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2.
Internist (Berl) ; 61(5): 513-517, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32246182

RESUMO

This article presents the case of a 75-year-old male patient, who underwent a percutaneous abscess puncture of a liver abscess. A few days after the puncture and drainage there was a sudden onset of right upper quadrant abdominal pain accompanied by hematochezia. The patient presented with markedly elevated liver enzyme levels and a significant drop in hemoglobin concentration. After gastroscopy and abdominal computed tomography (CT) in the portal venous phase no bleeding source could be identified. A false aneurysm of the cystic artery was identified only after a CT angiography of the abdomen. Due to spontaneous cessation of the bleeding a cholecystectomy was subsequently performed for definitive treatment of the false aneurysm.


Assuntos
Dor Abdominal/etiologia , Aneurisma/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Hemorragia Gastrointestinal/etiologia , Artéria Hepática/diagnóstico por imagem , Abscesso Hepático/cirurgia , Punções/efeitos adversos , Idoso , Aneurisma/cirurgia , Colecistectomia , Drenagem , Artéria Hepática/cirurgia , Humanos , Masculino , Resultado do Tratamento
3.
Acta Cir Bras ; 34(11): e201901103, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939502

RESUMO

PURPOSE: To evaluate liver regeneration after selective ligation of portal vein and hepatic artery by 3D Computed Tomography in an experimental model. METHODS: Sixteen Wistar rats were randomized into four equal groups: Group I- control (sham), Group II- isolated selective ligation of the hepatic artery, Group III- isolated selective ligation of the portal vein and Group IV- combined ligation of portal vein and hepatic artery. Before procedure and five days after a 3D CT Scan was performed to analyze the hypertrophy, weight and function of the remnant liver. RESULTS: The largest regeneration rate and increase of weight in the hypertrophied lobe was detected in group IV, the first with an average of 3.99 (p=0.006) and the last varying from 6.10g to 9.64g (p=0.01). However, total liver weight and the R1 ratio (Hypertrophied Lobe Weight/Total Liver Weight) was higher in group III (P<0.001) when compared with groups I, II and IV and showed no difference between them. The immunohistochemical examination with PCNA also found higher percentages with statistical significance differences in rats of groups III and IV. It was possible to confirm a strong correlation between hypertrophied lobe weight and its imaging volumetric study. Liver function tests only showed a significant difference in serum gamma-glutamyltransferase and phosphorous. CONCLUSION: There is a largest liver regeneration after combined ligation of portal vein and hepatic artery and this evidence may improve the knowledge of surgical treatment of liver injuries, with a translational impact in anima nobile.


Assuntos
Artéria Hepática/cirurgia , Regeneração Hepática/fisiologia , Fígado/diagnóstico por imagem , Veia Porta/cirurgia , Animais , Hepatomegalia/diagnóstico por imagem , Hepatomegalia/fisiopatologia , Imageamento Tridimensional/métodos , Imuno-Histoquímica , Ligadura , Fígado/irrigação sanguínea , Fígado/patologia , Masculino , Tamanho do Órgão/fisiologia , Distribuição Aleatória , Ratos Wistar , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
Rozhl Chir ; 98(10): 418-421, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31842573

RESUMO

Hepatic artery thrombosis is the most common vascular complication after liver transplantation. Early thrombosis is treated by surgical revascularization; if not feasible, there is need for urgent retransplantation. Late thrombosis is diagnosed mostly when clinical symptoms or graft dysfunction are present, in which case the only possible therapy is retransplantation. We present a case of a young patient with late thrombosis of an aorto-hepatic bypass, in whom we successfully used thrombolytic therapy with stent-graft placement.


Assuntos
Aorta/cirurgia , Implante de Prótese Vascular/métodos , Artéria Hepática/cirurgia , Hepatopatias/cirurgia , Transplante de Fígado/efeitos adversos , Trombose/cirurgia , Procedimentos Endovasculares , Humanos , Reoperação , Terapia Trombolítica , Trombose/etiologia , Trombose/terapia , Fatores de Tempo , Resultado do Tratamento
5.
Acta cir. bras ; 34(11): e201901103, Nov. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1054680

RESUMO

Abstract Purpose: To evaluate liver regeneration after selective ligation of portal vein and hepatic artery by 3D Computed Tomography in an experimental model. Methods: Sixteen Wistar rats were randomized into four equal groups: Group I- control (sham), Group II- isolated selective ligation of the hepatic artery, Group III- isolated selective ligation of the portal vein and Group IV- combined ligation of portal vein and hepatic artery. Before procedure and five days after a 3D CT Scan was performed to analyze the hypertrophy, weight and function of the remnant liver. Results: The largest regeneration rate and increase of weight in the hypertrophied lobe was detected in group IV, the first with an average of 3.99 (p=0.006) and the last varying from 6.10g to 9.64g (p=0.01). However, total liver weight and the R1 ratio (Hypertrophied Lobe Weight/Total Liver Weight) was higher in group III (P<0.001) when compared with groups I, II and IV and showed no difference between them. The immunohistochemical examination with PCNA also found higher percentages with statistical significance differences in rats of groups III and IV. It was possible to confirm a strong correlation between hypertrophied lobe weight and its imaging volumetric study. Liver function tests only showed a significant difference in serum gamma-glutamyltransferase and phosphorous. Conclusion: There is a largest liver regeneration after combined ligation of portal vein and hepatic artery and this evidence may improve the knowledge of surgical treatment of liver injuries, with a translational impact in anima nobile.


Assuntos
Animais , Masculino , Veia Porta/cirurgia , Artéria Hepática/cirurgia , Fígado/diagnóstico por imagem , Regeneração Hepática/fisiologia , Tamanho do Órgão/fisiologia , Imuno-Histoquímica , Distribuição Aleatória , Tomografia Computadorizada por Raios X/métodos , Reprodutibilidade dos Testes , Resultado do Tratamento , Ratos Wistar , Imageamento Tridimensional/métodos , Hepatomegalia/fisiopatologia , Hepatomegalia/diagnóstico por imagem , Ligadura , Fígado/irrigação sanguínea , Fígado/patologia
7.
Intern Med ; 58(18): 2721-2726, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31527370

RESUMO

A middle-aged man presented with a fever, arthralgia, gastrointestinal symptoms, headache, and rash. After two weeks, the patient suddenly complained of severe abdominal pain, and computed tomography revealed aneurysms in the hepatic and splenic arteries, which increased in size progressively. Given the elevated levels of inflammatory markers and orchitis, polyarteritis nodosa (PN) was initially suspected. Catheter embolization for the ruptured hepatic aneurysm and splenectomy for the large splenic ones were performed, and the pathological finding was consistent with segmental arterial mediolysis (SAM). Changes in inflammatory marker levels and aneurysmal size are also informative to differentiate SAM from PN.


Assuntos
Aneurisma Roto/cirurgia , Embolização Terapêutica/métodos , Artéria Hepática/cirurgia , Poliarterite Nodosa/diagnóstico , Poliarterite Nodosa/cirurgia , Artéria Esplênica/cirurgia , Túnica Média/cirurgia , Aneurisma Roto/fisiopatologia , Artéria Hepática/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Poliarterite Nodosa/fisiopatologia , Artéria Esplênica/fisiopatologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Túnica Média/fisiopatologia
8.
World J Surg Oncol ; 17(1): 124, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315628

RESUMO

BACKGROUND: The exact contribution of preoperative coil embolization in distal pancreatectomy with en bloc celiac axis resection (DP-CAR) for the prevention of ischemic liver complication is not fully elucidated. METHODS: From January 2004 to July 2015, 31 patients underwent DP-CAR for the pancreatic body-tail cancer. Twenty-three patients received preoperative coil embolization. The characteristics and operative outcomes were analyzed retrospectively. RESULTS: The median survival time and 1- and 3-year overall survival rates were 23.7 months and 74.2% and 34.4%, respectively. No 30-day mortality occurred in any of the patients. Postoperative liver infarction developed only in 8 patients (25.8%) even though 7 of 8 patients had undergone preoperative coil embolization. Tumor contact with the gastroduodenal artery (GDA)/proper hepatic artery (PHA) on preoperative multi-detector computed tomography (MDCT), tumor size, operative time, portal vein resection, and stenosis of the GDA/PHA after DP-CAR are related to liver infarction. Among them, postoperative stenosis of the GDA/PHA on MDCT, which was observed in all 8 patients with liver infarction, was the most closely related factor to postoperative liver infarction. Tumor contact with the GDA/PHA did not worsen the R0 resection rate or overall survival rate. CONCLUSION: Our data indicate that preoperative coil embolization of the common hepatic artery is not useful in DP-CAR as long as GDA is completely preserved during surgery.


Assuntos
Artéria Celíaca/cirurgia , Embolização Terapêutica/métodos , Artéria Hepática/cirurgia , Pancreatectomia/mortalidade , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Vasculares/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Celíaca/patologia , Embolização Terapêutica/instrumentação , Feminino , Seguimentos , Artéria Hepática/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/patologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
9.
Transplant Proc ; 51(9): 3103-3106, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31155307

RESUMO

BACKGROUND: Celiac axis compression syndrome (CACS) blocks adequate hepatic arterial flow and is a risk factor for hepatic artery thrombosis after liver transplantation. We report a case of living donor liver transplantation in a 65-year-old Brazilian male with liver cirrhosis of Child-Pugh class C and hepatocellular carcinoma caused by hepatitis C virus infection. RESULTS: The patient underwent living donor liver transplantation using the graft of his 34-year-old daughter. Stenosis of the celiac artery was detected on preoperative computed tomography (CT), and CACS was suspected. Maintaining blood supply through the hepatic artery to prevent potential graft loss is essential in liver transplantation. A decrease in common hepatic artery (CHA) flow due to CACS could disturb graft blood supply or lead to hepatic artery thrombosis. In this case, we confirmed CACS through dynamic CT and used intraoperative Doppler ultrasonography (US) to plan the surgical procedure. Three types of hepatic artery reconstruction have been described in liver transplantation for CACS, namely the release of the median arcuate ligament (MAL), aorto-hepatic graft reconstructions, and reconstruction preserving the gastroduodenal artery (GDA) without MAL release. We found that clamping the GDA completely abolished hepatic inflow, but clamping the CHA did not change the hepatic inflow. Therefore, we performed arterial reconstruction without division of the GDA. The patient's postoperative course was good, with excellent hepatic artery flow, as assessed by Doppler US. CONCLUSIONS: Preoperative dynamic CT evaluation, adequate preparation of surgical procedures, and intraoperative evaluation by Doppler US is recommended in liver transplantation patients with CACS.


Assuntos
Artéria Hepática/cirurgia , Transplante de Fígado/métodos , Síndrome do Ligamento Arqueado Mediano/complicações , Ultrassonografia Doppler/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Brasil , Humanos , Doadores Vivos , Masculino , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X/efeitos adversos
10.
Cardiovasc Intervent Radiol ; 42(9): 1352-1357, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31076840

RESUMO

PURPOSE: We evaluated the usefulness of the Amplatzer vascular plug (AVP) for preoperative embolization before distal pancreatectomy with en bloc celiac axis resection (DP-CAR). MATERIALS AND METHODS: Between April 2010 and September 2017, 19 patients with locally advanced pancreatic body cancer underwent preoperative embolization of the common hepatic and the left gastric artery (CHA, LGA) with AVP or coils. We compared the embolization success rate, embolization-related complications, the time required for preoperative embolization before DP-CAR and the procedure costs in patients whose CHA was AVP- (n = 7) or coil (n = 12) embolized. RESULTS: The success rate for preoperative AVP and coil embolization was 100% and 83.3%, respectively. The median procedure time was shorter in patients whose CHA was embolized with AVP than coils; the difference was not significant (p = 0.045). The total cost was significantly lower for AVP than coil embolization (p = 0.01). CONCLUSION: The AVP is useful for the preoperative embolization of the CHA before DP-CAR.


Assuntos
Artéria Celíaca/cirurgia , Embolização Terapêutica/instrumentação , Embolização Terapêutica/métodos , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Cuidados Pré-Operatórios/métodos , Idoso , Feminino , Artéria Gástrica/diagnóstico por imagem , Artéria Gástrica/cirurgia , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Neoplasias Pancreáticas/diagnóstico por imagem , Radiografia , Dispositivo para Oclusão Septal
12.
Ann Surg Oncol ; 26(9): 2980, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31102093

RESUMO

BACKGROUND: Despite the widespread use of laparoscopic hepatectomies in past decades, laparoscopic isolated total caudate lobectomy for hepatocellular carcinoma (HCC) remains challenging,1,2 especially for patients with cirrhosis. Moreover, a laparoscopic isolated total caudate lobectomy for HCC originating in the paracaval portion of the caudate lobe is very rare. We herein present a video showing laparoscopic total caudate lobectomy for a cirrhotic patient with HCC located in the paracaval portion of the caudate lobe. METHODS: A 58-year-old woman who suffered from hepatitis C virus-related cirrhosis was admitted to our institution. The preoperative computed tomography showed a 2.5 × 2.0 cm liver mass located in segment I that was very close to the right hepatic pedicle. Although her liver function was Child-Pugh A, the indocyanine green (ICG)-15 test was high at 10.9%. Right hepatectomy plus caudate lobectomy was not adopted because of the severe cirrhosis and the elevated ICG-15. Thus, laparoscopic isolated total caudate lobectomy was contemplated. RESULTS: The patient was placed in the supine position. After full mobilization, the caudate lobe was exposed. The third porta of the liver was then dissected and the short hepatic veins were controlled with clips and LigaSure. The dissection was finished when the whole third porta of the liver was freed. Subsequently, the portal branches to the caudate lobe were ligated and cut. The combination between the left- and right-sided laparoscopic approaches was used to transect liver parenchyma. The superficial parenchyma was divided using an harmonic scalpel, while the deeper tissue was divided using a Cavitron ultrasonic aspirator (CUSA). The Pringle maneuver was used intermittently during the parenchymal transection as necessary. In the left-sided approach, the caudate lobe was resected along the left and middle hepatic vein toward the right side, to expose the dorsal semicircle of the right hepatic vein. In the right-sided approach, the resection started from the right border of the process portion to the root of the right hepatic vein in the cranial direction. Finally, the whole caudate lobe was resected and the three main hepatic veins were exposed on the cutting plane. The specimen was removed from suprapubic incision. The operative time was 300 min and the total Pringle time was 50 min. The postoperative course was uneventful. CONCLUSIONS: A laparoscopic isolated total caudate lobectomy for HCC located in the paracaval portion of the cirrhotic liver seems to be feasible and safe in selected patients.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Artéria Hepática/cirurgia , Laparoscopia/métodos , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/cirurgia , Veia Porta/cirurgia , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/patologia , Feminino , Artéria Hepática/patologia , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/patologia , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/patologia , Pessoa de Meia-Idade , Veia Porta/patologia , Prognóstico , Gravação em Vídeo
13.
Transplant Proc ; 51(4): 1162-1168, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31101192

RESUMO

AIM: Hepatic artery thrombosis is one of the major complications affecting patient and graft survival after liver transplantation. In this study, we analyzed the factors affecting the development of early hepatic artery thrombosis (eHAT) and its outcomes in pediatric liver transplantation. METHODS: A total of 175 pediatric patients underwent living donor liver transplantation between January 2013 and November 2018. Factors affecting eHAT and its outcomes were examined. RESULTS: Nine patients (5.1%) developed eHAT. In multivariate analysis, intraoperative hepatic artery revision and Roux-en-Y hepaticojejunostomy biliary reconstruction type were statistically significant (all, P < .05). Thrombectomy and reanastomosis was performed in 5 patients. Two of them were successful. In total, 3 retransplantations were performed and all of those patients are still alive. CONCLUSION: The factors affecting eHAT are still a matter of debate. Intraoperative hepatic artery anastomosis revision and Roux-en-Y hepaticojejunostomy reconstruction were independent risk factors for development of eHAT. In the present study, the confidence interval of the variables is high, therefore exact determination of the risk factors may not be possible. Early detection and thrombectomy and reanastomosis may be the first treatment of choice to rescue the patient and graft. When it fails, retransplantation must be an alternative. The results of the present study state that at least once a day the vascular anastomosis must be examined by Doppler ultrasonography in the post-transplant first week. It must be repeated when liver enzymes increase. The patients under high risk for eHAT may be followed up closer.


Assuntos
Artéria Hepática/patologia , Transplante de Fígado/efeitos adversos , Trombose/etiologia , Adolescente , Criança , Pré-Escolar , Feminino , Artéria Hepática/cirurgia , Humanos , Doadores Vivos , Masculino , Fatores de Risco
14.
J Cancer Res Ther ; 15(2): 341-343, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30964108

RESUMO

Purpose: The purpose of this study is to evaluate the feasibility of percutaneous transauricular artery access for hepatic artery catheterization using a peripherally inserted central catheter (PICC) device and hepatic artery catheterization through auricular approach. Methods: Ten New Zealand White rabbits were used to establish a VX2 liver tumor model. Hepatic artery angiography and embolization were performed 3 weeks after inoculation. The rabbits were restrained in supine position under anesthesia. Intra-arterial access was accomplished with percutaneous Seldinger technique through the auricular artery using a PICC device. The hepatic artery catheterization was performed with a microcatheter and guide wire. The rate of technical success and procedure time was investigated. Results: Two rabbits failed initial percutaneous transauricular arterial access, with success in a contralateral attempt. Thus, percutaneous transauricular arterial access was achieved in 10 of 12 auricular arteries, with a technical success rate of 83.3%. The time needed to obtain intra-auricular access was 7.2 ± 3.1 min. Hepatic artery catheterization, angiography, and embolization were accomplished through the auricular approach in all 10 rabbits. Conclusion: Arterial access in rabbits can be achieved through the auricular artery. Hepatic artery catheterization, angiography, and embolization can be performed through auricular arterial access.


Assuntos
Carcinoma Hepatocelular/cirurgia , Quimioembolização Terapêutica/métodos , Artéria Hepática/cirurgia , Neoplasias Hepáticas/cirurgia , Angiografia/métodos , Animais , Carcinoma Hepatocelular/diagnóstico , Cateteres de Demora , Modelos Animais de Doenças , Humanos , Neoplasias Hepáticas/diagnóstico , Coelhos , Resultado do Tratamento , Ensaios Antitumorais Modelo de Xenoenxerto
16.
J Plast Surg Hand Surg ; 53(4): 216-220, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30929554

RESUMO

In living donor liver transplantation (LDLT) patients, the reconstruction of insufficiently long hepatic artery (HA) is difficult. However, no report has described the relationship between the length of HA and its reconstructive procedure. Herein, we aimed to identify the risk factors for the requirement of additional reconstructive procedures of direct anastomosis. Sixty-eight HA reconstructions in LDLT were conducted (37, men; 31, women). The causes of LDLT were hepatitis (n = 36), biliary atresia (n = 13), and primary biliary cirrhosis (n = 12). The graft HA comprised the right HA (n = 37) and left HA (n = 31). The recipient HA comprised the right HA (n = 39), left HA (n = 28), and right gastro-omental artery (n = 1). Two cases had graft HAs measuring 8 mm or more. The gap between the graft and recipient HA was 6 mm or more in nine cases. In 63 cases, direct anastomosis was performed. The extension of graft HA was performed using radial graft (n = 1) and two-step method (n = 1). The extension of recipient HA was performed using arterial graft (n = 2) extraanatomical recipient artery. Less than 8 mm length of graft HA (OR, 84) and 6 mm or greater gap between the recipient and graft HA (OR, 46.0) were identified as the risk factors for the need of additional procedures of direct anastomosis. We must always pay attention to the length of the graft and donor HA. To perform HA reconstruction safely, we should always consider using arterial grafts, extra-anatomical recipient artery, or the two-step method.


Assuntos
Anastomose Cirúrgica/métodos , Artéria Hepática/cirurgia , Transplante de Fígado , Doadores Vivos , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Artérias/transplante , Feminino , Artéria Hepática/anatomia & histologia , Humanos , Masculino , Fatores de Risco
17.
Langenbecks Arch Surg ; 404(3): 293-300, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30859361

RESUMO

PURPOSE: Occasionally, a recipient's native hepatic arteries are not suitable for reconstruction in living donor liver transplantation (LDLT). The use of the great saphenous vein (GSV) conduits in such patients is seldom practiced since arterial conduits from deceased donors are available. Here, we share our experience with a significantly large group of LDLT recipients who underwent arterial reconstruction with GSV conduits. METHODS: We reviewed patients who underwent LDLT between 2012 and 2017. Patients who had arterial reconstruction using native hepatic arteries (group 1)(n = 452) were compared with those who had GSV interposition conduits for reconstruction (group 2)(n = 21). We compared hepatic artery thrombosis (HAT) rate, allograft dysfunction, morbidity, mortality, and actuarial 5-year survival in the two groups. RESULTS: HAT was seen in 0/452 (0%) versus 1/21(4.7%) patients (P = 0.04). Allograft dysfunction was seen in 89/423 (21%) versus 6/19(31.5%) (P = 0.2) patients. Overall mortality was 81/452 (17.9%) versus 8/21(38%) (P = 0.02). Death after a biliary complication was seen in 24/452 (5.3%) versus 4/21 (19%) patients (P = 0.02). Actuarial 1- and 5-year overall survival was 85% versus 67% and 79% versus 58% (P = 0.008). CONCLUSION: GSV conduits are a suboptimal alternative for establishing hepatic arterial inflow in LDLT, but remain valuable in ominous situations.


Assuntos
Artéria Hepática/cirurgia , Transplante de Fígado , Doadores Vivos , Veia Safena/transplante , Procedimentos Cirúrgicos Vasculares/métodos , Adolescente , Adulto , Idoso , Anastomose Cirúrgica , Feminino , Sobrevivência de Enxerto , Humanos , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida
18.
J Hepatobiliary Pancreat Sci ; 26(5): 159-168, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30825363

RESUMO

BACKGROUND: We sought to expand the clinico-anatomical limit of the proximal ductal margin (Limit-PDM) for resectability of hilar cholangiocarcinoma (HCCA). METHODS: The practical boundary of the hilar plate (PBHP) was defined as the location where the bile duct (BD) could not be isolated by dissection. The distance between PBHP and two well-known clinical landmarks of Limit-PDM, the right edge of the bifurcation of the anterior and posterior branch of the right portal vein (Posterior-Landmark) and the left edge of the umbilical portion of the portal vein (Left-Landmark), and histological features around the PBHP were assessed using 55 adult cadaver livers. RESULTS: BD was almost always isolatable beyond the traditional clinical landmarks. The median distance was 6.9 mm (interquartile range [IQR] 6.0-8.3 mm) between the PBHP and the Posterior-Landmark, and 8.9 mm (IQR 6.7-10.2 mm) between the PBHP and the Left-Landmark. Histologically, the sheath surrounding the portal triad was loose, thick with few elastic fibers and small arteries near the hepatic hilum. Near the PBHP, the sheath was dense, thin, and abundant with elastic fibers and small arteries. CONCLUSIONS: Limit-PDM is more peripheral than the traditional clinical landmark-based margin and histological transition near the PBHP was revealed.


Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares/cirurgia , Tumor de Klatskin/cirurgia , Neoplasias dos Ductos Biliares/patologia , Ductos Biliares/anatomia & histologia , Ductos Biliares/patologia , Cadáver , Artéria Hepática/patologia , Artéria Hepática/cirurgia , Humanos , Tumor de Klatskin/patologia , Fígado/patologia , Fígado/cirurgia , Veia Porta/patologia , Veia Porta/cirurgia
20.
Transplant Proc ; 51(2): 416-420, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30879555

RESUMO

AIMS: Variations of the anatomy of donor hepatic arteries increase the number of arterial anastomoses during liver transplantation and, possibly, the incidence of hepatic artery thrombosis (HAT). In this study, we describe the arterial anatomic variations in liver grafts procured and transplanted by a single center in Greece, the techniques of arterial anastomosis, and their effect on the incidence of early HAT. MATERIALS AND METHODS: From January 2013 to December 2017, the arterial anatomy of 116 grafts procured for liver transplantation were recorded, as well as the technique of arterial anastomosis and the incidence of early hepatic artery thrombosis (HAT <30 days). RESULTS: A single hepatic artery was recorded in 72.41% of the procured grafts, an aberrant left hepatic artery (accessory or replaced) in 18 grafts (15.52%), and an aberrant right hepatic artery (accessory or replaced) in 17 grafts (14.66%), while other variations were observed in less than 1% of the procured livers. Of the 116 primary liver transplantations, 6 patients (5.17%) developed early HAT <30 days. Two of these patients (1.72%) had 1 anastomosis of the hepatic artery and 4 (3.45%) had 2 anastomoses due to anatomic variations. CONCLUSIONS: Anatomic variations of the hepatic artery in liver grafts is a common finding and increase the incidence of early HAT but not to a degree to make these grafts unusable.


Assuntos
Artéria Hepática/anormalidades , Artéria Hepática/cirurgia , Transplante de Fígado/métodos , Trombose/epidemiologia , Trombose/etiologia , Adulto , Anastomose Cirúrgica/métodos , Variação Anatômica , Feminino , Grécia , Humanos , Incidência , Hepatopatias/epidemiologia , Hepatopatias/etiologia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Vasculares/métodos
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