of realizable matrices. It is equivalent to exerting a certain control field on the system, and the control goal is usually gained by a sequence of control pulses. The general discussion on the realization of 2-qutrit logic gate is made first, and then the realization of the ternary SWAP gate and the ternary √SWAP gate are discussed specifically, and the sequences of control pulses and drift processes implementing these gates are given.

Extensive hepatic-portal and mesenteric venous gas due to sigmoid diverticulitis

Hepatic portal venous gas is most often associated with extensive bowel necrosis due to mesenteric infarction.Mortality exceeds 75% with this condition.The most common precipitating factors include ischemia,intra-abdominal abscesses and inflammatory bowel disease.In this report,we present a 75-year-old woman with extensive hepatic portal and mesenteric venous gas due to colonic diverticulitis.She had a 10-year history of type diabetes mellitus and hypertension.She was treated by sigmoid resection and Hartmann's procedure and discharged from the hospital without any complications.

Evolution of associating liver partition and portal vein ligation for staged hepatectomy: Simpler, safer and equally effective methods

Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) has been recently demonstrated as a method to induce rapid and extensive hypertrophy within a short time and has been employed for a variety of primary and metastatic liver tumors. However, controversies remain due to its high morbidity and mortality. To enable safer surgery, liver surgeons have searched for better technical modifications, such as partial ALPPS, mini-ALPPS, minimally invasive ALPPS, and Terminal branches portal vein Embolization Liver Partition for Planned hepatectomy(TELPP). It seems that TELPP is very promising, because it has the main advantage of ALPPS-the rapid increase of future liver remnant volume, but the morbidity and mortality are much lower because only one surgical operation is required.

Note on Implementation of Three-Qubit SWAP Gate

In this paper, the synthesis and implementation of three-qubit SWAP gate is discussed. The three-qubit SWAP gate can be decomposed into product of 2 two-qubit SWAP gates, and it can be realized by 6 CNOT gates. Research illustrated that although the result is very simple, the current methods of matrix decomposition for multi-qubit gate can not get that. Then the implementation of three-qubit SWAP gate in the three spin system with Ising interaction is investigated and the sequence of control pulse and drift process to implement the gate is given. It needs 23 control pulses and 12 drift processes. Since the interaction can not be switched on and off at will, the realization of three-qubit SWAP gate in specific quantum system also can not simply come down to 2 two-qubit SWAP gates.

慢性肝病肝组织病理学及门脉血流动力学变化

目的研究慢性乙型肝炎(CHB)、肝硬化门脉系血流动力学改变与肝组织病变的关系。方法82例CHB、肝硬化皆为住院患者,在实施彩色多普勒(CDFI)检测的同时进行肝组织活检观察。CDFI检测门静脉主干(MPV)、门静脉左支矢状部(LPV)、门静脉右支(RPV)、脾门处脾静脉(SPV)内径(D,cm)及流速(V,cm/s)。结果CDFI提示各组CHB患者上述静脉的V与对照组相比除CHB轻型外皆显著降低(P<0.01),D示扩大,但仅在门脉高压组差异有显著意义(P<0.01)。结论CDFI提供的数量化信息能较好地鉴别CHB、肝硬化不同的组织病理学表现,有着重要的实用价值。

A simple scoring system to predict early recurrence of Bismuth–Corlette type IV perihilar cholangiocarcinoma

Background:Early recurrence has been reported to be predictive of a poor prognosis for patients with perihilar cholangiocarcinoma(pCCA)after resection.The objective of our study was to construct a useful scoring system to predict early recurrence for Bismuth–Corlette type IV pCCA patients in clinic and to investigate the value of early recurrence in directing post-operative surveillance and adjuvant therapy.Methods:In total,244 patients who underwent radical resection for type IV pCCA were included.Data on clinicopathological characteristics,perioperative details and survival outcomes were analyzed.Survival curves were generated using the Kaplan–Meier method.Univariate and multivariate logistic-regression models were used to identify factors associated with early recurrence.Results:Twenty-one months was defined as the cutoff point to distinguish between early and late recurrence.Univariate and multivariate analysis revealed that CA19-9 level>200 U/mL,R1 resection margin,higher N category and positive lymphovascular invasion were independent predictors of early recurrence.The scoring system was constructed accordingly.The early-recurrence rates of patients with scores of 0,1,2,3,4,and 5 were 23.9%,38.7%,60.0%,78.6%,83.4%,and 100%,respectively.Adjuvant therapy was significantly associated with higher overall survival rate for patients with early recurrence,but not for those with late recurrence.Patients in the early-recurrence group with scores2 had better prognoses after adjuvant therapy.Conclusions:A simple scoring system using CA19-9 level,N category,resection margin and lymphovascular invasion status could predict early recurrence,and thus might direct post-operative surveillance and adjuvant therapy for patients with type IV pCCA.