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1.
Gan To Kagaku Ryoho ; 48(2): 282-284, 2021 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-33597382

RESUMO

A 77-year-old woman presented with a chief complaint of bloody stools. Detailed examination revealed a semi-circumferential type 2 tumor in the lower rectum, and a diagnosis of Group 5, tub1-2, cT3N2aM0, cStage Ⅲb rectal cancer was made. Preoperative abdominal CT scans revealed a shunt in the inferior mesenteric vein and left ovarian vein. Laparoscopic Hartmann's procedure was performed, and when the sigmoid mesentery was moved from the inner side, a shunt flowing from the left ovarian vein to the inferior mesenteric vein in the sigmoid mesentery was found, which was then dissected. The operating time was 253 min, and blood loss was approximately 140 g. There was no postoperative liver dysfunction, and the patient was transferred to another hospital on postoperative day 36. Causes of portal-systemic shunts are portal hypertension occurring due to liver cirrhosis or congenital causes and organ adhesion from abdominal surgery. In this case, there was no liver cirrhosis, and the blockage of the left renal vein perfusion by the superior mesenteric artery may have resulted in congestion and varicose of the left ovarian vein. Furthermore, the shunt with the inferior mesenteric vein may have been formed due to the adhesion of the left ovarian vein after ovariectomy. If preoperative tests reveal varices, a surgical treatment is recommended while keeping in mind the possibility of shunt formation as in this case.


Assuntos
Laparoscopia , Neoplasias Retais , Idoso , Feminino , Humanos , Veias Mesentéricas/cirurgia , Veia Porta
2.
BMC Surg ; 21(1): 4, 2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33397346

RESUMO

BACKGROUND: Mesentericoportal vein (MPV) resection in pancreatic ductal adenocarcinoma (PDAC) surgery has become a common procedure. A few studies had described the use of falciform ligament (FL) for MPV reconstruction and received encouraging preliminary effects. AIMS: This study was designed to explore the feasibility and efficacy of this technique compared with others. METHODS: Patients who underwent pancreaticoduodenectomy (PD) with MPV resection for PDAC from 2009 to 2018 were enrolled. Medical records were retrospectively reviewed, MPV reconstructions using FL were distinguished and compared with other techniques. RESULTS: 146 patients underwent MPV reconstruction, and 13 received FL venoplasty. Other reconstruction techniques included primary end-to-end anastomosis (primary, n = 30), lateral venorrhaphy (LV, n = 19), polytetrafluoroethylene conduit interposition (PTFE, n = 24), iliac artery (IA) allografts interposition (n = 47), and portal vein (PV) allografts interposition (n = 13). FL group holds the advantages of shortest operation time (p = 0.023), lowest blood loss (p = 0.109), and shortest postoperative hospital stay (p = 0.125). The grouped patency rates of FL, primary, LV, PTFE, IA, and PV were 100%, 90%, 68%, 54%, 68%, and 85% respectively. Comparison displayed that FL had the highest patency rate (p = 0.008) and lowest antiplatelet/anticoagulation proportion (p = 0.000). Complications and long-term survival were similar among different techniques. The median survival time of patent group (24.0 months, 95% CI: 22.0-26.0) was much longer than that of the thrombosed (17.0 months, 95% CI: 13.7-20.3), though without significant difference (P = 0.148). CONCLUSIONS: PD with MPV resection and reconstruction by FL is safe, feasible, and efficacious, it might provide a potential benefit for patients.


Assuntos
Carcinoma Ductal Pancreático/cirurgia , Ligamentos/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Veia Porta/cirurgia , Anastomose Cirúrgica , Estudos de Coortes , Estudos de Viabilidade , Humanos , Masculino , Veias Mesentéricas/cirurgia , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
3.
Ann Surg ; 272(5): 731-737, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32889866

RESUMO

OBJECTIVE: The aim of this study was to establish clinically relevant outcome benchmark values using criteria for pancreatoduodenectomy (PD) with portomesenteric venous resection (PVR) from a low-risk cohort managed in high-volume centers. SUMMARY BACKGROUND DATA: PD with PVR is regarded as the standard of care in patients with cancer involvement of the portomesenteric venous axis. There are, however, no benchmark outcome indicators for this population which hampers comparisons of patients undergoing PD with and without PVR resection. METHODS: This multicenter study analyzed patients undergoing PD with any type of PVR in 23 high-volume centers from 2009 to 2018. Nineteen outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of the centers (NCT04053998). RESULTS: Out of 1462 patients with PD and PVR, 840 (58%) formed the benchmark cohort, with a mean age was 64 (SD11) years, 413 (49%) were females. Benchmark cutoffs, among others, were calculated as follows: Clinically relevant pancreatic fistula rate (International Study Group of Pancreatic Surgery): ≤14%; in-hospital mortality rate: ≤4%; major complication rate Grade≥3 and the CCI up to 6 months postoperatively: ≤36% and ≤26, respectively; portal vein thrombosis rate: ≤14% and 5-year survival for patients with pancreatic ductal adenocarcinoma: ≥9%. CONCLUSION: These novel benchmark cutoffs targeting surgical performance, morbidity, mortality, and oncological parameters show relatively inferior results in patients undergoing vascular resection because of involvement of the portomesenteric venous axis. These benchmark values however can be used to conclusively assess the results of different centers or surgeons operating on this high-risk group.


Assuntos
Benchmarking , Veias Mesentéricas/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Pancreaticoduodenectomia , Veia Porta/cirurgia , Adulto , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias
4.
Zhonghua Wai Ke Za Zhi ; 58(8): 600-603, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727190

RESUMO

In order to increase the blood supply of anastomosis, surgeons choose to preserve the left colon artery (LCA) during the laparoscopic radical resection of rectal cancer. However, surgeons are always ailed by hemorrhage and incompletely dissection of No. 253 lymph nodes. One reason is the shortage of understanding the relationship between inferior mesenteric artery (IMA), LCA, and inferior mesenteric vein before surgery. Another reason is that surgeon always remove the lymph nodes around LCA, while don't normatively resect No. 253 lymph nodes, which affect the overall survival rate. Therefore, the "medial-to-lateral approach" for laparoscopic preservation with LCA radical resection in rectal cancer was suggested in this article. The CT technique could be used to analyze the IMA classification, which contribuated to the standard conservation of LCA. Laparoscopic radical resection of rectal cancer could be completed of high quality, through accurate definition and exactly dissection of the No. 235 lymph nodes.


Assuntos
Artéria Mesentérica Inferior/cirurgia , Neoplasias Retais/cirurgia , Reto/anatomia & histologia , Reto/cirurgia , Anastomose Cirúrgica/métodos , Humanos , Laparoscopia , Excisão de Linfonodo/métodos , Linfonodos/fisiologia , Linfonodos/cirurgia , Artéria Mesentérica Inferior/anatomia & histologia , Veias Mesentéricas/anatomia & histologia , Veias Mesentéricas/cirurgia , Reto/irrigação sanguínea
5.
Surgery ; 168(3): 434-439, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32600882

RESUMO

BACKGROUND: Pancreatoduodenectomy with synchronous resection of the portal vein/superior mesenteric vein confluence may result in the development of left-sided portal hypertension. Left-sided portal hypertension presents with splenomegaly and varices and may cause severe gastrointestinal bleeding. The aim of the study is to review the incidence, treatment, and preventive strategies of left-sided portal hypertension. METHODS: A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to identify all studies published up to September 30, 2019 reporting data on patients with left-sided portal hypertension after pancreatoduodenectomy with venous resection. RESULTS: Eight articles including 829 patients were retrieved. Left-sided portal hypertension occurred in 7.7% of patients who had splenic vein preservation and 29.4% of those having splenic vein ligation. Fourteen cases of gastrointestinal bleeding owing to left-sided portal hypertension were reported at a mean interval of 28 months from pancreatoduodenectomy. Related mortality at 1 month was 7.1%. Treatment of left-sided portal hypertension consisted of splenectomy in 3 cases (21%) and colectomy in 1 (7%) case, whereas radiologic, endoscopic procedures or conservative treatments were effective in the other cases (71%). CONCLUSION: Left-sided portal hypertension represents a potentially severe complication of pancreatoduodenectomy with venous resection occurring at greater incidence when the splenic vein is ligated and not reimplanted. Left-sided portal hypertension-related gastrointestinal bleeding although rare can be managed depending on the situation by endoscopic, radiologic procedures or operative intervention with low related mortality.


Assuntos
Hipertensão Portal/epidemiologia , Veias Mesentéricas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Veia Porta/cirurgia , Complicações Pós-Operatórias/epidemiologia , Carcinoma Ductal Pancreático/cirurgia , Colectomia/estatística & dados numéricos , Tratamento Conservador/estatística & dados numéricos , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Hipertensão Portal/etiologia , Hipertensão Portal/terapia , Incidência , Ligadura/efeitos adversos , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Esplenectomia/estatística & dados numéricos , Esplenomegalia/epidemiologia , Esplenomegalia/etiologia , Esplenomegalia/terapia , Resultado do Tratamento
6.
Comput Methods Biomech Biomed Engin ; 23(13): 981-986, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32583688

RESUMO

Abdominal malignant tumors originated from cancers, such as vater ampulla carcinoma (VAC) and pancreatic cancer (PC), often invades the portal vein (PV) and the superior mesenteric vein (SMV) upon metastasis. Surgical removal of these tumors leads to sacrifice of parts of these vessels that need to be reconstructed with autograft tissues. Current options for the replacement tissue all have their limitations in certain aspects. Therefore, improved interstitial material for the reconstruction with better tissue compatibility is urgently needed. In the present study, we explored the potential of hepatic round ligament (HRL) as a candidate tissue for the task from the biomechanical point of view. We reveal that HRL and PV share similar geometrical parameters in terms of vascular cavity diameter and wall thickness. In addition, they also have similar elastic properties and tissue flexibility and intensity upon increased cavity pressure. Our study strongly supports HRL as potential replacement tissue for PV reconstruction in term of mechanical properties and encourages further biological studies to be performed on these two tissues for further verification.


Assuntos
Veias Mesentéricas/cirurgia , Veia Porta/cirurgia , Ligamento Redondo do Fígado/cirurgia , Adolescente , Adulto , Módulo de Elasticidade , Humanos , Veias Mesentéricas/patologia , Pessoa de Meia-Idade , Maleabilidade , Veia Porta/patologia , Adulto Jovem
7.
Ulus Travma Acil Cerrahi Derg ; 26(3): 493-495, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32436972

RESUMO

Intraabdominal vascular injuries due to blunt abdominal trauma are rare. It is very difficult to visualize superior mesenteric vein (SMV) and portal vein injuries under emergency conditions. In this case study, we reported a low-speed car accident, a patient with isolated SMV injury as a result of a blunt abdominal trauma that arose from a collision with a steering wheel. A 62-year-old male patient was admitted to the emergency department with minimal distention and diffuse tenderness in the abdomen. The presence of diffuse fluid in the abdomen and suspected liver injury were reported in ultrasonography. The presence of fluid in perihepatic and perisplenic areas was detected in abdominal tomography. No solid organ injury was observed. Laparotomy revealed an injury in the small intestine mesentery. There was a defect on SMV under splenic vein combination. End side vein anastomosis and primary repair were performed. During six months follow-up, the patient did not have active complaints, and there was no pathology in the SMV and portal vein. We think that the use of vascular repair techniques applied by experienced surgeons in hemodynamically stable superior mesenteric venous injuries is important concerning continuity of anatomical and functional integrity.


Assuntos
Traumatismos Abdominais , Veias Mesentéricas , Lesões do Sistema Vascular , Ferimentos não Penetrantes , Acidentes de Trânsito , Humanos , Masculino , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/lesões , Veias Mesentéricas/cirurgia , Pessoa de Meia-Idade
10.
J Vis Exp ; (155)2020 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-31957748

RESUMO

This article shows the technique of robot-assisted radical antegrade modular pancreatosplenectomy, including resection and reconstruction of the spleno-mesenteric junction, for cancer of the body-tail of the pancreas. The patient is placed supine with the legs parted and a pneumoperitoneum is established and maintained at 10 mmHg. To use the surgical system, four 8 mm ports and one 12 mm port are required. The optic port is placed at the umbilicus. The other ports are placed, on either side, along the pararectal line and the anterior axillary line at the level of the umbilical line. The assistant port (12 mm) is placed along the right pararectal line. Dissection begins by detaching the gastrocolic ligament, thus opening the lesser sac, and by a wide mobilization of the splenic flexure of the colon. The superior mesenteric vein is identified along the inferior border of the pancreas. Lymph node number 8a is removed to permit clear visualization of the common hepatic artery. A tunnel is then created behind the neck of the pancreas. To permit safe resection and reconstruction of the spleno-mesenteric junction, further preemptive dissection is required before dividing the pancreatic neck to bring in clear view all relevant vascular pedicles. Next, the splenic artery is ligated and divided, and the pancreatic neck is divided, with selective ligature of the pancreatic duct. After vein resection and reconstruction, dissection proceeds to complete the clearance of peripancreatic arteries that are peeled off from all lympho-neural tissues. Both celiac ganglia are removed en-bloc with the specimen. The Gerota fascia covering the upper pole of the left kidney is also removed en-bloc with the specimen. Division of short gastric vessels and splenectomy complete the procedure. A drain is left near the pancreatic stump. The round ligament of the liver is mobilized to protect the vessels.


Assuntos
Veias Mesentéricas/cirurgia , Pâncreas/cirurgia , Pancreatectomia , Procedimentos Cirúrgicos Robóticos , Baço/cirurgia , Esplenectomia , Idoso , Dissecação , Feminino , Humanos , Veias Mesentéricas/diagnóstico por imagem , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Baço/diagnóstico por imagem , Tomografia Computadorizada por Raios X
11.
Dis Colon Rectum ; 63(4): 450-460, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31996584

RESUMO

BACKGROUND: Strong agreement exists concerning the standards of pathologic reporting for total mesorectal excision and complete mesocolic excision. It represents a quality standard that correlates with survival. However, no agreed standards of reporting are available to define D3 lymphadenectomy for right colectomy. OBJECTIVE: The purpose of this study was to define anatomopathological standards of specimen quality obtained from the surgical specimen when an oncologic right hemicolectomy with D3 lymphadenectomy has been correctly performed. DESIGN: This study was conducted in 2 different phases. The first part consisted of a cadaver-based study of right colon anatomy, and the second part consisted of a prospective assessment of a series of surgical specimens obtained after right hemicolectomy for cancer. SETTINGS: The anatomic phase of the study was performed in collaboration with the University of Valencia Department of Anatomy and Embryology. The second part was performed at a colorectal unit of a tertiary hospital. PATIENTS: Seventeen cadavers were used for the first phase, and 65 surgical specimens were examined for the second part of the study. MAIN OUTCOME MEASURES: In each specimen, the pathologists looked for anatomic structures defined as markers of quality standards of the D3 lymphadenectomy during the first phase. Specimens were classified as complete, partial, and incomplete D3 lymphadenectomy. RESULTS: Twenty percent of specimens were classified as incomplete D3 lymphadenectomy, 31% as partial, and 49% as complete. A median number of 14 (6-64), 22 (11-47), and 29 (14-55) lymph nodes were isolated (p = 0.01). Similarly, the median numbers of lymph nodes isolated in the area of D3 lymphadenectomy were 0 in incomplete, 1 (0-5) in Partial, and 3 (0-8) in Complete D3 lymphadenectomy specimens (p = 0.0001). LIMITATIONS: A large multicenter study with adequate power is needed. CONCLUSIONS: We propose the right mesocolic sail and trunk of superior right colic vein as new and reproducible anatomopathologic standards of D3 lymphadenectomy in oncologic right hemicolectomy. See Video Abstract at http://links.lww.com/DCR/B149. PROPUESTA PARA NUEVOS ESTÁNDARES HISTOPATOLÓGICOS EN LA LINFADENECTOMÍA D3 EN EL CÁNCER DE COLON DERECHO: LA VELA MESOCÓLICA Y LA VENA CÓLICA DERECHA SUPERIOR: Existe un claro acuerdo sobre los estándares de calidad patológicos para la escisión total del mesorrecto y la escisión completa del mesocolon. Son considerados "estándar de calidad" que se correlaciona con la supervivencia. Sin embargo, no se dispone de estándares de calidad para definir la linfadenectomía D3, en la colectomía derecha.Definir los estándares anatomopatológicos de calidad obtenidos de una muestra quirúrgica, cuando se ha realizado correctamente una hemicolectomía derecha oncológica, con linfadenectomía D3.Dos fases diferentes. La primera parte consistió en un estudio basado en la anatomía del colon derecho, realizado en cadáveres, y la segunda parte consistió en una evaluación prospectiva de una serie de muestras quirúrgicas obtenidas después de la hemicolectomía derecha para cáncer.La fase anatómica del estudio se realizó en colaboración con el Departamento de Anatomía y Embriología de la Universidad de Valencia. La segunda parte se realizó en la Unidad Colorrectal de un hospital terciario.Se utilizaron diecisiete cadáveres para la primera fase y se examinaron 65 muestras quirúrgicas para la segunda parte del estudio.En cada muestra, los patólogos buscaron estructuras anatómicas definidas, como marcadores de los estándares de calidad de la linfadenectomía D3, durante la primera fase. Las muestras se clasificaron como linfadenectomía D3 completa, parcial e incompleta.El veinte por ciento de las muestras se clasificaron como "Linfadenectomía D3 Incompleta", el 31% como "Parcial" y el 49% como "Completa." Se aisló una media de 14 (6-64), 22 (11-47) y 29 (14-55) ganglios linfáticos respectivamente (p = 0,01). Del mismo modo, el número medio de ganglios linfáticos aislados en el área de la linfadenectomía D3 fue 0 en "Incompleta", 1 (0-5) en "Parcial" y 3 (0-8) en muestras de "Linfadenectomía D3 Completa" (p = 0,0001).Se necesita un estudio multicéntrico con potencia adecuada.Proponemos la vela mesocólica derecha y el tronco de la vena cólica derecha superior, como estándares anatomopatológicos nuevos y reproducibles de linfadenectomía D3, en hemicolectomía derecha oncológica. Consulte Video Resumen en http://links.lww.com/DCR/B149.


Assuntos
Pontos de Referência Anatômicos , Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Linfonodos/patologia , Veias Mesentéricas/cirurgia , Estadiamento de Neoplasias , Idoso , Idoso de 80 Anos ou mais , Cadáver , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/secundário , Feminino , Seguimentos , Humanos , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
13.
Ann Vasc Surg ; 65: 285.e1-285.e5, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31705994

RESUMO

Abernethy malformation is a very rare congenital vascular malformation consisting of diversion of portal blood away from liver, and it is commonly associated with multiple congenital anomalies. Here, we present a case of a male from China with nonspecific abdominal pain associated with an unusual pattern of type II Abernethy malformation, whose was diagnosed with a portosystemic shunt via a giant portal-inferior vena cava fistula (17.22 mm in diameter). The patient underwent a surgical ligation of the portocaval shunt and recovered well. We believe that this is the first case of a type II Abernethy malformation presenting as a portosystemic shunt via the giant portal-inferior vena cava fistula.


Assuntos
Veias Mesentéricas/cirurgia , Veia Porta/cirurgia , Fístula Vascular/cirurgia , Malformações Vasculares/cirurgia , Veia Cava Inferior/cirurgia , Adulto , Humanos , Ligadura , Masculino , Veias Mesentéricas/anormalidades , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/fisiopatologia , Veia Porta/anormalidades , Veia Porta/diagnóstico por imagem , Veia Porta/fisiopatologia , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/fisiopatologia , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia , Veia Cava Inferior/anormalidades , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/fisiopatologia
14.
J Surg Oncol ; 121(5): 857-862, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31808559

RESUMO

INTRODUCTION: Pancreatic malignant tumors are resectable at diagnosis in only 15% to 20% of cases and invasion of vascular structures is commonly present. Therefore, extended resections are needed for adequate local control and negative margins. However, morbidity and mortality associated with these enlarged resections are limiting factors. The aim of this study was to correlate demographic and technical aspects that influenced early and late outcomes. MATERIALS AND METHODS: Between October 2007 and May 2019, 523 pancreatic surgeries were performed, of which 72 required vascular resections. Clinical and histopathological data, surgical techniques, and perioperative parameters were analyzed in a prospectively collected database. RESULTS: Of the 72 cases of vascular resection, 31 were male and 41 females with a mean age of 60.9 years (34-81). The most commonly affected vascular structure was the portal vein (in 40.3%). Free margins were obtained in 77.8% of cases. Postoperative mortality rate at 60 days was 13.9%. American Society of Anesthesiologists (ASA) and age were the most important predictors of major complications. CONCLUSION: Extended resections with vascular involvement in pancreatic surgeries are feasible and safe; furthermore, patient selection plays are key. ASA and age were the most important factors in the decision-making process for extended resections.


Assuntos
Veias Mesentéricas/cirurgia , Invasividade Neoplásica , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Veia Porta/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Carcinoma Ductal Pancreático/mortalidade , Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/cirurgia , Colangiocarcinoma/mortalidade , Colangiocarcinoma/patologia , Colangiocarcinoma/cirurgia , Estudos de Coortes , Feminino , Artéria Hepática/patologia , Artéria Hepática/cirurgia , Humanos , Masculino , Artérias Mesentéricas/patologia , Artérias Mesentéricas/cirurgia , Veias Mesentéricas/patologia , Pessoa de Meia-Idade , Pancreatectomia , Neoplasias Pancreáticas/mortalidade , Veia Porta/patologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
15.
Cardiovasc Intervent Radiol ; 43(1): 46-54, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31650241

RESUMO

PURPOSE: To evaluate the safety and the efficacy of percutaneous pharmaco-mechanical thrombectomy (PPMT) of acute superior mesenteric vein (SMV) thrombosis. METHODS: A database of patients treated between 2011 and 2018 with acute venous mesenteric ischemia (VMI) was reviewed. VMI was diagnosed in the presence of SMV thrombosis and CT evidence of jejunal thickening. All patients presented with mild to moderate peritonism, which allowed surgery to be postponed. Initial treatment consisted of heparinization. PPMT was indicated in case of worsening abdominal pain despite anticoagulation and was performed via a transjugular or transhepatic approach, using a rotational aspiration thrombectomy catheter, followed by transcatheter thrombolysis. Clinical success was defined as symptoms resolution. Technical success was defined as patency of > 50% of SMV at venography and resolution of jejunal thickening. Patients were discharged on lifelong oral anticoagulation (INR 2.5-3.5). Follow-ups were performed using CT and color Doppler ultrasound. RESULTS: Population consisted of eight males, aged 37-81 (mean 56.5 years). Causes for thrombosis were investigated. Urokinase infusion time ranged from 48 to 72 h (3,840,000-5,760,000 IU). Clinical and technical success was obtained in all cases. One patient experienced bleeding from the superior epigastric artery and was treated with embolization. One patient died of multi-organ failure after 35 days, despite resolution of SMV thrombosis. In no case was surgery required after PPMT; mean hospitalization was 14.1 days (9-24). Mean follow-up of remaining seven patients was 37.7 months (12-84 months). CONCLUSION: PPMT of acute SMV thrombosis seems safe and effective, with an 87.5% long-term survival rate and a 12.5% major complication rate.


Assuntos
Isquemia Mesentérica/tratamento farmacológico , Isquemia Mesentérica/cirurgia , Trombectomia/métodos , Trombose Venosa/tratamento farmacológico , Trombose Venosa/cirurgia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/cirurgia , Pessoa de Meia-Idade , Flebografia/métodos , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Trombose Venosa/diagnóstico por imagem
16.
Surg Endosc ; 34(1): 377-383, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30963260

RESUMO

BACKGROUND: To evaluate the surgical, oncological, and survival outcomes after pancreaticoduodenectomy (PD) with superior mesenteric vein (SMV)/portal vein (PV) resection by either robotic PD (RPD) or open PD (OPD). METHODS: Data of patients with periampullary lesions undergoing PD were retrieved from a prospectively collected computer database. Surgical risks as well as oncological and survival outcomes were compared between patients with (vein resection group) and without SMV/PV resection (without vein resection group). RESULTS: A total of 391 patients undergoing pancreaticoduodenectomy were enrolled, including 43 (11.0%) and 384 (89.0%) patients with and without vein resection, respectively. Eleven (25.6%) of PDs with vein resection were performed using the robotic approach. Operation time in the vein resection group was significantly longer (median of 8 vs. 7 h). Blood loss, curative resection (R0) rate, and harvested lymph node number were similar between these two groups. Surgical outcomes including postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), chyle leakage, wound infection, and hospital stay were not significantly different between the two groups. There was no survival difference between these groups, with 1- and 3-year survival rates of 92.6% and 26.5%, respectively, for vein resection group, vs. 70.3% and 37.2%, respectively, for the without vein resection group. CONCLUSIONS: PD with vein resection is technically feasible by OPD and RPD in selected patients. Additional SMV/PV would not increase the surgical risks of PD and could achieve similar survival outcomes for pancreatic head adenocarcinoma when compared to PD without vein resection.


Assuntos
Adenocarcinoma/cirurgia , Veias Mesentéricas/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Veia Porta/cirurgia , Procedimentos Cirúrgicos Robóticos , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pancreaticoduodenectomia/mortalidade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Robóticos/mortalidade , Análise de Sobrevida , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/mortalidade
18.
Medicine (Baltimore) ; 98(48): e18002, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770213

RESUMO

RATIONALE: Mesenteric venous thrombosis is an uncommon but potentially fatal condition that can cause bowel ischemia. It results from a systemic hypercoagulable state or abdominal infection draining into the portal venous system. Several cases regarding portomesenteric venous thrombosis as a complication of appendicitis were reported in adults, but there are far fewer reports in pediatric patients. The mortality rate of the condition is high if untreated, especially in children, reaching up to 50%. PATIENT CONCERNS: A healthy 15-year-old male with no significant past medical history presented with right lower quadrant pain, lethargy, and fever. The computed tomography scan showed a focal thrombosis at the superior mesenteric vein branch and an inflamed appendix. DIAGNOSES: Mesenteric venous thrombosis complicating acute appendicitis. INTERVENTIONS: Intravenous antibiotics along with anticoagulants and laparoscopic appendectomy OUTCOMES:: After 1 month, a follow-up ultrasonography revealed full resolution of the thrombosis. LESSONS: Appendicitis is one of the most frequently encountered causes of pediatric surgical emergencies; therefore, physicians should be conscious of mesenteric venous thrombosis as a possible complication of acute appendicitis, irrespective of whether patients have thrombophilic conditions or not.


Assuntos
Apendicite/complicações , Isquemia Mesentérica/terapia , Veias Mesentéricas/cirurgia , Doença Aguda , Adolescente , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Apendicectomia/métodos , Apendicite/terapia , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/etiologia , Veias Mesentéricas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia
19.
Arq Gastroenterol ; 56(3): 246-251, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31633719

RESUMO

BACKGROUND: Pancreaticoduodenectomy (PD) with the resection of venous structures adjacent to the pancreatic head, even in cases of extensive invasion, has been practiced in recent years, but its perioperative morbidity and mortality are not completely determined. OBJECTIVE: To describe the perioperative outcomes of PD with venous resections performed at a tertiary university hospital. METHODS: A retrospective study was conducted, classified as a historical cohort, enrolling 39 individuals which underwent PD with venous resection from 2000 through 2016. Preoperative demographic, clinical and anthropometric variables were assessed and the main outcomes studied were 30-day morbidity and mortality. RESULTS: The median age was 62.5 years (IQ 54-68); 55% were male. The main etiology identified was ductal adenocarcinoma of the pancreas (82.1%). In 51.3% of cases, the portal vein was resected; in 35.9%, the superior mesenteric vein was resected and in the other 12.8%, the splenomesenteric junction. Regarding the complications, 48.7% of the patients presented some type of morbidity in 30 days. None of the variables analyzed was associated with higher morbidity. Perioperative mortality was 15.4% (six patients). The group of individuals who died within 30 days presented significantly higher values for both ASA (P=0.003) and ECOG (P=0.001) scores. CONCLUSION: PD with venous resection for advanced pancreatic neoplasms is a feasible procedure, but associated with high rates of morbidity and mortality; higher ASA e ECOG scores were significantly associated with a higher 30-day mortality.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Adenocarcinoma/mortalidade , Adulto , Idoso , Brasil/epidemiologia , Feminino , Humanos , Complicações Intraoperatórias , Masculino , Veias Mesentéricas/cirurgia , Pessoa de Meia-Idade , Morbidade , Neoplasias Pancreáticas/mortalidade , Pancreaticoduodenectomia/mortalidade , Veia Porta/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos
20.
World J Surg ; 43(11): 2909-2919, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31396672

RESUMO

BACKGROUND: To report our experiences and outcome of pancreatectomy with hepatic artery resection (PT-HAR) for advanced pancreatic head cancer. METHODS: A retrospective study of clinical data from 14 patients with advanced pancreatic ductal adenocarcinoma undergoing PT-HAR in a tertiary academic center between March 2010 and June 2017 was performed. Furthermore, a comparison in a match-pair analysis (1:3) with patients received standard pancreatectomy during the same period was conducted to evaluate the clinical outcome. RESULTS: The PT-HAR cohort included pancreaticoduodenectomy (n = 11) and total pancreatectomy (n = 3). Of them, six underwent portal/superior mesenteric vein resection and reconstruction and three underwent hepatic artery reconstruction. Four patients without arterial reconstruction developed liver perfusion failure. No perioperative mortality occurred, with a median postoperative hospital stay of 10.5 days (range 6-39). The median overall survival was 30 months (95% confidence interval 9.8-50.2 months), with the 1-, 2-, and 3-year survival rates of 81.8%, 63.6%, and 42.4%, respectively. The matched-pair data analysis showed no significant differences between PT-HAR and standard pancreatectomy, except that liver perfusion failure occurred more frequently after PT-HAR. CONCLUSIONS: PT-HAR can be performed with acceptable morbidity, mortality, and survival for advanced pancreatic head cancer. Considering the potential risk of liver perfusion failure, only highly selected patients are eligible for PT-HAR without reconstruction.


Assuntos
Carcinoma Ductal Pancreático/cirurgia , Artéria Hepática/cirurgia , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Adulto , Idoso , Feminino , Humanos , Tempo de Internação , Fígado/irrigação sanguínea , Masculino , Veias Mesentéricas/cirurgia , Pessoa de Meia-Idade , Pancreatectomia/efeitos adversos , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/métodos , Veia Porta/cirurgia , Estudos Retrospectivos , Taxa de Sobrevida
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