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1.
Anticancer Res ; 40(2): 1107-1116, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014961

RESUMO

BACKGROUND/AIM: The aim of this study was to evaluate whether modern chemotherapy has changed characteristics of actual five-year survivors after liver resection for colorectal liver metastasis (CRLM). PATIENTS AND METHODS: The records of 210 patients, who underwent curative liver resection for CRLM at our institution between January 1990 and May 2014, were reviewed. The patients treated before 2004 when modern chemotherapy was not introduced were compared with the patients treated after 2005. RESULTS: Actual five-year survivor rates were significantly higher after 2005 (33.3% vs. 49.0%, p=0.022). Preoperative characteristics of actual five-year survivors were not different. The median survival time after non-resectable recurrence was significantly longer after 2005 (20.3 vs. 8.7 months, p=0.002). The proportion of 5-year survivors with recurrent site was significantly higher after 2005 (34.0% vs. 10.5%, p=0.019). CONCLUSION: Actual five-year survivors have increased by modern chemotherapy. However, approximately one-third of them were not cured.


Assuntos
Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais , Quimioterapia Adjuvante , Neoplasias Colorretais/terapia , Terapia Combinada , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Tomografia Computadorizada por Raios X
2.
Medicine (Baltimore) ; 99(3): e18595, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011438

RESUMO

INTRODUCTION: Acute pulmonary embolism (APE) during an operation is a very urgent occurrence, especially when the patient with hemodynamic instability. Generally, drugs are administered intravenously; however, these drugs have little effects under most circumstances. We present a case of successful resuscitation in a patient with endotracheal administration. PATIENT CONCERNS: A 67-year-old female presented for laparoscopic hepatectomy. Acute pulmonary gas embolism occurred during the operation with hemodynamic instability. The total amount of carbon dioxide and argon reached 300 mL. We used a novel way of administering drugs instead of intravenous administration for rescuing and the patient condition had improved greatly and was discharged from the hospital without any neurological deficits. DIAGNOSES: A diagnosis of APE was made because of a lot of gas was extracted out from central venous catheter and sudden observable decrease in end-tidal CO2. INTERVENTIONS: These measures included endotracheal administration, position adjustment, manual ventilation, and gas extraction. OUTCOMES: The patient was discharged from the hospital and had no signs of neurological deficits. CONCLUSION: Intravenous administration may not the best appropriate way of administration when patients occurred APE. Endotracheal administration as a unique method may work wonders and has the value of research and application.


Assuntos
Embolia Aérea/etiologia , Embolia Aérea/terapia , Hepatectomia/efeitos adversos , Laparoscopia/efeitos adversos , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Idoso , Feminino , Humanos
3.
J Surg Res ; 245: 500-509, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31446192

RESUMO

BACKGROUND: Abdominal surgery may increase the risk of splanchnic vein thrombosis (SVT). We determined the incidence of SVT after abdominal surgery and identified groups at highest risk. MATERIALS AND METHODS: MEDLINE and Embase were searched for clinical studies evaluating the incidence of postoperative SVT after abdominopelvic surgery. Study selection, data abstraction, and risk of bias assessment were carried out independently by two reviewers. Clinical heterogeneity was explored by subgroup analyses (i.e., type of intra-abdominal procedure and organ group). RESULTS: Of 5549 abstracts screened, 48 were analyzed. Pooled incidence of SVT (n = 50,267) was 2.68% [95% confidence interval (CI), 2.24 to 3.11] (1347 events), I2 = 96%. Pooled incidence of SVT in high-risk procedures were splenectomy with devascularization (24%), hepatectomy in patients with cirrhosis (9%), and pancreatectomy with venous resection (5%). Pooled incidence of symptomatic and asymptomatic SVT was 1.02% (95% CI: 0.97% to 1.07%) and 0.98% (95% CI 0.88% to 1.07%), respectively. Most common causes of SVT-related mortality were irreversible thrombosis, bowel ischemia, liver failure, and gastrointestinal bleed. Most studies included were at a high risk of bias due to lack of prospective data collection and lack of SVT screening for all participants. CONCLUSIONS: Incidence of SVT after abdominal surgery is low but remains a relevant complication. Patients undergoing procedures involving surgical manipulation of the venous system and splenectomy are at the highest risk. Given the life-threatening risks associated with SVT, there is a need for larger prospective studies on the incidence and impact of SVT after abdominal surgery.


Assuntos
Cavidade Abdominal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Circulação Esplâncnica , Trombose Venosa/epidemiologia , Hepatectomia/efeitos adversos , Humanos , Incidência , Pancreatectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Esplenectomia/efeitos adversos , Trombose Venosa/etiologia
4.
BMC Surg ; 19(1): 195, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842844

RESUMO

BACKGROUND: The goal of this study was to compare the postoperative results of liver resection and radiofrequency ablation (RFA) for the treatment of small hepatocellular carcinoma (HCC) (3-5 cm). PATIENTS AND METHODS: We retrospectively collected 122 cases of small solitary HCC treated at our center from Jan 2011 to Dec 2015, with diameters in the range of 3-5 cm. According to the treatment program received at our center, the patients were divided into liver resection (72 patients) and RFA (50 patients) groups. RESULT: In comparison with the RFA group, the resection group had a longer operative time, greater intraoperative blood loss (P < 0.01), more hepatic inflow occlusion, and a longer postoperative hospital stay (P < 0.01). The 1-, 3-, and 5-year expected overall survival rates and tumor-free survival rates were comparable between the two groups. Cox regression analysis showed that neither resection nor RFA was a significant risk factor for overall or tumor-free survival in HCC. CONCLUSIONS: For solitary HCC of 3-5 cm in diameter, RFA can achieve better in-hospital clinical results and similar long-term outcomes than resection and can be considered for wide application, especially for central-location cases.


Assuntos
Carcinoma Hepatocelular/cirurgia , Ablação por Cateter , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica , Ablação por Cateter/efeitos adversos , Intervalo Livre de Doença , Feminino , Hepatectomia/efeitos adversos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Taxa de Sobrevida
5.
Medicine (Baltimore) ; 98(51): e18490, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861033

RESUMO

To generate a nomogram to predict posthepatectomy liver failure (PHLF), we attempted to elucidate salient risk factors in patients with hepatocellular carcinoma (HCC).We performed a retrospective review of 665 patients with HCC who received hepatectomy in 2 academic institutions in China. Independent risk factors for PHLF were identified from putative demographic, intrinsic, biochemical, surgery-related, and volumetric data. A predictive nomogram was formulated based on relevant risk factors, and we compared this with existing models.We identified clinical signs of portal hypertension (P = .023), serum total bilirubin (P = .001), serum creatinine (P = .039), and intraoperative hemorrhage (P = .015) as being important risk factors in predicting PHLF. The nomogram had a C-index of 0.906 for the externally validated data. The nomogram displayed better predictive value than 2 of the other most cited models (C-indices of 0.641 and 0.616, respectively) in the current cohort. Additionally, we were able to patients into low- (<10%), intermediate- (10-30%), and high-risk (≥30%) groups based on the nomogram. This allows us to facilitate person-specific management.Here, we constructed a simple nomogram for prediction of PHLF in patients with HCC weighted by independent risk factors. Further prospective studies are required to confirm the predictive ability of our nomogram.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/efeitos adversos , Falência Hepática/epidemiologia , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , China/epidemiologia , Feminino , Humanos , Falência Hepática/etiologia , Masculino , Pessoa de Meia-Idade , Nomogramas , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
6.
BMC Surg ; 19(1): 162, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694627

RESUMO

BACKGROUND: Iatrogenic bile duct injuries (BDIs) are mostly associated with laparoscopic cholecystectomy but may also occur following gastroduodenal surgery or liver resection. Delayed diagnosis of type of injury with an ongoing biliary leak as well as the management in a non-specialized general surgical units are still the main factors affecting the outcome. CASE PRESENTATION: Herein we present three types of BDIs (Bismuth type I, IV and V) following three different types of upper abdominal surgery, ie. Billroth II gastric resection, laparoscopic cholecystectomy and left hepatectomy. All of them were complex injuries with complete bile duct transections necessitating surgical treatment. All were also very difficult to treat mainly because of a delayed diagnosis of type of injury, associated biliary leak and as a consequence severe inflammatory changes within the liver hilum. The treatment was carried out in our specialist hepatobiliary unit and first focused on infection and inflammation control with adequate biliary drainage. This was followed by a delayed surgical repair with the technique which had to be tailored to the type of injury in each case. CONCLUSION: We emphasize that staged and individualized treatment strategy is often necessary in case of a delayed diagnosis of complex BDIs presenting with a biliary leak, inflammatory intraabdominal changes and infection. Referral of such patients to expert hepatobiliary centres is crucial for the outcome.


Assuntos
Doenças dos Ductos Biliares/etiologia , Ductos Biliares/lesões , Complicações Pós-Operatórias/cirurgia , Adulto , Colecistectomia Laparoscópica/efeitos adversos , Drenagem , Feminino , Hepatectomia/efeitos adversos , Humanos , Doença Iatrogênica , Fígado/patologia , Masculino , Pessoa de Meia-Idade
7.
Medicine (Baltimore) ; 98(48): e18153, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770257

RESUMO

RATIONALE: Migration of endoclips and stitches into the duodenum after laparoscopic hepatectomy is incredibly rare with a poorly understood mechanism. PATIENT CONCERNS: A 56-year-old woman who underwent laparoscopic left hepatectomy and cholecystectomy in August 2016 was admitted to our hospital with nausea and vomiting in December 2017. DIAGNOSES: Abdominal computed tomography (CT) scan showed high density shades in duodenal ampulla. Esophagogastroduodenoscopy showed deformation of the duodenal ampulla into two lumens; hem-o-lock clips and stitches were detected in the upper lumen. Contrast enhanced CT scan revealed gastric cancer with liver metastasis (GCLM). INTERVENTIONS: The hem-o-lock clips and stitches were present in the wall of the duodenum; therefore, no attempt was made to remove them. High quality liquid diet, partial parenteral nutrition, and chemotherapy were administered to the patient. OUTCOMES: In September 2018, the patient died of hepatic failure caused by GCLM. LESSONS: This rare complication of the migration of endoclips and stitches into the duodenum after laparoscopic hepatectomy can cause epigastric pain and duodenal obstruction. The complication could be potentially avoided using absorbable endoclips and stitches or by performing of ultrasonic dissection by a skilled operator.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Obstrução Duodenal , Migração de Corpo Estranho , Hepatectomia/efeitos adversos , Complicações Pós-Operatórias , Instrumentos Cirúrgicos/efeitos adversos , Colecistectomia Laparoscópica/métodos , Tratamento Conservador/métodos , Obstrução Duodenal/diagnóstico por imagem , Obstrução Duodenal/etiologia , Obstrução Duodenal/fisiopatologia , Obstrução Duodenal/terapia , Endoscopia do Sistema Digestório/métodos , Feminino , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/diagnóstico , Migração de Corpo Estranho/fisiopatologia , Hepatectomia/métodos , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Administração dos Cuidados ao Paciente/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
8.
Medicine (Baltimore) ; 98(48): e18166, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770264

RESUMO

RATIONALE: Hepatectomy is a treatment to increase survival and curability of patients with intrahepatic lesions or malignant tumors. However, posthepatectomy liver failure (PHLF) can occur. This case is a patient showing acute mental change in postanesthetic care unit (PACU) as an uncommon symptom of PHLF after extended right hepatectomy. PATIENT CONCERNS: A 68-year-old male patient was admitted for surgery of Klatskin tumor. He had hypertension and atrial fibrillation. His model for end-stage liver disease score was 16 pts. His serum bilirubin and ammonia levels were 4.75 mg/dL and 132.8 mcg/dL, respectively. Other laboratory data were nonspecific. He underwent extended right hepatic lobectomy including segments IV-VIII for 9 hours. Weight of liver specimen was 1028 g which was about 58% of total liver volume based on computed tomographic volumetry. The patient was extubated and moved to the PACU with stable vital sign and regular self-breathing. He could obey verbal commands. Fifteen minutes after admission to the PACU, the patient showed abruptly decreasing mental status and self-breathing. DIAGNOSES: Brain computed tomography, blood culture, and sputum culture were performed to diagnose brain lesions and sepsis for evaluating the sudden onset comatous mental status. Results showed nonspecific finding. INTERVENTIONS: He was intubated for securing airway and applying ventilatory care. The patient was moved to the intensive care unit. He received intensive conservative therapy including continuous renal replacement therapy and broad-spectrum antibiotics. OUTCOMES: The patient's condition was worsened. He expired on postoperative day 3. LESSONS: Acute mental change is uncommon and rare as initial symptoms of PHLF. Therefore, clinician may overlook the diagnosis of PHLF in patients with acute mental change after hepatectomy. Thus, clinician should plan an aggressive treatment for PHLF including liver transplantation by recognizing any suspicious symptom, although such symptom is rare.


Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Hepatectomia , Encefalopatia Hepática , Tumor de Klatskin/cirurgia , Falência Hepática , Fígado , Complicações Pós-Operatórias , Idoso , Neoplasias dos Ductos Biliares/patologia , Tomografia Computadorizada de Feixe Cônico/métodos , Tratamento Conservador/métodos , Evolução Fatal , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/etiologia , Encefalopatia Hepática/fisiopatologia , Humanos , Tumor de Klatskin/patologia , Fígado/diagnóstico por imagem , Fígado/patologia , Fígado/cirurgia , Falência Hepática/diagnóstico , Falência Hepática/etiologia , Falência Hepática/psicologia , Testes de Função Hepática/métodos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/psicologia
9.
World J Gastroenterol ; 25(39): 6016-6024, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31660037

RESUMO

BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been adopted by liver surgeons in recent years. However, high morbidity and mortality rates have limited the promotion of this technique. Some recent studies have suggested that ALPPS with a partial split can effectively induce the growth of future liver remnant (FLR) similar to a complete split with better postoperative safety profiles. However, some others have suggested that ALPPS can induce more rapid and adequate FLR growth, but with the same postoperative morbidity and mortality rates as in partial split of the liver parenchyma in ALPPS (p-ALPPS). AIM: To perform a systematic review and meta-analysis on ALPPS and p-ALPPS. METHODS: A systematic literature search of PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov was performed for articles published until June 2019. Studies comparing the outcomes of p-ALPPS and ALPPS for a small FLR in consecutive patients were included. Our main endpoints were the morbidity, mortality, and FLR hypertrophy rates. We performed a subgroup analysis to evaluate patients with and without liver cirrhosis. We assessed pooled data using a random-effects model. RESULTS: Four studies met the inclusion criteria. Four studies reported data on morbidity and mortality, and two studies reported the FLR hypertrophy rate and one study involved patients with cirrhosis. In the non-cirrhotic group, p-ALPPS-treated patients had significantly lower morbidity and mortality rates than ALPPS-treated patients [odds ratio (OR) = 0.2; 95% confidence interval (CI): 0.07-0.57; P = 0.003 and OR = 0.16; 95%CI: 0.03-0.9; P = 0.04]. No significant difference in the FLR hypertrophy rate was observed between the two groups (P > 0.05). The total effects indicated no difference in the FLR hypertrophy rate or perioperative morbidity and mortality rates between the ALPPS and p-ALPPS groups. In contrast, ALPPS seemed to have a better outcome in the cirrhotic group. CONCLUSION: The findings of our study suggest that p-ALPPS is safer than ALPPS in patients without cirrhosis and exhibits the same rate of FLR hypertrophy.


Assuntos
Hepatectomia/métodos , Hepatomegalia/epidemiologia , Regeneração Hepática , Veia Porta/cirurgia , Complicações Pós-Operatórias/epidemiologia , Hepatectomia/efeitos adversos , Hepatomegalia/etiologia , Humanos , Ligadura/efeitos adversos , Ligadura/métodos , Fígado/irrigação sanguínea , Fígado/fisiologia , Fígado/cirurgia , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/etiologia , Análise de Sobrevida , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(41): e17533, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593128

RESUMO

BACKGROUND: With the improvements of surgical instruments and surgeons' experience, laparoscopic liver resection has been applied for recurrent tumors. However, the value of laparoscopic repeat liver resection (LRLR) is still controversial nowadays, which compelled us to conduct this meta-analysis to provide a comprehensive evidence about the efficacy of LRLR for recurrent liver cancer. METHODS: A computerized search was performed to identify all eligible trials published up to April 2019. This meta-analysis was conducted to estimate the perioperative data and oncological outcomes of LRLR by compared with open repeat liver resection (ORLR) and laparoscopic primary liver resection (LPLR). A fixed or random-effect modal was established to collect the data. RESULTS: A total of 1232 patients were included in this meta-analysis (LRLR: n = 364; ORLR: n = 396; LPLR: n = 472). LRLR did not increase the operative time compared to ORLR (WMD = 15.92 min; 95%CI: -33.53 to 65.37; P = .53). Conversely, LRLR for patients with recurrent tumors was associated with less intraoperative blood loss (WMD = -187.33 mL; 95%CI: -249.62 to -125.02; P < .00001), lower transfusion requirement (OR = 0.24; 95%CI: 0.06-1.03; P = .05), fewer major complications (OR = 0.42; 95%CI: 0.23-0.76; P = .004), and shorter hospital stays (WMD = -2.31; 95%CI: -3.55 to -1.07; P = .0003). In addition, the oncological outcomes were comparable between the two groups. However, as for the safety of LRLR compared with LPLR, although the operative time in LRLR group was longer than LPLR group (WMD = 58.63 min; 95%CI: 2.99-114.27; P = .04), the blood loss, transfusion rates, R0 resection, conversion, postoperative complications, and mortality were similar between the two groups. CONCLUSIONS: LRLR for recurrent liver cancer could be safe and feasible in selected patients when performed by experienced surgeons.


Assuntos
Laparoscopia/efeitos adversos , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/cirurgia , Reoperação/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Hepatectomia/tendências , Humanos , Laparoscopia/métodos , Tempo de Internação/tendências , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Seleção de Pacientes , Período Perioperatório , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Reoperação/métodos , Resultado do Tratamento
11.
Anticancer Res ; 39(10): 5755-5760, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570478

RESUMO

BACKGROUND/AIM: After primary resection of hepatocellular carcinoma (HCC), the impact of patient's characteristics at the initial hepatectomy, on long-term remnant liver function has not been reported. The aim of this study was to identify factors associated with the deterioration of remnant liver function among patients who developed recurrent HCC. PATIENTS AND METHODS: A total of 51 patients with intrahepatic recurrence after initial hepatic resection for HCC were included. We retrospectively investigated the relation between patient characteristics and the degree of deterioration of remnant liver function upon recurrence. RESULTS: In univariate analysis, significant predictors of deterioration of remnant liver function consisted of preoperative gastro-esophageal varices (p=0.0101), preoperative transcatheter arterial chemoembolization (p=0.0230) and hepatectomy beyond Makuuchi's criteria (p=0.0101). In multivariate analysis, the only significant independent predictor of deterioration of remnant liver function was hepatectomy beyond Makuuchi's criteria (p=0.0498). CONCLUSION: Hepatectomy beyond Makuuchi's criteria at the initial hepatectomy may predict deterioration of remnant liver function upon recurrence of HCC.


Assuntos
Carcinoma Hepatocelular/patologia , Hepatectomia/efeitos adversos , Neoplasias Hepáticas/patologia , Fígado/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/cirurgia , Quimioembolização Terapêutica/efeitos adversos , Quimioembolização Terapêutica/métodos , Feminino , Hepatectomia/métodos , Humanos , Fígado/cirurgia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Fatores de Risco
12.
Biomed Pharmacother ; 119: 109400, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31514067

RESUMO

AIMS: Post-operative cognitive dysfunction (POCD) occurs after major surgery in elderly patients and affects the quality of patients' lives. The present study aims to explore the protective effects and possible mechanisms of compound K in old mice with POCD caused by partial hepatectomy. METHODS: Sixteen month-old mice were administered different doses of compound K from the 8th day to 14th day after partial hepatectomy. Cognitive function was subsequently measured with a Morris water-maze (MWM) test. Serum inflammatory cytokine levels were measured by magnetic bead panel; levels of cytokines in the hippocampus were analyzed using immunohistochemistry and immunoblotting. The mRNA levels of target genes were measured using real-time PCR. RESULTS: Compared with the model group, MWM scores were significantly attenuated at days 10 and 14 post-surgery in mice receiving compound K (10, 30 mg/kg) in a dose-dependent manner. Both systemic and local cytokine levels were reduced after treatment of compound K. The alterations in serum lipids were independent of the attenuation of POCD syndrome. An inhibitor of liver X receptor-α (LXRα), GGPP, reversed the effects of compound K. CONCLUSIONS: The results provide evidence for an alleviation of POCD by compound K via local inflammation inhibition in hippocampus tissue; furthermore, the data suggests the mechanism involves the LXRα pathway. The present study supports further evaluation of compound K as a potential effective modulator for POCD.


Assuntos
Envelhecimento/patologia , Disfunção Cognitiva/tratamento farmacológico , Disfunção Cognitiva/etiologia , Ginsenosídeos/uso terapêutico , Hepatectomia/efeitos adversos , Receptores X do Fígado/metabolismo , Animais , Glicemia/metabolismo , Disfunção Cognitiva/sangue , Citocinas/metabolismo , Ginsenosídeos/química , Ginsenosídeos/farmacologia , Hipocampo/efeitos dos fármacos , Hipocampo/patologia , Mediadores da Inflamação/metabolismo , Lipídeos/sangue , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Camundongos
13.
World J Gastroenterol ; 25(34): 5185-5196, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31558866

RESUMO

BACKGROUND: Compared with traditional open surgery, laparoscopic surgery is preferred due to the advantages of less trauma, less pain, and faster recovery. Nevertheless, many patients still suffer from postoperative pain resulting from the surgical incision and associated tissue injury. Many researchers have reported methods to improve postoperative pain control, but there is not a simple and effective method that can be clinically adopted in a widespread manner. We designed this study to prove the hypothesis that application of ropivacaine in the port site and operative site in patients is an effective and convenient method which can decrease postoperative pain and accelerate recovery. AIM: To evaluate the effects of ropivacaine on pain control after laparoscopic hepatectomy and its contribution to patient recovery. METHODS: From May 2017 to November 2018, 146 patients undergoing laparoscopic hepatectomy were randomized to receive infiltration of either 7.5 mg/mL ropivacaine around the trocar insertions, incision, and cutting surface of the liver (with a gelatin sponge soaked with ropivacaine) at the end of surgery (ropivacaine group), or normal saline (5 mL) at the same sites at the end of surgery (control group). The degree of pain, nausea, vomiting, heart rate (HR), and blood pressure were collected. The length of postoperative hospitalization, complications, and the levels of stress hormones were also compared between the two groups. RESULTS: Compared with the control group, the ropivacaine group showed reduced postoperative pain at rest within 12 h (P < 0.05), and pain on movement was reduced within 48 h. The levels of epinephrine, norepinephrine, and cortisol at 24 and 48 h, HR, blood pressure, and cumulative sufentanil consumption in the ropivacaine group were significantly lower than those in the control group (P < 0.05). In the ropivacaine group, hospitalization after operation was shorter, but the difference was not statistically significant. There were no significant differences in postoperative nausea, vomiting, or other complications, including hydrothorax, ascites, peritonitis, flatulence, and venous thrombus (P > 0.05), although fewer patients in the ropivacaine group experienced these situations. CONCLUSION: Infiltration with ropivacaine in the abdominal wound and covering the cutting surface of the liver with a gelatin sponge soaked with ropivacaine significantly reduce postoperative pain and the consumption of sufentanil.


Assuntos
Analgesia/métodos , Anestésicos Locais/administração & dosagem , Hepatectomia/efeitos adversos , Laparoscopia/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Ferida Cirúrgica/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hepatectomia/métodos , Humanos , Injeções Intralesionais , Cuidados Intraoperatórios/métodos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Ropivacaina/administração & dosagem , Tampões de Gaze Cirúrgicos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
Med Sci Monit ; 25: 6755-6766, 2019 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-31494663

RESUMO

BACKGROUND Matricellular proteins of the extracellular matrix (ECM) include tenascin-C (TNC) and cellular communication network factor 3 (CCN3). This study aimed to investigate the role of TNC and CCN3 as prognostic factors for post hepatectomy liver failure (PHLF) in a rat model of partial hepatectomy and 50 patients following partial hepatectomy. MATERIAL AND METHODS Sprague-Dawley rats underwent 85% (n=53) or 90% hepatectomy (n=53) in the partial hepatectomy (PHx) model. TNC and CCN3 mRNA expression in residual liver tissue was evaluated using quantitative reverse transcription-polymerase chain reaction (qRT-PCR), and enzyme-linked immunoassay (ELISA) determined the serum levels of TNC and CCN3. In 50 patients who underwent partial hepatectomy, TNC and CCN3 serum levels were measured on postoperative day 1 and day 3. RESULTS In the rat partial hepatectomy model, mRNA and serum levels of TNC and CCN3 were significantly increased within the first 24 h, and were higher in the 90% PHx group compared with the 85% PHx group. Fifty patients who underwent partial hepatectomy, included patients with PHLF (n=12) and patients without PHLF (n=38). Multivariate analysis confirmed that serum levels on postoperative day 3 TNChigh+CCN3high was a significant predictor of PHLF, which was associated with more than twice the risk of severe morbidity when compared with the low-risk patients (80% vs. 30%) and a significantly longer hospital stay (17 days vs. 8 days). CONCLUSIONS Further studies are needed to evaluate the potential role of the matricellular proteins, TNC and CCN3 as early clinical predictors for PHLF.


Assuntos
Hepatectomia/efeitos adversos , Falência Hepática/etiologia , Proteína Sobre-Expressa em Nefroblastoma/metabolismo , Tenascina/metabolismo , Adulto , Idoso , Animais , Área Sob a Curva , Bilirrubina/sangue , Modelos Animais de Doenças , Feminino , Humanos , Tempo de Internação , Falência Hepática/sangue , Falência Hepática/genética , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Morbidade , Análise Multivariada , Proteína Sobre-Expressa em Nefroblastoma/sangue , Proteína Sobre-Expressa em Nefroblastoma/genética , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Curva ROC , Ratos Sprague-Dawley , Fatores de Risco , Análise de Sobrevida , Tenascina/sangue , Tenascina/genética
15.
Transplant Proc ; 51(7): 2379-2382, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474295

RESUMO

BACKGROUND: Hepatic steatosis carries a risk of postoperative liver dysfunction in donors and graft nonfunction in recipients. This article discusses the evaluation of fatty infiltration in donor liver parenchyma on multidetector computed tomography. MATERIALS AND METHODS: The methods of hepatic fat estimation include measurement of hepatic attenuation in HU and calculation of the liver attenuation index (LAI). Liver attenuation values reflect the degree of steatosis. Average attenuation of liver parenchyma is calculated by placing the circular region of interest of at least 1 cm2 area at multiple places in the liver on noncontrast CT images. Splenic attenuation is measured by placing the circular region of interest at its upper, middle, and lower poles. The LAI is the difference between mean hepatic attenuation and mean splenic attenuation. RESULTS: A total of 52 donors were evaluated as potential recipients (34 men, 18 women; mean age, 33.2 years; range, 23-55 years). In 34 donors liver attenuation index (LAI) values were from 2 HU to 22 HU. An LAI > 5 HU correctly predicted the absence of significant macrovesicular steatosis. These donors were acceptable for a liver transplant. The LAI values of -10 to 5 HU were suggestive of mild to moderate steatosis (6%-30%); 18 (34.6%) volunteers did not proceed to donation because of negative LAI < -5 HU. In 2 cases with LAI of -7 and LAI of -8 liver biopsy was performed, and 30% steatosis was confirmed in the pathohistologic examination. Unacceptable liver biopsy result was considered as contraindication for donation. The LAI values of < -10 HU were suggestive of moderate to severe hepatic steatosis of 30% or greater. In these cases liver biopsy is not needed, as such donors are not acceptable for liver transplant. CONCLUSION: Computed tomography imaging provides a detailed evaluation of fatty infiltration in donor liver parenchyma.


Assuntos
Fígado Gorduroso/etiologia , Hepatectomia/efeitos adversos , Doadores Vivos , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Biópsia , Contraindicações , Feminino , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Retrospectivos , Adulto Jovem
16.
Surg Oncol ; 30: 147-158, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31471139

RESUMO

The prevalence of elevated intra-hepatic fat (IHF) is increasing in the Western world, either alone as hepatic steatosis (HS) or in conjunction with inflammation (steatohepatitis). These changes to the hepatic parenchyma are an independent risk factor for post-operative morbidity following liver resection for colorectal liver metastases (CRLM). As elevated IHF and colorectal malignancy share similar risk factors for development it is unsurprisingly frequent in this cohort. In patients undergoing resection IHF may be elevated due to excess adiposity or its elevation may be induced by neoadjuvant chemotherapy, termed chemotherapy associated steatosis (CAS). Additionally, chemotherapy is implicated in the development of inflammation termed chemotherapy associated steatohepatitis (CASH). Following cessation of chemotherapy, patients awaiting resection have a 4-6 week washout period prior to resection that is a window for prehabilitation prior to surgery. In patients with NAFLD dietary and pharmacological interventions can reduce IHF within this timeframe but this approach to modifying IHF is untested in this population. In this review, the aetiology of CAS and CASH is reviewed with recommendations to identify those at risk. We also focus on the post-chemotherapy washout period, reviewing dietary interventions applied to the metabolic population and suggest this window may be used as an opportunity to optimise IHF with such a regime as part of a pre-operative prehabilitation programme to produce improved patient outcomes.


Assuntos
Neoplasias Colorretais/cirurgia , Fígado Gorduroso/etiologia , Hepatectomia/efeitos adversos , Neoplasias Hepáticas/cirurgia , Cuidados Pré-Operatórios/métodos , Neoplasias Colorretais/patologia , Fígado Gorduroso/patologia , Humanos , Neoplasias Hepáticas/secundário , Fatores de Risco
17.
BMC Surg ; 19(1): 128, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488117

RESUMO

BACKGROUND: The aim of the study was to develop a scoring system for the prediction of postoperative complications of open hepatectomy. METHOD: All consecutive patients receiving open hepatectomy from 2015 to 2017 were included in the study. Univariate and multivariate analyses were used to confirm the risk factors for postoperative complications. Afterwards, a novel scoring system was developed to predict the postoperative complications. RESULTS: The study included a total of 207 patients. For the test dataset, multivariate analysis indicated that diabetes, scale of surgery, serum potassium, and blood loss versus body weight were independent risk factors of the postoperative complications. The area under the curve (AUC) of the novel scoring system we proposed for prediction of postoperative complications of hepatectomy was 0.803, which is comparable with the AUCs of previous scoring systems. Furthermore, in the validation dataset, the corresponding AUC of the new scoring system was 0.717. CONCLUSION: This novel and simplified scoring system can effectively predict the postoperative complications of open hepatectomy and could help identify patients who are at high risk of postoperative complications.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/efeitos adversos , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco
18.
Anticancer Res ; 39(9): 5019-5026, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519609

RESUMO

BACKGROUND: Portal vein thrombosis (PVT) is a life-threatening complication after hepatectomy. However, the relationship between postoperative PVT and morphometric features of the PV has not been fully elucidated yet. PATIENTS AND METHODS: A total of 81 patients who underwent hepatectomy for perihilar cholangio-carcinoma (PHCC) were studied. We investigated the diameters and angles of PV using pre- and postoperative computed tomography (CT) reconstructed by SYNAPSE VINCENT®. RESULTS: The incidence of PVT after hepatectomy was 11.1%. There were significant differences with respect to the remnant liver PV diameter (p=0.015), the diameter ratio (p=0.001), and the postoperative PV angle (p=0.001) between patients with and without PVT. Multivariate analysis revealed that a postoperative PV angle of less than 90° (p=0.008) and a diameter ratio of less than 45% (p=0.041) were independent risk factors for PVT. CONCLUSION: A postoperative PV angle of less than 90° and diameter ratio of less than 45% eventually lead to PVT after hepatectomy for PHCC.


Assuntos
Hepatectomia/efeitos adversos , Tumor de Klatskin/complicações , Tumor de Klatskin/cirurgia , Veia Porta/patologia , Complicações Pós-Operatórias , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Gerenciamento Clínico , Feminino , Hepatectomia/métodos , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Veia Porta/anatomia & histologia , Veia Porta/diagnóstico por imagem , Período Pós-Operatório , Prognóstico , Tomografia Computadorizada por Raios X
19.
Anticancer Res ; 39(9): 5143-5148, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519626

RESUMO

BACKGROUND/AIM: We aimed to assess surgical outcome and long-term survival after elective hepatic resection for hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM) in patients aged 80 years or older. PATIENTS AND METHODS: This study included 100 patients aged 70 years or older, who underwent hepatic resection for HCC or CRLM between January 2000 and December 2012. Outcomes and clinicopathological data were compared between the elderly (aged 70-79 years; n=84) and extremely elderly groups (aged 80 years or over; n=16). RESULTS: Incidence of postoperative complications, in-hospital mortality, and postoperative OS in the extremely elderly group were comparable with those of the elderly group. In patients with HCC, the extremely elderly group was associated with shorter DFS (p=0.030) in univariate analysis, while multivariate analysis showed significant and independent factors of cancer recurrence. CONCLUSION: Hepatic resection for HCC and CRLM in patients aged 80 years and over may be safe and acceptable with appropriate selection. For HCC in patients aged 80 years and over, hepatic resection may be effective when negative surgical margins can be achieved.


Assuntos
Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/diagnóstico , Masculino , Estadiamento de Neoplasias , Complicações Pós-Operatórias , Prognóstico , Resultado do Tratamento
20.
S Afr J Surg ; 57(3): 11-16, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392859

RESUMO

BACKGROUND: Living donor liver transplantation (LDLT) plays a crucial role in liver transplant programmes, particularly in regions with a scarcity of deceased donor organs and especially for paediatric recipients. LDLT is a complex and demanding procedure which places a healthy living donor in harm's way. Donor safety is therefore the overriding concern. This study aimed to report our standardised approach to the evaluation, technical aspects and outcomes of LDLT donor hepatectomy at Wits Donald Gordon Medical Centre. METHOD: The study population consisted of all patients undergoing LDLT donor hepatectomy since the inception of the programme in March 2013 until 2018. Sixty five living donor hepatectomies were performed. Primary outcome measures included donor demographics, operative time, peak bilirubin, aspartate and alanine transaminase levels postoperatively, length of hospital stay and postoperative complications using the Clavien-Dindo classification. RESULTS: The majority of the donors were female, most were parents with mothers being the donor almost 85% of the time. The median operative time was 374 minutes with a downward trend over time as experience was gained. The median length of hospital stay was 7 days. There was no mortality and the complication rate was 30% with the majority being minor (Grade 1). CONCLUSION: Living donor liver transplant from adult-to-child has been successfully initiated in South Africa. Living donor hepatectomy can be safely performed with acceptable outcomes for the donor. Wait-list mortality however remains unacceptably high. Expansion of LDLT as well as real change in deceased donor policy is required to address this issue.


Assuntos
Hepatectomia/efeitos adversos , Doadores Vivos , Feminino , Hepatectomia/métodos , Humanos , Tempo de Internação , Transplante de Fígado , Masculino , Duração da Cirurgia , África do Sul
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