Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.089
Filtrar
1.
Surg Clin North Am ; 100(2): 265-281, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32169180

RESUMO

Robotic surgery has rapidly evolved. It is particularly attractive as an alternative minimally invasive approach in liver surgery because of improvements in visualization and articulated instruments. Limitations include increased operative times and lack of tactile feedback, but these have not been shown in studies. Considerations unique to robotic surgery, including safety protocols, must be put in place and be reviewed at the beginning of every procedure to ensure safety in the event of an emergent conversion. Despite the lack of early adoption by many hepatobiliary surgeons, robotic liver surgery continues to evolve and find its place within hepatobiliary surgery.


Assuntos
Hepatectomia/métodos , Hepatopatias/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Humanos , Laparoscopia/métodos
2.
Medicine (Baltimore) ; 98(49): e18176, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804334

RESUMO

INTRODUCTION: Choice of treatment in patients with symptomatic polycystic liver diseases (PLD) remains controversial. Various surgical procedures aiming at eliminating symptomatic cysts are widely used in mild and advanced PLD patients, but liver transplantation is currently recommended as the only curative treatment especially in severe cases. PATIENT CONCERNS: Case 1: A 51-year-old male was admitted for severe eating disorder and dyspnea for 2 months. He had been diagnosed as PLD, PKD, and hypertension for 9 years, with only antihypertensive drug therapy. No significant family history could be traced.Case 2: A 54-year-old female was admitted to our hospital for ventosity during nearly 5 years. She had been diagnosed as PLD and hypertension for 22 years, for which only aspiration-sclerotherapy therapy was performed for multiple times. Both her mother and sister were diagnosed with PLD previously. DIAGNOSIS: They were diagnosed as PLD by medical history, family history, and computed tomography scan (multiple cysts dispersively presenting in the liver). INTERVENTIONS: The 2 patients underwent hepatectomy with fenestration, and were well recovered with no mortality. OUTCOMES: While case 1 only experienced relief of symptoms, case 2 experienced massive growth of hepatic parenchyma, which indicated positive prognosis and showed the possibility to avoid or at least postpone liver transplantation for a long time, considering the lack of liver parenchyma is one of the main reason for urgency of liver transplantation. CONCLUSION: Here we described subradical polycystic hepatectomy, a special form of hepatectomy with fenestration modified by us, as a safe and effective treatment to potentially achieve long-term effects in PLD patients.


Assuntos
Cistos/cirurgia , Hepatectomia/métodos , Hepatopatias/cirurgia , Cistos/diagnóstico por imagem , Feminino , Humanos , Hepatopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
3.
Arq Bras Cir Dig ; 32(4): e1463, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31859916

RESUMO

BACKGROUND: Primary intrahepatic lithiasis is defined when the stones are formed in the liver and associated with local dilatation and biliary stricture. Liver resection is the ideal procedure. AIM: To evaluate the results of liver resection in the treatment of non-oriental intrahepatic lithiasis. METHODS: Fifty-one patients with symptomatic benign non-oriental hepatolithiasis underwent surgical resection in six institutions in Brazil. Demography data, clinical symptoms, classification, diagnosis, management and postoperative course were analyzed. RESULTS: Of the 51 patients, 28 were male (54.9%), with a mean age of 49.3 years. History of cholangitis was observed in 15 (29.4%). The types of intrahepatic lithiasis were type I in 39 (76.5%) and type IIb in 12 (23.5%), with additional type Ea in six (11.8%). Liver function test were normal in 42 patients (82.4%). Segmental atrophy was observed in 12 (23.5%). Treatments included left lateral sectionectomy in 24 (47.1%), left hepatectomy in 14 (27.5%) and right hepatectomy in eight (15.7%), with associated hepaticojejunostomy in four (7.8%). Laparoscopic liver resection was performed in eight (15.7%). Postoperative complications were observed in 20 (39.2%) with no mortality. CONCLUSION: Liver resection in patients with hepatolithiasis is the ideal procedure as it removes stones, stricture, atrophic parenchyma, and minimizes the risk of cholangiocarcinoma.


Assuntos
Hepatectomia/métodos , Litíase/cirurgia , Hepatopatias/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
4.
Rozhl Chir ; 98(10): 404-407, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31842570

RESUMO

INTRODUCTION: Liver cysts are present in about 5% of the population and are asymptomatic in most cases. Currently, liver cystic lesions are disco-vered arbitrarily during imaging assessments of the abdomen indicated for unrelated reasons. The final findings vary from solitary cysts to multiple lesions or eventually the polycystic liver disease which can result in liver transplantation. Most cases are congenital. In the case of a symptomatic manifestation, pressure pain in the upper right quadrant is the predominant symptom. The therapy is surgical; laparoscopic approach is preferred. METHODS: A retrospective evaluation of the sample of 55 patients was conducted. The patients had been surgically treated at the Department of Surgery, University Hospital in Pilsen, from 01 Jan 2009 to 21 Dec 2017. The evaluation covered basic demographic data, the size of the dominant cyst, complications, hospitalization length, any relapse of the disease, etc. Results: In the presented period 62 surgeries of symptomatic liver cysts were performed, 55 of them by laparoscopy. The mean age of the patients was 61.7 years (32-83 years), women predominated (N=54, i.e. 87.1%). Complications occurred in 8 patients (12.9%); the most common was a bile leak. The mean length of hospitalisation was 4.5 days (2-20 days). In the follow-up period, 41 patients (66.1%) remained without any recidivism. CONCLUSION: Currently, the treatment of symptomatic liver cysts is laparoscopic, with fenestration being the standard approach. Due to potential complications centres with experience in liver surgery are prioritized.


Assuntos
Cistos/cirurgia , Hepatopatias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laparoscopia , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Rozhl Chir ; 98(10): 418-421, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31842573

RESUMO

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


Assuntos
Aorta/cirurgia , Implante de Prótese Vascular/métodos , Artéria Hepática/cirurgia , Hepatopatias/cirurgia , Transplante de Fígado/efeitos adversos , Trombose/cirurgia , Procedimentos Endovasculares , Humanos , Reoperação , Terapia Trombolítica , Trombose/etiologia , Trombose/terapia , Fatores de Tempo , Resultado do Tratamento
7.
Am Surg ; 85(9): 1033-1039, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638520

RESUMO

Regionalization of complex surgical care has increased interhospital transfers to quaternary centers within large health-care systems. Risk-based patient selection is imperative to improve resource allocation without compromising care. This study aimed to develop predictive models for identifying low-risk patients for transfer to a fully integrated satellite hepatopancreatobiliary (HPB) service in the northeast region of the health-care system. HPB transfers to the quaternary center over 15 months from hospitals in proximity to the satellite HPB center. A predictive tool was developed based on simple pretransfer variables and outcomes for 30-day major complications (Clavien grade ≥ 3), readmission, and mortality. Thresholds for "low risk" were set at different SDs below mean for each model. Predictive models were developed from 51 eligible northeast region patient transfers for major complications (Brier score 0.1948, receiver operator characteristic (ROC) 0.7123, P = 0.0009), readmission (Brier score 0.0615, ROC 0.7368, P = 0.0020), and mortality (Brier score 0.0943, ROC 0.7989, P = 0.0023). Thresholds set from 2 SD below the mean for all models identified 2 as "low risk." Adjusting the threshold for the serious complication model to only 1 SD below the mean increased the "low-risk" cohort to five patients. These models demonstrate an easy-to-use tool to assist surgeons in identifying low-risk patients for diversion to a fully integrated satellite center. Improved interhospital transfers within a region could begin a transition from centers of excellence toward health-care systems of excellence.


Assuntos
Doenças Biliares/cirurgia , Hepatopatias/cirurgia , Modelos Logísticos , Pancreatopatias/cirurgia , Transferência de Pacientes , Medição de Risco/estatística & dados numéricos , Tomada de Decisão Clínica , Cuidados Críticos , Feminino , Mortalidade Hospitalar , Planejamento Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina , Readmissão do Paciente , Complicações Pós-Operatórias , Medição de Risco/métodos
8.
Z Gastroenterol ; 57(10): 1196-1199, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31610582

RESUMO

Many patients with intrahepatic cholelithiasis need surgical treatment during their life. For patients with hepatolithiasis, conventional therapy methods suggest partial hepatectomy or hepatic transplantation, while both kinds of surgery carry a considerable risk and trauma. Under such conditions, percutaneous transhepatic cholangioscopic lithotripsy provides an alternative method for hepatolithiasis treatment. Conventional rigid choledochoscope applied in percutaneous transhepatic cholangioscopic lithotripsy often lack sufficient flexibility for complete intrahepatic bile duct inspection. In this article, we report a case of one patient with complex hepatolithiasis and choledocholithiasis who received percutaneous transhepatic cholangioscopic lithotripsy using the newly-developed soft fiber-optic choledochoscope. This treatment represents a safe and effective outcome. We came to the conclusion that soft fiber-optic choledochoscope guided percutaneous transhepatic cholangioscopic lithotripsy seems a promising treatment option for selected patients with hepatolithiasis, especially for those who cannot accept conventional methods.


Assuntos
Coledocolitíase , Litotripsia , Hepatopatias , Idoso , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/patologia , Ductos Biliares Intra-Hepáticos/cirurgia , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/patologia , Coledocolitíase/cirurgia , Humanos , Laparoscopia/instrumentação , Litotripsia/instrumentação , Fígado/diagnóstico por imagem , Fígado/patologia , Fígado/cirurgia , Hepatopatias/diagnóstico por imagem , Hepatopatias/patologia , Hepatopatias/cirurgia , Masculino , Resultado do Tratamento
9.
J Laparoendosc Adv Surg Tech A ; 29(10): 1325-1329, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31549901

RESUMO

Background: Congenital nonparasitic liver cysts in newborns are rare. Surgical excision of these formations is necessary to prevent complications. Reports of laparoscopic treatment of simple liver cysts in children are sporadic. We present a series of 3 patients with liver cysts treated laparoscopically in a single center. We added a short review of the literature. Methods: Data of 3 patients with nonparasitic liver cysts were collected at our center, from 2014 to 2019. Early and long-term results of laparoscopic operations were studied. Results: All patients were newborns, and of these, 2 were girls and 1 boy. The primary diagnosis was established during prenatal ultrasound examination. The laparoscopic approach was used in all patients. Complete resection of the cysts was achieved laparoscopically in all cases. Pathology reports were consistent with nonparasitic liver cysts. The early postoperative period was uneventful with prompt discharge. In the long-term follow-up period, there were no recurrences of the disease. Conclusions: The study presents one of the largest series of laparoscopic excision of nonparasitic liver cysts in newborns. We conclude that laparoscopy is a safe and effective method of treating of congenital hepatic cysts.


Assuntos
Cistos/cirurgia , Laparoscopia/métodos , Hepatopatias/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Masculino , Recidiva , Ultrassonografia
10.
Neurology ; 93(17): e1587-e1596, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31511348

RESUMO

OBJECTIVE: To elucidate the clinical characteristics of acquired ATTR amyloidosis after domino liver transplantation (DLT) with liver grafts explanted from patients with hereditary variant ATTR (ATTRv) amyloidosis. METHODS: We evaluated the presence of amyloid deposits and clinical symptoms in 30 recipients of domino liver transplants (24 men and 6 women) who underwent DLT with liver grafts explanted from patients with ATTRv amyloidosis. We analyzed symptoms and measures of 7 cases of symptomatic acquired ATTR amyloidosis and compared those with 30 patients with ATTRv amyloidosis who were the domino liver donors. We also reviewed the literature on case studies of acquired ATTR amyloidosis. RESULTS: We found amyloid deposition in 13 of our 30 domino liver recipients. A Kaplan-Meier analysis estimated that the median time from DLT to the first detection of amyloid was 8.5 years. In the literature review, the mean time was 7.3 years, with a wide range of 0.5-13 years. Our 7 symptomatic cases and the literature cases with acquired ATTR amyloidosis presented with clinical features that differed from patients with ATTRv amyloidosis who were the domino liver donors. Patients with acquired ATTR amyloidosis showed markedly milder autonomic disturbance, which is one of the main symptoms of ATTRv amyloidosis. CONCLUSIONS: Careful monitoring is required for DLT recipients of ATTRv liver grafts because the time from DLT to disease onset has a wide range and the clinical picture of these DLT recipients is distinct from that of liver donors.


Assuntos
Amiloidose/etiologia , Transplante de Fígado , Complicações Pós-Operatórias , Adolescente , Adulto , Feminino , Humanos , Hepatopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
BMJ Case Rep ; 12(9)2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31527205

RESUMO

Simple hepatic cysts are usually asymptomatic but can rarely result in life-threatening complications such as haemoperitoneum secondary to rupture. A 70-year-old woman with known simple hepatic cyst presented with acute chest pain and dyspnoea. The initial diagnosis was pulmonary embolism, and anticoagulation was commenced. However, she subsequently collapsed with haemodynamic instability. CT revealed a large hepatic cyst haematoma with rupture into the peritoneal cavity. The patient underwent emergency laparotomy, haemostasis and partial deroofing of the cyst. Retrospective review of CT scans suggested that the bleed had begun on presentation but was exacerbated by anticoagulation. To our knowledge, this is the first report of haemorrhagic hepatic cyst associated with acute anticoagulation. We discuss several important clinical lessons including cyst rupture as a possible cause of chest pain, the need for careful review of imaging and the choice of anticoagulation in patients with known simple hepatic cyst.


Assuntos
Anticoagulantes/efeitos adversos , Hemoperitônio/etiologia , Ruptura Espontânea/induzido quimicamente , Idoso , Dor no Peito , Cistos/diagnóstico por imagem , Cistos/cirurgia , Diagnóstico Diferencial , Dispneia , Feminino , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/cirurgia , Humanos , Hepatopatias/diagnóstico por imagem , Hepatopatias/cirurgia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia
12.
Transplant Proc ; 51(9): 3147-3149, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31371215

RESUMO

BACKGROUND: Fibrocystic liver-kidney disease is caused by a group of rare and genetically diverse disorders that are associated with kidney cysts or dysplasia and ductal plate malformation in the liver. There have been several reports of liver neoplasias arising in hepatobiliary fibrocystic diseases. However, most were cholangiocarcinoma; cases involving hepatocellular carcinoma (HCC) are rare, and all the reported cases are related with adults. CASE REPORT: A 10-year-old girl with a history of repeated gastrointestinal bleeding underwent banding and sclerotherapy multiple times and had a history of a Portosystemic shunt without any significant benefit. She was referred to us as a case of fibrocystic liver disease with decompensated liver disease for liver transplantation. The patient underwent living donor liver transplantation, and the explanted liver histopathology report is documented. The explant liver weighed 838 g and measured 21 × 13 × 8.5 cm with the attached gallbladder measuring 7 × 3 × 0.2 cm (in wall thickness). The external surface was covered with multiple white nodules ranging in size from 0.4 to 1 cm. Serial slicing revealed an ill-defined, yellow, soft lesion (4 × 2.5 × 2.5 cm) localized in the subcapsular area of the left lobe (segment 4). The rest of the cut surface was green and nodular (cirrhotic). Microscopy from largest nodule was consistent with early hepatocellular carcinoma.The rest of the liver was cirrhotic, and the morphology was consistent with fibrocystic disease of liver. CONCLUSION: We report a rare case of HCC associated with fibrocystic liver disease. When diagnosing fibrocystic liver disease without known risk factors, the presence of HCC must be considered, and vice versa. To our knowledge, this is the first reported case of HCC associated with fibrocystic liver disease in a 10-year-old child.


Assuntos
Carcinoma Hepatocelular/complicações , Cistos/complicações , Hepatopatias/complicações , Neoplasias Hepáticas/complicações , Adulto , Carcinoma Hepatocelular/cirurgia , Criança , Cistos/cirurgia , Feminino , Humanos , Hepatopatias/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Masculino , Fatores de Risco
13.
Pediatr Cardiol ; 40(8): 1759-1760, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31440767

RESUMO

In a newborn that underwent surgery due to omphalocele, postoperative echocardiography revealed an accidental finding of a right atrial (RA) mass. Echocardiography prior to surgery was inconspicuous. Applying color Doppler, a pulsatile flow exiting the mass could be depicted and a tubular structure lancing through the mass. Thrombus formation was suspected. However, sonographic tissue texture of this formation equaled liver tissue. Abdominal ultrasound revealed protrusion of hepatic tissue through a diaphragmatic hernia indenting the RA mimicking a thrombus.


Assuntos
Hérnias Diafragmáticas Congênitas/cirurgia , Hepatopatias/diagnóstico , Diagnóstico Diferencial , Ecocardiografia , Feminino , Átrios do Coração/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Humanos , Achados Incidentais , Recém-Nascido , Hepatopatias/cirurgia , Ultrassonografia Doppler em Cores
14.
Br J Surg ; 106(11): 1512-1522, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31441944

RESUMO

BACKGROUND: Laparoscopic liver resection demands expertise and a long learning curve. Resection of the posterosuperior segments is challenging, and there are no data on the learning curve. The aim of this study was to evaluate the learning curve for laparoscopic resection of the posterosuperior segments. METHODS: A cumulative sum (CUSUM) analysis of the difficulty score for resection was undertaken using patient data from four specialized centres. Risk-adjusted CUSUM analysis of duration of operation, blood loss and conversions was performed, adjusting for the difficulty score of the procedures. A receiver operating characteristic (ROC) curve was used to identify the completion of the learning curve. RESULTS: According to the CUSUM analysis of 464 patients, the learning curve showed an initial decrease in the difficulty score followed by an increase and, finally, stabilization. More patients with cirrhosis or previous surgery were operated in the latest phase of the learning curve. A smaller number of wedge resections and a larger number of anatomical resections were performed progressively. Dissection using a Cavitron ultrasonic surgical aspirator and the Pringle manoeuvre were used more frequently with time. Risk-adjusted CUSUM analysis showed a progressive decrease in operating time. Blood loss initially increased slightly, then stabilized and finally decreased over time. A similar trend was found for conversions. The learning curve was estimated to be 40 procedures for wedge and 65 for anatomical resections. CONCLUSION: The learning curve for laparoscopic liver resection of the posterosuperior segments consists of a stepwise process, during which accurate patient selection is key.


Assuntos
Hepatectomia/educação , Laparoscopia/educação , Curva de Aprendizado , Hepatopatias/cirurgia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Conversão para Cirurgia Aberta/estatística & dados numéricos , Feminino , Hepatectomia/métodos , Hepatectomia/normas , Humanos , Laparoscopia/normas , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Seleção de Pacientes , Curva ROC
15.
Arq Gastroenterol ; 56(2): 165-171, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31460581

RESUMO

BACKGROUND: Liver transplantation (LTx) is the primary and definitive treatment of acute or chronic cases of advanced or end-stage liver disease. Few studies have assessed the actual cost of LTx categorized by hospital unit. OBJECTIVE: To evaluate the cost of LTx categorized by unit specialty within a referral center in southern Brazil. METHODS: We retrospectively reviewed the medical records of 109 patients undergoing LTx between April 2013 and December 2014. Data were collected on demographic characteristics, etiology of liver disease, and severity of liver disease according to the Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores at the time of LTx. The hospital bill was transformed into cost using the full absorption costing method, and the costs were grouped into five categories: Immediate Pretransplant Kit; Specialized Units; Surgical Unit; Intensive Care Unit; and Inpatient Unit. RESULTS: The mean total LTx cost was US$ 17,367. Surgical Unit, Specialized Units, and Intensive Care Unit accounted for 31.9%, 26.4% and 25.3% of the costs, respectively. Multivariate analysis showed that total LTx cost was significantly associated with CTP class C (P=0.001) and occurrence of complications (P=0.002). The following complications contributed to significantly increase the total LTx cost: septic shock (P=0.006), massive blood transfusion (P=0.007), and acute renal failure associated with renal replacement therapy (dialysis) (P=0.005). CONCLUSION: Our results demonstrated that the total cost of LTx is closely related to liver disease severity scores and the development of complications.


Assuntos
Hepatopatias/cirurgia , Transplante de Fígado/economia , Adulto , Idoso , Brasil , Feminino , Custos Hospitalares , Humanos , Tempo de Internação , Hepatopatias/economia , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Arq Gastroenterol ; 56(2): 213-231, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31460590

RESUMO

Liver and biliary tract diseases are common causes of morbidity and mortality worldwide. Invasive procedures are usually performed in those patients with hepatobiliary diseases for both diagnostic and therapeutic purposes. Defining proper indications and restraints of commonly used techniques is crucial for proper patient selection, maximizing positive results and limiting complications. In 2018, the Brazilian Society of Hepato-logy (SBH) in cooperation with the Brazilian Society of Interventional Radiology and Endovascular surgery (SOBRICE) and the Brazilian Society of Digestive Endoscopy (SOBED) sponsored a joint single-topic meeting on invasive procedures in patients with hepatobiliary diseases. This paper summarizes the proceedings of the aforementioned meeting. It is intended to guide clinicians, gastroenterologists, hepatologists, radiologists, and endoscopists for the proper use of invasive procedures for management of patients with hepatobiliary diseases.


Assuntos
Doenças Biliares/cirurgia , Hepatopatias/cirurgia , Brasil , Gerenciamento Clínico , Guias como Assunto , Humanos , Sociedades Médicas
17.
Medicina (Kaunas) ; 55(7)2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31277322

RESUMO

Gastric varices are less common than esophageal varices, and their treatment is quite challenging. Gastric varix bleedings (GVB) occur less frequently than esophageal varix (EV) bleedings and represent 10% to 30% of all variceal bleedings. They are; however, more severe and are associated with high mortality. Re-bleeding may occur in 35% to 90% of cases after spontaneous hemostasis. GV bleedings represent a serious clinical problem compared with esophageal varices due to their location. Sclerotherapy and band ligation, in particular, are less effective. Based on the anatomic site and location, treatment differs from EV and is categorized into two groups (i.e., endoscopic or radiologic treatment). Surgical management is used less frequently. Balloon-occluded retrograde transvenous obliteration (BRTO) and cyanoacrylate are safe but there is a high risk of re-bleeding. Portal pressure elevates following BRTO and leads to worsening of esophageal varix pressure. Other significant complications may include hemoglobinuria, abdominal pain, fever, and pleural effusion. Shock and atrial fibrillation are major complications. New and efficient treatment modalities will be possible in the future.


Assuntos
Varizes Esofágicas e Gástricas/cirurgia , Resultado do Tratamento , Adesivos/normas , Adesivos/uso terapêutico , Oclusão com Balão/métodos , Oclusão com Balão/normas , Varizes Esofágicas e Gástricas/etiologia , Humanos , Hepatopatias/complicações , Hepatopatias/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Derivação Portossistêmica Transjugular Intra-Hepática/normas
18.
Transplant Proc ; 51(6): 1874-1879, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31262437

RESUMO

BACKGROUND: Patients on a waiting list for liver transplantation frequently show core muscle wasting, referred to as sarcopenia, which results in poor prognosis. To date, there has been a lack of research on the association between inflammation mediators, including cytokines, and loss of core muscle mass in cirrhotic patients scheduled for living donor liver transplantation (LDLT). METHODS: Cytokines in serum, such as interleukin (IL)-2, IL-6, IL-10, IL-12, IL-17, interferon-γ, and tumor necrosis factor (TNF)-α, were retrospectively investigated in 234 LDLT patients 1 day before surgery. The psoas muscle area was measured using abdominal computed tomography within 1 month before surgery and used to calculate the psoas muscle index (PMI = psoas muscle area/height2). The study population was classified into 2 groups according to the interquartile range of PMI: a non-sarcopenia group (> 25th quartile) and a sarcopenia group (≤ 25th quartile) in each sex. RESULTS: In both sexes, IL-10 and TNF-α levels were significantly higher in the sarcopenia group than the non-sarcopenia group. In a univariate analysis, male patients showed that serum IL-10 and TNF-α levels were potentially associated with sarcopenia. Serum TNF-α was independently associated with sarcopenia in a multivariate analysis. In female patients, TNF-α was significantly associated with sarcopenia in both univariate and multivariate analyses. Male patients with a PMI ≤ 25th quartile had significantly higher TNF-α levels than those in other quartile ranges, and female patients with a PMI ≤ 25th quartile had a significantly higher TNF-α level than those with a PMI > 75th quartile. CONCLUSIONS: Serum levels of TNF-α are inversely associated with skeletal muscle wasting in both male and female patients scheduled for LDLT.


Assuntos
Hepatopatias/sangue , Transplante de Fígado , Sarcopenia/sangue , Índice de Gravidade de Doença , Fator de Necrose Tumoral alfa/sangue , Adulto , Citocinas/sangue , Feminino , Humanos , Hepatopatias/complicações , Hepatopatias/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Músculos Psoas/patologia , Estudos Retrospectivos , Sarcopenia/etiologia , Sarcopenia/patologia , Tomografia Computadorizada por Raios X , Listas de Espera
19.
Zhonghua Wai Ke Za Zhi ; 57(7): 488-493, 2019 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-31269608

RESUMO

In the past 20 years,the advancement and breakthrough of applied basic research,the invention and renewal of medical devices,the popularization and improvement of minimally invasive techniques,the development and debate of innovative surgical methods and the establishment of the diagnosis and treatment standard brought the unprecedented development momentum to traditional liver surgery.This article combined the domestic and foreign related literature and the research results of our team. The current status and progress of the application of preoperative evaluation and surgical planning of liver surgery,surgical techniques of liver resection,laparoscopic and robotic techniques in liver surgery,enhanced recovery after surgery and associating liver partition and portal vein ligation for staged hepatectomy are briefly discussed.


Assuntos
Hepatectomia/métodos , Hepatectomia/normas , Hepatopatias/cirurgia , Fígado/cirurgia , Protocolos Clínicos , Difusão de Inovações , Hepatectomia/instrumentação , Humanos , Laparoscopia , Ligadura , Fígado/anatomia & histologia , Neoplasias Hepáticas/cirurgia , Assistência Perioperatória , Veia Porta/cirurgia , Cuidados Pré-Operatórios , Procedimentos Cirúrgicos Robóticos
20.
Zhonghua Wai Ke Za Zhi ; 57(7): 500-502, 2019 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-31269610

RESUMO

Blood control technology and determination of hepatectomy plane are the core techniques of liver resection, which not only affect the operative performance, but also affect the prognosis of patients.The concept of pre-control the blood vessels in the hepatic segment which should be resected can effective control of bleeding during hepatectomy.A comprehensive application of the ischemic line guidance, the intraoperative ultrasound, the segmental portal staining, fluorescent staining, the hepatic vein-oriented technique, and three-dimensional technique are helpful to precisely determine the boundary of hepatic segment to be resected and guide the hepatectomy plane.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Hemostasia Cirúrgica/métodos , Hepatectomia/métodos , Hepatopatias/cirurgia , Fígado/anatomia & histologia , Fígado/cirurgia , Hepatectomia/efeitos adversos , Veias Hepáticas/cirurgia , Humanos , Hepatopatias/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Ultrassonografia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA