Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.475
Filtrar
1.
Medicine (Baltimore) ; 100(9): e24975, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655966

RESUMO

RATIONALE: Jejunal varices are rare in portal hypertension and are often difficult to diagnose and treat. Herein, we present a case of gastrointestinal bleeding due to jejunal varices after hepatobiliary surgery. PATIENT CONCERNS: A 69-year-old man presented with recurrent massive gastrointestinal bleeding. He underwent partial right hepatectomy and cholangiojejunostomy 2 years prior to the first onset of bleeding. Two sessions of endoscopic vessel ligation for esophageal varices were performed afterwards, and hematemesis resolved completely, but massive melena still recurred during the following 5 years. DIAGNOSIS: The patient was diagnosed with jejunal varices caused by portal venous stenosis after hepatobiliary surgery. INTERVENTION: Portal venous angioplasty using balloon dilation and stent implantation was performed. OUTCOMES: After the intervention procedure, the patient did not experience any onset of gastrointestinal bleeding during follow-up. LESSONS: Hepatopancreatobiliary could lead to the formation of jejunal varices. The combined use of capsule endoscopy, contrast-enhanced computed tomography, and sometimes portal venography is a promising strategy to search for jejunal varices. Transcatheter angioplasty appears to be a safe and effective method for treatment of jejunal varices in certain appropriate cases.


Assuntos
Hemorragia Gastrointestinal/etiologia , Hepatectomia/efeitos adversos , Jejunostomia/efeitos adversos , Litíase/cirurgia , Hepatopatias/cirurgia , Hemorragia Pós-Operatória/etiologia , Idoso , Endoscopia por Cápsula , Colonoscopia/métodos , Diagnóstico Diferencial , Endoscopia do Sistema Digestório/métodos , Hemorragia Gastrointestinal/diagnóstico , Humanos , Masculino , Hemorragia Pós-Operatória/diagnóstico
2.
Medicine (Baltimore) ; 100(6): e24689, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578602

RESUMO

OBJECTIVES: To evaluate comparative outcomes of routine abdominal drainage (RAD) and non-routine abdominal drainage (NRAD) during elective hepatic resection for hepatic neoplasms. MATERIALS AND METHODS: We systematically searched MEDLINE, EMBASE, The Cochrane Library, Web of Science. The searching phrases included "liver resection," "hepatic resection," "hepatectomy," "abdominal drainage," "surgical drainage," "prophylactic drainage," "intraperitoneal drainage," "drainage tube," "hepatectomy," "abdominal drainage" and "drainage tube." Two independent reviewers critically screened literature, extracted data and assessed the risk of bias. Post-operative morbidity and mortality were the outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effect model. RESULTS: We have identified 9 RCTs and 3 comparative studies reporting total of 5726 patients undergoing elective hepatectomy under RAD (n = 3084) or NRAD (NRAD group, n = 2642). RAD was associated with significantly higher overall complication rate [odds risk  = 1.79, 95% CI (1.10, 2.93), P = .02] and biliary leakage rate [odds risk  = 2.41, 95% CI (1.48, 3.91), P = .0004] compared with NRAD. Moreover, it significantly increased hospital stays [mean difference  = 0.95, 95% CI (0.02, 1.87), P = .04] compared with NRAD. RAD showed no difference regarding intra-abdominal hemorrhage, wound complications, liver failure, subphrenic complications, pulmonary complications, infectious complications, reoperation and mortality compared with NRAD. CONCLUSIONS: Although routine abdominal drainage may help surgeons to observe post-operative complication, it seems to be associated with increased post-operative morbidity and longer hospital stays. Non-routine abdominal drainage may be an appropriate option in selected patients undergoing hepatic resection. Higher level of evidence is needed.


Assuntos
Ascite/cirurgia , Drenagem/métodos , Hepatectomia/efeitos adversos , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/mortalidade , Cavidade Abdominal/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ascite/epidemiologia , Ascite/etiologia , Drenagem/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Hepatectomia/métodos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação/estatística & dados numéricos
3.
Khirurgiia (Mosk) ; (2): 101-105, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570363

RESUMO

The authors have analyzed the indications and outcomes after ALPPS procedure considering modern literature data devoted to this surgery in pediatric patients. No data on post-resection liver failure, as well as unclear future liver remnant function make it possible to question the feasibility of such procedures in children.


Assuntos
Hepatectomia/métodos , Insuficiência Hepática , Neoplasias Hepáticas , Fígado/patologia , Fígado/cirurgia , Veia Porta/cirurgia , Criança , Hepatectomia/efeitos adversos , Insuficiência Hepática/etiologia , Humanos , Ligadura , Neoplasias Hepáticas/cirurgia , Tamanho do Órgão
5.
Medicine (Baltimore) ; 100(6): e24420, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578534

RESUMO

ABSTRACT: Optimal treatment of patients with various types of liver tumors or certain liver diseases frequently demands major liver resection, which remains a clinical challenge especially in children.Eighty seven consecutive pediatric liver resections including 51 (59%) major resections (resection of 3 or more hepatic segments) and 36 (41%) minor resections (resection of 1 or 2 segments) were analyzed. All patients were treated between January 2010 and March 2018. Perioperative outcomes were compared between major and minor hepatic resections.The male to female ratio was 1.72:1. The median age at operation was 20 months (range, 0.33-150 months). There was no significant difference in demographics including age, weight, ASA class, and underlying pathology. The surgical management included functional assessment of the future liver remnant, critical perioperative management, enhanced understanding of hepatic segmental anatomy, and bleeding control, as well as refined surgical techniques. The median estimated blood loss was 40 ml in the minor liver resection group, and 90 ml in major liver resection group (P < .001). Children undergoing major liver resection had a significantly longer median operative time (80 vs 140 minutes), anesthesia time (140 vs 205 minutes), as well as higher median intraoperative total fluid input (255 vs 450 ml) (P < .001 for all). Fourteen (16.1%) patients had postoperative complications. By Clavien-Dindo classification, there were 8 grade I, 4 grade II, and 2 grade III-a complications. There were no significant differences in complication rates between groups (P = .902). Time to clear liquid diet (P = .381) and general diet (P = .473) was not significantly different. There was no difference in hospital length of stay (7 vs 7 days, P = .450). There were no 90-day readmissions or mortalities.Major liver resection in children is not associated with an increased incidence of postoperative complications or prolonged postoperative hospital stay compared to minor liver resection. Techniques employed in this study offered good perioperative outcomes for children undergoing major liver resections.


Assuntos
Hepatectomia , Fígado/cirurgia , Fatores Etários , Criança , Pré-Escolar , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Humanos , Lactente , Recém-Nascido , Cuidados Intraoperatórios , Masculino , Estudos Retrospectivos
6.
Medicine (Baltimore) ; 100(6): e24425, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578535

RESUMO

ABSTRACT: In humans, thrombocytopenic patients have increased incidence of post-hepatectomy liver failure (PHLF), but existing evidence is heterogeneous. Our objective was to determine if preoperative platelet count or antiplatelet drugs were associated with PHLF.Patients who underwent hepatic resection in the University Hospitals of Geneva, Switzerland, from 01.12.2009 to 18.12.2018 were identified. Platelet count at day 0, postoperative days (POD) 1, 3, and 5 were retrieved. Occurrence of PHLF according to the ISGLS definition was determined. Logistic regression was performed to determine if platelet count or antiplatelet drug were predictors for PHLF.Five hundred ninety seven patients were included. Eighty patients (17.8%) had a preoperative platelet count <150 (G/l) and 24 patients (5.3%) had a platelet count <100 (G/l). Thirty five patients (5.9%) were under antiplatelet drug. Platelet count significantly decreased at POD 1 and POD 3 when compared to preoperative platelet count (182 ±â€Š71.61 (G/l) vs 212 ±â€Š85.26 (G/l), P < .0001; 162 ±â€Š68.5 (G/l) vs 212 ±â€Š85.26 (G/l), P < .0001). At POD 5, post-operative platelet count did not significantly differ from its preoperative value. Forty three patients (11.2%) suffered from PHLF. Their platelet count was not significantly different than patients without PHLF (211 ±â€Š89.7 (G/l) vs 211 ±â€Š83.5 (G/l), P = .671). One patient with PHLF had a platelet count <100 (G/l) and 5 had a count <150 (G/l). Univariate logistic regression did not identify preoperative thrombocytopenia (<100 (G/l) or <150 (G/l)), postoperative thrombocytopenia, or the presence of antiagregant drug, as predictors of PHLF. We did not identify preoperative or postoperative thrombocytopenia as predictor of PHLF in a cohort of 597 patients.


Assuntos
Hepatectomia/efeitos adversos , Falência Hepática/etiologia , Contagem de Plaquetas , Cuidados Pré-Operatórios/métodos , Feminino , Hepatectomia/métodos , Humanos , Falência Hepática/sangue , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/efeitos adversos , Contagem de Plaquetas/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos
7.
BMC Surg ; 21(1): 57, 2021 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-33485329

RESUMO

BACKGROUND: To determine the standard remnant liver volume (SRLV) threshold to avoid postoperative hepatic insufficiency inpatients in different stages of hepatic fibrosis who undergo right hemi-hepatectomy. METHODS: Data for 85 patients at our single medical center were analysed prospectively to examine whether the following factors differed significantly between those who experienced postoperative hepatic insufficiency and those who did not: height, prothrombin time, remnant liver volume, SRLV or hepatic fibrosis stage. RESULTS: Logistic regression showed SRLV and hepatic fibrosis stage to be independent risk factors for postoperative hepatic insufficiency. The threshold SRLV for predicting insufficiency was 203.2 ml/m2 across all patients [area under receiver operating characteristic curve (AUC) 0.778, sensitivity 66.67%, specificity 83.64%, p<0.0001), 193.8 ml/m2 for patients with severe hepatic fibrosis (AUC 0.938, sensitivity 91.30%, specificity 85.71%, p<0.0001), and 224.3 ml/m2 for patients with cirrhosis (AUC 0.888, sensitivity 100%, specificity 64.29%, p<0.0001). CONCLUSIONS: Right hemi-hepatectomy may be safer in Chinese patients when the standard remnant liver volume is more than 203.2 ml/m2 in the absence of hepatic fibrosis or cirrhosis, 193.8 ml/m2 in the presence of severe hepatic fibrosis or 224.3 ml/m2 in the presence of cirrhosis.


Assuntos
Carcinoma Hepatocelular , Hepatectomia/efeitos adversos , Cirrose Hepática , Neoplasias Hepáticas , Fígado , Adulto , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Simulação por Computador , Feminino , Hepatectomia/métodos , Insuficiência Hepática/etiologia , Insuficiência Hepática/prevenção & controle , Humanos , Imageamento Tridimensional , Fígado/diagnóstico por imagem , Fígado/patologia , Fígado/cirurgia , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Prospectivos , Padrões de Referência , Valores de Referência , Fatores de Risco , Tomografia Computadorizada por Raios X
8.
Anticancer Res ; 41(1): 409-415, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33419838

RESUMO

BACKGROUND/AIM: We aimed to evaluate the correlation between stroke volume variation (SVV) and intraoperative blood loss (IBL) in hepatocellular carcinoma (HCC) resection and examine the perioperative utility of SVV-based management. PATIENTS AND METHODS: Ninety-five patients who underwent partial or sub-segmental hepatectomy for HCC between 2013 and 2019 at the University of Yamanashi Hospital were retrospectively analyzed. A correlation analysis between IBL and SVV was performed, and then all cases were divided into three groups: high, middle, and low-SVV groups. Perioperative short-term outcomes based on SVV groups were analyzed. RESULTS: There was a weak but significant negative correlation between SVV and IBL (ρ=-0.372, p<0.001). Comparative analysis revealed that low-SVV was associated with a high incidence of postoperative complications and blood transfusion (p=0.018 and 0.037, respectively), and high-SVV was not related with postoperative complications. CONCLUSION: SVV-based management is a significant and feasible strategy to achieve safe and exact surgical resection of HCC.


Assuntos
Perda Sanguínea Cirúrgica , Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Monitorização Intraoperatória , Volume Sistólico , Idoso , Biomarcadores , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Carcinoma Hepatocelular/diagnóstico , Feminino , Testes de Função Cardíaca , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/diagnóstico , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Complicações Pós-Operatórias , Estudos Retrospectivos
12.
J Surg Oncol ; 123(4): 932-938, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33368336

RESUMO

BACKGROUND AND OBJECTIVES: Current management guidelines recognize the impact of hepatic versus peritoneal sided gallbladder cancers (GBC) on survival. However, no data exist regarding the significance of anatomic tumor location within the gallbladder. METHODS: We retrospectively analyzed all GBC that underwent surgical resection with curative intent in our health system from 2007 to 2017. We evaluated the effect of anatomic pathologic tumor location (fundus/body, neck, and multifocal) on clinicopathologic, perioperative, and oncologic outcomes. RESULTS: About 97 patients met criteria; 63% fundus/body, 22% multifocal, and 15% neck. Compared with fundus/body, neck tumors more frequently presented with preoperative jaundice (53% vs. 13%, p < .001), were smaller (20 mm vs. 30 mm, p = .068) and had significantly more biliary tree invasion (33% vs. 13%, p = .030) on histopathology. Although tumor characteristics (pTNM stage, liver invasion, lymphovascular invasion, prognostic nutritional index, and grade) were similar, neck tumors had significantly higher rates of R0 resection (53% vs. 11%, p < .001). Rates of adjuvant therapy were similar. Median PFS was similar between cohorts (p = .356). However, median overall survival (OS) was significantly shorter in neck (21 months) than fundus/body tumors (NR > 109 months), p = .015. CONCLUSIONS: Neck tumors were rare, small and more likely to result in jaundice secondary to biliary tree invasion. Despite higher R0 resection rates, these tumors had significantly worse OS.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Carcinoma in Situ/patologia , Neoplasias da Vesícula Biliar/patologia , Hepatectomia/efeitos adversos , Icterícia/patologia , Complicações Pós-Operatórias/patologia , Idoso , Carcinoma in Situ/cirurgia , Feminino , Seguimentos , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Icterícia/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
13.
Medicine (Baltimore) ; 99(50): e23230, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327242

RESUMO

BACKGROUND: Hepatolithiasis commonly occurs in the bile duct proximal to the confluence of the right and left hepatic ducts, regardless of the coexistence of gallstones in gallbladder or the common bile duct. Clinical research proves that minimally invasive surgery is effective in the treatment of hepatolithiasis. Although previous meta-analysis also shows that it could reduce intraoperative bleeding and blood transfusion, and shorten hospital stay time, there are few meta-analyses on its long-term efficacy. We conducted the meta-analysis and systematic review to systematically evaluate the long-term efficacy and advantages of minimally invasive hepatectomy in the treatment of hepatolithiasis. METHODS: Articles of randomized controlled trials will be searched in the PubMed, Medline, Embase, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP Chinese Science and Technology Periodical Database, Chinese Biological and Medical database, and Wanfang database until September, 2020. Literature extraction and risk of bias assessment will be completed by 2 reviewers independently. Statistical analysis will be conducted in RevMan 5.3. RESULTS: This study will summarize the present evidence by exploring the long-term efficacy and advantages of minimally invasive hepatectomy in the treatment of hepatolithiasis CONCLUSIONS:: The findings of the study will help to determine potential long-term efficacy and advantages of minimally invasive hepatectomy in the treatment of hepatolithiasis. ETHICS AND DISSEMINATION: The private information from individuals will not be published. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/H6WRV.


Assuntos
Colelitíase/cirurgia , Hepatectomia , Procedimentos Cirúrgicos Minimamente Invasivos , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do Tratamento
14.
Chirurgia (Bucur) ; 115(6): 707-714, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378629

RESUMO

Background-Objectives: It has been reported, that high posthepatectomy portal vein pressure (PVP) has deleterious effect on the liver parenchyma and causes posthepatectomy liver failure (PHLF) and increased 90-day mortality. Terlipressin, is widely used to mitigate the effects of portal hyper-tension. Randomised clinical trials (RCTs) demonstrated encouraging results of use of terlipressin for modulation of increased posthepatectomy PVP. The aim of the present study was to evaluate the effectiveness of the pharmacological modulation of the increased posthepatectomy PVP after major hepatectomy. Methods: Systematic literature searches of electronic databases in accordance with PRISMA was conducted. Meta-analysis was conducted using both fixed- and random-effects models. Results: Three randomised controlled trials (RCTs) comparing terlipressin versus placebo including 284 patients of pooled 60 studies were selected. Placebo cohort patients were significantly younger by 5 years compared to terlipressin cohort. However, the terlipressin cohort demonstrated significantly shorter intensive care unit (ICU) stay compared to placebo cohort. Conclusions: The first meta-analysis demonstrated that terlipressin cohort patients although significantly older by 5 years had significantly shorter ICU stay compared to placebo cohort. Furthermore, though statistically nonsignificant only 6% of terlipressin patients needed inotropic support compared to 16.4% of placebo cohort.


Assuntos
Fármacos Cardiovasculares/farmacologia , Hepatectomia , Hepatopatias/cirurgia , Pressão na Veia Porta/efeitos dos fármacos , Veia Porta , Terlipressina/farmacologia , Hepatectomia/efeitos adversos , Humanos , Cirrose Hepática/cirurgia , Veia Porta/efeitos dos fármacos , Veia Porta/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
15.
Cir. Esp. (Ed. impr.) ; 98(8): 456-464, oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-199049

RESUMO

INTRODUCCIÓN: La relación entre las infecciones nosocomiales en pacientes quirúrgicos y la vitamina D ha sido estudiada por algunos autores. Sin embargo, hasta la fecha no existe ningún estudio realizado sobre pacientes de cirugía hepatobiliar. El objetivo de nuestro trabajo es estudiar la infección del sitio quirúrgico (ISQ) en la unidad de cirugía hepatobiliar, y valorar su relación con la concentración sérica de vitamina D. MÉTODOS: Se llevó a cabo un estudio analítico observacional de pacientes sucesivos intervenidos en la unidad de cirugía hepatobiliar de nuestro centro durante un año. Se incluyeron las intervenciones relativas a enfermedad biliar, pancreática y hepática. Se determinaron los niveles de vitamina D al ingreso, así como las ISQ de tipo superficial, profunda y órgano-cavitaria diagnosticadas durante el estudio. El seguimiento del paciente se realizó durante al menos un mes tras la cirugía, dependiendo de la enfermedad. La estadística se realizó mediante el programa estadístico R V.3.1.3. RESULTADOS: La muestra quedó constituida por 321 pacientes, de los cuales el 25,8% presentó ISQ a expensas fundamentalmente de las infecciones órgano-cavitarias que presentaron una incidencia del 24,3%. Concentraciones séricas superiores a 33,5 nmol/l demostraron reducir en un 50% el riesgo de ISQ. CONCLUSIONES: Las concentraciones elevadas de vitamina D en sangre demostraron ser un factor protector frente a las ISQ (OR: 0,99). Nuestros resultados sugieren una relación directa entre la concentración sérica de vitamina D y la ISQ, justificando la realización de nuevos estudios prospectivos


INTRODUCTION: While several studies have examined the correlation between vitamin D concentrations and post-surgical nosocomial infections, this relationship has yet to be characterized in hepatobiliary surgery patients. We investigated the relationship between serum vitamin D concentration and the incidence of surgical site infection (SSI) in patients in our hepatobiliary surgery unit. METHODS: Participants in this observational study were 321 successive patients who underwent the following types of interventions in the hepatobiliary surgery unit of our center over a 1-year period: cholecystectomy, pancreaticoduodenectomy, total pancreatectomy, segmentectomy, hepatectomy, hepaticojejunostomy and exploratory laparotomy. Serum vitamin D levels were measured upon admission and patients were followed up for 1 month. Mean group values were compared using a Student's T-test or Chi-squared test. Statistical analyses were performed using the Student's T-test, the Chi-squared test, or logistic regression models. RESULTS: Serum concentrations >33.5 nmol/l reduced the risk of SSI by 50%. Out of the 321 patients analyzed, 25.8% developed SSI, mainly due to organ-cavity infections (incidence, 24.3%). Serum concentrations of over 33.5 nmol/l reduced the risk of SSI by 50%. CONCLUSIONS: High serum levels of vitamin D are a protective factor against SSI (OR, 0.99). Our results suggest a direct relationship between serum vitamin D concentrations and SSI, underscoring the need for prospective studies to assess the potential benefits of vitamin D in SSI prevention


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Hepatectomia/efeitos adversos , Vitamina D/sangue , Deficiência de Vitamina D/complicações , Vitamina D/metabolismo , Estudos Prospectivos , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle
16.
Zhonghua Wai Ke Za Zhi ; 58(10): 765-769, 2020 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-32993263

RESUMO

Objective: To investigate the value of Gd-EOB-DTPA-enhanced MRI in evaluating liver function and predicting the risk of post-hepatoectomy liver failure in patients with major resection of liver cancer. Methods: A total number of 212 patients were included from June 2016 to June 2019 at Department of General Surgery, Peking University Third Hospital with a retrospectively collected data.All patients underwent Gd-EOB-DTPA-enhanced MRI for diagnosis and preoperative evaluation of liver function.There were 135 males and 77 females, with age of (63.1±10.3) years old (range: 18 to 86 years old) . Relative enhancement ratio (RER) of the region of interest on Gd-EOB-DTPA-enhanced MRI was acquired by two independent researcher and then conducted the comparison of RER among the patients with or without post-hepatoectomy liver failure (PHLF) .Preoperative evaluation demonstrated that 141 cases infected by hepatitis virus, 128 cases with hepatitis B alone and 11 cases with hepatitis C alone, 2 cases had both of hepatitis B and C, and all patients were grade A judged by Child-Pugh score. The relationship between RER and PHLF was evaluated by Pearson correlation analysis and the diagnostic value of RER in predicting PHLF was test by receiver operating characteristic curve. Results: PHLF occurred in 42 patients according to ISGLS standard. Among them, 31 cases had level A liver failure, 9 cases had level B liver failure and 2 had level C failure. There was a significant correlation between RER and overall level of PHLF and RER was also significantly associated with severe B to C level of PHLF (P<0.05) .The further receiver operating characteristics curve analysis showed that the diagnostic accuracy of RER on overall PHLF was 0.818 (sensitivity 72.9%, specificity 83.3%, cut-off value 73.5%, 95%CI: 0.75 to 0.887) and on severe PHLF was 0.924 (sensitivity 97.0%, specificity 90.9%, cut-off value: 61.5%, 95%CI: 0.79 to 0.90) . Conclusion: For patients who planned to undergo major resection of liver cancer, preoperative Gd-EOB-DTPA-enhanced MRI can help with the assessment of liver function and predicting the risk for post-hepatectomy liver failure.


Assuntos
Meios de Contraste , Gadolínio DTPA , Neoplasias Hepáticas , Imagem por Ressonância Magnética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hepatectomia/efeitos adversos , Humanos , Falência Hepática/etiologia , Falência Hepática/prevenção & controle , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/fisiopatologia , Neoplasias Hepáticas/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco , Adulto Jovem
17.
Rev Fac Cien Med Univ Nac Cordoba ; 77(3): 199-202, 2020 08 21.
Artigo em Espanhol | MEDLINE | ID: mdl-32991107

RESUMO

INTRODUCTION: Pleuro-biliary fistula is a rare complication that originates from various causes, including liver resections. There is no consensus on how to manage them. There are 2 types of treatment: surgical and conservative. Both can be combined. The latter involves the combination of minor surgical procedures such as pleural drainage placement, image-guided percutaneous procedures, and endoscopic procedures. Surgical treatment includes more aggressive approaches such as thoracotomy and / or laparotomy, and can be performed at the start of fistula management or in the event of failure of conservative treatment. In these cases open thoracotomy is the most used approach according to the literature. METHOD: We present the case of a patient undergoing a postoperative right hepatectomy for hepatoarcinoma that complicates with an external biliary fistula and then with a pleuro-biliary fistula with empyema, in which thoracoscopy is used as part of the treatment. RESULT: the patient resolved the complication and the pleural drainage was removed 7 days later. CONCLUSION: thoracoscopy is a safe and effective approach in the treatment of this complication.


Assuntos
Fístula Biliar , Fístula Biliar/etiologia , Fístula Biliar/cirurgia , Drenagem , Hepatectomia/efeitos adversos , Humanos
18.
Adv Clin Exp Med ; 29(7): 887-892, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32750753

RESUMO

BACKGROUND: Microvascular invasion (MVI) is a significant sign of the invasive property and a strong predictor of poor prognosis in hepatocellular carcinoma (HCC), a life-threatening malignancy. However, recurrence-associated and post-surgical long-term prognosis-associated factors in HCC with MVI remain unknown. OBJECTIVES: To address the abovementioned issues, based on a Chinese patient cohort with HCC after curative hepatic resection. MATERIAL AND METHODS: The patient cohort consisted of 62 consecutive patients with HCC and MVI who underwent curative hepatic resection. The associations between clinicopathologic variables and recurrence, as well as patient overall/disease-free survival, were uniand multivariately evaluated. RESULTS: Univariate χ2 test identified hepatitis B surface antigen (HBsAg) positivity, high Edmondson-Steiner grade and male gender as risk factors of recurrence, whereas Edmondson-Steiner grade and HBsAg positivity were significant or marginally significant in the multivariate stepwise logistic regression analysis. Subsequently, univariate log-rank test showed that Edmondson-Steiner grade, HBsAg positivity and Child-Pugh grade were associated with overall and/or disease-free survival. Among them, the independent prognostic impact of Edmondson-Steiner grade and HBsAg positivity for both overall and disease-free survival were proven in the multivariate Cox regression analysis. CONCLUSIONS: Our data suggested that Edmondson-Steiner grade and HBsAg positivity might serve as useful indicators of recurrence and pessimistic prognosis in HCC with MVI.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Carcinoma Hepatocelular/cirurgia , Criança , Intervalo Livre de Doença , Hepatectomia/efeitos adversos , Humanos , Neoplasias Hepáticas/cirurgia , Masculino , Invasividade Neoplásica , Recidiva Local de Neoplasia , Prognóstico , Estudos Retrospectivos , Fatores de Risco
19.
Surgery ; 168(5): 868-875, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32800602

RESUMO

BACKGROUND: Previous studies have largely examined social determinants of health relative to individual surgery quality metrics. We sought to characterize possible differences in "textbook outcome," a composite measure of quality, relative to social vulnerability index. METHODS: The Medicare Standard Analytical Files from 2013 to 2017 were used to identify beneficiaries who underwent hepatopancreatic surgery. Individuals were stratified into 3 groups dependent on their social vulnerability (low, average, high). Textbook outcome was defined as absence of postoperative surgical complications, prolonged length of stay, 90-day readmission, and 90-day mortality. RESULTS: Among 32,142 patients who underwent hepatopancreatic surgery, 18,841 (58.6%) patients underwent a pancreatectomy, whereas 13,301 (41.4%) underwent a hepatectomy. The overall incidence of textbook outcome after hepatopancreatic surgery was 51.2% (n = 16,445). Patients with a low social vulnerability index who underwent pancreatic resection more often achieved a textbook outcome versus patients who had an average or high social vulnerability index (low social vulnerability index: 48.3% vs average social vulnerability index: 46.5% vs high social vulnerability index: 44.9%; P = .004). The odds of obtaining a textbook outcome after pancreatic surgery was inversely associated with degree of vulnerability (low social vulnerability index, referent: average social vulnerability index: odds ratio 0.94, 95% confidence interval 0.87-1.00 vs high social vulnerability index: odds ratio 0.89, 95% confidence interval 0.82-0.97). Similarly, social vulnerability index was independently associated with textbook outcome after hepatic resection. Likewise, there were increased risks and incidence of various postoperative surgical outcomes, including 90-day mortality and complications as the social vulnerability index increased. CONCLUSION: Only one-half (51.2%) of Medicare beneficiaries achieved the composite quality textbook outcome metric. Social vulnerability was associated with lower attainment of textbook outcome and an increased risk of adverse postoperative surgical outcomes after hepatopancreatic surgery.


Assuntos
Hepatectomia/efeitos adversos , Tempo de Internação , Pancreatectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Determinantes Sociais da Saúde , Idoso , Feminino , Hepatectomia/mortalidade , Humanos , Masculino , Pancreatectomia/mortalidade , Readmissão do Paciente , Características de Residência
20.
Surgery ; 168(4): 643-652, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32792098

RESUMO

BACKGROUND: Posthepatectomy liver failure is a worrisome complication after major hepatectomy for hepatocellular carcinoma and is the leading cause of postoperative mortality. Recommendations for hepatectomy for hepatocellular carcinoma are based on the risk of severe posthepatectomy liver failure, and accurately predicting posthepatectomy liver failure risk before undertaking major hepatectomy is of great significance. Thus, herein, we aimed to establish and validate an artificial neural network model to predict severe posthepatectomy liver failure in patients with hepatocellular carcinoma who underwent hemihepatectomy. METHODS: Three hundred and fifty-three patients who underwent hemihepatectomy for hepatocellular carcinoma were included. We randomly divided the patients into a development set (n = 265, 75%) and a validation set (n = 88, 25%). Multivariate logistic analysis facilitated identification of independent variables that we incorporated into the artificial neural network model to predict severe posthepatectomy liver failure in the development set and then verified in the validation set. RESULTS: The morbidity of patients with severe posthepatectomy liver failure in the development and validation sets was 24.9% and 23.9%, respectively. Multivariate analysis revealed that platelet count, prothrombin time, total bilirubin, aspartate aminotransferase, and standardized future liver remnant were all significant predictors of severe posthepatectomy liver failure. Incorporating these factors, the artificial neural network model showed satisfactory area under the receiver operating characteristic curve for the development set of 0.880 (95% confidence interval, 0.836-0.925) and for the validation set of 0.876 (95% confidence interval, 0.801-0.950) in predicting severe posthepatectomy liver failure and achieved well-fitted calibration ability. The predictive performance of the artificial neural network model for severe posthepatectomy liver failure outperformed the traditional logistic regression model and commonly used scoring systems. Moreover, stratification into 3 risk groups highlighted significant differences between the incidences and grades of posthepatectomy liver failure. CONCLUSION: The artificial neural network model accurately predicted the risk of severe posthepatectomy liver failure in patients with hepatocellular carcinoma who underwent hemihepatectomy. Our artificial neural network model might help surgeons identify intermediate and high-risk patients to facilitate earlier interventions.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/efeitos adversos , Falência Hepática/etiologia , Neoplasias Hepáticas/cirurgia , Redes Neurais de Computação , Medição de Risco/métodos , Adulto , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...