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Effect of an Airbag-selective portal vein Blood Arrester on the Liver after Hepatectomy:A New Technique for Selective Clamping of the portal vein

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Current Medical Science 2024年第2期44卷 380-390页

作者： Ce-xiong FU Xiao-ri QIN Jin-song CHEN Jie ZHONG Yu-xu XIE Bi-dan LI Qing-qing FU Fang LI Jin-fang ZHENG Department of Hepatobiliary and Pancreatic Surgery Hainan General HospitalHainan Affiliated Hospital of Hainan Medical UniversityHaikou 570311China University of South China Hengyang 421001China Department of Gastroenterology Gastroenterology Endoscopy CenterHainan General HospitalHainan Affiliated Hospital of Hainan Medical UniversityHaikou 57031lChina Center of Clinical Laboratory Hainan General HospitalHainan Affiliated Hospital of Hainan Medical UniversityHaikou 570311China Department of Radiology Hainan General HospitalHainan Affiliated Hospital of Hainan Medical UniversityHaikou 570311China

Objective:A novel technique was explored using an airbag-selective portal vein blood arrester that circumvents the need for an intraoperative assessment of anatomical variations in patients with complex intrahepatic space-occupying ***:Rabbits undergoing hepatectomy were randomly assigned to 4 groups:intermittent portal triad clamping(PTC),intermittent portal vein clamping(PVC),intermittent portal vein blocker with an airbag-selective portal vein blood arrester(APC),and without portal blood occlusion(control).Hepatic ischemia and reperfusion injury were assessed by measuring the 7-day survival rate,blood loss,liver function,hepatic pathology,hepatic inflammatory cytokine infiltration,hepatic malondialdehyde levels,and proliferating cell nuclear antigen ***:Liver damage was substantially reduced in the APC and PVC *** APC animals exhibited transaminase levels similar to or less oxidative stress damage and inflammatory hepatocellular injury compared to those exhibited by the PVC *** was significantly higher in the control group than in the other *** APC group had less bleeding than the PVC group because of the avoidance of portal vein skeletonization during ***,more operative time was saved in the APC group than in the PVC ***,the total 7-day survival rate in the APC group was higher than that in the PTC ***:Airbag-selective portal vein blood arresters may help protect against hepatic ischemia and reperfusion injury in rabbits undergoing partial *** technique may also help prevent liver damage in patients requiring hepatectomy.

关键词： hepatectomy portal vein hepatic damage selective clamping

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Current concepts in the management of non-cirrhotic non-malignant portal vein thrombosis

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World Journal of Hepatology 2024年第5期16卷 751-765页

作者： Adam J Willington Dhiraj Tripathi Department of Hepatology University Hospitals Birmingham NHS Foundation TrustBirmingham B152GWUnited Kingdom Department of Hepatology University Hospitals BirminghamBirmingham B152THUnited Kingdom

Non-cirrhotic non-malignant portal vein thrombosis(NCPVT)is an uncommon condition characterised by thrombosis of the portal vein,with or without extension into other mesenteric veins,in the absence of cirrhosis or intra-abdominal *** can include intestinal infarction,variceal bleeding and portal *** this article,we address current concepts in the management of NCPVT including identification of risk factors,classification and treatment,and review the latest evidence on medical and interventional management options.

关键词： Non-cirrhotic portal vein thrombosis portal vein Mesenteric veins Venous thrombosis portal hypertension

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Recognition and management of stent malposition in the portal vein during endoscopic retrograde cholangiopancreatography:A case report

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World Journal of Gastrointestinal Endoscopy 2024年第7期16卷 432-438页

作者： Rui Wu Feng Zhang Hao Zhu Ming-Dong Liu Yu-Zheng Zhuge Lei Wang Bin Zhang Department of Gastroenterology Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjing 210008Jiangsu ProvinceChina

BACKGROUND portal vein injury is an uncommon complication of endoscopic retrograde cholangiopancreatography(ERCP),for which stent malpositioning in the portal vein is very rare and can lead to fatal *** report a case of biliary stent migration to the portal vein and a novel method for its safe removal under the guidance of portal ***,we reviewed the literature and summarized reports on the identification and management of this *** SUMMARY A 59-year-old woman with pancreatic cancer presented with abdominal pain and a high fever 20 days after the placement of two plastic biliary stents under the guidance of *** cultures and laboratory tests revealed sepsis,which was treated with antibiotics.A contrast-enhanced computed tomography scan revealed that one of the biliary stents in the main portal vein was *** safely remove the stent,portal angiography was performed to visualize the portal vein and to allow the management of any *** two stents were removed without obvious bleeding,and an uncovered self-expanding metal stent was placed in the common bile duct for *** patient had an uneventful 6-month follow-up period,except for self-resolving portal vein *** The combination of endoscopic and angiographic techniques allowed uneventful management of stent malposition in the portal vein.

关键词： Endoscopic retrograde cholangiopancreatography Stent malposition portal vein portal angiography Case report

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portal vein aneurysm-etiology,multimodal imaging and current management

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World Journal of Clinical Cases 2023年第4期11卷 725-737页

作者： Admir Kurtcehajic Enver Zerem Ervin Alibegovic Suad Kunosic Ahmed Hujdurovic Jasmin A Fejzic Department of Gastroenterology and Hepatology Plava Medical GroupTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Medical Sciences The Academy of Sciences and Arts of Bosnia and HerzegovinaSarajevo 71000Bosnia and Herzegovina Department of Gastroenterology and Hepatology University Clinical Center TuzlaTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Physics Faculty of Natural Sciences and MathematicsUniversity of TuzlaTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Internal Medicine Plava Medical GroupTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Internal Medicine General Hospital TesanjTesanj 74260Bosnia and Herzegovina

portal vein aneurysm(PVA)is a rare vascular abnormality,representing 3%of all venous aneurysms in the human body,and is not well *** can be congenital or acquired,located mainly at the level of confluence,main trunk,branches and bifurcation.A PVA as an abnormality of the portal venous system was first reported in 1956 by Barzilai and Kleckner.A review from 2015 entitled“portal vein aneurysm:What to know”considered fewer than 200 *** the last seven years,there has been an increase in the number of PVAs diagnosed thanks to routine abdominal *** aim of this review is to provide a comprehensive update of PVA,including aetiology,epidemiology,and clinical assessment,along with an evaluation of advanced multimodal imaging features of aneurysm and management approaches.

关键词： Aneurysm portal vein Abdominal imaging Treatment Follow-up

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Clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure

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World Journal of Cardiology 2023年第11期15卷 599-608页

作者： Naoya Kuwahara Tomoyuki Honjo Naohiko Sone Junichi Imanishi Kazuhiko Nakayama Kohei Kamemura Masanori Iwahashi Soichiro Ohta Kenji Kaihotsu Department of Cardiology Shinko HospitalKobe 651-0072Japan

BACKGROUND Heart failure(HF)causes extracardiac organ congestion,including in the hepatic portal *** venous congestion is essential for HF treatment,but evaluating venous congestion is sometimes difficult in patients with chronic *** portal vein(PV)flow pattern can be influenced by right atrial *** images of the PV are quite easy to obtain and are reproducible among ***,the association between PV pulsatility and the condition of HF remains *** hypothesize that PV pulsatility at discharge reflects the condition of *** To evaluate the usefulness of PV pulsatility as a prognostic marker for hospit-alized patients with acute *** This observational study was conducted from April 2016 to January 2017 and April 2018 to April 2019 at Shinko *** enrolled 56 patients with acute HF,and 17 patients without HF served as *** flow velocity was mea-sured by ultrasonography on admission and at *** calculated the PV pulsatility ratio(PVPR)as the ratio of the difference between the peak and minimum velocity to the peak *** primary endpoint was cardiac death and HF *** observation period was 1 year from the first *** Kaplan-Meier method was used to determine the stratified composite event-free rates,and the log-rank test was used for comparisons between *** On admission,the PVPR was significantly higher in patients with acute HF than controls(HF:0.29±0.20 vs controls:0.08±0.07,P0.21).The Kaplan-Meier analysis s

关键词： Heart failure Venous congestion Atrial pressure Ultrasonography portal vein Prognosis

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Experimental study on enhancement of the metastatic potential of portal vein tumor thrombus-originated hepatocellular carcinoma cells using portal vein serum

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Chinese Journal of Cancer Research 2014年第5期26卷 588-595页

作者： Yufu Tang Hongming Yu Long Zhang Kang Wang Weixing Guo Jie Shi Shupeng Liu Mengchao Wu Hongyang Wang Shuqun Cheng Eastern Hepatobiliary Surgery Hospital Second Military Medical University Department of Hepatobiliary Surgery General Hospital of Shenyang Military Area Command Changhai Hospital Second Military Medical University International Cooperation Laboratory on Signal Transduction of Eastern Hepatobiliary Surgery Institute Second Military Medical University

Objective： portal vein metastasis of hepatocellular carcinoma（HCC） results in a poor prognosis and seriously affects the survival rate of patients. The mechanism underlying the formation of portal vein tumor thrombus（PVTT） is complex and is not yet fully understood. This study was conducted to investigate the impact of portal vein blood on the proliferation, metastasis, invasion and apoptosis of PVTT cells and to explore its possible mechanisms, which was expected to lay a foundation for ascertaining the mechanism underlying the portal vein metastasis of HCC.Methods： Peripheral blood and portal vein blood were collected from patients with HCC, and the sera from these two sources were used to culture the PVTT-originated HCC cell line CSQT-2. The cells were collected after 24 h, and flow cytometry was performed to detect cell proliferation, cell cycle stages and apoptosis. Transwell migration and invasion assays were applied to detect the metastasis and invasion of the cells in each group. The changes in the expression of MMP-2 and MMP-9 in cells were detected via Western blotting. The contents of IL-12, IFN-γ, IL-1β, IL-2 and TNF-α in the two groups of sera were quantified using corresponding kits. Results： Compared with the group of cells cultured with peripheral serum, the cells cultured with portal vein serum showed significantly lower apoptosis（P〈0.01）, significantly enhanced cell metastasis and invasion（P〈0.01）, whereas cell proliferation and the stages of the cell cycle did not differ significantly（P〉0.05）. A significantly increased expression level of MMP-2 has been observed in tumor cells treated portal vein serum. In addition, compared with peripheral serum, the content of IL-12 was significantly decreased in portal vein serum（P〈0.05）, while the contents of IFN-γ, IL-1β, IL-2, and TNF-α did not differ significantly（P〈0.05）. Conclusions： portal vein serum from HCC patients could inhibit the apoptosis of PVTT-originated HCC cells and promote cell metasta

关键词： Hepatocellular carcinoma(HCC) portal vein portal vein tumor thrombus(PVTT) metastasis

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Transjugular intrahepatic portosystemic shunt for the prevention of recurrent esophageal variceal bleeding in patients with cavernous transformation of portal vein

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Hepatobiliary & Pancreatic Diseases International 2018年第6期17卷 517-523页

作者： Zhao-Peng Li Sui-Sui Wang Guang-Chuan Wang Guang-Jun Huang Jing-Qin Cao Chun-Qing Zhang Department of Gastroenterology Shandong Provincial Hospital Affiliated to Shandong UniversityJinan 250021China Department of Interventional Radiology Jining No.1 People’s HospitalJining 272011China Department of Pediatrics The Affiliated Hospital of Jining Medical CollegeJining 272000China

Background: Treatment options for patients with cavernous transformation of portal vein(CTPV) are limited. This study aimed to evaluate the feasibility, efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS) to prevent recurrent esophageal variceal bleeding in patients with CTPV. Methods: We retrospectively analyzed 67 consecutive patients undergone TIPS from January 2011 to December 2016. All patients were diagnosed with CTPV. The indication for TIPS was a previous episode of variceal bleeding. The data on recurrent bleeding, stent patency, hepatic encephalopathy and survival were retrieved and analyzed. Results: TIPS procedure was successfully performed in 56 out of 67(83.6%) patients with CTPV. TIPS was performed via a transjugular approach alone( n = 15), a combined transjugular/transhepatic approach( n = 33) and a combined transjugular/transsplenic approach( n = 8). Mean portosystemic pressure gradient(PSG) decreased from 28.09 ± 7.28 mmHg to 17.53 ± 6.12 mmHg after TIPS( P < 0.01). The probability of the remaining free recurrent variceal bleeding was 87.0%. The probability of TIPS patency reached 81.5%. Hepatic encephalopathy occurrence was 27.8%, and survival rate was 88.9% until the end of follow-up. Four out of 11 patients who failed TIPS died, and 4 had recurrent bleeding. Conclusions: TIPS should be considered a safe and feasible alternative therapy to prevent recurrent esophageal variceal bleeding in patients with CTPV, and to achieve clinical improvement.

关键词： Cavernous transformation portal vein Transjugular intrahepatic portosystemic shunt Variceal rebleeding portal hypertension

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Update on Management of portal vein Thrombosis and the Role of Novel Anticoagulants

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Journal of Clinical and Translational Hepatology 2019年第2期7卷 154-164页

作者： Matthew Wu Michael Schuster Micheal Tadros Albany Medical College AlbanyNYUSA Department of Radiology Albany Medical Center HospitalAlbanyNYUSA Department of Gastroenterology Albany Medical Center HospitalAlbanyNYUSA

The clinical management of portal vein thrombosis(PVT)remains ambiguous due to its heterogeneous presentations and its associations with liver disease,malignancy,and hypercoagulable *** natural history and clinical outcome of PVT are highly variable,dependent upon size,extent and degree of the thrombotic occlusion,as well as the physiological impact of patient *** existing clinical guidelines consistently recommend low molecular weight heparin or vitamin K antagonist anticoagulation in cirrhotic patients with symptomatic acute PVT,management of asymptomatic and chronic PVT may need to be determined on a case-by-case basis,factoring in the state of underlying liver *** general,patients with PVT and underlying malignancy should be anticoagulated to alleviate symptoms and prevent recurrences that could disrupt the cancer ***,existing clinical data does not support routine anticoagulation of cirrhotic patients with asymptomatic PVT in the absence of underlying *** low molecular weight heparin and vitamin K antagonist remain the most commonly used agents in PVT,an emerging body of clinical evidence now suggests that direct-acting oral anticoagulants may be used safely and effectively in *** such,direct-acting oral anticoagulants may offer a more convenient anticoagulation alternative for PVT management in future practice.

关键词： portal vein Thrombosis Liver cirrhosis Neoplasm Anticoagulant

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Mesenterico-portal vein invasion should be an important factor in TNM staging for pancreatic ductal adenocarcinoma: Proposed modification of the 8th edition of the American Joint Committee on Cancer staging system

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World Journal of Gastroenterology 2019年第46期25卷 6752-6766页

作者： Hong-Yu Chen Xing Wang Hao Zhang Xu-Bao Liu Chun-Lu Tan Department of Pancreatic Surgery West China HospitalSichuan University

BACKGROUND The 8^th edition of the American Joint Committee on Cancer(AJCC)staging system for pancreatic ductal adenocarcinoma(PDAC)excludes extrapancreatic extension from the assessment of T stage and restages tumors with mesenterico-portal vein(MPV)invasion into T1-3 diseases according to tumor ***,MPV invasion is believed to be correlated with a poor *** To analyze whether the inclusion of MPV invasion can further improve the 8th edition of the AJCC staging system for *** This study retrospectively included 8th edition AJCC T1-3N0-2M0 patients undergoing pancreaticoduodenectomy/total pancreatectomy from two cohorts and analyzed survival *** the first cohort,a total of 7539 patients in the surveillance,epidemiology,and end results database was included,and in the second cohort,689 patients from the West China Hospital database were *** Cox regression analysis showed that MPV invasion is an independent prognostic factor in both *** the MPV-group,all pairwise comparisons between the survival functions of patients with different stages were significant except for the comparison between patients with stage IIA and those with stage ***,in the MPV+group,pairwise comparisons between the survival functions of patients with stage IA,stage IB,stage IIA,stage IIB,and stage III were not significant.T1-3N0 patients in the MPV+group were compared with the T1N0,T2N0,and T3N0 subgroups of the MPV-group;only the survival of MPV-T3N0 and MPV+T1-3N0 patients had no significant *** comparisons of patients with stage IIA and subgroups of stage IIB showed(1)no significant difference between the survival of T2N1 and T3N0 patients;(2)a longer survival of T1N1 patients that was shorter than the survival of T2N0 patients;and(3)and a shorter survival of T3N1 patients that was similar to that of T1-3N2 *** The modified 8th edition of the AJCC staging system for PDAC proposed in this study,which i

关键词： Pancreatic ductal adenocarcinoma portal vein Mesenteric veins Neoplasm staging Pancreaticoduodenectomy

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Predictive Value of Inflammation Biomarkers in Patients with portal vein Thrombosis

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Journal of Clinical and Translational Hepatology 2021年第3期9卷 384-391页

作者： Jian-Bo Han Qing-Hua Shu Yu-Feng Zhang Yong-Xiang Yi Department of Hepatopancreatobiliary Surgery The Second Hospital of NanjingNanjing University of Chinese MedicineNanjingJiangsuChina

Background and Aims:To investigate the usefulness of inflammation biomarkers to serve as a predictors of portal vein thrombosis(PVT)postoperatively(post)in patients with portal hypertension after splenectomy and periesophagogastric ***:A total of 177 liver cirrhosis patients were recruited from January 2013 to December *** were divided into a PVT group(n=71)and a non-PVT group(n=106),according to ultrasound examination findings at 7-day *** biomarkers involving platelet-to-lymphocyte ratio(PLR),neutrophil-to-lymphocyte ratio(NLR),monocyte-to-lymphocyte ratio(MLR),red blood cell distribution width-to-platelet ratio(RPR),mean platelet volume-to-platelet ratio(MPR)preoperatively(pre)and at 1,3,7-days post were ***:The univariate logistic regression analysis indicated that PLR(pre)(odds ratio(OR)=3.963,95%confidence interval(CI)=2.070–7.587,pportal vein thrombosis post in patients with portal hypertension after splenectomy and periesophagogastric devascularization.

关键词： Inflammation biomarker Thrombosis Splenectomy portal vein

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