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1.
Int J Clin Oncol ; 2020 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-32036480

RESUMO

BACKGROUND: Neuroendocrine carcinoma (NEC) of the esophagus and the stomach is aggressive. The purpose of this study was to determine the optimal therapeutic strategy. METHODS: Both clinicopathological factors and treatment results were examined in 34 patients with immunohistochemically diagnosed NEC of the upper gastrointestinal tract (esophagus 22; stomach 12). RESULTS: Twenty-nine tumors showed protruding and localized type, like submucosal tumor. Esophagectomy and gastrectomy were performed in six and eight patients, respectively. Among the six patients with esophageal NEC, three with node metastasis developed recurrence within seven months, while the other three (pT1bN0) had no recurrence. Regarding gastric NEC, three patients with pT3N1 or 2 tumor received adjuvant chemotherapy and achieved a 5-year survival. However, the other five experienced recurrence after gastrectomy. Systemic chemotherapy was performed as the main treatment for 18 patients with advanced NEC. The median survival was 10 months after initial chemotherapy. No marked differences in the response were recognized between the 14 cases with esophageal NEC and the 4 with gastric NEC. The median survival was 14.3 and 5.3 months for the 11 effective and 7 non-effective patients, respectively. CONCLUSIONS: A macroscopically unique appearance, like submucosal tumor, suggests the possibility of NEC. Esophagectomy is an effective treatment option for limited-stage NEC without node metastasis, while gastrectomy followed by adjuvant chemotherapy may be effective for NEC even with node metastasis when R0 resection can be achieved. Systemic chemotherapy is relatively effective for advanced NEC, although early progression frequently develops.

2.
Anticancer Res ; 39(11): 6347-6353, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704866

RESUMO

BACKGROUND/AIM: The aim of this study was to determine the significance of immunonutritional and physical index in the assessment of risk associated with pancreaticoduodenectomy (PD) in the elderly. PATIENTS AND METHODS: This study enrolled 92 patients who underwent PD. They were divided into 2 groups: Group A included patients 79 years and younger (n=79) and Group B patients 80 years and older (n=13). Among 37 patients, physical function and body composition were also evaluated. RESULTS: Significantly higher neutrophil-lymphocyte ratio, lower prognostic nutritional index (PNI), and controlling nutritional score were observed in Group B. Muscle strength and walking ability were significantly impaired in Group B, although there was no significant difference in body composition. Age was not correlated with the incidence of postoperative complications, overall survival or recurrence-free survival by univariate and multivariate analysis. CONCLUSION: PD is justified for the elderly, with acceptable morbidity and prognosis. However, immunonutritional status and physical function are significantly impaired; thus, appropriate case selection and active nutritional support are required for the elderly.


Assuntos
Limitação da Mobilidade , Força Muscular , Estado Nutricional , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Neoplasias dos Ductos Biliares/cirurgia , Composição Corporal , Comorbidade , Neoplasias Duodenais/cirurgia , Feminino , Humanos , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos/citologia , Avaliação Nutricional , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/mortalidade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Medição de Risco , Albumina Sérica/análise
3.
World J Hepatol ; 6(2): 64-71, 2014 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-24575165

RESUMO

Portal vein thrombosis (PVT) is considered to be a frequent complication of liver cirrhosis. However, unlike PVT in patients without cirrhosis, very few data are available on the natural history and management of PVT in cirrhosis, despite its association with potentially life-threatening conditions, such as gastroesophageal bleeding and acute intestinal ischemia. Moreover, no consensus regarding PVT in cirrhosis exists. Suggested causes of PVT in cirrhosis include reduced portal blood flow velocity, multiple congenital or acquired thrombophilic factors, inherited or acquired conditions, and derangement of liver architecture. However, the understanding of PVT in cirrhosis is incomplete. In addition, information on the management of PVT in cirrhosis is inadequate. The aims of this review are to: (1) assemble data on the physiopathological mechanism, clinical findings, diagnosis and management of PVT in cirrhosis; (2) describe the principal factors most frequently involved in PVT development; and (3) summarize the recent knowledge concerning diagnostic and therapeutic procedures.

4.
Asian J Endosc Surg ; 7(2): 138-44, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24571442

RESUMO

INTRODUCTION: Laparoscopic devascularization of the upper stomach and splenectomy (Dev+Sp), is technically difficult in patients with portal hypertension because of enlarged collateral vessels and spleen. This report presents the efficacy and safety of hand-assisted laparoscopic (HALS) Dev+Sp. METHODS: Ten patients underwent HALS Dev+Sp as a treatment for esophagogastric varices between 2005 and 2012 (HALS group). A vessel-sealing system was used for devascularization of vessels. An autosuture device was applied to dissect the splenic hilum and the left gastric and enlarged short gastric vessels. The operative and postoperative data were compared between patients who previously underwent laparoscopic Dev+Sp (LAP group, n = 9) and conventional Dev+Sp (OP group, n = 10) between 2001 and 2008. RESULTS: The mean operative time was 328, 336, and 245 min (P < 0.05) and the mean blood loss was 1786, 981, and 250 mL (P < 0.05) in the OP, LAP, and HALS groups, respectively. Laparoscopic surgery was converted to HALS in one patient and to open surgery in three patients. There were no conversions in the HALS group. There was no significant difference in the cumulative recurrence rate and bleeding rate in the groups. CONCLUSION: HALS Dev+Sp is a feasible and effective surgery in patients with portal hypertension.


Assuntos
Varizes Esofágicas e Gástricas/cirurgia , Hipertensão Portal/cirurgia , Laparoscopia/métodos , Estômago/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Laparoscopia Assistida com a Mão , Hemostasia Cirúrgica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estômago/irrigação sanguínea , Resultado do Tratamento
5.
Surg Today ; 44(4): 633-9, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23467977

RESUMO

PURPOSES: The purpose of our study was to evaluate the efficacy of balloon-occluded retrograde transvenous obliteration (B-RTO) in patients after living donor liver transplantation (LDLT). METHODS: Five patients with gastric varices (GVx) and/or liver dysfunction who were treated with B-RTO from January 2001 to December 2007 were enrolled in this study (GVx, n = 2; liver dysfunction, n = 1; both, n = 2). The eradication rate of the GVx, portal vein hemodynamics and improvement of liver function were evaluated. RESULTS: B-RTO was performed successfully, and the GVx disappeared or decreased markedly in all patients. Recurrence of GVx was not observed during the follow-up. Significantly increased portal vein inflow and improved liver function were observed in all patients. CONCLUSIONS: B-RTO may be an effective treatment for patients after LDLT to prevent bleeding from GVx or to modulate portal vein inflow that is reduced by prolonged large portosystemic shunts.


Assuntos
Oclusão com Balão/métodos , Varizes Esofágicas e Gástricas/terapia , Hepatopatias/terapia , Transplante de Fígado , Doadores Vivos , Derivação Portossistêmica Cirúrgica/efeitos adversos , Complicações Pós-Operatórias/terapia , Idoso , Varizes Esofágicas e Gástricas/etiologia , Estudos de Viabilidade , Feminino , Humanos , Hepatopatias/etiologia , Masculino , Pessoa de Meia-Idade , Veia Porta/fisiopatologia , Complicações Pós-Operatórias/etiologia , Fluxo Sanguíneo Regional
6.
Hepatol Res ; 43(9): 933-41, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23317427

RESUMO

AIM: Whether hepatic function can recover in cirrhotic patients after splenectomy remains controversial. METHODS: All consecutive Japanese patients with hepatic cirrhosis due to hepatitis C who had undergone elective splenectomy in Kyushu University Hospital between January 2008 and December 2009 were included in this retrospective study. Prothrombin time, serum albumin and total bilirubin concentrations were reviewed before and after splenectomy and analyzed to clarify whether splenectomy improves hepatic function in patients with cirrhosis and to determine the factors predictive of improvement in hepatic function. RESULTS: Prothrombin time and total serum bilirubin concentration improved after splenectomy; however, serum albumin concentrations did not increase significantly. Twelve months after splenectomy, total serum bilirubin had decreased by over 0.3 mg/dL in 52.3% of patients and prothrombin time had improved by over 10% in 52.3% of patients. Multiple linear regression analysis identified hepatic vein waveform (HVWF) type I (P = 0.0174) and spleen weight (P = 0.0394) as independent predictors of improvement in prothrombin time and preoperative total serum bilirubin (P = 0.0002) as the only independent predictor of decrease in total bilirubin. Total bilirubin and prothrombin time were significantly improved after splenectomy in patients with HVWF type I, however, they were not improved in patients with HVWF type II. CONCLUSION: Prothrombin time and total bilirubin improve in approximately half of cirrhotic patients within a year after splenectomy. HVWF type I and splenomegaly may be predictive factors for improvement in prothrombin time after splenectomy in patients with cirrhosis due to hepatitis C.

7.
Surg Endosc ; 26(12): 3573-9, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22678174

RESUMO

BACKGROUND: We recently experienced 10 patients with cirrhosis who underwent laparoscopic splenectomy. A portion of these patients underwent dissection with a flexible endoscope in the peritoneal cavity. This pilot study mainly focused on the technical aspects and immediate results. METHODS: From November 2009 to September 2010, 10 patients with cirrhosis and hypersplenism were entered into this pilot study. They were indicated to undergo laparoscopic splenectomy to treat portal hypertension and to facilitate initiation and completion of either interferon therapy for liver cirrhosis or anticancer therapy for hepatocellular carcinoma. To dissect the upper end of the gastrosplenic ligament and the marginal region between the left diaphragm and upper pole of the spleen, a flexible single-channel endoscope was introduced into the peritoneal cavity simultaneously with the use of a rigid laparoscope. Dissection with the flexible endoscope in the peritoneal cavity was performed using an insulation-tipped electrosurgical knife through the channel of the flexible endoscope. RESULTS: The flexible endoscope offered a magnified operative view, a water-jet lens cleaner, and a powerful lavage and suction capability. The upper end of the gastrosplenic ligament and the marginal region between the left diaphragm and upper pole of the spleen were easily seen, and dissection of these critical regions was smoothly conducted with articulation of the tip of the flexible endoscope, even in patients with splenomegaly. No patient experienced major intraoperative complications or required conversion to open surgery. CONCLUSIONS: Dissection with a flexible endoscope in the peritoneal cavity may be an effective tactic for laparoscopic megasplenectomy, and significant implications for pure natural orifice translumenal endoscopic surgery have been raised. Although future randomized controlled prospective studies are needed to confirm these findings, surgeons might find this to be a typical example of an appropriate strategy for high-risk patients.


Assuntos
Laparoscopia/métodos , Cirurgia Endoscópica por Orifício Natural , Esplenectomia/métodos , Esplenomegalia/cirurgia , Endoscópios , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
8.
Oncol Lett ; 3(1): 94-99, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22740862

RESUMO

The prognosis of type IV scirrhous gastric cancer (SGC) is extremely poor. Linitis plastica (LP), the so-called 'leather bottle stomach', is believed to be a typical case of SGC, which is usually diagnosed as a far-advanced gastric cancer. The pathogenesis of this disease remains unclear. Although typical SGC often invades the entire stomach, atypical cases show SGC localized to one region of the stomach. The aim of the present study was to investigate localized SGC (LSGC) and its biological significance. A total of 509 patients with advanced gastric cancer who underwent gastrectomy were evaluated. These patients were divided into three groups as follows: 19 patients with type IV scirrhous lesions invading the whole stomach (defined as LP), 60 patients with type IV scirrhous lesions localized in less than two thirds of the stomach (defined as LSGC) and the remaining 430 patients with all other types of gastric cancer (OGC), and then clinicopathologically compared. Results showed that LP had deeper invasion (p=0.006), more frequent peritoneal dissemination including positive cytology (p=0.01 and p=0.018) and lower curability (p=0.03) compared with LSGC, whereas LSGC showed a higher malignant potential in a number of clinicopathological factors compared with OGC. Univariate analysis showed that survival in patients with LP was significantly poorer than in those with LSGC (p=0.002) whose survival was, in turn, inferior to those with OGC. By contrast, LSGC was not a prognostic factor in SGC according to the multivariate analysis. The findings of this study suggested that the malignant status of LSGC differs from that of LP, and that curative gastrectomy is effective in improving the outcome for LSGC but not for LP, as LSGC may represent the prelinitis condition.

9.
Hepatol Res ; 42(10): 1039-47, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22594838

RESUMO

AIM: Splenectomy or partial splenic embolism has been reported to improve liver function in patients with hypersplenism and liver dysfunction. The aim of this study was to investigate the mechanism of improvement after splenectomy. METHODS: Liver cirrhosis was induced by bile duct ligation (BDL). Rats underwent sham operation, splenectomy (Sp group), BDL, or BDL plus splenectomy (BDL + Sp group), and were subjected to experiments at 2 weeks after the operation. Portal venous pressure (PVP) and hepatic tissue blood flow (HTBF) were measured in each group. The plasma concentration of endothelin-1 (ET-1) and endothelial nitric oxide synthase (eNOS), RhoA and Rho-kinase expressions were studied. RESULTS: There were significant differences in PVP (17.9 ± 0.91 vs 23.3 ± 3.91 cmH(2) O; P < 0.01) and HTBF (16.6 ± 1.72 vs 13.3 ± 1.82 mL/min; P < 0.01) between the BDL + Sp and BDL groups. In the liver of BDL rats, eNOS phosphorylation and NOx levels were decreased, accompanied by RhoA activation compared with the BDL + Sp group. Splenectomy decreased serum ET-1 levels, RhoA activation and consequently increased eNOS phosphorylation. CONCLUSION: ET-1 derived from the spleen might increase intrahepatic resistance by downregulating Rho signaling in liver cirrhosis. Splenectomy for splenomegaly in liver cirrhosis might partially improve liver function by enhancing intrahepatic microcirculation.

10.
J Gastroenterol Hepatol ; 27(1): 137-41, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21722180

RESUMO

BACKGROUND AND AIMS: Balloon-occluded retrograde transvenous obliteration (B-RTO) is an effective treatment for gastric varices (GVx), as well as hepatic encephalopathy. The aim of this study was to examine the changes of the hepatic vein pressure gradient (HVPG) after B-RTO and determine the relation between the changes of HVPG and liver function. PATIENTS AND METHODS: B-RTO was performed in 30 patients with GVx and hepatic encephalopathy. HVPG was measured in 19 of 30 patients both before and after B-RTO. RESULTS: The B-RTO was successful in all patients. The GVx and hepatic encephalopathy were improved, and no recurrence or bleeding was observed within the follow- up period. The serum albumin and prothrombin activity were significantly improved 6 months after B-RTO in all patients. HVPG was elevated 44% above the baseline after B-RTO. Liver function significantly improved 6 months after B-RTO in patients whose HVPG increased ≥ 20% from baseline. CONCLUSION: An elevated HVPG after B-RTO is one aspect of the effect of liver function, and an HVPG increase of ≥ 20% from baseline is a predictive factor for obtaining an improvement of liver function.


Assuntos
Oclusão com Balão , Varizes Esofágicas e Gástricas/terapia , Encefalopatia Hepática/terapia , Veias Hepáticas/fisiopatologia , Fígado/irrigação sanguínea , Fígado/fisiopatologia , Escleroterapia , Idoso , Oclusão com Balão/efeitos adversos , Biomarcadores/sangue , Varizes Esofágicas e Gástricas/sangue , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/fisiopatologia , Feminino , Encefalopatia Hepática/sangue , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/fisiopatologia , Humanos , Japão , Fígado/metabolismo , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Ácidos Oleicos/administração & dosagem , Protrombina/metabolismo , Recuperação de Função Fisiológica , Soluções Esclerosantes/administração & dosagem , Escleroterapia/efeitos adversos , Albumina Sérica/metabolismo , Fatores de Tempo , Resultado do Tratamento , Pressão Venosa
11.
Hepatol Int ; 6(3): 657-61, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21959984

RESUMO

PURPOSE: The purpose of our study was to investigate predictive factors for platelet count at 1 month after splenectomy in patients with liver cirrhosis. METHODS: A total of 60 patients with liver cirrhosis who were treated with splenectomy from January 2005 to December 2006 were enrolled in the study (hepatitis C, n = 50; hepatitis B, n = 6; alcoholism, n = 2; others, n = 2). Various preoperative clinical characteristics, including spleen weight, were analyzed by simple and multiple linear regressions to study the relationship between platelet count before and after splenectomy. RESULTS: Platelet count increased significantly after splenectomy. After simple linear regression, spleen weight, preoperative platelet count, lymphocyte count, and total bilirubin were significantly correlated with platelet count after splenectomy. Spleen weight, preoperative platelet count, and lymphocyte count also had a significant correlation after multiple linear regression analysis. CONCLUSIONS: Platelet count after splenectomy in cirrhotic patients can be predicted on the basis of preoperative clinical characteristics. When selecting patients for splenectomy, spleen weight, preoperative platelet count, and lymphocyte count should be taken into consideration.

12.
Hepatol Res ; 41(8): 784-94, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21699634

RESUMO

AIM: Liver cirrhosis clinically shows thrombocytopenia and hypersplenism. Although splenectomy is performed to achieve higher platelet count and better hemostasis, the effect of splenectomy for liver cirrhosis remains unclear. The aim of the present study that was focused on serotonin was to investigate the relationship between splenectomy and liver regeneration in rats with secondary biliary cirrhosis. METHODS: Liver cirrhosis was induced in Sprague-Dawley rats by bile duct ligation (BDL). In addition, splenectomy and administration of ketanserin, which selectively antagonizes 5-HT2A and 2B serotonin receptors, were performed. Three weeks after the interventions, whole blood, plasma, serum, and liver specimens were obtained for the following studies: peripheral platelet counts, hemodynamics of serotonin, histopathological examination, immunostaining, and quantification of mRNA expression. RESULTS: Splenectomy induced thrombocytosis, and increased serotonin content in cirrhotic liver. Stimulation of liver regeneration was indicated by the following parameters: hepatocyte ratio to the entire liver area, Ki67-positive hepatocyte count, and expression of phosphorylated extracellular signal-regulated kinases. This enhancement of liver regeneration was negated by ketanserin. CONCLUSION: Our results showed that splenectomy promoted liver regeneration by increasing serotonin content in liver even under cirrhotic conditions.

13.
Ann Surg ; 251(1): 76-83, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19864937

RESUMO

OBJECTIVE: The aim of this study was to determine the role of antithrombin III (AT-III) in portal vein thrombosis (PVT) after splenectomy in cirrhotic patients. SUMMARY BACKGROUND DATA: There is no standard treatment for PVT after splenectomy in liver cirrhosis. METHODS: A total of 50 consecutive cirrhotic patients who underwent laparoscopic splenectomy for hypersplenism were enrolled into this study. From January 2005 to December 2005, 25 cirrhotic patients received no prophylactic anticoagulation therapy after the operation (AT-III [-] group). From January 2006 to July 2006, 25 cirrhotic patients received prophylactic administration of AT-III concentrates (1500 U/d) on postoperative day (POD) 1, 2, and 3 (AT-III [+] group). RESULTS: In AT-III (-) group, 9 (36.0%) patients developed PVT up to POD 7, and risk factors for PVT were identified as: low platelet counts, low AT-III activity, and increased spleen weight. Although there were no significant differences in the clinical characteristics, including the above risk factors, between the 2 groups, only 1 (4.0%) patient developed PVT on POD 30 in AT-III (+) group, and the incidence of PVT was significantly lower than in AT-III (-) group (P = 0.01). In AT-III (-) group, AT-III activity was significantly decreased from POD 1 to POD 7, as compared with the preoperative level, whereas AT-III concentrates prevented the postoperative decrease in AT-III activity. CONCLUSIONS: These results demonstrate that low AT-III activity and further decreases in this activity are associated with PVT after splenectomy in cirrhotic patients, and that treatment with AT-III concentrates is likely to prevent the development of PVT in these patients.


Assuntos
Anticoagulantes/administração & dosagem , Antitrombina III/administração & dosagem , Hiperesplenismo/cirurgia , Cirrose Hepática/complicações , Veia Porta , Esplenectomia/efeitos adversos , Trombose Venosa/prevenção & controle , Adulto , Idoso , Anticoagulantes/uso terapêutico , Antitrombina III/análise , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Hiperesplenismo/complicações , Infusões Intravenosas , Laparoscopia , Cirrose Hepática/sangue , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Fatores de Risco , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler , Trombose Venosa/diagnóstico , Trombose Venosa/tratamento farmacológico , Trombose Venosa/etiologia
14.
Surgery ; 148(1): 145-50, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20004438

RESUMO

BACKGROUND: Small intestinal variceal bleeding is an unusual cause of gastrointestinal hemorrhaging of portal hypertensive patients, but once it occurs it may lead to life-threatening bleeding because this problem is difficult to diagnose and treat. This study investigated the efficacy of balloon occluded retrograde transvenous obliteration (B-RTO) to treat small intestinal variceal bleeding. METHODS: From 2003 to 2007, 6 patients with small variceal bleeding were treated by B-RTO. The characteristics of the patients, B-RTO procedures, prognosis, and occurrence of risky esophageal and gastric varices were evaluated according to their medical records. RESULTS: Three-dimensional (3-D) angiography by MD-CT was useful for the diagnosis of small intestinal varices and the draining vessels. In all cases, variceal bleeding was controlled by B-RTO treatment, although rebleeding was recognized in one patient after 30 months (16.6%). All patients were alive throughout the follow-up except 1 patient who died of liver failure (6-44 months). Risky esophageal varices and gastric varices occurred in 2 patients (33.3%) after B-RTO. However, no variceal bleeding occurred. CONCLUSION: B-RTO was found to be an effective treatment modality which provided good initial hemostasis, thereby eradicating ectopic small intestinal varices.


Assuntos
Oclusão com Balão/métodos , Hemorragia Gastrointestinal/terapia , Hipertensão Portal/complicações , Intestino Delgado/irrigação sanguínea , Varizes/complicações , Adulto , Idoso , Angiografia , Feminino , Técnicas Hemostáticas , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Tomografia Computadorizada por Raios X , Varizes/diagnóstico por imagem
15.
Dig Surg ; 27(6): 515-20, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21196735

RESUMO

BACKGROUND/AIMS: Recently, partial splenic arterial embolization (PSE) has become a supportive intervention for cirrhotic patients with hypersplenism in the administration of interferon therapy. However, relapsed thrombocytopenia is often observed in patients following PSE. This study aimed to report the clinical efficiency of laparoscopic splenectomy as a salvage treatment for relapsed thrombocytopenia following PSE. METHODS: From 2005 to 2009, 6 patients with prior PSE treatment underwent laparoscopic splenectomy. We reviewed the surgical method of laparoscopic splenectomy and the peri- and postoperative outcomes. RESULTS: Laparoscopic splenectomy effectively provided sufficient increases in patient platelet counts. In all patients, laparoscopic splenectomy was performed safely with no significant complications despite PSE-associated dense adhesion to the diaphragm and/or retroperitoneal attachments. CONCLUSION: Laparoscopic splenectomy provides a sufficient increase in patient platelet counts in relapsed thrombocytopenia following PSE. Therefore, laparoscopic splenectomy appears to be a superior supportive therapy for the treatment of thrombocytopenia in cirrhotic patients.


Assuntos
Embolização Terapêutica/métodos , Laparoscopia , Terapia de Salvação , Baço/irrigação sanguínea , Esplenectomia , Trombocitopenia/cirurgia , Idoso , Feminino , Humanos , Hiperesplenismo/complicações , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Recidiva , Trombocitopenia/terapia , Resultado do Tratamento
16.
Surg Today ; 39(12): 1054-9, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19997800

RESUMO

PURPOSE: We investigated the effects of thrombopoietin (TPO) on platelet counts and liver regeneration after partial hepatectomy in rats. METHODS: We performed 70% partial hepatectomy on 60 rats given either TPO or a vehicle (controls). The rats were killed 6 h, 24 h, 72 h, or 168 h after the procedure, and we examined the platelet counts, weight of the regenerated liver, hepatocyte proliferation by bromodeoxyuridine (BrdU) labeling index, and expression of hepatocyte growth factor (HGF) mRNA by reverse transcription-polymerase chain reaction. RESULTS: In the controls, the platelet counts were significantly lower than the basal levels, by about 20%, at 6, 24, and 72 h; then recovered to the basal level at 168 h. Conversely, in the TPO-treated rats, the platelet counts increased significantly by 17%, 35%, and 60%, at 24, 72, and 168 h, respectively. The regenerated liver regained 80% of the pre-hepatectomy weight by 72 h in the controls, whereas reconstitution of the liver was accomplished by 72 h in the TPO-treated rats. Thrombopoietin significantly enhanced the BrdU labeling index of hepatocytes and expression of HGF mRNA 24 h post hepatectomy in TPO-treated rats versus controls. CONCLUSION: Thrombopoietin increased platelet counts; thereby accelerating liver regeneration after partial hepatectomy with enhanced induction of HGF.


Assuntos
Hepatectomia/métodos , Fator de Crescimento de Hepatócito/metabolismo , Regeneração Hepática/efeitos dos fármacos , Trombopoetina/farmacologia , Animais , Modelos Animais de Doenças , Fator de Crescimento de Hepatócito/análise , Regeneração Hepática/fisiologia , Masculino , Contagem de Plaquetas , Probabilidade , RNA Mensageiro/análise , Distribuição Aleatória , Ratos , Ratos Wistar , Valores de Referência , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sensibilidade e Especificidade
17.
Surg Laparosc Endosc Percutan Tech ; 19(6): 484-7, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20027092

RESUMO

BACKGROUND: A laparoscopic splenectomy in patients who previously underwent living-donor liver transplantation (LDLT) is thought to be technically difficult because of the presence of severe adhesions and splenomegaly. This report documents the efficacy and safety of a hand-assisted laparoscopic splenectomy (HALS) for hypersplenism in patients after LDLT. METHODS: Five patients underwent HALS for hypersplenism after LDLT between 1999 and 2007. The medical records of those patients were retrospectively evaluated. RESULTS: The mean operative time was 237+/-12 minutes. The mean blood loss was 229+/-100 mL and the mean weight of excised spleen was 461+/-46 g. There was no conversion to open surgery. The number of platelets and leukocytes were significantly increased after surgery. No major complications were observed except for a patient who suffered paralytic ileus postoperatively. The mean hospital stay after the operation was 16.7+/-2.5 days. CONCLUSIONS: HALS for patients after LDLT is a feasible and safe procedure. This technique can thus become a standard procedure after LDLT.


Assuntos
Hiperesplenismo/cirurgia , Laparoscopia/estatística & dados numéricos , Transplante de Fígado/efeitos adversos , Doadores Vivos , Esplenectomia/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Hiperesplenismo/etiologia , Japão , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esplenectomia/efeitos adversos , Esplenectomia/métodos , Esplenopatias/cirurgia , Fatores de Tempo , Aderências Teciduais/cirurgia
18.
J Gastroenterol Hepatol ; 24(9): 1554-8, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19743999

RESUMO

AIM: This study investigated the relationship between portal hypertensive gastropathy (PHG) and splenomegaly, and the effect of laparoscopic splenectomy on PHG in cirrhotic patients with portal hypertension. METHODS: Seventy patients with liver cirrhosis and portal hypertension were prospectively studied. Indication for laparoscopic splenectomy was bleeding tendency in 10 patients, induction of interferon in 45, treatment of hepatocellular carcinoma in seven, and treatment for endoscopic injection sclerotherapy-resistant esophagogastric varices in eight. The severity of PHG was classified into none, mild, or severe according to the classification by McCormack et al. The severity of liver disease was classified using the Child-Pugh score. All patients underwent upper gastrointestinal endoscopy before and 1 month after the operation. RESULTS: The prevalence of PHG was significantly correlated with the severity of liver disease using the Child-Pugh score. The severity of PHG was significantly correlated with the resected spleen volume. One month after the operation, PHG was improved in 16 of 17 patients with severe PHG and in 12 of 32 with mild PHG. The Child-Pugh score showed a significant improvement (6.8 +/- 1.4 to 6.2 +/- 1.2) at 3 months after laparoscopic splenectomy (P < 0.0001). CONCLUSIONS: PHG may be associated with splenomegaly, and laparoscopic splenectomy may have a beneficial effect on PHG, at least for a short time.


Assuntos
Hipertensão Portal/etiologia , Laparoscópios , Cirrose Hepática/complicações , Esplenectomia/métodos , Esplenomegalia/cirurgia , Gastropatias/etiologia , Adulto , Idoso , Endoscopia Gastrointestinal , Feminino , Humanos , Hipertensão Portal/patologia , Hipertensão Portal/cirurgia , Cirrose Hepática/patologia , Cirrose Hepática/cirurgia , Testes de Função Hepática , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Esplenomegalia/etiologia , Esplenomegalia/patologia , Gastropatias/patologia , Gastropatias/cirurgia , Fatores de Tempo , Resultado do Tratamento
19.
J Hepatobiliary Pancreat Surg ; 16(6): 749-57, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19629372

RESUMO

BACKGROUND/PURPOSE: The aims of this study were to standardize the techniques of laparoscopic splenectomy (LS) to improve safety in liver cirrhosis patients with portal hypertension. METHODS: From 1993 to 2008, 265 cirrhotic patients underwent LS. Child-Pugh class was A in 112 patients, B in 124, and C in 29. Since January 2005, we have adopted the standardized LS including the following three points: hand-assisted laparoscopic surgery (HALS) should be performed in patients with splenomegaly (> or =1,000 mL), perisplenic collateral vessels, or Child-Pugh score 9 or more; complete division and sufficient elevation of the upper pole of the spleen should be performed before the splenic hilar division; and when surgeons feel the division of the upper pole of the spleen is too difficult, conversion to HALS should be performed. RESULTS: There were no deaths related to LS in this study. After the standardization, conversion to open surgery significantly reduced from 11 (10.3%) of 106 to 3 (1.9%) of 159 patients (P < 0.05). The average operation time and blood loss significantly reduced from 259 to 234 min (P < 0.01) and from 506 to 171 g (P < 0.01), respectively. CONCLUSIONS: With the technical standardization, LS becomes a feasible and safe approach in the setting of liver cirrhosis and portal hypertension.


Assuntos
Hiperesplenismo/cirurgia , Laparoscopia/normas , Cirrose Hepática/complicações , Esplenectomia/normas , Adulto , Idoso , Feminino , Humanos , Hiperesplenismo/patologia , Hipertensão Portal/complicações , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Esplenectomia/métodos
20.
Surg Today ; 38(6): 576-7, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18516544

RESUMO

Small-bowel volvulus around the superior mesenteric artery is a very unusual cause of small-intestinal obstruction, which may result in intestinal ischemia and necrosis. A 45-year-old woman, who had received a living-donor liver transplant with a right lobe graft for fulminant hepatic failure 5 years earlier, underwent a liver biopsy and was placed in the right decubitus position. Abdominal pain, high fever, tachycardia, and altered mental status developed quickly, suggesting abdominal sepsis. Computed tomography (CT) showed a "target sign," representing a counter-clockwise rotation of the mesenteric pedicle. However, without laparotomy, the symptoms subsided completely within 12 h by her lying strictly in the left decubitus position. A second CT scan showed an orthotopic untwisted jejunum. Although many complications associated with percutaneous liver biopsy have been described, to our knowledge this is the first report of positioning-associated intestinal volvulus after a liver biopsy.


Assuntos
Biópsia/efeitos adversos , Volvo Intestinal/etiologia , Doenças do Jejuno/etiologia , Fígado/patologia , Artéria Mesentérica Superior , Feminino , Humanos , Volvo Intestinal/diagnóstico por imagem , Doenças do Jejuno/diagnóstico por imagem , Transplante de Fígado , Pessoa de Meia-Idade , Postura , Tomografia Computadorizada por Raios X
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