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1.
Am J Vet Res ; 83(6)2022 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-35524960

RESUMO

OBJECTIVE: To evaluate the clinical impact on quantitative analysis of contrast-enhanced ultrasound (CEUS) on single extrahepatic portosystemic shunt (PSS) in dogs. ANIMALS: 21 client-owned dogs with single extrahepatic PSS and 5 healthy Beagles. PROCEDURES: In all dogs, CEUS was performed to calculate the rising time (RT), rising rate (RR), and portal vein-to-hepatic parenchyma transit time (ΔHP-PV) from the time-intensity curve obtained in the hepatic parenchyma and portal vein. All dogs in the PSS group underwent preoperative CT angiography (CTA) and surgery. The CEUS variables in the PSS group were compared with those in the healthy dogs (control group) and were analyzed for shunt types and grades of intrahepatic portal venous branches based on CTA findings, intraoperative portal pressure, and surgical procedures. RESULTS: All 3 CEUS variables showed no significant differences between the PSS and control groups. The RT and ΔHP-PV in the left gastrophrenic shunt group were significantly longer than in the other shunt types. In the intrahepatic portal vascularity, the RT in grade 1 was significantly shorter than in grades 3 and 4, and the RR in grade 1 was significantly higher than in grade 4. The RT and ΔHP-PV were significantly correlated with portal pressure variables. The RT in dogs with partial ligation was significantly shorter than in dogs with complete ligation and percutaneous transvenous coil embolization. CLINICAL RELEVANCE: Quantitative assessments of CEUS may be useful for estimating intrahepatic portal vascularity in dogs with single extrahepatic PSS.


Assuntos
Doenças do Cão , Derivação Portossistêmica Transjugular Intra-Hepática , Animais , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/cirurgia , Cães , Ligadura/veterinária , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Fígado/cirurgia , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/veterinária , Ultrassonografia/métodos , Ultrassonografia/veterinária
2.
Am J Case Rep ; 23: e936148, 2022 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-35437299

RESUMO

BACKGROUND Varices of the upper gastrointestinal tract are due to portal hypertension and can result from occlusion of the portal venous system. This report is of a 55-year-old man with recurrent gastrointestinal bleeding due to stricture of the portal vein anastomotic site to inferior vena cava (IVC) 12 years after combined pancreas and kidney transplantation. CASE REPORT A 55-year-old man presented bleeding episodes requiring transfusion of more than 70 units of red blood cells (RBCs), complicated by bacterial and viral infection episodes including cytomegalovirus (CMV) reactivation and hepatitis E and transient impairment of function of the renal allograft. Endoscopy, computed tomography (CT) scan, and angiography revealed jejunal varices due to anastomotic stricture at the portal vein to IVC as the cause of the hemorrhage. Neither conservative therapy nor an anastomosis between the splenic vein of the graft and the internal iliac vein as a bypass could stop the life-threatening bleeding. During the recurrent bleeding, CD4 T lymphocytes were low, indicating immunodeficiency despite paused immunosuppressive therapy. After the hemorrhage resolved and immunosuppression was restarted, CD4 T lymphocyte levels normalized. Finally, to stop the hemorrhage and save the transplanted kidney and the patient's life, graft pancreatectomy was performed. Long-term damage to the renal transplant was not found. CONCLUSIONS This report is of a rare case of portal hypertension as a long-term complication of transplant surgery. Although acute venous thrombosis at the anastomotic site is a recognized postoperative complication of pancreatic transplant surgery, this case highlights the importance of post-transplant follow-up and diagnostic imaging.


Assuntos
Hipertensão Portal , Transplante de Rim , Varizes , Constrição Patológica/complicações , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/cirurgia , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pâncreas , Veia Porta/cirurgia
3.
Gan To Kagaku Ryoho ; 49(4): 437-439, 2022 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-35444129

RESUMO

A 65-year-old woman was admitted to our institution with sonography results indicating a caudate lobe mass. CT showed a large low-density mass in the caudate lobe, extensively involving the inferior vena cava and main portal vein. Moderately differentiated adenocarcinoma was found on transcutaneous biopsy. We therefore regarded this tumor as a severe locally advanced hilar cholangiocarcinoma and initiated gemcitabine/cisplatin combined chemotherapy. The tumor gradually reduced in size. However, after 28 courses of treatment, CT showed persistent tumor invasion in the left trunk of the portal vein and inferior vena cava invasion in succession in the middle; the tumor had not yet invaded the left hepatic vein. Owing to myelosuppression and general malaise, it was difficult to continue chemotherapy. After 32 courses of treatment, the patient underwent a left trisegmentectomy with combined resection of the portal vein and inferior vena cava. Postoperative microscopic findings revealed no apparent invasion of the tumor in the inferior vena cava, thus suggesting successful R0 resection. The patient is alive without recurrence 18 months postoperatively.


Assuntos
Neoplasias dos Ductos Biliares , Colangiocarcinoma , Tumor de Klatskin , Idoso , Neoplasias dos Ductos Biliares/tratamento farmacológico , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/tratamento farmacológico , Colangiocarcinoma/patologia , Colangiocarcinoma/cirurgia , Cisplatino , Desoxicitidina/análogos & derivados , Quimioterapia Combinada , Feminino , Hepatectomia/métodos , Humanos , Tumor de Klatskin/cirurgia , Veia Porta/patologia , Veia Porta/cirurgia , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgia
4.
Medicine (Baltimore) ; 101(10): e29040, 2022 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-35451414

RESUMO

RATIONALE: Tumor lysis syndrome is a potentially lethal condition caused by rapid cell death, releasing a high level of toxic cytokines. It is common in patients with hematological malignancy but rare in solid tumors. PATIENT CONCERNS: A 64-year-old patient presented to our unit with a 17.3-cm hepatocellular carcinoma and marginal liver reserve. The first-stage operation of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was performed. DIAGNOSIS: The patient was found to be anuric with grossly deranged electrolytes after the first-stage operation. Tumor lysis syndrome was diagnosed. INTERVENTIONS: The patient was transferred to the intensive care unit for aggressive fluid administration and continuous venovenous hemofiltration for the management of tumor lysis syndrome. OUTCOMES: The patient recovered and then underwent the second-stage operation of ALPPS with extended right hepatectomy 8 days after the initial operation without any long-term sequelae. LESSONS: ALPPS is a relatively new technique in liver surgery, entailing an increased risk of tumor lysis syndrome due to an in situ tumor after the first-stage operation. Clinicians should have a high index of suspicion regarding this potentially lethal complication with prompt management.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Síndrome de Lise Tumoral , Carcinoma Hepatocelular/patologia , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Humanos , Ligadura/efeitos adversos , Ligadura/métodos , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/patologia , Pessoa de Meia-Idade , Veia Porta/cirurgia , Resultado do Tratamento , Síndrome de Lise Tumoral/etiologia
5.
Ann Med ; 54(1): 1188-1201, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35481406

RESUMO

BACKGROUND: Associating liver partition and portal vein ligation (ALPPS) technique is a promising strategy for unresectable primary liver tumours without sufficient future liver remnants (FLRs). OBJECTIVE: Our study explored the effect of corosolic acid (CA) on inhibiting tumour growth without compromising ALPPS-induced liver regeneration. METHODS: The ALPPS procedure was performed in Sprague-Dawley rats with orthotopic liver cancer. Blood, tumour, and FLR samples were collected, and the effect of CA on the inhibition of tumour progression and ALPPS-induced liver regeneration, and its possible mechanism, were investigated. RESULTS: The tumour weight in the implantation/ALPPS group was higher than in the implantation without ALPPS group (p < .05), and the tumour weight in the implantation/ALPPS/CA group was lower than in the implantation/ALPPS group (p < .05). On postoperative day 15, the hepatic regeneration rate, and the expression of Ki67+ hepatocytes in the FLRs had increased significantly in the group that underwent ALPPS. The number of cluster of differentiation (CD) 86+ macrophages markedly increased in the FLRs and in the tumours of groups that underwent the ALPPS procedure. Additionally, the number of CD206+ macrophages was higher than the number of CD86+ macrophages in the tumours of the implantation and the implantation/ALPPS groups (p < .01, respectively); however, the opposite results were observed in the CA groups. The administration of CA downregulated the expression of transforming growth factor-beta (TGF-ß), CD31, and programmed cell death protein 1 (PD-1) but increased the number of CD8+ lymphocytes in tumours. CONCLUSION: Corosolic acid inhibits tumour growth without compromising ALPPS-induced liver regeneration. This result may be attributed to the CA-induced downregulation of PD-1 and TGF-ß expression and the increased CD8+ lymphocyte infiltration in tumour tissue associated with the suppression of M2 macrophage polarisation. Key MessagesThis study aimed to investigate the effect of CA on ALPPS-induced liver regeneration and hepatic tumour progression after ALPPS-induced liver regeneration.Corosolic acid inhibits tumour growth without compromising ALPPS-induced liver regeneration. This result may be attributed to the CA-induced downregulation of PD-1 and TGF-ß expression and the increased CD8+ lymphocyte infiltration in tumour tissue associated with the suppression of M2 macrophage polarisation.


Assuntos
Neoplasias Hepáticas , Regeneração Hepática , Animais , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Regeneração Hepática/fisiologia , Veia Porta/cirurgia , Receptor de Morte Celular Programada 1 , Ratos , Ratos Sprague-Dawley , Fator de Crescimento Transformador beta , Triterpenos
6.
J Vasc Interv Radiol ; 33(5): 525-529, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35489784

RESUMO

Future liver remnant (FLR) volume is an important indicator of the risk of posthepatectomy liver failure (PHLF) and limits the feasibility of major hepatectomies. A case series of 5 patients treated with a novel approach is presented. Laparoscopic liver partitioning was combined with subsequent liver venous deprivation (embolization of both the portal and the hepatic veins). Baseline average FLR was 28.8%. All procedures were successfully performed without major complications. Mean 1-, 2- and 4-week hypertrophy of the FLR were 35%, 40.3%, and 46.4%, respectively. Four patients underwent planned surgery after a mean interval of 28 days. Of these, 2 patients achieved sufficient FLR volume and function after 2 weeks and underwent surgery before the 4-week volumetric analysis. One patient did not undergo surgery because of intraoperative diagnosis of peritoneal metastases. No cases of PHLF were observed at 5-day follow-up.


Assuntos
Laparoscopia , Falência Hepática , Neoplasias Hepáticas , Humanos , Hipertrofia/complicações , Hipertrofia/cirurgia , Laparoscopia/efeitos adversos , Falência Hepática/diagnóstico , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia
7.
Transpl Int ; 35: 10308, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35387395

RESUMO

The predictive value of a subjective difficulty scale (DS) after surgical procedures is unknown. The objective of this study was to evaluate the prognostic value of a DS after liver transplantation (LT) and to identify predictors of difficulty. Surgeons prospectively evaluated the difficulty of 441 consecutive liver transplantations from donation after brain death at the end of the surgery by using a DS from 0 to 10 ("the easiest to the hardest you can imagine"). DS was associated with severe morbidity. The risk of graft loss at 1 year remained unchanged from 0 to 6 but increased beyond 6. Graft survival and patient survival of group with DS 7-10 was significantly impaired compared to groups with DS: 0-3 or DS: 4-6 but were significantly impaired for the group with DS: 7-10. Independent predictors of difficult LT (DS ≥ 7) were annular segment 1, transjugular intrahepatic portosystemic shunt, retransplantation beyond 30 days, portal vein thrombosis, and ascites. Of them, ascites was a borderline non-significant covariate (p = .04). Vascular complications occurred more often after difficult LT (20.5% vs. 5.9%), whereas there was no difference in the other types of complications. DS can be used to tailor monitoring and anticipate early complications. External validation is needed.


Assuntos
Transplante de Fígado , Derivação Portossistêmica Transjugular Intra-Hepática , Ascite/complicações , Humanos , Cirrose Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Veia Porta/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Resultado do Tratamento
8.
J Vis Exp ; (181)2022 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-35343950

RESUMO

Metabolic diseases such as diabetes, pre-diabetes, non-alcoholic fatty liver disease (NAFLD), and nonalcoholic steatohepatitis (NASH) are becoming increasingly common. Ex vivo liver perfusions allow for a comprehensive analysis of liver metabolism using nuclear magnetic resonance (NMR), in nutritional conditions that can be rigorously controlled. As in silico simulations remain a primarily theoretical means of assessing hormone actions and the effects of pharmaceutical intervention, the perfused liver remains one of the most valuable test beds for understanding hepatic metabolism. As these studies guide basic insights into hepatic physiology, results must be accurate and reproducible. The greatest factor in the reproducibility of ex vivo hepatic perfusion is the quality of surgery. Therefore, we have introduced an organized and streamlined method to perform ex vivo mouse liver perfusions in the context of in situ NMR experiments. We also describe a unique application and discuss common issues encountered in these studies. The overall purpose is to provide an uncomplicated guide to a technique we have refined over several years that we deem the golden standard for obtaining reproducible results in hepatic resections and perfusions in the context of in situ NMR experiments. The distance to the center of the field for the magnet as well as the inaccessibility of the tissue to intervention during the NMR experiment makes our methods novel.


Assuntos
Hepatopatia Gordurosa não Alcoólica , Veia Porta , Animais , Fígado/metabolismo , Fígado/cirurgia , Camundongos , Hepatopatia Gordurosa não Alcoólica/metabolismo , Perfusão , Veia Porta/cirurgia , Reprodutibilidade dos Testes
9.
Updates Surg ; 74(2): 779-782, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35262843

RESUMO

The aim of this didactical video is to show an easy and standardized technique of liver preparation after "en bloc" extraction and access a young surgeon to perform liver procurement. The technique entails five steps: beginning with the dissection of the vena cava, the superior mesenteric artery, and the coeliac trunk, followed by the common hepatic artery, the bile duct and finally the portal vein. This technique of liver graft preparation has high reproducibility while maintaining the safety of the procedure for young surgeons. The "en bloc" extraction with a standardized liver graft preparation is an easy and a reproducible technique.


Assuntos
Transplante de Fígado , Fígado , Artéria Hepática/cirurgia , Humanos , Fígado/irrigação sanguínea , Fígado/cirurgia , Transplante de Fígado/métodos , Veia Porta/cirurgia , Reprodutibilidade dos Testes
10.
Ann Transplant ; 27: e935892, 2022 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-35256580

RESUMO

BACKGROUND Few series of cavoportal (CPA) or renoportal (RPA) anastomosis have been published and their survival rates have never been compared. The objective of this study was to evaluate perioperative and long-term outcomes of CPA and RPA in a nationwide multicentric series and to compare hemitranspositions (HT) to paired orthotopic liver transplantations (OLT). MATERIAL AND METHODS HT performed in France up to April 2019 were analyzed. Endpoints were the incidence of severe (Clavien-Dindo>IIIa) 90-day perioperative complications and long-term patient and graft survival. RESULTS Sixty-four HT (13 CPA, 51 RPA) were performed in 59 patients. The rates of perioperative CD>IIIa complications were 64% and 49% in patients with CPA and RPA, respectively (P=0.59), and the rates of portal thrombosis and ascites were 38.5% and 9.8% (p=0.023) and 53.8% and 21.6% (p=0.049) in patients with CPA and RPA, respectively. The patient and graft perioperative survival rates were 54.4% and 83.3% (HR=3.2; CI 95 [1.1-9.9]; p=0.039) and 54.4% and 77.1% (HR=2.2; CI 95 [0.77-6.4]; P=0.14) in the CPA and RPA groups, respectively. Five-year patient survival was 36.4% and 61.8% in the CPA and RPA groups, respectively (HR=2.5; CI95 [1-6.1]; P=0.039). Compared with OLT grafts, long-term HT graft survival rates were not different (HR=1.7; CI 95 [0.96-3.1]; P=0.066), while patient survival rates were lower in the HT group (HR=4.6; CI 95 [2-11]; P<0.001). CONCLUSIONS Compared to OLT, HT significantly reduces patient survival. Given the poor survival results of CPA, the indication deserves to be limited in the context of organ shortage and RPA should be preferred when HT is needed.


Assuntos
Transplante de Fígado , Trombose Venosa , Anastomose Cirúrgica/métodos , Sobrevivência de Enxerto , Humanos , Transplante de Fígado/efeitos adversos , Veia Porta/cirurgia , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
11.
World J Gastroenterol ; 28(7): 704-714, 2022 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-35317274

RESUMO

Portal invasion of hepatocellular carcinoma (HCC) occurs in 12.5%-40% of patients diagnosed with cancer and yields poor clinical outcomes. Since it is a common cause of inoperability, sorafenib was regarded as the standard treatment for HCC in the Barcelona Clinic of Liver Cancer guidelines. However, the median survival of the Asian population was only approximately 6 mo, and the tumor response rate was less than moderate (< 5%). Various locoregional modalities were performed, including external beam radiotherapy (EBRT), transarterial chemoembolization, hepatic arterial infusion chemotherapy, and surgery, alone or in combination. Among them, EBRT is a noninvasive method and can safely treat tumors involving the major vessels. Palliative EBRT has been commonly performed, especially in East Asian countries, where locally invasive HCC is highly prevalent. Although surgery is not commonly indicated, pioneering studies have demonstrated encouraging results in recent decades. Furthermore, the combination of neo- or adjuvant EBRT and surgery has been recently used and has significantly improved the outcomes of HCC patients, as reported in a few randomized studies. Regarding systemic modality, a combination of novel immunotherapy and vascular endothelial growth factor inhibitor showed results superior to that of sorafenib as a first-line agent. Future clinical trials investigating the combined use of these novel agents, surgery, and EBRT are expected to improve the prognosis of HCC with portal invasion.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Trombose Venosa , Carcinoma Hepatocelular/radioterapia , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/radioterapia , Veia Porta/patologia , Veia Porta/cirurgia , Fator A de Crescimento do Endotélio Vascular , Trombose Venosa/terapia
12.
Acta Cir Bras ; 37(1): e370103, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35262597

RESUMO

INTRODUCTION: Portal hypertension still represents an important health problem worldwide. In the search for knowledge regarding this syndrome, experimental studies with animal models have proven to be useful to point the direction to be taken in future randomized clinical trials. PURPOSE: To validate the experimental model of portal hypertension and esophagogastric varices in a medium-sized animal. METHODS: This study included five minipigs br1. Midline laparotomy with dissection of the portal vein and production of a calibrated stenosis of this vein was performed. Measurement of pressure in the portal venous and digestive endoscopic were performed before and five weeks after the production of a stenosis. RESULTS: All animals were 8 months old, average weight of 17 ± 2.5 kg. The mean pressure of the portal vein immediately before the partial ligation of the portal vein was 8.9 + 1.6 mm Hg, with 26.6 + 5.4 mm Hg in the second measurement five weeks later (p < 0.05). No gastroesophageal varices or hypertensive portal gastropathy were seen at endoscopy procedures in our sample at any time in the study. CONCLUSION: Portal vein ligation in minipigs has been validated in the production of portal hypertension, but not in the formation of esophageal varices.


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal , Varizes , Animais , Endoscopia , Varizes Esofágicas e Gástricas/cirurgia , Modelos Teóricos , Projetos Piloto , Veia Porta/cirurgia , Suínos , Porco Miniatura
13.
IEEE Trans Image Process ; 31: 2503-2517, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35275817

RESUMO

Segmenting portal vein (PV) and hepatic vein (HV) from magnetic resonance imaging (MRI) scans is important for hepatic tumor surgery. Compared with single phase-based methods, multiple phases-based methods have better scalability in distinguishing HV and PV by exploiting multi-phase information. However, these methods just coarsely extract HV and PV from different phase images. In this paper, we propose a unified framework to automatically and robustly segment 3D HV and PV from multi-phase MR images, which considers both the change and appearance caused by the vascular flow event to improve segmentation performance. Firstly, inspired by change detection, flow-guided change detection (FGCD) is designed to detect the changed voxels related to hepatic venous flow by generating hepatic venous phase map and clustering the map. The FGCD uniformly deals with HV and PV clustering by the proposed shared clustering, thus making the appearance correlated with portal venous flow robustly delineate without increasing framework complexity. Then, to refine vascular segmentation results produced by both HV and PV clustering, interclass decision making (IDM) is proposed by combining the overlapping region discrimination and neighborhood direction consistency. Finally, our framework is evaluated on multi-phase clinical MR images of the public dataset (TCGA) and local hospital dataset. The quantitative and qualitative evaluations show that our framework outperforms the existing methods.


Assuntos
Veias Hepáticas , Veia Porta , Veias Hepáticas/diagnóstico por imagem , Veias Hepáticas/cirurgia , Imageamento por Ressonância Magnética , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia
14.
Chirurgia (Bucur) ; 117(1): 81-93, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35272758

RESUMO

Background: Associating liver partition and portal vein ligation (ALPPS) has evolved as a treatment strategy for patients with liver tumors who are not amenable for upfront hepatectomy because of an insufficient future liver remnant (FLR). Aim of this study was to test the applicability of ultrasound guided parenchyma sparing surgery to ALPPS concept, by non-anatomically shifting the plane of transection in favor of FLR, resulting in a new technical variant of ALPPS, entitled parenchyma sparing ALPPS (psALPPS). Materials and Methods: Patients who could not safely undergo right trisectionectomy ALPPS because of insufficient FLR were considered eligible for psALPPS, consisting in liver partition through segment 4 using ultrasound guidance. Results: Between April 2017 and April 2021, five patients with median age of 68 years (range: 66-78), four male and one female, underwent psALPPS for colorectal liver metastases (N=2), intrahepatic cholangiocarcinoma (N=2), and hepatocellular carcinoma (N=1). Standardized FLR (sFLR) for segments 2-3 before stage 1 surgery would have been a median of 11.6%. PsALPPS could double the sFLR at stage 1 resulting in an increase of ps-sFLR from a median of 22.7% (at stage 1) to 34.0% (at stage 2) after a median interstage interval of 15 days. All patients tolerated surgery well and no major complications were recorded. Conclusions: Applying the principles of parenchyma sparing surgery to ALPPS offers the advantage to maximize FLR and simultaneously reduce ischemic injury of segment 4 compared to conventional ALPPS. In this way, psALPPS may markedly increase resectability while reducing morbidity.


Assuntos
Hepatectomia , Veia Porta , Idoso , Feminino , Hepatectomia/métodos , Humanos , Masculino , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Resultado do Tratamento , Ultrassonografia , Ultrassonografia de Intervenção
15.
BMC Gastroenterol ; 22(1): 96, 2022 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-35240998

RESUMO

BACKGROUND: Portal hypertensive biliopathy (PHB) was caused by anatomical and functional abnormalities in the intrahepatic and extrahepatic bile ducts secondary to portal hypertension. Currently, there is no consensus regarding to the optimal treatment for PHB. Transjugular intrahepatic portosystemic shunt (TIPS) is the treatment choice for the management of symptomatic PHB, however, it could be very difficult in patients with PHB and cavernous transformation of portal vein. CASE PRESENTATION: We report a case of PHB, successfully managed with TIPS. A 23-year-old man with liver cirrhosis presented with jaundice. Magnetic resonance cholangiopancreatography (MRCP) showed multiple tortuous hepatopetal collateral vessels compressing the common bile duct (CBD) and leading to the dilated proximal bile duct. He was diagnosed with PHB and treated with TIPS. A guidewire was inserted into the appropriate collateral vessel through transsplenic approach to guide intrahepatic puncture and TIPS was performed successfully. After the operation, portal vein pressure decreased and the symptoms of biliary obstruction were relieved significantly. In addition, the patient showed no jaundice at a follow-up of one year. CONCLUSIONS: For PHB patients presenting for cavernous transformation of the portal vein, which precludes the technical feasibility of TIPS, a combined transjugular/transsplenic approach could be an alternative option.


Assuntos
Colestase , Hipertensão Portal , Derivação Portossistêmica Transjugular Intra-Hepática , Adulto , Colestase/patologia , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/cirurgia , Masculino , Pressão na Veia Porta , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Veia Porta/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Resultado do Tratamento , Adulto Jovem
16.
Curr Opin Organ Transplant ; 27(2): 144-147, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35143434

RESUMO

PURPOSE OF REVIEW: Portomesenteric thrombosis (PMT) is a serious condition encountered mainly in cirrhotic patients awaiting liver transplantation. More recently, this potentially fatal complication has been described after bariatric surgery and inflammatory bowel disease. Several consensus guidelines have been published over the past few years and this mini review was conducted to discuss updated nontransplant treatment options based on currently available evidence. RECENT FINDINGS: Anticoagulation is the mainstay of treatment for PMT involving <50% of the main portal vein. Transjugular intrahepatic portosystemic shunt are usually preserved for patients with more extensive disease or those with clinically significant portal hypertension that are treatment refractory. SUMMARY: The extent of PMT, response to therapy, and complications related with PMT are the determinants of therapy.


Assuntos
Hipertensão Portal , Transplante de Fígado , Derivação Portossistêmica Transjugular Intra-Hepática , Trombose , Humanos , Hipertensão Portal/etiologia , Hipertensão Portal/cirurgia , Cirrose Hepática/complicações , Transplante de Fígado/efeitos adversos , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Trombose/complicações , Trombose/patologia , Resultado do Tratamento
17.
Mol Immunol ; 144: 71-77, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35203023

RESUMO

Radio-frequency-assisted Liver Partition with Portal Vein Ligation (RALPP) induces comparable hypertrophy of the liver remnant compared to Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) in humans. However, whether it is significantly improved compared to ALPPS is unclear, and the underlying mechanisms of liver regeneration after RALPP need to further investigate. The present study was to develop an animal model mimicking RALPP and explore mechanisms of liver regeneration. The mice in RALPP group received liver radiofrequency ablation and 90% portal vein ligation (PVL), followed by resection of the targeted liver within two days after the first surgery. The mice in ALPPS group underwent 90% PVL combined with parenchyma transection. Controls received liver radiofrequency ablation (RAF group) or PVL (PVL group) or small left lateral lobe (LLL group) resection alone. Liver regeneration was assessed by liver weight and proliferation-associated molecules. The role of Kupffer cells (KCs) in liver regeneration was investigated after RALPP. The results showed that RALPP induced comparable liver regeneration compared to ALPPS, but with less liver injury and mortality in mice. RALPP led to over-expression of TNF-α and IL-6 in the circulating plasma compared with PVL. KCs infiltrating in liver tissues was a characteristic of mice in the RALPP group. KCs depletion markedly depressed cytokine expression and delayed liver regeneration after RALPP. These results suggested that RALPP in mice induced accelerated liver regeneration similar to ALPPS, but safer than ALPPS. KCs depletion altered cytokine expression and delayed liver regeneration after RALPP.


Assuntos
Neoplasias Hepáticas , Regeneração Hepática , Animais , Citocinas/metabolismo , Modelos Animais de Doenças , Hepatectomia/métodos , Macrófagos do Fígado , Ligadura/métodos , Fígado/metabolismo , Neoplasias Hepáticas/metabolismo , Camundongos , Veia Porta/cirurgia
18.
JNMA J Nepal Med Assoc ; 60(246): 177-182, 2022 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-35210628

RESUMO

INTRODUCTION: Pancreatoduodenectomy with vascular resection is performed in locally advanced periampullary malignancies. In our practice, early oral feeding is initiated in patients undergoing pancreatoduodenectomy. This study aims to find the prevalence of early oral feeding with vascular resection among patients undergoing pancreatoduodenectomy. METHODS: This was a descriptive cross-sectional study conducted among hospital records of 152 patients who underwent pancreatoduodenectomy in the department of surgery of a tertiary care hospital from 2016 to 2020. Ethical approval was taken from the Institutional Review Committee (Reference number: 0812202102). Convenience sampling was done. Patients clinical and sociodemographic data were collected and analyzed using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean, and median. RESULTS: Among 152 patients undergoing pancreatoduodenectomy, early oral feeding with vascular resection was done in 17 (11.18%) (6.17-16.19 at 95% Confidence Interval). Portal vein and superior mesenteric artery were resected in one (5.88%) and hepatic artery in one (5.88%) patient. Type I, III and IV reconstruction was done in nine (52.9%), five (29.41%) and one (5.88%) respectively. Clinically relevant delayed gastric emptying and postoperative pancreatic fistula were seen in two (11.7%). Complication of Clavien-Dindo Grade III or higher was seen in one (5.88%) patient. One (5.88%) mortality was noted. CONCLUSIONS: The prevalence of early oral feeding with vascular resection among patients undergoing pancreatoduodenectomy was similar to other studies done in similar settings. Early enteral feeding is well tolerated in patients undergoing pancreatoduodenectomy with vascular resection.


Assuntos
Neoplasias Pancreáticas , Pancreaticoduodenectomia , Estudos Transversais , Humanos , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia/efeitos adversos , Veia Porta/patologia , Veia Porta/cirurgia , Centros de Atenção Terciária
19.
Transplant Proc ; 54(2): 454-456, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35148883

RESUMO

BACKGROUND: Portal vein (PV) stenosis is sometimes seen in pediatric living donor liver transplantation (LDLT). PV stents have been attempted in adults with persistent stenosis. However, long-term usefulness of PV stenting is unknown because stents do not expand with growth. We investigated the effect and long-term outcome of PV stenting for stenosis after pediatric LDLT. METHODS: We included patients aged <18 years who underwent LDLT from 1998 to 2020 and who underwent PV stenting for stenosis. We assessed age at procedure, stent complications, and long-term outcomes. RESULTS: Five patients underwent PV stent placement. The median age at LDLT was 10 years (range, 0.8-18.1 years). The median interval between LDLT and stent placement was 25 months. The median age at stent placement was 16 years (range, 3-20 years). The median body weight was 38 kg (range, 13-63 kg). The median stent diameter was 8 mm. The median observation period after stent placement was 8 years. On average, body weight increased 1.6 times. One complication associated with stent placement was PV thrombosis, which resulted in stent failure, but we observed no portal hypertension. In the other 4 patients, the stent has remained functioning, and there was no clinical evidence of portal hypertension. CONCLUSIONS: PV stents are effective for intractable PV stenosis in children. PV stents were successfully placed in children as young as 3 years old and weighing 13 kg. Our data suggests that a stent placed in young children does not cause portal hypertension as patients grow.


Assuntos
Transplante de Fígado , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Transplante de Fígado/efeitos adversos , Transplante de Fígado/métodos , Doadores Vivos , Veia Porta/cirurgia , Estudos Retrospectivos , Stents , Resultado do Tratamento
20.
BMC Surg ; 22(1): 55, 2022 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-35152891

RESUMO

BACKGROUND: Prepancreatic portal vein (PPV) is a congenital anatomical variant of the portal vein (PV). PPVs are extremely rare and generally classified into two categories, prepancreatic preduodenal portal vein and prepancreatic postduodenal portal vein (PPPV). Prepancreatic preduodenal portal veins are rare, with approximately 100 reported cases globally; PPPVs are even more atypical, with less than 20 documented cases globally. Despite the extremely low occurrence, PPPV knowledge and recognition are important, especially for hepatobiliary-pancreatic (HBP) surgeries, such as pancreaticoduodenectomy (PD) for patients of a PPPV. Here, we report a case of PPPV and a literature review. CASE PRESENTATION: A 73-year-old-male with ampullary carcinoma underwent PD at our hospital. Preoperative enhanced CT revealed an abnormal L-shaped PV, identified as a PPPV. Both the PPPV and the postpancreatic "normal" superior mesenteric vein (SMV) divaricated from the SMV at the caudal side of the pancreas. A splenic vein and inferior mesenchymal vein flowed into the postpancreatic "normal" PV, which encircled the common bile duct and potentially flowed into the liver, forming a cavernous transformation at the hilar plate. During surgery, we attempted to isolate the PV from the pancreas and common bile duct. However, it was difficult to isolate from the pancreas. The PPPV was so fragile that bleeding from the PPPV became uncontrollable. To remove the tumor, we resected the PPPV and reconstructed a "normal" PV as an autogenous graft. To maintain intraoperative hepatic blood flow and avoid small bowel congestion, an antithrombogenic bypass catheter was placed between the SMV and umbilical vein during reconstruction. After surgery, several complications occurred, such as PV thrombosis and hyperammonemia. The patient was discharged on postoperative day 45. CONCLUSIONS: PPPV is a rare vascular variant but is easily diagnosed preoperatively due to its distinct shape on CT imaging. However, isolating the PPPV from the pancreas and bile duct is incredibly difficult and potentially associated with increased operative risks and postoperative complications. PV resection rather than isolation is a potential solution to reduce the risk of hemorrhage, even in the absence of invasion.


Assuntos
Neoplasias Pancreáticas , Veia Porta , Idoso , Humanos , Masculino , Veias Mesentéricas/cirurgia , Pâncreas , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Veia Porta/cirurgia
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