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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.
Ann R Coll Surg Engl ; 103(4): e131-e135, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682478

RESUMO

Fungal infections are generally observed in immunosuppressed patients only, with a diagnostic challenge due to non-specific symptoms. For this reason, appropriate management may be delayed. This case report concerns a 36-year-old man with history of pancreas and kidney transplantation. He had chemotherapy for post-transplant B-cell lymphoma and presented with left upper abdominal pain and fever. Multiple investigations led to a final diagnosis of disseminated abdominal mucormycosis with multiple Rhizomucor abscesses in the liver, spleen and kidney transplant. Treatment was antifungal therapy and laparotomy with splenectomy, wedge resection of two fungal abscesses in segments II and IVb, and segmental left colic resection.


Assuntos
Abscesso Abdominal/diagnóstico , Transplante de Rim , Mucormicose/diagnóstico , Transplante de Pâncreas , Complicações Pós-Operatórias/diagnóstico , Rhizomucor/isolamento & purificação , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Adulto , Hepatectomia , Humanos , Hepatopatias/diagnóstico , Hepatopatias/etiologia , Hepatopatias/cirurgia , Masculino , Mucormicose/etiologia , Mucormicose/cirurgia , Complicações Pós-Operatórias/cirurgia , Esplenectomia , Esplenopatias/diagnóstico , Esplenopatias/etiologia , Esplenopatias/cirurgia
3.
J Clin Gastroenterol ; 55(3): 187-194, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394628

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has brought challenges to clinicians caring for patients with chronic liver disease. In the past 6 months, COVID-19 has led to over 150,000 deaths in the United States and over 660,000 deaths around the world. Mounting evidence suggests that chronic liver diseases can have an adverse effect on the clinical outcomes of patients with COVID-19. We present a comprehensive review of the latest literature on preexisting liver diseases and its interrelationship with COVID-19 infection in cirrhosis, hepatocellular carcinoma, nonalcoholic fatty liver disease, autoimmune hepatitis, and viral hepatitis B. As social distancing and telemedicine gain new footing, we synthesize recommendations from 3 major hepatology societies [American Association for the Study of Liver Disease (AASLD), the European Association for the Study of Liver (EASL), and the Asian Pacific Association for the Study of Liver (APASL)] to present the best approaches for caring for patients with liver diseases as well as those requiring liver transplantation.


Assuntos
/terapia , Hepatopatias/cirurgia , Transplante de Fígado , Fígado/cirurgia , /patogenicidade , /diagnóstico , /virologia , Nível de Saúde , Interações Hospedeiro-Patógeno , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Fígado/virologia , Hepatopatias/diagnóstico , Hepatopatias/mortalidade , Hepatopatias/virologia , Transplante de Fígado/efeitos adversos , Transplante de Fígado/mortalidade , Medição de Risco , Fatores de Risco , Resultado do Tratamento
4.
Arq Bras Cir Dig ; 33(4): e1556, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33503116

RESUMO

BACKGROUND: Hepatic artery thrombosis is an important cause of graft loss and ischemic biliary complications. The risk factors have been related to technical aspects of arterial anastomosis and non-surgical ones. AIM: To evaluate the risk factors for the development of hepatic artery thrombosis. METHODS: The sample consisted of 1050 cases of liver transplant. A retrospective and cross-sectional study was carried out, and the variables studied in both donor and recipient. RESULTS: Univariate analysis indicated that the variables related to hepatic artery thrombosis are: MELD (p=0.04) and warm time ischemia (p=0.005). In the multivariate analysis MELD=14.5 and warm ischemia time =35 min were independent risk factors for hepatic artery thrombosis. In the prevalence ratio test for analysis of the anastomosis as a variable, it was observed that patients with continuous suture had an increase in thrombosis when compared to interrupted suture. CONCLUSIONS: Prolonged warm ischemia time, calculated MELD and recipient age were independent risk factors for hepatic artery thrombosis after liver transplantation in adults. Transplanted patients with continuous suture had an increase in thrombosis when compared to interrupted suture. Re-transplantation due to hepatic artery thrombosis was associated with higher recipient mortality.


Assuntos
Artéria Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Trombose/etiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto , Estudos Transversais , Humanos , Hepatopatias/cirurgia , Transplante de Fígado/métodos , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Vasculares/métodos
5.
Zhonghua Wai Ke Za Zhi ; 59(1): 18-23, 2021 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-33412629

RESUMO

Objective: To evalutate the safety and efficacy of infrahepatic inferior vena cava clamping robot-assisted laparoscopic liver resection. Methods: All data about 24 patients with robotic liver resection at Hepatic Surgery Center,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology between February 2015 and December 2017 were collected and analyzed. These patients were divided into two groups based on different methods to decrease central venous pressure. Eight patients(6 males and 2 females,aged 49 years(range:50 to 56 years)) were applied with infrahepatic inferior vena cava clamping,and the other 16 matched cases (15 males and 1 female,aged 53 years(range:38 to 69 years)) were categorized into lowering central venous pressure group. Intraoperative blood loss,blood transfusion,intraoperative hemodynamic parameters,postoperative complications,and renal function were compared by t-test,non-parametric test,χ2 test,or Fisher exact test. Results: There was significantly difference in the intraoperative blood loss between the infrahepatic vena cava clamping group and the lowering central venous group(200(220) ml (range:100 to 400 ml) vs. 750(800) ml (range:100 to 2 000 ml),Z=‒2.169,P=0.030). The clamping time of portal triad and infrahepatic inferior vena cava were 24 (18) minutes and 29 (20) minutes in the infrahepatic inferior vena cava clamping group, and portal triad clamping time was 23 (23) minutes in the low central venous group. There was no significant difference between the two groups (Z=‒0.323, P=0.747). There was no intraoperative blood transfusion in the infrahepatic inferior vena cava clamping group, and 5 cases in the low central venous group, with a transfusion volume of 1.5(1.5)U. The difference between the two groups was statistically significant (Z=‒3.353, P=0.001). However, the mean arterial pressure in the infrahepatic vena cava clamping group decreased from (88.6±4.9) mmHg to (67.4±3.8) mmHg(1 mmHg=0.133 kPa), which was lower than that of lowering central venous group (72.4±3.3) mmHg (t=2.315,P=0.003). And there were no significant differences related to postoperative complications rate or hepatic and renal function in both groups. Conclusion: The infrahepatic inferior vena cava technology is safe and feasible to decrease central venous pressure during robotic liver resections,which will not affect the recovery of hepatic and renal functions.


Assuntos
Hepatectomia/métodos , Laparoscopia , Hepatopatias/cirurgia , Procedimentos Cirúrgicos Robóticos , Procedimentos Cirúrgicos Vasculares/métodos , Veia Cava Inferior/cirurgia , Adulto , Idoso , Pressão Venosa Central/fisiologia , Constrição , Feminino , Humanos , Hepatopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Veia Cava Inferior/fisiologia , Veia Cava Inferior/fisiopatologia
6.
Zhonghua Wai Ke Za Zhi ; 59(1): 59-65, 2021 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-33412635

RESUMO

Objective: To examine the feasibility, safety and efficacy of simultaneous combined radical surgery for hepatic and renal alveolar echinococcosis (AE). Methods: Clinical dates of consecutive 10 hepatic and renal AE patients who accepted surgical treatment in the First Affiliated Hospital of Xinjiang Medical University during April 2013 to September 2019 were analyzed retrospectively. There were 8 males and 2 females, aged (42.5±10.3) years (range: 27 to 52 years). Seven of them had previously palliative surgical treatment with poor compliance to post-operative medication. All of the patients had hepatic-renal combined AE lesions, and two of them had left lateral and left renal lesions for each, which sized for (726.4±576.1)cm3 (range: 117.0 to 1 998.0 cm3). Extra-hepatic or renal lesions infiltrated to right diaphragm, inferior vena cava, right adrenal gland, abdominal wall, right psoas muscle, duodenum wall and right pulmonary lobe (respectively were 7, 7, 6, 2, 1, 1, 2 cases). Surgery were performed mainly with simultaneous combined surgery and vascular reconstruction techniques for this series. Hemi-hepatectomy or extended right lobectomy was applied in 8 patients, while 2 other patients received ex vivo liver resection and autotransplantation, additionally, one patient had partial hepatectomy for left lateral lobular lesion. Total right nephrectomy, partial right nephrectomy and partial left nephrectomy were respectively performed on 7, 3 and 1 patient(s). Additionally, extra-hepatic or renal lesions were eradicated followed by relevant repairments or reconstructions. Results: Surgeries went well and there was no intra-or post-operative liver or renal dysfunction occurred. During recovery period, 3 cases experienced with hydrothorax and managed well after drainage and supportive treatment, and one patient developed peri-renal urinary leakage and cured by "J" catheter. The subjects were followed-up for 6 to 81 months (median: 21 months), no death, organ dysfunction, chronic or acute kidney diseases occurred. One case encountered with abdominal hernia at post-operative 7th month and was successfully managed with laparoscopic repair with artificial mesh. No disease recurrence in all patients, which reached clinical cure at last. Conclusion: When complied strictly to indications, simultaneous combined radical surgery could be a feasible, safe and efficient approach for patients with hepatic and renal AE, which is primary or relapsed from previous hepatic AE surgery or interventional therapies as well as neighboring organ AE invasions.


Assuntos
Equinococose/cirurgia , Nefropatias/cirurgia , Hepatopatias/cirurgia , Adulto , Equinococose Hepática/cirurgia , Estudos de Viabilidade , Feminino , Hepatectomia , Humanos , Masculino , Pessoa de Meia-Idade , Nefrectomia , Pneumonectomia , Estudos Retrospectivos , Resultado do Tratamento
7.
Int J Mol Sci ; 22(1)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33375200

RESUMO

Microbiota is defined as the collection of microorganisms within the gastrointestinal ecosystem. These microbes are strongly implicated in the stimulation of immune responses. An unbalanced microbiota, termed dysbiosis, is related to the development of several liver diseases. The bidirectional relationship between the gut, its microbiota and the liver is referred to as the gut-liver axis. The translocation of bacterial products from the intestine to the liver induces inflammation in different cell types such as Kupffer cells, and a fibrotic response in hepatic stellate cells, resulting in deleterious effects on hepatocytes. Moreover, ischemia-reperfusion injury, a consequence of liver surgery, alters the microbiota profile, affecting inflammation, the immune response and even liver regeneration. Microbiota also seems to play an important role in post-operative outcomes (i.e., liver transplantation or liver resection). Nonetheless, studies to determine changes in the gut microbial populations produced during and after surgery, and affecting liver function and regeneration are scarce. In the present review we analyze and discuss the preclinical and clinical studies reported in the literature focused on the evaluation of alterations in microbiota and its products as well as their effects on post-operative outcomes in hepatic surgery.


Assuntos
Microbioma Gastrointestinal/fisiologia , Trato Gastrointestinal/metabolismo , Hepatopatias/cirurgia , Transplante de Fígado/métodos , Fígado/fisiologia , Animais , Disbiose/metabolismo , Disbiose/microbiologia , Disbiose/fisiopatologia , Trato Gastrointestinal/microbiologia , Hepatectomia/métodos , Humanos , Hepatopatias/fisiopatologia , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/microbiologia , Traumatismo por Reperfusão/fisiopatologia
8.
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
10.
Arq Bras Cir Dig ; 33(3): e1541, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33331436

RESUMO

BACKGROUND: - Biliary complications (BC) represent the most frequent complication after liver transplantation, up to 34% of cases. AIM: To identify modifiable risk factors to biliary complications after liver transplantation, essential to decrease morbidity. METHOD: Clinical data, anatomical characteristics of recipient and donors, and transplant operation features of 306 transplants with full arterial patency were collected to identify risk factors associated with BC. RESULTS: BC occurred in 22.9% after 126 days (median) post-transplantation. In univariate analyses group 1 (without BC, n=236) and group 2 patients (with BC, n=70) did not differ on their general characteristics. BC were related to recipient age under 40y (p=0.029), CMV infection (p=0.021), biliary disease as transplant indication (p=0.018), lower pre-transplant INR (p=0.009), and bile duct diameter <3 mm (p=0.033). CMV infections occurred sooner in patients with postoperative biliary complications vs. control (p=0.07). In a multivariate analysis, only CMV infection, lower INR, and shorter bile duct diameter correlated with BC. Positive CMV antigenemia correlated with biliary complications, even when titers lied below the treatment threshold. CONCLUSIONS: Biliary complications after liver transplantation correlated with low recipient INR before operation, bile duct diameter <3 mm, and positive antigenemia for CMV or disease manifestation. As the only modifiable risk factor, routine preemptive CMV inhibition is suggested to diminish biliary morbidity after liver transplant.


Assuntos
Ductos Biliares/patologia , Hepatopatias/cirurgia , Transplante de Fígado , Complicações Pós-Operatórias/epidemiologia , Humanos , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco
11.
Ann Transplant ; 25: e926196, 2020 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-33106469

RESUMO

Liver transplantation during the COVID-19 pandemic is challenging. Both donor and recipient issues can be influenced by the risks attributed to the pandemic. Allocation policy may need to be modified and criteria may be influenced by local infection rates and availability of medical facilities. Modifying immunosuppression (IS) protocols is controversial and is not evidence-based. In this study, we review the published literature on liver transplant recipients who were infected with COVID-19. A literature review was performed using PubMed, ScienceDirect, and WHO databases to identify relevant English-language articles published up to May 20, 2020. Fifteen articles reported 120 liver transplant recipients who were infected with COVID-19. Only 10 papers with 22 patients reported full encounter characteristics. Four papers reported 23, 17, 13, and 6 patients, respectively, but with minimal data. One paper reported the authors' own 39 patients' characteristics and demographics. The mean age was 58.2 years with 66% males. The most commonly reported presentations in descending order were fever (91%), cough (36.7%), shortness of breath (SOB) (31.8%), and diarrhea (31.8%). Liver transplant patients infected with COVID-19 were maintained on Tac (79%), mycophenolate (MMF) (48.4%), and Prednisone (29.6%) and were managed by reducing MMF in 14.3% of patients and reducing Tac in 14.3% of patients; 28.6% of patients needed ICU admission, 13.6% of patients had died, and the reported general population COVID-19 mortality rate was 3.4%. The clinical presentation of COVID-19 in liver transplant recipients may be different from the general population, with higher rates of severe disease, complications, and mortality.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Controle de Infecções , Hepatopatias/cirurgia , Transplante de Fígado , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Humanos , Hepatopatias/complicações , Hepatopatias/mortalidade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Prognóstico
12.
Arch Iran Med ; 23(10): 713-717, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33107315

RESUMO

The coronavirus associated disease 2019 (COVID-19) caused by the SARS-CoV-2 virus has rapidly spread all around the world and became pandemic in March 2020. Data on liver transplantation and chronic liver disease during the pandemic has remained scarce, and there is little information on whether immunosuppressed patients are at higher risk of developing severe COVID-19 infection. This review provides information for health care providers who care for patients with liver transplantation and chronic liver diseases.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Controle de Infecções , Hepatopatias/cirurgia , Transplante de Fígado , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/terapia , Humanos , Hepatopatias/complicações , Hepatopatias/mortalidade , Pandemias , Pneumonia Viral/terapia
13.
Acta Biomed ; 91(3): e2020005, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921703

RESUMO

ackground: During the pandemic of COVID-19, the overwhelm of infected patients created an exponential surge for ICU and ward beds. As a result, a major proportion of elective surgeries was postponed. However, various emergency and urgent procedures were allowed. Due to the mortality complications of hepatopancreatobiliary issues, we decided to afford urgent procedures under intensive protective arrangements. Method and results: In our ward (liver transplant), 4 ICU beds and 16 ward beds were allocated to non-COVID-19 patients. A total of 36 hepatopancreatobiliary procedures were managed for one month. All the surgeries were afforded under personal protective equipment and other intensive protective arrangements for personnel and patients. During 6 weeks following the surgery, all patients were followed up through telemedicine and no new case of COVID-19 was detected. Conclusion: In general, it appears that intensive protections could significantly reduce the number of COVID-19 incidence among patients with co-morbidities who undergo invasive procedures.


Assuntos
Doenças Biliares/cirurgia , Infecções por Coronavirus/complicações , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Serviço Hospitalar de Emergência/normas , Hepatopatias/cirurgia , Pancreatopatias/cirurgia , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/complicações , Betacoronavirus , Doenças Biliares/complicações , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Humanos , Hepatopatias/complicações , Masculino , Pessoa de Meia-Idade , Pancreatopatias/complicações , Pandemias , Pneumonia Viral/epidemiologia
14.
Ann Surg ; 272(5): 834-839, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925252

RESUMO

OBJECTIVE: To assess whether specific patterns of early postoperative complications may predict overall severe morbidity after major surgery, warranting early escalation of care and prevention of failure to rescue. SUMMARY OF BACKGROUND DATA: It is unclear whether early postoperative complications predict a poor outcome. Detailed knowledge of the chronology and type of early complications after major surgery may alert clinicians when to expect higher risk for subsequent major negative events. METHODS: All 90-day postoperative events following complex pancreas, liver, and rectal surgeries, and liver transplantation were analyzed over a 3-year period in a single tertiary center. Each complication was recorded regarding severity, type (cardiac, infectious, etc), etiology (surgical/medical), and timing of occurrence. The Comprehensive Complication Index (CCI), covering the first 7 postoperative days, was calculated as a measure for early cumulative postoperative morbidity. The statistical analysis (descriptive, sequence pattern analyses, and logistic regression analyses) aimed to detect any combinations of events predicting poor outcome as defined by a cumulative CCI ≥37.1 at 90-days. RESULTS: The occurrence of ≥2 complications, irrespective of severity, type or etiology, was strongly associated with a severe postoperative course (P < 0.001). Even 2 mild complications (≤ grade II) greatly increased the chance for high morbidity compared to patients with 0 or 1 complication within the first postoperative week (odds ratio 10.2, 95% confidence interval 5.82-17.98). The CCI at postoperative day 7 strongly predicted high 90-day morbidity (odds ratio 3.96 per 10 CCI points, P < 0.001). CONCLUSION: Multiple complications of any cause or severity within the first postoperative days represents a "warning-signal" for overall high morbidity by 90 days, which should be used to trigger an escalation of care to prevent failure to rescue and eventually poor outcome.


Assuntos
Falha da Terapia de Resgate , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hepatopatias/cirurgia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Morbidade , Pancreatopatias/cirurgia , Valor Preditivo dos Testes , Doenças Retais/cirurgia , Fatores de Risco , Índice de Gravidade de Doença
15.
Ann Surg ; 272(5): 827-833, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925253

RESUMO

OBJECTIVE: To stratify major hepatectomies (MajHs) according to their outcomes. SUMMARY OF BACKGROUND DATA: MajHs are associated with non-negligible operative risks, but they include a wide range of procedures. Detailed depiction of the outcomes of different MajHs is the basis for a new classification of liver resections. METHODS: We retrospectively considered patients that underwent hepatectomy in 17 high-volume centers. Patients with an associated digestive/biliary resection were excluded. We analyzed open MajHs in non-cirrhotic patients. MajHs were classified according to the Brisbane nomenclature. Right hepatectomies (RHs) were reference standards. Outcomes were adjusted for potential confounders, including indication, liver function, preoperative portal vein embolization, and enrolling center. RESULTS: We analyzed a series of 2212 patients. In comparison with RH, left hepatectomy had lower mortality [0.6% vs 2.2%, odds ratio (OR) = 0.25], severe morbidity (11.7% vs 14.4%, OR = 0.62), and liver failure rates (2.1% vs 11.6%, OR = 0.16). Left hepatectomy+Sg1 and mesohepatectomy+/-Sg1 had outcomes similar to RH, except for higher bile leak rate (31.3% and 13.5% vs 6.7%, OR = 4.36 and OR = 2.29). RH + Sg1 had slightly worse outcomes than RH. Right and left trisectionectomies had higher mortality (5.0% and 7.3% vs 2.2%, OR = 2.07 and OR = 2.71) and liver failure rates than RH (19.0% and 22.0% vs 11.6%, OR = 2.03 and OR = 2.21). Left trisectionectomy had even higher severe morbidity (25.6% vs 14.4%, OR = 2.07) and bile leak rates (14.6% vs 6.7%, OR = 2.31). CONCLUSIONS: The term "major hepatectomy" includes resections having heterogeneous outcome. Different MajHs can be stratified according to their mortality, severe morbidity, liver failure, and bile leak rates.


Assuntos
Hepatectomia/métodos , Hepatopatias/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Idoso , Feminino , Humanos , Hepatopatias/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Ann Surg ; 272(5): 786-792, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32833753

RESUMO

INTRODUCTION: Laparoscopy is becoming the standard approach in liver surgery. As the degree of difficulty varies greatly from core skills to advanced procedures, strategies for teaching young surgeons need to be reconsidered. We here aimed to design a skills curriculum for LLR. METHODS: Using the nominal group technique, 22 substeps of LLR were identified by 61 hepatobiliary surgeons. The raters were asked to rate (1) the difficulty of substeps and (2) the minimum number of times that the substep must be performed for mastery of the technique. According to the frequency of defined substeps, being estimated on the basis of high volume center experiences (n = 222 LLR; 1/2017-12/2018), the center's training capacity and defined goals for a 2-year fellowship were calculated. RESULTS: Ten surgical substeps (45%) are routinely performed and can thus be taught sufficiently at centers carrying out ≥50 LLR in 2 years. As the mobilization of the right liver lobe and the dissection of the hepatic artery or portal vein is performed in only 27% and 28% of all LLR, respectively, sufficient training can only be provided at centers with ≥100 LLRs in 2 years. Mastery of complex parenchymal dissection (19%) and hilar lymphadenectomy (8%) can only be achieved in center performing ≥200 LLR in 2 years. CONCLUSION: We here suggest a stepwise approach for training of hepatobiliary fellows in LLR. Based on the estimated complexity of the substeps and the size of the center, not every substep can be learned within 2 years.


Assuntos
Competência Clínica , Currículo , Hepatectomia/educação , Laparoscopia/educação , Hepatopatias/cirurgia , Bolsas de Estudo , Humanos , Inquéritos e Questionários
17.
Khirurgiia (Mosk) ; (7): 111-118, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736475

RESUMO

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


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Hemostasia Cirúrgica/métodos , Hepatectomia/métodos , Hepatopatias/cirurgia , Fígado/cirurgia , Humanos , Fígado/irrigação sanguínea , Recuperação de Sangue Operatório/métodos
18.
Z Gastroenterol ; 58(10): 945-954, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32838433

RESUMO

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


Assuntos
Rejeição de Enxerto , Hepatopatias/cirurgia , Transplante de Fígado , Fígado/fisiopatologia , Perfusão/métodos , Doadores de Tecidos/estatística & dados numéricos , Alemanha , Humanos , Fígado/cirurgia , Preservação de Órgãos
20.
Zhonghua Wai Ke Za Zhi ; 58(7): 530-538, 2020 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-32610424

RESUMO

To compare short-term and long-term efficacy after laparoscopic left hepatectomy(LLR) to open left hepatectomy(OLH) for primary left-sided hepatolithiasis. Methods: Clinical data of 187 patients with left-sided hepatolithiasis and underwent laparoscopically or open left-sided hepatectomy from October 2014 to October 2019 at the Second Affiliated Hospital of Anhui Medical University were retrospectively analyzed in this propensity score matching (PSM) study and were matched in terms of age, sex, body mass index, liver function, ASA score, comorbidities, history of biliary surgery, and smoking history on the ratio of 1∶1.There were 47 cases in each group and the mean age were (54.7±12.3)years old(range:34 to 75 years old) and (53.2±12.6) years old (range: 34 to 75 years old) in open and laparoscopically group respectively. The data of operation time, intraoperative blood loss, postoperative hospital-stay, complication rate, biliary fistula rate, stone clearance rate, and stone recurrence rate were compared. The quantitative data were compared using t-test or rank-sum test. Count data were analyzed with χ(2) test or Fisher test. Results: No significant difference was observed in the clinical characteristics of included 94 patients in this study(all P>0.05).The length of the postoperative hospital-stay after OLH was significantly higher than that in the LLH group((10.8±3.1) days vs.(8.5±2.2)days, t=4.085, P=0.000). LLR significantly decreased the incidence of postoperative biliary fistula compared with the OLH (6.3% vs.21.2%, χ(2)=4.374, P=0.036) and the rates of postoperative complications in the OLH group was significantly higher than that in the LLH group (48.9% vs.27.6%, χ(2)=4.502, P=0.034). Moreover, the stone recurrence rates in the LLH group was significantly lower than that after OLR (4.2% vs. 17.0%, χ(2)=4.029, P=0.045). OLH (95% CI: 1.55 to 10.75, P=0.004) and postoperative complications (95% CI: 1.29 to 9.52, P=0.013) were independent risk factors for prolonged hospital stay. OLH (95% CI: 1.428 to 44.080, P=0.018) and residual stones (95% CI: 1.580 to 62.379, P=0.014) were independent risk factors for the occurrence of postoperative biliary fistula. Biliary fistula (95% CI: 1.078 to 24.517, P=0.040) was an independent risk factor for the recurrence of stones. Conclusion: Compared with OLH, LLH is safe and effective for the treatment of the primary left-sided hepatolithiasis with the clinical benefits of shorter hospital stay, fewer morbidity and biliary fistula occurrence, and lower stone recurrence rates.


Assuntos
Hepatectomia/métodos , Litíase/cirurgia , Hepatopatias/cirurgia , Adulto , Idoso , Seguimentos , Hepatectomia/efeitos adversos , Humanos , Laparoscopia , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
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