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EFFECTS OF SPLENECTOMY ON ANTI-TUMOR IMMUNITY DURING THE INDUCTION OF HEPATOCELLULAR CARCINOMA IN RATS

Objective To study the effect of splenectomy on the anti-tumor immunity in rats with induced hepatocellular carcinoma (HCC). Methods At the second and fourth month of the induced HCC, the NK cell activity, TNF-α level and total lymphcyte in blood were measured in the group of splenectomy and the control group. Results There were no different in the total lymphcyte and TNF-α in the blood in two groups, but there were significant difference in the NK cell activity between the group of splenectomy and the control group (Ｐ＜0.05). Conclusion There are some change in the anti-tumor immunity after splenectomy in rats, in which NK cell activity is at low level continuously. TNF-α isn′t affected after the second month after splenectomy.

Effects of Liver Transplantation on Splenic Function in Rats with Hepatic Cirrhosis

【Abstract】ObjectiveTo investigate the effects of liver transplantation on splenic function in rats with hepatic cirrhosis. MethodsHepatic cirrhosis model was established in rats by subcutaneous injections of carbon tetrachloride. Liver transplantation model was established with twocuff technique. Spleen index, morphological changes of spleen were observed before and after liver transplantation in hepatic cirrhosis rats. Spleen T lymphocyte subgroups before and after liver transplantation were also assayed by immunofluorescence staining and flow cytometry. ResultsBefore liver transplantation, spleen index was increased from (2.42±0.11) mg/g to (3.62±0.14) mg/g， P＜0.01; pathological examination of spleen samples showed that the areas of white pulp were decreased from (23.47±2.30)% to (7.70±2.01)%， P＜0.01， and the areas of spleen trabecula were increased from (1.75±0.61)% to (4.46±0.71)%， P＜0.01. Meanwhile, the ratio of CD4/CD8 of spleen T lymphocyte subgroups was decreased from 2.67±0.15 to 1.18±0.15, P＜0.01. After liver transplantation, spleen index was decreased from (3.62±0.14) mg/g to (2.62±0.11) mg/g， P＜0.01; pathological examination of spleen showed that the areas of white pulp were increased from (7.70±2.01)% to (15.07±1.97)%， P＜0.01, and those of spleen trabecula were decreased from (4.46±0.71)% to (3.11±0.51)%， P＜0.05. Meanwhile, the ratio of CD4/CD8 of spleen T lymphocyte subgroups was increased from 1.18±0.15 to 2.32±0.11, P＜0.01. ConclusionImpaired function of spleen resulting from liver function damage can be improved in rats with hepatic cirrhosis after liver transplantation.

OPERATION OF RETAINING SPLEEN FOR SPLEEN TRAUMA (REPORT OF 77 CASES)

目的 探讨外伤性脾破裂手术适应证和方法。方法 对77例外伤性脾破裂进行保脾手术治疗，按姜洪池脾损伤四级分类法： Ⅰ级8例，Ⅱ级41例，Ⅲ级18例，Ⅳ级10例。附加脾动脉结扎术6例。结果 死亡4例； 2例并粘连性肠梗阻。获随访45例，随访时间3个月至3年，仅4例儿童有反复上呼吸道感染，无1例发生脾切除后凶险感染(OPSI)。结论 根据脾损伤的部位和程度，可采用两种以上的联合保脾术式，对控制伤脾出血及保留脾脏功能有重要价值。

Application and Experience of Laparoscopic Partial Splenectomy: Report of 11 Cases

ObjectiveTo explore the clinical efficacy and experience of laparoscopic partial splenectomy. MethodsThe clinical data of 11 cases of splenic space occupying lesions in the author's hospital from January 2011 to May 2014 were retrospectively analyzed. Laparoscopic partial splenectomy were carried out in 11 patients. ResultsEleven patients were successfully completed the laparoscopic partial resection of spleen. Operative timewas 2.0-3.5 h, the average operative time was (2.5±0.3) h. Intraoperative blood loss was 155-320 mL, the average blood loss was (200.3±55.1) mL. Eleven patients who ride smoothly, there was no case of pancreatic injury, gastrointestinal injury, major bleeding and other complications. Postoperative patients recovered well, 24 h after operation gastrointestinal function recovery, and can get out of bed activities. Silicone drainage tube placement time was 3-5 d, the average for placing time was (4.0±1.3) d. about 60-100 mL, the average (70.3±15.8) mL. The average length in hospital was 5-8 d, patients with an average of (6.3±1.5) d, all of the patients without postoperative complications such as infection, splenic infarction. Postoperative pathologic results suggested 6 cases were spleen hemangioma, 3 cases were pseudocyst of spleen, and 2 cases were true epithelial cyst. Conciusions Laparoscopic partial spleen resection should fully grasp the operative indication, fully understand the pathological changes and the structure of door of the spleen, in earnest and patient, under the operation of laparoscopic spleen resection is safe, feasible, and the clinical curative effect is satisfied, worthy of clinical popularization and application.

Predictive Factors for Portal Vein Thrombosis after Splenectomy and Gastroesophageal Devascularization

ObjectiveTo investigate the predictive factors of portal vein thrombosis (PVT) before and after splenectomy and gastroesophageal devascularization for liver cirrhosis with portal hypertension. MethodsSixty-one cases of liver cirrhosis with portal hypertension who underwent splenectomy and gastroesophageal devascularization were enrolled retrospectively. The patients were divided into PVT group and non-PVT group based on the presence or absence of postoperative PVT on day 7. The clinical factors related with PVT were analyzed. ResultsThere were 25 cases in the DVT group and 36 cases in the non-DVT group. The results of univariate analysis showed that the preoperative platelet (P=0.006), activated partial thromboplastin time (P=0.048), prothrombin time (P=0.028), and international normalized ratio (P=0.029), postoperative fibrin degradation product (P=0.002) and D-dimer (P=0.014) on day 1, portal venous diameter (P=0.050) had significant differences between the DVT group and non-DVT group. The results of logistic multivariate regression analysis showed that the preoperative platelet (OR=0.966, 95% CI 0.934-1.000, P=0.048) and postoperative fibrin degradation product on day 1(OR=1.055, 95% CI 1.011-1.103, P=0.017) were correlated with the PVT. The PVT might happen when preoperative platelet was less than 34.5×109/L (sensitibity 80.6%, specificity 60.0%) or postoperative fibrin degradation product on day 1 was more than 64.75 mg/L (sensitibity 48.0%, specificity 91.7%). ConclusionPreoperative platelet and postoperative fibrin degradation product on day 1 might predict PVT after splenectomy and gastroesophageal devascularization for liver cirrhosis with portal hypertension.

射频消融在脾脏外伤后保脾手术中的临床应用

目的 探讨射频消融在保脾手术治疗脾脏外伤中的临床应用效果。 方法 回顾性分析笔者所在医院科室于 2010 年 7 月至 2015 年 3 月期间行保脾手术治疗的 23 例脾脏外伤患者的临床资料，术中均利用了射频消融技术。 结果 23 例患者均保脾成功，其中 11 例行射频消融止血修补术，12 例行射频消融联合部分脾脏切除术。手术时间为 75～150 min，平均 117 min；术中出血量为 40～500 mL，平均 223 mL；术中见腹腔出血量 800～2 000 mL，平均 1 452 mL，均行自体血回输；术中见脾脏裂伤程度：Ⅰ 度 10 例，Ⅱ 度 11 例，Ⅲ 度 2 例；拔除引流管时间为术后 2～5 d，平均 2.8 d；术后住院时间为 6～15 d，平均 8.5 d。术后出现发热 3 例，腹腔再次出血 1 例，血小板计数升高 7 例。术后获访 16 例，随访时间 8～26 个月，中位数为 11 个月。随访期间患者健康情况良好，未见血小板计数异常、脾脓肿等情况。 结论 射频消融在保脾手术治疗脾脏外伤中的应用是可行的。

腹腔镜保留脾脏胰体尾切除术(附7例报道)

目的探讨经腹腔镜下保留脾脏胰体尾切除术（LSPDP）在治疗胰腺体尾部良性肿瘤的可行性及手术技巧。 方法对我院2009年6月至2013年12月期间行LSPDP治疗7例胰腺体尾部良性肿瘤患者的临床资料进行回顾性分析。 结果7例均无中转开腹，平均手术时间218.57 min（120～300 min），术中平均出血量135.71 mL（50～300 mL），术后平均住院时间12.14 d（7～21 d）。术后2例B级胰瘘，经充分引流后出院；1例脾下极局灶性梗死，经保守治疗后治愈。术后病理诊断：胰腺浆液性囊腺瘤4例，胰腺神经内分泌肿瘤3例。术后随访12～48个月，均未出现脾梗死和食管胃底静脉曲张、出血。 结论对胰腺体尾部良性肿瘤患者行LSPDP具有恢复快、并发症少等优点。

Clinical Analysis of 46 Cases of Non-Operative Management of Traumatic Splenic Rupture

目的　探讨外伤性脾破裂非手术治疗的可行性、适应证及其治疗效果。 方法　回顾性分析我院1990年1月至2005年1月收治的外伤性脾破裂非手术治疗46例临床资料。结果　非手术治愈43例，3例因提前下床活动致大出血而中转手术，其中1例并发膈下脓肿，仍经保守治疗痊愈。无死亡病例。结论　在严格掌握适应证前提下非手术治疗外伤性脾破裂安全可行，年龄及腹腔外合并伤不是影响非手术治疗的主要因素。

ＤＩＡＧＮＯＳＩＳ　ＡＮＤ　ＴＲＥＡＴＭＥＮＴ　ＯＦ　ＬＩＥＮＡＬ　ＨＹＤＡＴＩＤＯＳＩＳ（Ａ　ＲＥＰＯＲＴ　ＯＦ　１８　ＣＡＳＥＳ）

Ｗｅ　ｒｅｃｅｉｖｅｄ　ａｎｄ　ｔｒｅａｔｅｄ　１８　ｃａｓｅｓ　ｏｆ　ｌｉｅｎａｌ　ｈｙｄａｔｉｄｏｓｉｓ　ｉｎ　ｒｅｃｅｎｔ　ｙｅａｒｓ．Ｆｉｆｔｅｅｎ　ｐａｔｉｅｎｔｓ　ｗｅｒｅ　ｔｒｅａｔｅｄ　ｓｕｒｇｉｃａｌｌｙ：７　ｃａｓｅｓ　ｕｎｄｅｒｗｅｎｔ　ｒｅｍｏｖａｌ　ｏｆ　ｅｎｄｏｃｙｓｔ　ｆｏｌｌｏｗｉｎｇ　ｔｈｅ　ａｓｐｉｒａｔｉｏｎ　ｏｆ　ｃｙｓｔ　ｆｌｕｉｄ　ａｎｄ　ｔｈｅ　ｅｃｔｏｃｙｓｔｉｃ　ｗａｌｌ　ｏｐｅｎｅｄ　ｏｒ　ｆｉｌｌｅｄ　ｗｉｔｈ　ｇｒｅａｔｅｒ　ｏｍｅｎｔｕｍ，２　ｃａｓｅｓ　ｗｉｔｈ　ｓｍａｌｌ　ｃｙｓｔｓ，ｕｎｄｅｒｗｅｎｔ　ｃｌｏｓｕｒｅ　ｏｆ　ｅｃｔｏｃｙｓｔ　ｂｙ　ｓｕｔｕｒｅ　ｆｏｌｌｏｗｉｎｇ　ｔｈｅ　ｃｏｍｐｌｅｔｅ　ｃｌｅａｎｉｎｇ　ｏｆ　ｔｈｅ　ｒｅｓｉｄｕａｌ　ｃａｖｉｔｙ，Ｏｎｅ　ｃａｓｅ　ｒｅｃｅｉｖｅｄ　ｌａｐｒａｓｃｏｐｉｃ　ｃｙｓｔｅｃｔｏｍｙ　ａｎｄ　５　ｃａｓｅｓ　ｕｎｄｅｒｗｅｎｔ　ｃｏｍｐｌｅｔｅ　ｒｅｓｅｃｔｉｏｎ　ｏｆ　ｔｈｅ　ｓｐｌｅｅｎ．Ａｌｌ　ｏｆ　ｔｈｅ　ｓｕｒｇｉｃａｌ　ｃａｓｅｓ　ａｔｔａｉｎｅｄ　ｃｏｍｐｌｅｔｅ　ｈｅａｌｉｎｇ．Ｉｎ　ｔｈｉｓ　ｐａｐｅｒ　ｔｈｅ　ｅｔｉｏｌｏｇｙ，ｄｉａｇｎｏｓｔｉｃ　ｃｒｉｔｅｒｉａ　ａｎｄ　ｄｉｆｆｅｒｅｎｔｉａｌ　ｄｉａｇｎｏｓｉｓ　ａｎｄ　ｔｈｅ　ｉｍｐｒｏｖｅｄ　ｍｅｔｈｏｄ　ｏｆ　ｓｕｒｇｉｃａｌ　ｔｒｅａｔｍｅｎｔ　ａｒｅ　ｄｉｓｃｕｓｓｅｄ．

Clinical Application of Laparoscopic Partial Splenectomy