BACKGROUND Hepatic portal blood flow occlusion is a common technique for reducing hepatic hemorrhage during hepatectomy.We designed a novel Y-Z magnetic hepatic portal blocking band(Y-Z MHPBB)based on the principle of...BACKGROUND Hepatic portal blood flow occlusion is a common technique for reducing hepatic hemorrhage during hepatectomy.We designed a novel Y-Z magnetic hepatic portal blocking band(Y-Z MHPBB)based on the principle of magnetic compression technique.AIM To introduce the Y-Z MHPBB device and verify the feasibility of this device for hepatic portal blood flow occlusion in dogs.METHODS Ten beagles were randomly divided into the experimental group and control group.The operation time,intraoperative blood loss,the number of portal blood flow occlusions,the total time spent on adjusting the blocking band,and the average time spent on adjusting the blocking band were recorded.The surgeons evaluated the feasibility and flexibility of the two portal occlusion devices.RESULTS Laparoscopic hepatectomy was successfully performed in both the experimental group and control group.There was no statistical difference between the two groups in the operation time,intraoperative blood loss,and the number of hepatic portal blood flow occlusions.With respect to the total time spent on adjusting the blocking band and the average time spent on adjusting the blocking band,the experimental group showed significantly better outcomes than the control group,with a statistical difference(P<0.05).The operators found that the Y-Z MHPBB was superior to the modified T-tube in terms of operational flexibility.CONCLUSION The Y-Z MHPBB seems to be an ingenious design,accurate blood flow occlusion effect,and good flexibility;and it can be used for hepatic portal blood flow occlusion during laparoscopic hepatectomy.展开更多
Portal hypertension and bleeding from gastroesophageal varices is the major cause of morbidity and mortality in patients with cirrhosis. Portal hypertension is initiated by increased intrahepatic vascular resistance a...Portal hypertension and bleeding from gastroesophageal varices is the major cause of morbidity and mortality in patients with cirrhosis. Portal hypertension is initiated by increased intrahepatic vascular resistance and a hyperdynamic circulatory state. The latter is characterized by a high cardiac output, increased total blood volume and splanchnic vasodilatation, resulting in increased mesenteric blood flow. Pharmacological manipulation of cirrhotic portal hypertension targets both the splanchnic and hepatic vascular beds. Drugs such as angiotensin converting enzyme inhibitors and angiotensin Ⅱ type receptor 1 blockers, which target the components of the classical renin angiotensin system(RAS), are expected to reduce intrahepatic vascular tone by reducing extracellular matrix deposition and vasoactivity of contractile cells and thereby improve portal hypertension. However, these drugs have been shown to produce significant offtarget effects such as systemic hypotension and renal failure. Therefore, the current pharmacological mainstay in clinical practice to prevent variceal bleeding and improving patient survival by reducing portal pressure is non-selective-blockers(NSBBs). These NSBBs work by reducing cardiac output and splanchnic vasodilatation but most patients do not achieve an optimal therapeutic response and a significant proportion of patients are unable to tolerate these drugs.Although statins, used alone or in combination with NSBBs, have been shown to improve portal pressure and overall mortality in cirrhotic patients, further randomized clinical trials are warranted involving larger patient populations with clear clinical end points. On the other hand, recent findings from studies that have investigated the potential use of the blockers of the components of the alternate RAS provided compelling evidence that could lead to the development of drugs targeting the splanchnic vascular bed to inhibit splanchnic vasodilatation in portal hypertension. This review outlines the mechanisms related to the pathogenesis of portal hypertension and attempts to provide an update on currently available therapeutic approaches in the management of portal hypertension with special emphasis on how the alternate RAS could be manipulated in our search for development of safe, specific and effective novel therapies to treat portal hypertension in cirrhosis.展开更多
AIM： To study the changes of portal blood flow in congestive heart failure. METHODS： We studied the congestion index （CI） and portal vein pulsatility index （PI） in patients with varied degrees of congestive hear...AIM： To study the changes of portal blood flow in congestive heart failure. METHODS： We studied the congestion index （CI） and portal vein pulsatility index （PI） in patients with varied degrees of congestive heart failure using ultrasonic Doppler. Ten patients with mean right atrial pressure （RA） 〈10 mmHg were classified as group 1 and the remaining 10 patients with RA〉 10 mmHg as group 2. RESULTS： There were no difference on cardiac index （HI, P= 0.28）, aortic pressure （AO, P= 0.78）, left ventricular end-diastolic pressure （LVED, P=0.06）, maximum portal blood velocity （Vmax, P= 0.17）, mean portal blood velocity （Vmean, P=0.15） and portal blood flow volume （PBF, P= 0.95） between the two groups. Group 2 patients had higher pulmonary wedge pressure （PW, 29.9 ± 9.3 mmHg vs 14.6±7.3 mmHg, P=0.002）, pulmonary arterial pressure （PA, 46.3± 13.2 mmHg vs 25.0±8.2 mmHg, P=0.004）, RA （17.5±5.7 mmHg vs 4.7±2.4 mmHg, P〈 0.001）, right ventricular end-diastolic pressure （RVED, 18.3±5.6 mmHg vs 6.4±2.7 mmHg, P〈0.001）, CI （8.7±2.4 vs 5.8± 1.2, P=0.03）, and PI （87.8±32.3% vs 27.0±7.4%, P〈0.001） than Group 1. CI was correlated with PI （P〈0.001）, PW （P〈0.001）, PA （P〈0.001）, RA （P=0.043）, RVED （P=0.005）, HI （P〈0.001）, AO （P〈0.001）, CO （P〈0.001）, LVED （P〈0.001）, Vmax （P〈0.001）, Vmax （P〈0.001）, cross-sectional area of the main portal vein （P〈0.001） and PBF （P〈0.001）. CI could be as high as 8.3 in patients with RA〈 10 mmHg and as low as 5.9 in those with RA≥10 mmHg.CONCLUSION： Our data show that RI is a more significant indicator than CI in the clinical evaluation of high RA≥ 10 mmHg, whereas CI is better than PI in the assessment of left heart function.展开更多
通过彩色多普勒超声显像仪观测普萘洛尔与5-单硝酸异山梨醇酯(ISMN)联用对肝硬化门静脉血流动力学的影响。19例乙型肝炎后肝硬化患者并有内镜证实的食管静脉曲张。治疗组ISMN 20mg,每日2次,普萘洛尔10mg～20mg,每日3次;对照组为健康受...通过彩色多普勒超声显像仪观测普萘洛尔与5-单硝酸异山梨醇酯(ISMN)联用对肝硬化门静脉血流动力学的影响。19例乙型肝炎后肝硬化患者并有内镜证实的食管静脉曲张。治疗组ISMN 20mg,每日2次,普萘洛尔10mg～20mg,每日3次;对照组为健康受试者。采用同个体自身治疗前后对照研究。结果表明应用普萘洛尔与ISMN治疗1周后,Dpv、Vpv均显著性下降(P<0.01),Opv也显著性降低(711.76±515.52 vs 484.02±222.93)mL/min,P<0.01;Qsv显著性降低(558.07±354.62 vs 394.02±267.57)ml/min,P<0.01;但Qsmv的变化不明显(P>0.05)。治疗4周后也获得了同样的效果。普萘洛尔与ISMN联用可以降低Qpv和Qsv,具有预防上消化道出血的作用。展开更多
目的探讨MRI电影法相位对比(Cine PC)与屏气二维相位对比(2D PC)在肝硬化患者和正常志愿者门静脉血流测量中的诊断价值。资料与方法对照组为82名志愿者,男45名,女37名,平均年龄26.65岁;肝硬化组24例,男14例,女10例,平均年龄42.00岁。空...目的探讨MRI电影法相位对比(Cine PC)与屏气二维相位对比(2D PC)在肝硬化患者和正常志愿者门静脉血流测量中的诊断价值。资料与方法对照组为82名志愿者,男45名,女37名,平均年龄26.65岁;肝硬化组24例,男14例,女10例,平均年龄42.00岁。空腹状态下采用CinePC技术对门静脉血流定量测量,同期采用2DPC技术3种不同屏气状态(正常吸气屏气,呼气屏气,平静呼吸屏气)与其进行比较。结果肝硬化患者门静脉血流速度较对照组略减低,除2D PC平静呼吸法,余方法两组差异均无统计学意义,肝硬化组门静脉血流量与对照组比较明显增大(P<0.01),但2DPC吸气屏气技术两者差异无统计学意义。采用相关性分析对屏气2DPC(不同呼吸状态)与Cine PC MRI方法定量门静脉血流速度、血流量,显示两种技术相关性很好(r>0.8;P<0.01),但在对照组行相关性分析,仅呼气后屏气2D PC与Cine PC显示中度相关(r>0.5;P<0.01),吸气后屏气与CinePC相关性较差(r<0.4)。结论MRI Cine PC在正常呼吸情况下对门静脉血流行定量测量,接近人体生理状态,适合门静脉血流测量;正常呼吸状态屏气对肝硬化患者门静脉血流影响较正常人小,在肝硬化血流测量中,MRI Cine PC与屏气2DPCMRI法显示很好相关性。屏气2DPCMRI技术提供了一种简便、实用、相对准确的肝硬化门静脉血流测量方法。展开更多
基金Institutional Foundation of The First Affiliated Hospital of Xi’an Jiaotong University(to Yan XP),No.2022MS-07。
文摘BACKGROUND Hepatic portal blood flow occlusion is a common technique for reducing hepatic hemorrhage during hepatectomy.We designed a novel Y-Z magnetic hepatic portal blocking band(Y-Z MHPBB)based on the principle of magnetic compression technique.AIM To introduce the Y-Z MHPBB device and verify the feasibility of this device for hepatic portal blood flow occlusion in dogs.METHODS Ten beagles were randomly divided into the experimental group and control group.The operation time,intraoperative blood loss,the number of portal blood flow occlusions,the total time spent on adjusting the blocking band,and the average time spent on adjusting the blocking band were recorded.The surgeons evaluated the feasibility and flexibility of the two portal occlusion devices.RESULTS Laparoscopic hepatectomy was successfully performed in both the experimental group and control group.There was no statistical difference between the two groups in the operation time,intraoperative blood loss,and the number of hepatic portal blood flow occlusions.With respect to the total time spent on adjusting the blocking band and the average time spent on adjusting the blocking band,the experimental group showed significantly better outcomes than the control group,with a statistical difference(P<0.05).The operators found that the Y-Z MHPBB was superior to the modified T-tube in terms of operational flexibility.CONCLUSION The Y-Z MHPBB seems to be an ingenious design,accurate blood flow occlusion effect,and good flexibility;and it can be used for hepatic portal blood flow occlusion during laparoscopic hepatectomy.
基金Supported by National Health and Medical Research Council (NHMRC) of Australia Project Grants,No. APP1124125。
文摘Portal hypertension and bleeding from gastroesophageal varices is the major cause of morbidity and mortality in patients with cirrhosis. Portal hypertension is initiated by increased intrahepatic vascular resistance and a hyperdynamic circulatory state. The latter is characterized by a high cardiac output, increased total blood volume and splanchnic vasodilatation, resulting in increased mesenteric blood flow. Pharmacological manipulation of cirrhotic portal hypertension targets both the splanchnic and hepatic vascular beds. Drugs such as angiotensin converting enzyme inhibitors and angiotensin Ⅱ type receptor 1 blockers, which target the components of the classical renin angiotensin system(RAS), are expected to reduce intrahepatic vascular tone by reducing extracellular matrix deposition and vasoactivity of contractile cells and thereby improve portal hypertension. However, these drugs have been shown to produce significant offtarget effects such as systemic hypotension and renal failure. Therefore, the current pharmacological mainstay in clinical practice to prevent variceal bleeding and improving patient survival by reducing portal pressure is non-selective-blockers(NSBBs). These NSBBs work by reducing cardiac output and splanchnic vasodilatation but most patients do not achieve an optimal therapeutic response and a significant proportion of patients are unable to tolerate these drugs.Although statins, used alone or in combination with NSBBs, have been shown to improve portal pressure and overall mortality in cirrhotic patients, further randomized clinical trials are warranted involving larger patient populations with clear clinical end points. On the other hand, recent findings from studies that have investigated the potential use of the blockers of the components of the alternate RAS provided compelling evidence that could lead to the development of drugs targeting the splanchnic vascular bed to inhibit splanchnic vasodilatation in portal hypertension. This review outlines the mechanisms related to the pathogenesis of portal hypertension and attempts to provide an update on currently available therapeutic approaches in the management of portal hypertension with special emphasis on how the alternate RAS could be manipulated in our search for development of safe, specific and effective novel therapies to treat portal hypertension in cirrhosis.
基金Supported by the grant from the Cathay Groups,Taipei,Taiwan,China
文摘AIM： To study the changes of portal blood flow in congestive heart failure. METHODS： We studied the congestion index （CI） and portal vein pulsatility index （PI） in patients with varied degrees of congestive heart failure using ultrasonic Doppler. Ten patients with mean right atrial pressure （RA） 〈10 mmHg were classified as group 1 and the remaining 10 patients with RA〉 10 mmHg as group 2. RESULTS： There were no difference on cardiac index （HI, P= 0.28）, aortic pressure （AO, P= 0.78）, left ventricular end-diastolic pressure （LVED, P=0.06）, maximum portal blood velocity （Vmax, P= 0.17）, mean portal blood velocity （Vmean, P=0.15） and portal blood flow volume （PBF, P= 0.95） between the two groups. Group 2 patients had higher pulmonary wedge pressure （PW, 29.9 ± 9.3 mmHg vs 14.6±7.3 mmHg, P=0.002）, pulmonary arterial pressure （PA, 46.3± 13.2 mmHg vs 25.0±8.2 mmHg, P=0.004）, RA （17.5±5.7 mmHg vs 4.7±2.4 mmHg, P〈 0.001）, right ventricular end-diastolic pressure （RVED, 18.3±5.6 mmHg vs 6.4±2.7 mmHg, P〈0.001）, CI （8.7±2.4 vs 5.8± 1.2, P=0.03）, and PI （87.8±32.3% vs 27.0±7.4%, P〈0.001） than Group 1. CI was correlated with PI （P〈0.001）, PW （P〈0.001）, PA （P〈0.001）, RA （P=0.043）, RVED （P=0.005）, HI （P〈0.001）, AO （P〈0.001）, CO （P〈0.001）, LVED （P〈0.001）, Vmax （P〈0.001）, Vmax （P〈0.001）, cross-sectional area of the main portal vein （P〈0.001） and PBF （P〈0.001）. CI could be as high as 8.3 in patients with RA〈 10 mmHg and as low as 5.9 in those with RA≥10 mmHg.CONCLUSION： Our data show that RI is a more significant indicator than CI in the clinical evaluation of high RA≥ 10 mmHg, whereas CI is better than PI in the assessment of left heart function.
文摘通过彩色多普勒超声显像仪观测普萘洛尔与5-单硝酸异山梨醇酯(ISMN)联用对肝硬化门静脉血流动力学的影响。19例乙型肝炎后肝硬化患者并有内镜证实的食管静脉曲张。治疗组ISMN 20mg,每日2次,普萘洛尔10mg～20mg,每日3次;对照组为健康受试者。采用同个体自身治疗前后对照研究。结果表明应用普萘洛尔与ISMN治疗1周后,Dpv、Vpv均显著性下降(P<0.01),Opv也显著性降低(711.76±515.52 vs 484.02±222.93)mL/min,P<0.01;Qsv显著性降低(558.07±354.62 vs 394.02±267.57)ml/min,P<0.01;但Qsmv的变化不明显(P>0.05)。治疗4周后也获得了同样的效果。普萘洛尔与ISMN联用可以降低Qpv和Qsv,具有预防上消化道出血的作用。
文摘目的探讨MRI电影法相位对比(Cine PC)与屏气二维相位对比(2D PC)在肝硬化患者和正常志愿者门静脉血流测量中的诊断价值。资料与方法对照组为82名志愿者,男45名,女37名,平均年龄26.65岁;肝硬化组24例,男14例,女10例,平均年龄42.00岁。空腹状态下采用CinePC技术对门静脉血流定量测量,同期采用2DPC技术3种不同屏气状态(正常吸气屏气,呼气屏气,平静呼吸屏气)与其进行比较。结果肝硬化患者门静脉血流速度较对照组略减低,除2D PC平静呼吸法,余方法两组差异均无统计学意义,肝硬化组门静脉血流量与对照组比较明显增大(P<0.01),但2DPC吸气屏气技术两者差异无统计学意义。采用相关性分析对屏气2DPC(不同呼吸状态)与Cine PC MRI方法定量门静脉血流速度、血流量,显示两种技术相关性很好(r>0.8;P<0.01),但在对照组行相关性分析,仅呼气后屏气2D PC与Cine PC显示中度相关(r>0.5;P<0.01),吸气后屏气与CinePC相关性较差(r<0.4)。结论MRI Cine PC在正常呼吸情况下对门静脉血流行定量测量,接近人体生理状态,适合门静脉血流测量;正常呼吸状态屏气对肝硬化患者门静脉血流影响较正常人小,在肝硬化血流测量中,MRI Cine PC与屏气2DPCMRI法显示很好相关性。屏气2DPCMRI技术提供了一种简便、实用、相对准确的肝硬化门静脉血流测量方法。
