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DYNAMIC OBSERVATION ON THE CHANGES OF PLASMA SOMATOSTATIN AND GLUCAGON DURING THE DEVELOPMENT OF CIRRHOSIS AND AFTER portacaval SHUNTING IN THE CIRRHOTIC RATS

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Medical Bulletin of Shanghai Jiaotong University 1992年第1期15卷 17-26页

作者：吴志勇黄安郑忠华陈聿修陈治平邝耀麟小野慶一金充 Department of Surgery Renji Hospital SSMU Shanghai Department of Surgery Hirosaki University School of Medicine Hirosaki Japan

In the present study we observed dynamically and systemically the changes of plasma somatostatin and glucagon in the peripheral and portal vein, and the changes of pancreatic immunopathology in the course of development of cirrhosis induced by CCl4 and after portacaval shunt （PCS） in the cirrhotic rats as well as investigated their causes and correlationship. The results showed that hyperglucagonemia was caused by spontaneous portosystemic shunting and surgically induced portacaval anastomosis. Moreover, there was much higher level of glucagon in the portal vein with corresponding increase of A cells in PCS rats than those in the controls, indicating that another cause for elevation of glucagon was hypersecretion of pancreatic A cells. Our data demonstrated that both deterioration of liver function and portosystemic shunting might not be responsible for the elevated level of somatostatin in the cirrhotic rats with PCS. However, there was a closed positive correlation between plasma glucagon and somatostatin. Thus it was concluded that hyperglucagonemia stimulated the release of somatostatin. In view of the fact the elevated level of glucagon was much higher than that of somatostatin, there was probably a relative lack of somatostatin in cirrhosis with portal hypertension.

关键词： somatostatin glucagon pancreatic immunopathology cirrhosis of liver portal hypertension portacaval shunt deterioration of liver function

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Partial IVC Clamping Improves Intraoperative Hemodynamic Parameters in the Rodent portacaval Anastomosis Model

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Surgical Science 2011年第2期2卷 102-108页

作者： Mehrdad Asgeri Nisheet Waghray Kevin Mullen Nader Nader Henri Brunengraber Juan Sanabria 不详

The mechanisms involved in the development of hepatic encephalopathy still remain uncertain. The rodent portacaval shunt is a model that reproduces many of the pathological features observed in humans (1), but is a technically demanding exercise. While the traditional technique involves complete occlusion of the IVC, a c-clamp was fashioned to partially clamp the IVC thereby sustaining venous return and cardiac output. The aim of this study is to determine if the c-clamp technique provides greater hemodynamic stability and enhances the success rate of the portacaval shunt procedure. To answer this question, two experimental groups, c-clamp (N = 7) and cross-clamp (N = 7), and a sham group (N = 3) were included. Intraoperative hemodynamic parameters were recorded at specific times during the procedure. The c-clamp group showed greater hemodynamic stability when compared to the cross-clamp group. It was manifested by 1) significantly higher mean arterial blood pressure [63 (range, 8) vs 47 (range, 10) mmHg, p portacaval shunt model.

关键词： portacaval Anastomosis Portosystemic Shunt Microvascular Surgery Ivc Clamping Surgical Technique Encephalopathy-Like Rodent Model

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A half century (1961-2011) of applying microsurgery to experimental liver research

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World Journal of Hepatology 2012年第7期4卷 199-208页

作者： Maria-Angeles Aller Natalia Arias Isabel Prieto Salvador Agudo Carlos Gilsanz Laureano Lorente Jorge-Luis Arias Jaime Arias Surgery I Department School of Medicine Complutense University of Madrid 28040 Madrid Spain Neurosciences Lab Psychobiology Department School of Psychology University of Oviedo 33003 Oviedo Spain Surgery Department La Paz Hospital School of Medicine Autonomous University of Madrid 28049 Madrid Spain General Surgery Unit Sudeste Hospital Arganda del Rey 28500 Madrid Spain

The development of microsurgery has been dependent on experimental animals. Microsurgery could be a very valuable technique to improve experimental models of liver diseases. Microdissection and microsutures are the two main microsurgical techniques that can be considered for classifying the experimental models developed for liver research in the rat. Partial portal vein ligation, extrahepatic cholestasis and hepatectomies are all models based on microdissection. On the other hand, in portacaval shunts, orthotopic liver transplantation and partial heterotopic liver transplantation, the microsuture techniques stand out. By reducing surgical complications, these microsurgical techniques allow for improving the resulting experimental models. If good experimental models for liver research are successfully developed, the results obtained from their study might be particularly useful in patients with liver disease. Therefore experimental liver microsurgery could be an invaluable way to translate laboratory data on liver research into new clinical diagnostic and therapeutic strategies.

关键词： Microsurgery portacaval shunts Cholestasis Hepatectomies Liver transplantation Portal hypertension

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Transjugular Intrahepatic Portosystemic Shunt Versus Surgical Shunting in the Management of Portal Hypertension

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Chinese Medical Journal 2015年第6期128卷 826-834页

作者： Long Huang Qing-Sheng Yu Qi Zhang Ju-Da Liu Zhen Wang Department of No. 1 Surgery Anhui Chinese Medical Research Institute of Surgery The First Hospital Affiliated to Anhui Chinese Medical University Hefei Anhui 230031 China

Background:The purpose of this article was to clarify the optimal management concerning transjugular intrahepatic portosystemic shunts (TIPSs) and surgical shunting in treating portal ***:All databases,including CBM,CNKI,WFPD,Medline,EMBASE,PubMed and Cochrane up to February 2014,were searched for randomized controlled trials (RCTs) comparing TIPS with surgical *** RCTs,which were extracted by two independent investigators and were evaluated in postoperative complications,mortality,2-and 5-year survival,hospital stay,operating time and hospitalization ***:The morbidity in variceal rehemorrhage was significantly higher in TIPS than in surgical shunts (odds ratio [OR] =7.45,95％confidence interval [CI]:(3.93-14.15),P ＜ 0.00001),the same outcomes were seen in shunt stenosis (OR =20.01,95％ CI:(6.67-59.99),P ＜ 0.000001) and in hepatic encephalopathy (OR =2.50,95％ CI:(1.63-3.84),P ＜ 0.0001).Significantly better 2-year survival (OR =0.66;95％ CI:(0.44-0.98),P =0.04) and 5-year survival (OR =0.44; 95％ CI:(0.30-0.66),P ＜ 0.00001) were seen in patients undergoing surgical shunting compared with ***:Compared with TIPS,postoperative complications and survival after surgical shunting were superior for patients with portal *** of surgical shunting was recommended for patients rather than TIPS.

关键词： Complications Hypertension portacaval Shunt Portal Portosystemic Shunt Surgical Survival Rate Transjugular Intrahepatic

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STUDIES OF EFFECTS OF PORTASYSTEMIC SHUNT ON THE FUNCTION OF HEPATIC AND PANCREATIC ISLET CELLS

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Medical Bulletin of Shanghai Jiaotong University 1991年第1期14卷 6-13页

作者：邝耀麟陈治平吴志勇黄安袁济民陈聿修曾民德萧树东 Department of Surgery Renji HospitalSSMUShanghai Shanghai Institute of Digestive Disease SSMUShanghai

The present study was aimed at dynamic observation of the ef fects of end to side portacaval shunt (PCS) and end to side mesocaval shunt (MCS) in dogs on the functions of the liver and pancreatic islet cells. According to correlation between the changes of plasma insulin level in the portal vein and hepatic flow and liver morphology after PCS and MCS, we conclude that the depletion of hepatic flow is the major factor in the deterioration of liver functions. The levels of insulin and glucagon in both the peripheral vein and the portal vein were decreased after PCS and MCS. There was also depletion of pancreatic islet A and B cells and vacuolar degeneration of the pancreas. These changes were more signifcant in PCS than in MCS, suggesting that portasystemic shunt, especially total portasystemie shunt, might damage pancreatic endocrine functions.

关键词： end to side portacaval shunt end to side mesocaval shunt hepatic flow insulin glucagon pancreatic islet Cells

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Small for size syndrome following living donor and split liver transplantation

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World Journal of Gastrointestinal Surgery 2010年第12期2卷 389-394页

作者： Hector Daniel Gonzalez Sophia Cashman Giuseppe K Fusai Centre for HPB Surgery and Liver Transplantation Royal Free Hospital Pond StreetNW3 2QG

The field of liver transplantation is limited by the availability of donor organs. The use of living donor and split cadaveric grafts is one potential method of expanding the donor pool. However, primary graft dysfunction can result from the use of partial livers despite the absence of other causes such as vascular obstruction or sepsis. This increasingly recognised phenomenon is termed "Small-for-size syndrome" (SFSS). Studies in animal models and humans have suggested portal hyperperfusion of the graft combined with poor venous outflow and reduced arterial flow might cause sinusoidal congestion and endothelial dysfunction. Graft related factors such as graft to recipient body weight ratio 30% and pro- longed warm/cold ischemia time are positively predictive of SFSS. Donor related factors include deranged liver function tests and prolonged intensive care unit stay greater than five days. Child-Pugh grade C recipients are at relatively greater risk of developing SFSS. Surgi- cal approaches to prevent SFSS fall into two categories: those targeting portal hyperperfusion by reducing inflow to the graft, including splenic artery modulation and portacaval shunts; and those aiming to relieve paren-chymal congestion. This review aims to examine thecontroversial diagnosis of SFSS, including current strate-gies to predict and prevent its occurrence. We will also consider whether such interventions could jeopardize the graft by compromising regeneration.

关键词： Liver transplantation Living donors Hypertension Portal Splenic artery Liver regeneration Hepatic veins portacaval shunt Surgical

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