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1.
Background The aim of this research was to analyze the perioperative factors of regular hepatectomy and irregular hepatectomy.The superiority of the clinical application of the two methods was compared in the perioperative period.Methods From 1986 to 2011,1798 patients underwent consecutive liver resections with regular hepatectomy and irregular hepatectomy at the Air Force General Hospital of People's Liberation Army and the General Hospital of Chinese People's Liberation Army.Their medical documentation was investigated retrospectively.Results In patients on whom regular hepatectomy and irregular hepatectomy were performed,there was no significant difference in perioperative blood loss,complications,in-hospital mortality,hospital stay,and so on.But in regular hepatectomy,operating time was an independent risk factor (P <0.001,OR=1.004).Conclusions There was no significant difference between the perioperative risk of regular hepatectomy and that of irregular hepatectomy.  相似文献   

2.
Objective: To analyze the peroperative factors of regular hepatectomy and irregular hepatectomy. The superiority of the clinical application of the two methods was compared in peroperative period.Methods: From 1986 to 2011, 1798 patients had consecutive liver resections with regular hepatectomy and irregular hepatectomy at the Air Force General Hospital of PLA and the General Hospital of Chinese PLA. Their medical documentation was investigated retrospectively.Results: In patients on whom regular hepatectomy and irregular hepatectomy were performed, there was no significant difference in the perioperative blood loss, complications, in-hospital mortality, hospital day, and so on. But the regular hepatectomy was independent risk factor of operating time (P<0.001,OR=1.004).Conclusions: There were no significant difference between the peroperative risk of regular hepatectomy and that of irregular hepatectomy.  相似文献   

3.
930321 Prognostic facters for surgical treat-ment of hilar cholangiocarcinoma.ZHOUNingxin (周宁新),et al.Dept Hepatobili Surg,General Hosp,PLA,Beijing,100853.NatlMed J Chin 1993;73(4):232-234.Forty—five patients with hilar choiangiocar-cinoma were operated on at our department.The tumor was resected in 29 patients (64%).There were no operative deaths and the survivalrate was 41% and 21% at 12 and 24 months re-spectively.In patients with no tumor resectionthe 60—day mortality rate was 37.5% and noneof them survival for 12 monthrs.Significant dif-ference waa noted in survival rates of the pa-tients with radical resection,those with resec-  相似文献   

4.
Resection of the extrahepatic bile tract for hilar bile duct carcinoma was performed at the PLA General Hospital, with a resectability rate of 62% (31/50) and no operative mortality. Hepatic lobectomy was performed at the same time in 16 cases (51.6%). Reoperative resections were successfully done in 5 cases; 4 cases are still living 1-4 years after the second operation. The cause of late death was mainly biliary infection due to local recurrence and bile duct obstruction. The median survival period was 15 months. 32 cases were studied pathologically, of which 27 were resected surgical specimens and 5 autopsies. The tumors were histologically classified into 4 types: papillary adenocarcinoma (6 cases); well differentiated adenocarcinoma (21); poorly differentiated adenocarcinoma (3); and simple carcinoma (2). The importance of early diagnosis of hilar bile duct carcinoma at its subclinical stage before appearance of clinical jaundice is stressed.
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5.
Laparoscopic hepatectomy by curettage and aspiration: a new technique   总被引:1,自引:1,他引:0  
Background Laparoscopic surgery is advantageous for minimal invasiveness and rapid postoperative recovery. Since the use of laparoscopic hepatectomy in liver resection in the 1990s, it has been performed in a few institutions worldwide. Lack of efficient and safe techniques for liver transaction is the major obstacle preventing from its further development. We developed a new technique for laparoscopic hepatectomy by curettage and aspiration in 1998. In this paper we analyze the clinical outcomes of this technique after 7 years of practice.Methods Altogether 59 consecutive patients underwent laparoscopic hepatectomy by curettage and aspiration from August 1998 to January 2005 at our institution. These patients included 33 males and 26 females, with a mean age of 47 years. For liver transecsion laparoscopic Peng’s multifunctional operative dissector (LPMOD) was used. Lesions included malignant liver tumors in 19 patients, benign liver tumors in 17, intrahepatic calculus in 18, and other liver lesions in 5. Procedures included local resections in 30 patients, left lateral segmentectomy in 28, and right hemihepatectomy in 1. Results Laparoscopic operation was completed in 57 patients. Two patients (3.4%) had the operation converted to laparotomy. The mean operating time was 143 minutes and the mean intraoperative blood loss was 456 ml. The mean length of postoperative hospital stay was 7 days. Complications occurred in 2 patients (3.4%), and there was no perioperative death.Conclusion Laparoscopic hepatectomy by curettage and aspiration is efficient and safe for liver resection.  相似文献   

6.
Primary liver cancer is one of the most common cancers in China.Among all liver cancers,more than 90% of the cases are hepatocellular carcinoma (HCC) with a mortality of 20.40/0.1 million people.In general,surgery is the first-line treatment for primary liver cancer.With the development of diagnostic procedures,surgical technologies,and perioperative treatments,the mortality and complications of HCC have decreased.However,compared to other surgeries,the postoperative complications of hepatectomy have remained at relatively high levels.Of these complications,liver failure is one of the most important and common complications,and may lead to death.Functional protection after hepatectomy is crucial for the postoperative treatment and rehabilitation of patients.Derived from the cytotrophoblast,the amniotic membrane (AM) is the inner membrane of the fetal membranes.Keywords:amniotic membrane; liver regeneration; partial hepatectomy; proliferation index  相似文献   

7.
Objective To investigate the perioperative morbidity and mortality of patients with colorectal cancer. Methods Postoperative morbidity and mortality were analyzed in 903 colorectal cancer patients of Peking University Third Hospital from 1992 to 2005. Results There was colonic carcinoma in 518 cases (CC 57.4 % ) rectal carcinoma in 385 casec (RC 42.6 % ). The overall pefioperative morbidity rate was 21.8 %, with 18.3 % in CA,  相似文献   

8.
Background Patients presenting with severe left ventricular dysfunction (SLVD) undergoing conventional coronary artery bypass grafting (CCABG) are at an increased risk of perioperative mortality and morbidity. The aim of this study was to assess the risk factors responsible for mortality and morbidity among patients with SLVD by comparing CCABG and oft-pump coronary artery bypass surgery (OPCAB).
Methods We retrospectively evaluated 186 consecutive patients with SLVD who underwent coronary artery bypass grafting (CABG), including 102 by CCABG and 84 by OPCAB. Registry database, medical notes, and charts were studied for preoperative and postoperative data of the patients. Different variables and risk factors (preoperative, intraoperative, and postoperative) were evaluated and compared. The morbidity and mortality outcomes were compared in the two groups. The follow-up results and quality of life were assessed after surgery.
Results The two groups had similar percentage of patients with preoperative high-risk profiles and no significant differences were found between groups in baseline variables such as age or comorbidities. There was a significant difference in the number of grafts used between the two groups. CCABG patients received (3.6±0.5) grafts per patient, while OPCAB patients had (2.7±0.6) grafts (P 〈0.05). Completeness of revascularization was also significantly different between the two groups (CCABG 91.1% vs OPCAB 73.8%, P 〈0.05). The hospital mortality was similar in the two groups (4.8% in OPCAB vs 5.9% in CCABG). The risk-adjusted mortality, according to the calculated propensity score, did not reach statistical significance in the two groups. In this study, OPCAB seemed to have a beneficial effect on reducing reoperation for bleeding, blood transfusion requirement, and the length of stay at ICU. But the incidence of perioperative myocardial infarction was more common in the off-pump group (P 〈0.05). The degree of improvement in angina and qual  相似文献   

9.
Extrahepatic bile duct cancers (BDC) are still frustratingly difficult lesions to deal with at present. 106 cases of BDC treated between January 1986 and December 1990 were reviewed retrospectively. The resectability rate of the entire series was 18.9%. Hilar (upper third) BDC accounted for 51% of the entire series and its resection rate was 14.8%. Lymph node metastases occurred in 40.9% of the cases and were mostly seen in the middle 1/3 of BDC. 32% of the cases had liver metastases, frequently occurred in hilar BDC. Sixty-four patients had specimens histologically studied. Of them, adenocarcinomas accounted for 90.6% (58 cases) and adenosquamous carcinomas 4.7% (3). Among the adenocarcinomas, 32 (55.2%) cases were well differentiated and 26 (44.8%) poorly differentiated.
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10.
Background Orthotopic liver retransplantation (re-OLT) is the only effective therapy for irreversible failure of a liver graft. Early and late graft failure gives way to two different clinical conditions that should be discussed separately. This study was designed to compare early and late re-OLT for patients with poor graft function after primary transplantation at our center and sum up our clinical experience in re-OLT.
Methods The clinical data of 31 re-OLTs at our center from January 2004 to February 2007 were analyzed retrospectively, consisting of the first group with 14 cases of early re-OLT and the second group with 17 cases of late re-OLT.
Results Biliary tract complications were the main indications for early re-OLT (57.1%) and late re-OLT (52.9%). Other common indications were vascular complications in early re-OLT and recurrence of primary diseases in late re-OLT. No significant differences were found between the groups with regard to the volume of bleeding during operation, cold ischemia time, operative duration, and perioperative mortality; except for the model of end-stage liver disease (MELD) score. Outcome was fatal for 7 patients in early re-OLT and 9 patients in late re-OLT. Two deaths were due to multiple organ failure with 3 deaths due to severe sepsis-related disease in early re-OLT, and 4 deaths were due to severe sepsis-related disease with 3 deaths due to recurrence of hepatocellular carcinoma (HCC) in late re-OLT. One and 2-year actuarial survival rates after re-OLT were 55.2% and 36.9%, respectively, for patients in early re-OLT, and 65.1% and 52% respectively, for patients in late re-OLT. No significant differences were found regarding survival rates between the two groups.
Conclusions Similar clinical results can be achieved in early and late re-OLT. Proper indications and optimal operation timing, adequate preoperative preparation, experienced surgical procedures, and effective perioperative anti-infection strategy contribute to the improvement of overall sur  相似文献   

11.
祁军安  李宗芳  江奎  朱海林  王钢  程伟华 《吉林医学》2009,30(22):2742-2743
目的:探讨肝部分切除术治疗复杂肝内胆管结石的方法及疗效。方法:回顾性分析肝部分切除术治疗138例复杂肝内胆管结石患者临床资料。结果:无手术死亡患者。术后并发胆漏5例(3.6%),膈下感染4例(2.9%),腹腔脓肿3例(2.2%),肝衰1例(0.7%)。结论:肝部分切除术是治疗复杂肝内胆管结石最有效的手段之一。  相似文献   

12.
This study aimed to evaluate the role of hepatectomy in the treatment of hepatolithiasis. One hundred and forty-seven patients with hepatolithiasis were subjected to hepatectomy and preoperative evaluation for hepatolithiasis typing. In 108 cases, the hepatectomy was left hepatic lobectomy and in 30 cases, it was right hepatic lobectomy. There were 17 cases of multiple segmental resections. The stone clearance was 85% (125/147). Residual stones were removed through the T-tube sinus postoperatively, and the final stone clearance was 95.9% (141/147). There were 28 cases (19.1%) of postoperative complications, including temporary biliary fistula, resectional surface and subphrenic infection and haematobilia. Hepatic lobectomy was an effective method in the treatment of hepatolithiasis.  相似文献   

13.
目的评价基于三维技术的保护性肝切除治疗肝胆管结石的临床应用价值。方法采用MI-3DVS软件对21例肝胆管结石患者上腹部64排多层螺旋CT薄层图像进行三维重建及可视化仿真手术,制定手术规划,指导临床施行保护性肝切除术。观察实际肝切除方式与仿真手术符合情况,平均手术时间及住院日,术中出血量,结石取尽情况及术中术后并发症发生情况等。结果 21例患者实际肝切除方式与仿真手术一致,与常规的规则性肝切除术相比,均不同程度的保留功能正常的肝脏组织,平均手术时间(215.2±51.3)min,住院时间(10.7±4.3)d,术中出血量(301.4±60.7)ml,结石取尽率为95.2%(20/21),手术并发症发生率为19.0%(4/21)。结论基于三维技术的保护性肝切除治疗肝胆管结石,在实现取尽结石、祛除病灶、解除狭窄、通畅引流的同时,能最大程度保留残肝体积,并降低肝切除相关并发症的发生。  相似文献   

14.
邹明扬 《四川医学》2002,23(12):1228-1229
目的 探讨肝内胆管结石的治疗方法及疗效。方法 对1991年1月至2001年12月的90例肝内胆管结石的各类治疗方法的疗效进行总结。结果 总管切开(包括肝内胆管剖开)取石+“T”管引流20例(22%),肝叶切除,肝门部胆管原位整形胆管-空肠Roux-Y吻合21例(23%),左外叶切除+“T”管引流25例(27%),左半肝切除11例(12%),右肝段楔形切除6例(6.6%)。肝门部胆管狭窄切开原们整形,包括3例脐静脉修补7例(7.7%)。随访结果表明:肝切除,胆管狭窄原位整形,肝管-空肠Roux-Y吻合是治疗肝内胆管结石的主要方法,能取得良好疗效。结论 肝叶或肝段切除是肝内胆管结石治疗的首选方法,胆肠吻合前必须先矫正胆管狭窄,清除结石病灶。  相似文献   

15.
肝切除术治疗肝内胆管结石36例临床分析   总被引:1,自引:0,他引:1  
目的探讨肝切除术治疗肝内胆管结石的效果.方法对1991年9月-1997年12月肝切除术治疗肝内胆管结石患者36例进行分析,包括结石分布和胆道狭窄部位、手术方式、术后并发症及结石残留等.结果肝内胆管结石以左肝多见(22例),全肝结石其次(11例),22.2%同时存在胆道狭窄.肝切除以左外叶及左半肝切除为主(30例).8例行肝内狭窄胆管切开整形、胆管空肠吻合.5例出现手术后并发症.19.4%的病例有结石残留.治疗效果优良者占86.2%.结论肝切除术是治疗肝内胆管结石的主要方法,为减少结石的残留和复发,应根据情况同时行肝内狭窄胆管切开整形、胆管空肠吻合.  相似文献   

16.
目的评价肝切除术治疗肝内胆管结石的疗效。方法回顾性分析我院手术治疗的169例肝内胆管结石患者的临床资料。根据患者接受手术方式的不同分为肝切除组(n=105)和无肝切除组(n=64),比较两组的手术并发症、术后残余结石率和治疗效果。结果肝切除组与无肝切除组间术后并发症发生率和病死率差异无统计学意义,而肝切除组术后结石残余率(7.1%)明显低于无肝切除组(34.5%),且肝切除组优良率(90.8%)明显高于无肝切除组(70.7%)。结论肝切除术治疗肝内胆管结石安全、有效,且残余结石率明显降低。  相似文献   

17.
《中国现代医生》2020,58(11):34-37+46+封三
目的 探讨Child-Pugh肝功能分级在老年心力衰竭患者严重程度和预后评估中的应用。方法 纳入2017年1月~2018年9月于南充市中心医院老年病科已确诊为心力衰竭的患者132例,按照Child-Pugh肝功能的得分将患者分为3个等级:A级、B级、C级,观察记录三组患者的临床特征、肝功能分级与心衰严重程度指标如NYHA分级、NT-proBNP、LVEF的关系,住院时间及患者出院后随访1年的全因死亡率。结果 入院的心力衰竭患者中,Child-Pugh A级占比最多;病史特征上,Child-Pugh A、B级心力衰竭患者以合并冠心病病史居多,而Child-Pugh C级心力衰竭患者以合并扩心病病史居多(P0.05)。Child-Pugh肝功能分级越高,其心衰的NYHA的分级及NTproBNP的水平也越高,同时LVEF的水平越低(P0.05)。Child-Pugh肝功能分级越高,心衰患者的住院时间越长,随访1年的全因死亡率越高(P0.05)。结论 肝功能损伤在老年心力衰竭患者中比较常见,Child-Pugh肝功能分级可用于判断老年心力衰竭患者的严重程度,在长期随访中对老年心力衰竭患者的预后有较好的预测价值。  相似文献   

18.
目的回顾性分析肝血管瘤切除术相关围术期因素,探讨肝血管瘤的手术适应证及治疗方法。方法回顾性研究和分析了空军总医院1991~2011年423例肝血管瘤切除术围术期病例资料。结果本组病例中伴上腹部不适症状的肝血管瘤患者占91.3%(386/423)。术中失血≤200 mL者276例(65.25%),200~400 mL者86例(20.33%),400~1 000 mL者42例(9.93%),〉1 000 mL者19例(4.49%)。手术时间平均(170.60±78.23)min。术后住院天数平均(12.67±10.51)d。总的术后并发症发生率为7.80%,围手术期死亡率为0。经多因素Logistic回归分析,手术时间的延长为危险因素(P=0.004,or=1.015),ALB值的升高为保护因素(P=0.021,or=0.852)。结论肝血管瘤切除手术适应证应从严掌握,在重视优化围术期处理和创新手术技术的前提下,肝切除术是治疗肝血管瘤安全有效的方法,并可保持低并发症发生率。  相似文献   

19.
中央区肝癌肝切除的手术体会   总被引:2,自引:0,他引:2  
目的总结中央区原发性肝癌手术治疗的经验,以提高中央区肝癌手术的安全性。方法回顾性分析2004~2007年我院行手术切除的中央区肝癌和非中央区(周边区)肝癌患者的临床资料,比较两组术后生化指标和手术时间、血流阻断时间、住院时间、术中出血量、输血量、术后并发症等,及肝切除手术中Pringle s法、半肝阻断法和改良Pringle s法3种不同入肝血流阻断方法的效果。结果中央区肝癌和周边区肝癌两组病变大小、Child-Pugh评分、吲哚青绿15 min潴留率、术后1周内血清天冬氨酸转氨酶、丙氨酸转氨酶、谷氨酰转肽酶、总胆红素、直接胆红素、白蛋白、前白蛋白、胆碱脂酶、血流阻断时间、输血量和肝切除术后并发症发生率、术中出血量差异均无显著性。中央区组肝癌手术时间、住院时间显著长于周边区组(P<0.05)。保留半肝动脉血流的改良Pringle s法入肝血流阻断操作简单,且可有效控制术中出血,减轻肝脏缺血再灌注损伤。结论对中央区肝癌,只要术前做好充分评估和准备,熟悉解剖,选择合适的血流阻断方法,手术切除是安全可行的。  相似文献   

20.
目的探讨肝叶切除术治疗肝胆管结石的临床疗效及其影响因素。方法回顾性分析2007年1月~2012年12月在海南省人民医院接受肝叶切除术治疗的780例肝胆管结石患者的临床资料,包括病例的人口学特征、年龄、结石的分布、肝叶切除的分区、术后结石残留及随访情况等进行讨论分析。结果左肝外叶切除427例,占54.74%,左外叶上段切除286例,占36.67%,左外叶下段切除141例,占18.07%,左半肝切除96例,占12.31%,右前叶切除73例,占9.35%,右后叶切除105例,占13.46%,右半肝切除33例,占4.24%,双侧多区段切除46例,占5.90%。术后残石率10.38%,术后并发症发生率为14.36%;其中627例获得随访4个月~4年,优良率为94.26%,复发率为5.74%。结论肝叶切除术是治疗肝胆管结石行之有效的方法,复发率低,结石残留率低,治疗过程需要根据结石分布情况,同时进行附加手术,改善治愈率。  相似文献   

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