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1.
Ultrasonics ; 110: 106287, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33091652

RESUMO

In this paper, we proposed ultrasound homodyned K (HK) imaging based on the noise-assisted correlation algorithm (NCA) for monitoring microwave ablation of porcine liver ex vivo. The NCA-based HK (αNCA and kNCA) imaging was compared with NCA-based Nakagami (mNCA) imaging and NCA-based cumulative echo decorrelation (CEDNCA) imaging. Backscattered ultrasound radiofrequency signals of porcine liver ex vivo during and after the heating of microwave ablation were collected (n = 15), which were processed for constructing B-mode imaging, NCA-based HK imaging, NCA-based Nakagami imaging, and NCA-based CED imaging. To quantitatively evaluate the final coagulation zone, the polynomial approximation (PAX) technique was applied. The accuracy of detecting coagulation area with αNCA, kNCA, mNCA, and CEDNCA parametric imaging was evaluated by comparing the PAX imaging with the gross pathology. The receiver operating characteristic (ROC) curve was used to further evaluate the performance of the three quantitative ultrasound imaging methods for detecting the coagulation zone. Experimental results showed that the average accuracies of αNCA, kNCA, mNCA, and CEDNCA parametric imaging combined with PAX imaging were 89.6%, 83.25%, 89.23%, and 91.6%, respectively. The average areas under the ROC curve (AUROCs) of αNCA, kNCA, mNCA, and CEDNCA parametric imaging were 0.83, 0.77, 0.83, and 0.86, respectively. The proposed NCA-based HK imaging may be used as a new method for monitoring microwave ablation.


Assuntos
Técnicas de Ablação , Fígado/diagnóstico por imagem , Fígado/cirurgia , Micro-Ondas/uso terapêutico , Ultrassonografia/métodos , Algoritmos , Animais , Processamento de Imagem Assistida por Computador , Técnicas In Vitro , Suínos
2.
Br J Radiol ; 94(1117): 20200415, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33245679

RESUMO

OBJECTIVE: To evaluate the use of transarterial chemoembolisation (TACE) combined with microwave ablation (MWA) to treat patients with hepatocellular carcinoma (HCC) and type Ⅱ-Ⅲ portal vein tumour thrombosis (PVTT) intolerant to targeted drug (TG) therapy. METHODS: A total of 18 patients with HCC and type Ⅱ-Ⅲ PVTT intolerant to TG were enrolled between June 2015 and December 2019, who were treated with TACE + MWA (MWA group). 24 patients were treated with TACE + TG (TG group; control cohort). Time to progression and overall survival (OS) were analysed along with the incidence of adverse events. RESULTS: The median follow-up time was 19.0 months (9.0-32.0 months). The median OS was 17.0 months (8.3-29.3 months; MWA group) and 13.5 months (5.5-22.5 months; TG group) and was not significantly different. The 1- and 2 year OS was also comparable (MWA group: 66.7%, 44.4% vs Target group: 41.7%, 29.2%). Time to progression showed no distinct differences (MWA group: 11.5 months; TG group: 9.0 months) between the two groups. Moreover, the incidence of major Grade 3-4 adverse events in the MWA group (5.6%) was similar to those in the TG group (8.3%). CONCLUSION: TACE + MWA and TACE + TG were comparable in their safety and efficacy in patients with HCC, type Ⅱ-Ⅲ PVTT, and intolerance to TG. ADVANCES IN KNOWLEDGE: TACE + MWA can be used as a palliative treatment alternative for TACE + TG in patients with HCC, type Ⅱ-Ⅲ PVTT, and intolerance to TG.


Assuntos
Técnicas de Ablação/métodos , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Veia Porta/patologia , Trombose Venosa/terapia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/cirurgia , Terapia Combinada/métodos , Feminino , Seguimentos , Humanos , Fígado/cirurgia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/cirurgia , Masculino , Micro-Ondas , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
3.
Zhonghua Wai Ke Za Zhi ; 58(11): 835-840, 2020 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-33120445

RESUMO

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can speed up the regeneration of future liver remnant (FLR) in short period of time, and offer a chance for surgical resection for patients without sufficient FLR. However, ALPPS still remains controversy due to its high perioperative morbidity and mortality, as well as the uncertain long-term oncological benefits. How to solve these problems is the key to ensure the safety of surgery.This article focus on the indication selection, liver function reserve evaluation and timing to perform the second stage surgery, surgical mode evolution and comparison with portal venous embolization/portal venous ligation+two-stage hepatectomy.


Assuntos
Hepatectomia , Neoplasias Hepáticas , Fígado/cirurgia , Veia Porta/cirurgia , Embolização Terapêutica , Hepatectomia/métodos , Humanos , Ligadura , Fígado/anatomia & histologia , Fígado/fisiologia , Neoplasias Hepáticas/cirurgia , Regeneração Hepática , Resultado do Tratamento
4.
Anticancer Res ; 40(11): 6465-6471, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109585

RESUMO

AIM: To assess the utility of the perioperative use of direct oral anticoagulants for patients with hepatocellular carcinoma (HCC) with cancer-associated thrombosis. CASE REPORT: An 83-year-old woman was admitted with a solitary HCC (10-cm diameter), as well as with multiple sites of venous thromboembolism and macroscopic portal vein tumor thrombosis. She had appropriate liver function without viral hepatitis, triple-positive tumor markers, and secondary polycythemia. Edoxaban at 30 mg was initiated 10 days before surgery to remove HCC. Complete remission of the pulmonary embolism and stability of the deep vein thrombosis and massive superior mesenteric vein thrombosis were recognized preoperatively. An extended left hepatectomy was successfully performed. To avoid hemorrhage complications, we used intravenous administration of nafamostat mesylate for 2 days, thereafter we restarted edoxaban. Superior mesenteric vein thrombosis resolved 5 months after surgery. CONCLUSION: Perioperative oral administration of edoxaban was useful in multidisciplinary treatment for a patient with advanced HCC with cancer-associated thrombosis.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Fígado/cirurgia , Trombose/tratamento farmacológico , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/patologia , Feminino , Humanos , Fígado/efeitos dos fármacos , Fígado/patologia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/patologia , Trombose/complicações , Trombose/patologia , Trombose/cirurgia
5.
Anticancer Res ; 40(11): 6545-6550, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109596

RESUMO

BACKGROUND/AIM: To evaluate the complication rates and risk factors associated with transumbilical wounds and investigate the usefulness of an incision for organ removal in laparoscopic hepatectomy (Lap-H). PATIENTS AND METHODS: We enrolled 42 patients who underwent Lap-H excluding a small partial resection in our hospital between 2013 and 2018. The occurrences of superficial surgical site infection (SSI) and transumbilical port-site incisional hernia were recorded. RESULTS: SSI was not observed, and hernia occurred in 3 patients (7.14%). Univariate analysis revealed that body mass index (BMI) (p=0.004) was significantly associated with the risk of hernia formation. CONCLUSION: High BMI is a risk factor for hernia formation in patients undergoing Lap-H with transumbilical incision; hence, wound closure should be performed carefully. The construction of the transumbilical wound for organ removal was feasible with rationality, with no need to create a new wound.


Assuntos
Hepatectomia , Neoplasias Hepáticas/cirurgia , Fígado/cirurgia , Umbigo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hérnia/fisiopatologia , Humanos , Laparoscopia , Fígado/patologia , Neoplasias Hepáticas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Infecção da Ferida Cirúrgica/fisiopatologia , Umbigo/fisiopatologia
6.
Khirurgiia (Mosk) ; (8): 103-106, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869622

RESUMO

The authors describe modern 3D technologies in hepatobiliary surgery. These approaches reduce the risk of intra- and postoperative complications. Virtual 3D reconstruction with clear visualization of parasitic cyst, adjacent vessels and bile ducts is valuable to create 3D-model of liver. This model may be applied for personalized laparoscopic approach and precise surgical intervention.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/métodos , Hepatectomia/métodos , Imageamento Tridimensional , Fígado/cirurgia , Cirurgia Assistida por Computador , Ductos Biliares/diagnóstico por imagem , Ductos Biliares/cirurgia , Humanos , Laparoscopia , Fígado/diagnóstico por imagem , Modelagem Computacional Específica para o Paciente , Complicações Pós-Operatórias/prevenção & controle
7.
Nat Commun ; 11(1): 4383, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32873799

RESUMO

Mongolia has the highest incidence of hepatocellular carcinoma (HCC) in the world, but its causative factors and underlying tumor biology remain unknown. Here, we describe molecular characteristics of HCC from 76 Mongolian patients by whole-exome and transcriptome sequencing. We present a comprehensive analysis of mutational signatures, driver genes, and molecular subtypes of Mongolian HCC compared to 373 HCC patients of different races and ethnicities and diverse etiologies. Mongolian HCC consists of prognostic molecular subtypes similar to those found in patients from other areas of Asia, Europe, and North America, as well as other unique subtypes, suggesting the presence of distinct etiologies linked to Mongolian patients. In addition to common driver mutations (TP53, CTNNB1) frequently found in pan-cancer analysis, Mongolian HCC exhibits unique drivers (most notably GTF2IRD2B, PNRC2, and SPTA1), the latter of which is associated with hepatitis D viral infection. These results suggest the existence of new molecular mechanisms at play in Mongolian hepatocarcinogenesis.


Assuntos
Biomarcadores Tumorais/genética , Carcinoma Hepatocelular/genética , Regulação Neoplásica da Expressão Gênica , Hepatite D/genética , Neoplasias Hepáticas/genética , Idoso , Carcinogênese/genética , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/cirurgia , Carcinoma Hepatocelular/virologia , Análise Mutacional de DNA , Feminino , Perfilação da Expressão Gênica , Hepatectomia , Hepatite D/epidemiologia , Hepatite D/cirurgia , Hepatite D/virologia , Vírus Delta da Hepatite/isolamento & purificação , Humanos , Incidência , Fígado/patologia , Fígado/cirurgia , Fígado/virologia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/virologia , Masculino , Pessoa de Meia-Idade , Mongólia/epidemiologia , Mutação , Prognóstico , Sequenciamento Completo do Exoma
8.
PLoS One ; 15(9): e0239857, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986787

RESUMO

OBJECTIVE: The outcomes of children with Choledochal cyst who undergo laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy versus open cyst excision and Roux-en-Y hepaticojejunostomy have not been adequately compared. We conducted a systematic review and meta-analysis to gain further insight into the efficacy and safety of laparoscopic excision in children with choledochal cysts. METHODS: A systematic search of PubMed, Embase, Cochrane Central Register, and ClinicalTrials.gov databases from January 1973 to January 31, 2020 was performed utilizing the PRISMA guidelines. Short-term, long-term and total postoperative complications were the primary endpoint measurements, whereas intraoperative outcomes and other postoperative outcomes were the secondary endpoints. RESULTS: The final analysis included 14 retrospective cohorts comprising 1767 patients. There were no significant differences in the patients' short-term postoperative complications (RR = -1.08; 95% CI = -1.72 to -0.67) between the 2 approaches. However, improvements in long-term (RR = 0.09; 95% CI = 0.01 to 0.18) and total postoperative complications (RR = -0.29; 95% CI = -0.40 to -0.21), estimated intraoperative blood loss and transfusion, time of initial feeding, and length of hospital stay were observed in patients who underwent laparoscopic excision when compared to those who underwent open surgery. CONCLUSIONS: Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy provides similar or even improved intraoperative, postoperative outcomes when compared to open excision for children with Choledochal cyst.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Cisto do Colédoco/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Adolescente , Anastomose em-Y de Roux , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Jejuno/cirurgia , Tempo de Internação , Fígado/cirurgia , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
9.
BMC Surg ; 20(1): 172, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32736550

RESUMO

BACKGROUND: The bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components. This study aimed to analyze the structure of the bare area by an integrated study of surgical and laparoscopic images and pathological studies and describe surgical procedures focusing on the multilayered structure. METHODS: Several surgical specimens of hepatectomy were analyzed histologically to evaluate the macroscopic structure of the bare area. Laparoscopic images and cadaver anatomy of the bare area were also examined. RESULTS: The multilayered structure of the bare area comprised the liver, sub-serosal connective tissue, liver serosa, parietal peritoneum, retroperitoneal connective tissue, epimysium of the diaphragm, and diaphragm, in order from the liver to the diaphragm. The liver serosa and the parietal peritoneum fused with each other. This multilayered structure of the bare area is observed almost constantly. There are two layers in the dissection of the bare area in surgical procedures, an outer layer of the fused peritoneum (near the diaphragm) and an inner layer of the fused peritoneum (near the liver). Laparoscopic images enabled us to recognize the multilayered structure of the bare area. CONCLUSIONS: Histopathological findings showed the bare area to be a multilayered structure. In cases where tumors are located underneath the bare area, it could be important to dissect the bare area, with careful attention to its multilayered structure. Surgical dissection of the bare area in the outer layer of the fused peritoneum could allow a sufficient safety margin.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias do Colo/cirurgia , Hepatectomia , Neoplasias Hepáticas , Fígado/cirurgia , Peritônio/cirurgia , Idoso , Cadáver , Carcinoma Hepatocelular/patologia , Neoplasias do Colo/patologia , Diafragma/patologia , Diafragma/cirurgia , Dissecação , Feminino , Hepatectomia/métodos , Humanos , Laparoscopia , Fígado/anatomia & histologia , Fígado/patologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Peritônio/anatomia & histologia , Peritônio/patologia , Membrana Serosa/anatomia & histologia , Membrana Serosa/patologia , Membrana Serosa/cirurgia
10.
Z Gastroenterol ; 58(10): 945-954, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32838433

RESUMO

BACKGROUND: The lack of suitable allografts limits the availability of liver transplantation in Germany. The quality of potentially available German donor livers has to date not been analyzed. METHODS: Analysis of all donors for potential liver transplantations reported to the Eurotransplant by the German Organ Transplantation Foundation from 2010 to 2018. Categorization of transplanted and discarded organs utilizing available histopathological reports and predefined extended criteria for organ donation. RESULTS: A total of 8594 livers were offered for transplantation, of which 15.2 % were discarded. During the analysis period the proportion of donor livers from extended criteria donors increased from 65 % to 70 % (p = 0.005). In 2018, 21.3 % of offered donor livers were discarded, more than half (56.4 %) of these organs came from donors meeting multiple extended criteria. Livers were significantly more likely to be not transplanted, when from donors of older age (> 65 years; 41 vs. 28 %), BMI > 30 kg/m2 (29 vs. 14 %) or elevated transaminase levels (all p < 0,001). CONCLUSION: Despite the consistent organ scarcity in Germany, a relevant amount of livers cannot be transplanted due to a multitude of organ quality limitations. This should stimulate the search for concepts such as normothermic ex vivo machine perfusion to evaluate, protect and potentially improve organ quality.


Assuntos
Rejeição de Enxerto , Hepatopatias/cirurgia , Transplante de Fígado , Fígado/fisiopatologia , Perfusão/métodos , Doadores de Tecidos/estatística & dados numéricos , Alemanha , Humanos , Fígado/cirurgia , Preservação de Órgãos
11.
J Comput Assist Tomogr ; 44(5): 744-749, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842063

RESUMO

PURPOSE: The aim of this study was to investigate the diagnostic accuracy of computed tomography (CT) for the prediction of ablation zones from microwave ablation (MWA) and cryoablation (CA) in an ex vivo porcine liver model. METHODS: Sequential (30 seconds) CT scans were acquired during and after MWA and CA in an ex vivo porcine liver model. We generated 120-kVp equivalent reconstructions of generic dual-energy CT data sets, and comprehensive region-of-interest measurements were statistically correlated with invasive temperature monitoring using Pearson correlation coefficient. Binary logistic regression was performed for prediction of successful ablation. RESULTS: With the use of pooled data from 6 lesions in 2 separate experiments, correlation analysis of attenuation in Hounsfield units (HU) and temperature yielded r = -0.79 [confidence interval (CI), -0.85 to -0.71] for MWA and r = 0.62 (CI, 0.55 to 0.67) for CA.For MWA, there was a linear association between attenuation and temperature up to 75°C; thus, linear regression yielded a slope of -2.00 HU/°C (95% CI, -1.58 to -2.41). For CA, a linear association between attenuation and temperature was observed in the cooling phase with a slope of 2.11 HU/°C (95% CI, 1.79 to 2.58). In MWA treatment, binary logistic regression separated less than 70°C and greater than 70°C with 89.2% accuracy. Within the ice ball, temperatures above and below -20°C were distinguished with 65.3% accuracy. CONCLUSIONS: Our experiments reveal several difficulties in predicting ablation zone temperature from CT attenuation. Microwave ablation leads to gas production in the tissue, which degrades the accuracy of noninvasive temperature measurement, especially at higher temperatures. In CA, CT thermometry is limited by ice ball formation, which leads to homogeneous attenuation, nearly independent of temperature. Further research is needed to define the role of CT thermography in ablation zone monitoring in liver malignancies.


Assuntos
Técnicas de Ablação/métodos , Termografia/métodos , Tomografia Computadorizada por Raios X/métodos , Animais , Criocirurgia , Fígado/diagnóstico por imagem , Fígado/cirurgia , Micro-Ondas , Suínos
12.
Ann R Coll Surg Engl ; 102(9): 663-671, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32808799

RESUMO

INTRODUCTION: Evidence suggests that midline incisions should be closed with the small-bite technique to reduce IH formation. No recommendations exist for the closure of transverse incisions used in hepatobiliary surgery. This work systematically summarises rates of IH formation and associated technical factors for these transverse incisions. METHODS: A systematic search was undertaken. Studies describing the incidence of IH were included. Incisions were classified as transverse (two incision types) or hybrid (transverse with midline extension, comprising five incision types). The primary outcome measure was the pooled proportion of IH. Subgroup analysis based on minimum follow-up of two years and a priori definition of IH with clinical and radiological diagnosis was undertaken. FINDINGS: Thirteen studies were identified and included 5,427 patients; 1,427 patients (26.3%) underwent surgery for benign conditions, 3,465 (63.8%) for malignancy and 535 (9.9%) for conditions that were not stated or classified as 'other'. The pooled incidence of IH was 6.0% (2.0-10.0%) at a weighted mean follow-up of 17.5 months in the transverse group, compared with 15.0% (11.0-19.0%) at a weighted mean follow-up of 42.0 months in the hybrid group (p = 0.045). Subgroup analysis did not demonstrate a statistical difference in IH formation between the hybrid versus transverse groups. CONCLUSION: Owing to the limitations in study design and heterogeneity, there is limited evidence to guide incision choice and methods of closure in hepatopancreatobiliary surgery. There is an urgent need for a high-quality prospective cohort study to understand the techniques used and their outcomes, to inform future research.


Assuntos
Doenças do Sistema Digestório/cirurgia , Hérnia Incisional/etiologia , Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Colecistectomia/efeitos adversos , Colecistectomia/métodos , Humanos , Fígado/cirurgia , Transplante de Fígado/efeitos adversos
13.
Khirurgiia (Mosk) ; (7): 89-92, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736470

RESUMO

Two patients with severe liver trauma undergoing staged surgical treatment are reported in the article.


Assuntos
Traumatismos Abdominais/cirurgia , Fígado/lesões , Fígado/cirurgia , Humanos
14.
Khirurgiia (Mosk) ; (7): 111-118, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736475

RESUMO

The researches devoted to blood-saving technologies in extensive liver resections are analyzed in the manuscript. Resection of three and more liver segments is effective method of surgical treatment of various focal liver lesions. Surgical (anatomical resection with hilar glissonean access, Pringle maneuver, modern technical equipment, etc.), anesthesiological (reduction of central venous pressure, hemostatic agents) and transfusion (autologous blood donation, transfusion, cell saver, etc.) methods contribute to prevention and reduction of blood loss. Intraoperative measures for blood loss prevention should include adequate surgical incision and liver mobilization, precise techniques of parenchymal dissection (for example, cavitation surgical aspirator-destructor), use of clip applicators and local or systemic hemostatic agents.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Hemostasia Cirúrgica/métodos , Hepatectomia/métodos , Hepatopatias/cirurgia , Fígado/cirurgia , Humanos , Fígado/irrigação sanguínea , Recuperação de Sangue Operatório/métodos
16.
Surgery ; 168(3): 419-425, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32600880

RESUMO

BACKGROUND: Recent evidence suggests that gadolinium ethoxybenzyl diethylenetriamine penta acetic acid-enhanced (Gd-EOB-DTPA) magnetic resonance imaging may be used to evaluate liver function. The aim of this study was to assess whether the signal intensity of Gd-EOB-DTPA magnetic resonance imaging may be used to predict functional liver reserve and posthepatectomy liver failure in patients undergoing hepatectomy for liver tumors. METHODS: This is an observational retrospective study on 137 preoperative Gd-EOB-DTPA magnetic resonance imaging of patients undergoing hepatectomy between 2015 and 2018. Mean signal intensity of liver (L20) and spleen (S20) were measured on T1-weighted single-breath-hold 3-dimensional fat-saturated gradient echo sequences acquired 20 minutes after Gd-EOB-DTPA administration. The hepatocellular uptake index of liver volume (VL) was calculated with the formula VL([L20/S20] - 1) and was tested with several score systems for liver diseases and to the occurrence of post-hepatectomy liver failure. RESULTS: Patients with diseased liver had significantly lower values of hepatic uptake index in comparison with those with normal function. This was found for a Model for End-Stage Liver Disease score ≤9 versus >9 (P = .04), combination of bilirubin and cholinesterases levels score ≤2 versus >2 (P = .02), albumin to bilirubin grades (P = .03), and Humanitas score ≤6 versus >6 (P = .03). Twenty-two patients (16%) developed posthepatectomy liver failure, and 2 (1.4%) died within 90 days. The hepatocellular uptake index was significantly lower in those patients with posthepatectomy liver failure (P < .01). Receiver operating characteristics curve analysis revealed valuable hepatocellular uptake index ability in predicting post-hepatectomy liver failure (area under the curve = 0.84; 95% confidence interval, 0.71-0.92; P < .01), with a cutoff value of 574.33 (98% sensitivity; 83% specificity). CONCLUSION: The hepatocellular uptake index hepatocellular uptake index measured on preoperative Gd-EOB-DTPA magnetic resonance imaging identifies patients with diseased liver and predicts posthepatectomy liver failure. This index could be used to discern those patients at higher risk of complications after hepatectomy.


Assuntos
Meios de Contraste/farmacocinética , Gadolínio DTPA/farmacocinética , Hepatectomia/efeitos adversos , Falência Hepática/epidemiologia , Neoplasias Hepáticas/cirurgia , Imagem por Ressonância Magnética , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Estudos de Viabilidade , Feminino , Gadolínio DTPA/administração & dosagem , Humanos , Incidência , Fígado/diagnóstico por imagem , Fígado/patologia , Fígado/cirurgia , Falência Hepática/diagnóstico , Falência Hepática/etiologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Estudos Retrospectivos
17.
Surgery ; 168(3): 411-418, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32600884

RESUMO

BACKGROUND: The development of laparoscopic liver resection has led to the hypothesis that intraoperative blood loss may be a key indicator of surgical care quality. This study assessed short- and long-term results of patients according to three levels of intraoperative blood loss during laparoscopic liver resection for colorectal liver metastasis. METHODS: All patients who underwent laparoscopic liver resection for colorectal liver metastasis between 2000 and 2018 were included. Difficulty of laparoscopic liver resection was defined according to the Institut Mutualiste Montsouris classification. Three levels of the extent of intraoperative blood loss were defined: massive (≥1,000 mL), substantial (≥75th percentile of intraoperative blood loss within each grade of difficulty), and normal intraoperative blood loss. RESULTS: During study period, 317 patients underwent laparoscopic liver resection for colorectal liver metastasis. Among them, 213 (67.2%), 80 (25.2%), and 24 (7.6%) patients had normal, substantial, and massive intraoperative blood loss, respectively. Twenty-six patients (8.2%) required transfusion. Massive intraoperative blood loss came from a major hepatic vein in 54% of cases and were managed by laparoscopy in 83% of the cases. Laparoscopic liver resection difficulty grade (odds ratio = 3.15; P = .053) and number of colorectal liver metastasis (odds ratio = 1.24; P = .020) were independently associated with massive intraoperative blood loss. Risks factors for substantial intraoperative blood loss were bi-lobar colorectal liver metastasis (odds ratio = 3.12; P = .033) and sinusoidal obstruction syndrome (odds ratio = 3.27; P = .004). The level of intraoperative blood loss was not associated with severe complications nor overall and disease-free survival. Requirement of transfusion was associated with severe complications (odds ratio = 7.27; P = .002) and decreased 1-, 3-, and 5-year overall survival (87%, 68%, and 61% vs 95%, 88%, and 79%; P = .042). CONCLUSION: The extent of intraoperative blood loss did not affect short- and long-term results of laparoscopic liver resection for colorectal liver metastasis. Massive intraoperative blood loss was often incidental and, 83% of the time, manageable by laparoscopy. Rather than intraoperative blood loss, transfusion is a better relevant indicator of laparoscopic liver resection surgical quality.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Neoplasias Colorretais/patologia , Hepatectomia/efeitos adversos , Laparoscopia/efeitos adversos , Neoplasias Hepáticas/cirurgia , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Idoso , Transfusão de Sangue/estatística & dados numéricos , Intervalo Livre de Doença , Feminino , Seguimentos , Hemostasia Cirúrgica/estatística & dados numéricos , Hepatectomia/métodos , Hepatectomia/normas , Hepatectomia/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Laparoscopia/métodos , Laparoscopia/normas , Laparoscopia/estatística & dados numéricos , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Complicações Cognitivas Pós-Operatórias/epidemiologia , Complicações Cognitivas Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
18.
Zhonghua Wai Ke Za Zhi ; 58(7): 555-557, 2020 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-32610427

RESUMO

An estimate of about 50% of new liver cancer cases worldwide occur in China every year.Surgical resection is still the major treatment choice for longer survival of patients with hepatocellular carcinoma. Blocking hepatic blood flow and reducing intraoperative bleeding ensure the success of the operation. Anatomic separation of hepatic hilar region is the precondition of hepatic inflow occlusion. The hepatic hilar plate system involves a thick layer of connective tissue covering the hepatic inflow ducts of hepatic hilar region. The descending part of hilar plate assists in reducing the anatomical difficulty of the hepatic hilar region. The "forth porta hepatis" that is hidden in the hepatic hilar plate system involves the accumulation area of "short hepatic portal veins" .The communicating branch vessels between the hepatic inflow vessels form the anatomical basis in reducing the indocyanine green fluorescence stain effect.The relatively fixed position of the hepatic portal plate is considered as a positioning marker for accurate liver resection. The intrahepatic Glisson sheath is connected with thick connective tissue of the hepatic portal panel system, and is regarded as the physical barrier in limiting the proliferation and hypertrophy of hepatocytes and continuation of hepatic portal panel system in the liver.This paper summarizes the anatomy and application of hepatic hilar plate system during hepatobiliary surgery.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Fígado/anatomia & histologia , Fígado/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , China , Tecido Conjuntivo/anatomia & histologia , Tecido Conjuntivo/cirurgia , Hepatectomia/efeitos adversos , Humanos , Fígado/irrigação sanguínea , Veia Porta/anatomia & histologia , Veia Porta/cirurgia
20.
Expert Rev Med Devices ; 17(8): 845-853, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32686517

RESUMO

PURPOSE: To evaluate the diagnostic performance of sound touch elastography (STE) for staging liver fibrosis in chronic hepatitis B (CHB) patients using pathological stage of surgical specimens as the reference standard. METHOD: 239 CHB patients were included. Liver stiffness measurements (LSMs) on STE and Supersonic shear imaging (SSI), gamma glutamyl transferase-to-platelet ratio (GPR), aspartate aminotransferase-to-platelet ratio index (APRI) and four-factor Fibrosis-4 (FIB-4) index were obtained. Areas under the receiver operating characteristic (ROC) curves (AUCs) for the diagnosis of fibrosis stage were calculated and compared. RESULTS: The LSMs obtained by STE and SSI significantly correlated with the fibrosis stages (r = 0.757; r = 0.758, respectively, both p < 0.001). No significant differences in AUCs were observed between STE and SSI in identifying fibrosis ≥stage 1 (0.92 vs. 0.94), ≥stage 2 (0.89 vs. 0.91), ≥stage 3 (0.90 vs. 0.91) or stage 4 (0.92 vs. 0.91). Both STE and SSI had significantly higher AUCs in identifying each fibrosis stage than the GPR (0.68, 0.77, 0.76 and 0.79), APRI (0.53, 0.66, 0.74 and 0.69) and FIB-4 (0.61, 0.77, 0.79 and 0.74). CONCLUSIONS: STE is an efficient tool for assessing liver fibrosis in CHB patients, with performance comparable to that of SSI and superior to that of biomarkers.


Assuntos
Técnicas de Imagem por Elasticidade , Hepatite B Crônica/diagnóstico por imagem , Hepatite B Crônica/cirurgia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/cirurgia , Tato , Área Sob a Curva , Biomarcadores/sangue , Fenômenos Biomecânicos , Biópsia , Feminino , Hepatite B Crônica/patologia , Hepatite B Crônica/fisiopatologia , Humanos , Fígado/patologia , Fígado/fisiopatologia , Fígado/cirurgia , Cirrose Hepática/patologia , Cirrose Hepática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Curva ROC , gama-Glutamiltransferase/sangue
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