共查询到20条相似文献,搜索用时 15 毫秒
1.
Yang SH Yin YH Jang JY Lee SE Chung JW Suh KS Lee KU Kim SW 《World journal of surgery》2007,31(12):2384-2391
Background Pancreatic surgeons often must make decisions regarding hepatic artery (HA) resection while performing a pancreatoduodenectomy
(PD). The purpose of this report was to review and summarize HA resection experience with a focus on vascular preservation
during PD and to develop a useful guideline for pancreatic surgeons in dealing with these needs.
Methods We reviewed 1324 cases that had available computed tomographic and angiographic findings and summarized the problematic HA
variations encountered in PD. In reviewing our PD series (n = 254), we have created a set of guidelines that enable a pragmatic approach to the unique variations in HA and the risks
of cancer invasion.
Results Challenging HA variations during PD were found in 20.1% of the cases and included the common HA arising from the superior
mesenteric artery (SMA) (2.34%), a replaced right HA (RHA) from the SMA (9.82%), an RHA or left HA from the gastroduodenal
artery (0.97%), and the right anterior or right posterior HA from the SMA (1.06%), among others. In our PD series, the problematic
HAs (15.8%) were preserved, except for a single case (0.4%) in which PD involved en bloc resection of the RHA from the SMA
due to a cancerous invasion and without right hemihepatectomy.
Conclusions Surgeons should have knowledge of the anatomically variable vasculature of the HA when planning for PD. Preoperative imaging
studies can aid and should be performed in anticipation of the potential HA variations during PD. 相似文献
2.
Filippo Catalano Antonello Trecca Luca Rodella Francesco Lombardo Anna Tomezzoli Serena Battista Marco Silano Fabio Gaj Giovanni de Manzoni 《Surgical endoscopy》2009,23(7):1581-1586
Background Endoscopic submucosal dissection (ESD) has been developed as treatment for early gastric cancer (EGC) by Japanese authors.
However, there are no reports about its possible implementation in the Western setting. The aim of the present work is to
determine the safety and efficacy of the endoscopic treatments for EGC in an Italian cohort.
Methods Forty-five patients for a total of 48 gastric lesions were enrolled in the study. Thirty-six EMR procedures were performed
with the strip biopsy technique using a double-channel endoscope. En bloc resection refers to resection in one piece, while
piecemeal refers to resections in which the lesion was removed in multiple fragments. A total of 12 ESD were performed and
completed with IT knife. We define as curative treatment lateral and vertical margins of the resected specimens free of cancer
and repeat endoscopic finding of no recurrent disease.
Results Out of 36 EMR procedures, 10 were piecemeal resections (28%), while 26 were en bloc (72%). ESD led to en bloc resection in
11/12 cases (92%). Histological assessment of curability in the EMR group was achieved in 56% of the cases, and in 92% of
the ESD group. Mean follow-up period was 31 months (range: 12–71 months). There was no local recurrence or distant metastasis
in the curative group patients.
Conclusions These results seem to confirm the safety and the clinical efficacy of the ESD procedure in the Western world too. 相似文献
3.
Multiple reconstructions of the hepatic arteries (HA) after cancer resection presents a surgical challenge, not only because it is technically demanding, but also because attention must be paid to potential ischemic injury to the liver caused by the prolonged ischemia. We present a novel “preexcisional artery reconstruction” method for minimizing ischemic injury of the liver. A 65‐year‐old woman presented with cholangiocarcinoma invading the HA. Pancreatoduodenectomy, resection, and multiple reconstruction of the HA were performed. First, the left hepatic artery (LHA) was reconstructed prior to the tumor resection. During this procedure, blood supply was maintained to most of the liver via the right hepatic artery (RHA). Then, resection of the tumor en bloc with the HA was performed, followed by reconstruction of the RHA. During this procedure, blood supply was maintained via the already‐reconstructed LHA, thereby limiting the ischemic area. Use of this method allowed the ischemia time and region to be divided and minimized, thereby leading to a reduced risk of ischemia‐related complications. We believe that this method may be one of the useful approaches in multiple HA reconstruction. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012. 相似文献
4.
Aberrant right hepatic artery in laparoscopic cholecystectomy. 总被引:1,自引:0,他引:1
Matthew J Blecha Angela R Frank Todd A Worley Francis J Podbielski 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2006,10(4):511-513
INTRODUCTION: Presented herein is a case in which an aberrant right hepatic artery (RHA) passes anterior to the infundibulum and fundus of the gallbladder and courses to an unusually anterior hepatic entry. CASE REPORT: A 54-year-old female with a history of biliary colic was scheduled for laparoscopic cholecystectomy. Laparoscopic dissection revealed an aberrant right hepatic artery (RHA) anterior to the infundibulum and fundus of the gallbladder. Further dissection revealed the cystic artery to branch laterally off this RHA over the gallbladder fundus anteriorly. The cystic artery then wrapped posterolaterally on the gallbladder's surface to its neck. After the gallbladder was removed, the aberrant RHA was readily visible traveling across the gallbladder bed and entering the liver at an unusually anterior location. Intraoperative images are included. The procedure was completed laparoscopically without complication. DISCUSSION: The origins and paths of both the cystic and right hepatic arteries have several documented anomalies. We are unaware of any reports of an RHA that transverses the entire neck and fundus of the gallbladder before such an anterior hepatic entry. Conclusion: This case serves as a striking reminder of the variations in extrahepatic biliary and vascular anatomy. Ligation of this uniquely located aberrant RHA could have led to intraoperative hemorrhage or potential hepatic ischemia. 相似文献
5.
肝动脉外科解剖在肝动脉置管术中的应用及意义 总被引:2,自引:0,他引:2
目的 目前术中肝动脉置管术(IHAC)已广泛应用于肝脏恶性肿瘤的综合治疗,但多采用盲目插管的方法,影响了IHAC的疗效。通过术中肝动脉的外科解剖结合肝动脉造影,了解肝总动脉及其主要分支的行径及相互关系,证明肝动脉外科解剖在IHAC中的意义。方法 采用电凝锐性解剖技术对116例肝脏或胆道疾病患者行肝动脉外科解剖,详细记录肝总动脉(CHA)、肝固有动脉(PHA)、肝左、右动脉(LHA、RHA)及胃十二指肠动脉(GDA)的位置和相互间的成角(锐角或钝角),并在术中观察自然状态下导管经胃网膜右动脉插入后的走向。部分病例结合肝动脉造影资料进行分析。结果 (1)GDA与CHA呈水平或钝角72例(62%)。其中20例行IHAC,导管经胃网膜右动脉插入时全部进入CHA;(2)GDA与CHA呈锐角,而与PHA呈水平或钝角36例(31%),13例行IHAC,导管或进入PHA或RHA;(3)PHA缺如8例(7%)。此外,116例中RHA起源于肠系膜上动脉9例(7.7%),肝左动脉源于胃左动脉7例(6.0%),肝左、右动脉之间在肝门部存在明显异常交通支2例(1.7%)。结论 影响IHAC准确性的关键是GDA与CHA的成角,以及肝动脉解剖异常。由于绝大多数GDA与CHA成角为钝角,加上一定比例的肝动脉解剖异常,因此,非肝动脉外科解剖的盲目插管其成功率不足25%,应引起临床的高度重视。 相似文献
6.
Stefano Boriani Stefano Bandiera Rakesh Donthineni Luca Amendola Michele Cappuccio Federico De Iure Alessandro Gasbarrini 《European spine journal》2010,19(2):231-241
The morbidity of surgical procedures for spine tumors can be expected to be worse than for other conditions. This is particularly
true of en bloc resections, the most technically demanding procedures. A retrospective review of prospective data from a large
series of en bloc resections may help to identify risk factors, and therefore to reduce the rate of complications and to improve
outcome. A retrospective study of 1,035 patients affected by spine tumors—treated from 1990 to 2007 by the same team—identified
134 patients (53.0% males, age 44 ± 18 years) who had undergone en bloc resection for primary tumors (90) and bone metastases
(44). All clinical, histological and radiological data were recorded from the beginning of the period in a specifically built
database. The study was set up to correlate diagnosis, staging and treatment with the outcome. Oncological and functional
results were recorded for all patients at periodic, diagnosis-related controls, until death or the latest follow-up examination
(from 0 to 211 months, median 47 months, 25th–75th percentile 22–85 months). Forty-seven on the 134 patients (34.3%) suffered
a total of 70 complications (0.86 events per 100 patient-years); 32 patients (68.1%) had one complication, while the rest
had 2 or more. There were 41 major and 29 minor complications. Three patients (2.2%) died from complications. Of the 35 patients
with a recurrent or contaminated tumor, 16 (45.7%) suffered at least one complication; by contrast, complications arose in
31 (31.3%) of the 99 patients who had had no previous treatment and who underwent the whole of their treatment in the same
center (P = 0.125). The risk of major complications was seen to be more than twice as high in contaminated patients than in non-contaminated
ones (OR = 2.52, 95%CI 1.01–6.30, P = 0.048). Factors significantly affecting the morbidity are multisegmental resections and operations including double contemporary
approaches. A local recurrence was recorded in 21 cases (15.7%). The rate of deep infection was higher in patients who had
previously undergone radiation therapy (RT), but the global incidence of complications was lower. Re-operations were mostly
due to tumor recurrences, but also to hardware failures, wound dehiscence, hematomas and aortic dissection. En bloc resection
is able to improve the prognosis of aggressive benign and low-grade malignant tumors in the spine; however, complications
are not rare and possibly fatal. The rate of complication is higher in multisegmental resections and when double combined
approach is performed, as it can be expected in more complex procedures. Re-operations display greater morbidity owing to
dissection through scar/fibrosis from previous operations and possibly from RT. The treatment of recurrent cases and planned
transgression to reduce surgical aggressiveness are associated with a higher rate of local recurrence, which can be considered
the most severe complication. In terms of survival and quality of life, late results are worse in recurrent cases than in
complicated cases. Careful treatment planning and, in the event of uncertainty, referral to a specialty center must be stressed. 相似文献
7.
Tiffany C. Lee Alexander R. Cortez Al‐Faraaz Kassam Mackenzie C. Morris Leah K. Winer Latifa S. Silski Ralph C. Quillin Madison C. Cuffy Courtney R. Jones Tayyab S. Diwan Shimul A. Shah 《American journal of transplantation》2020,20(4):1181-1187
Simultaneous liver‐kidney transplantation (SLKT) is indicated for patients with end‐stage liver disease (ESLD) and concurrent renal insufficiency. En bloc SLKT is an alternative to traditional separate implantations, but studies comparing the two techniques are limited. The en bloc technique maintains renal outflow via donor infrahepatic vena cava and inflow via anastomosis of donor renal artery to donor splenic artery. Comparison of recipients of en bloc (n = 17) vs traditional (n = 17) SLKT between 2013 and 2017 was performed. Recipient demographics and comorbidities were similar. More recipients of traditional SLKT were dialysis dependent (82.4% vs 41.2%, P = .01) with lower baseline pretransplant eGFR (14 vs 18, P = .01). En bloc SLKT was associated with shorter kidney cold ischemia time (341 vs 533 minutes, P < .01) and operative time (374 vs 511 minutes, P < .01). Two en bloc patients underwent reoperation for kidney allograft inflow issues due to kinking and renal steal. Early kidney allograft dysfunction (23.5% in both groups), 1‐year kidney graft survival (88.2% vs 82.4%, P = 1.0), and posttransplantation eGFR were similar between groups. In our experience, the en bloc SLKT technique is safe and feasible, with comparable outcomes to the traditional method. 相似文献
8.
Purpose An aberrant right hepatic artery (ARHA) is a common anomaly and its implications for patients undergoing a pancreaticoduodenectomy
(PD) have not yet been previously reported. We compared the outcomes following PD in patients with and without an ARHA. A
novel classification of the anatomical course of ARHA, and surgical techniques for its identification and preservation are
described herein.
Methods All patients undergoing PD between June 1, 2002, and May 31, 2007, were divided into two groups, one with ARHA and the other
without. These groups were compared to identify differences in the intraoperative variables, the oncological clearance, the
postoperative complications, and the survival.
Results A total of 135 patients underwent PD of which 28 (20.8%) patients were found to have either accessory or replaced right hepatic
arteries (ARHA group). There were no significant differences in the intraoperative variables (blood loss and operative time)
and the incidence of postoperative complications (pancreatic leak and delayed gastric emptying). Oncological clearance (nodal
yield and resection margins) and survival were also similar in the two groups.
Conclusions The surgical and oncological outcomes of PD remain unaffected by the presence of ARHA provided that the anatomy is recognized
and appropriately managed. Aberrant right hepatic artery can be classified into three types according to their anatomical
relationship with the head of the pancreas.
Presented in part at the 7th World Congress of International Hepato-Pancreatico-Biliary Association (IHPBA), September 2006,
Edinburgh, UK. 相似文献
9.
Richard J Hendrickson Sherman Yu Denis D Bensard John K Petty David A Patrick Frederick M Karrer 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2006,10(2):180-183
OBJECTIVE: Laparoscopic Nissen fundoplication is performed in neonates and children for significant gastroesophageal reflux. An aberrant left hepatic artery encountered during laparoscopic Nissen fundoplication makes dissection around the esophageal hiatus more difficult if the artery is not transected. Although some suggest division of the aberrant left hepatic artery, this is associated with risk of significant hepatic injury from ischemia. We routinely preserve the aberrant left hepatic artery and sought to determine (1) the incidence of aberrant left hepatic artery and (2) the results following preservation of the aberrant left hepatic artery. METHODS: Between January 2000 and October 2002, 195 laparoscopic Nissen fundoplications were performed. We documented intraoperative findings of each procedure, and reviewed postoperative radiographic studies and clinic visits. RESULTS: In 30 patients (15%), an aberrant left hepatic artery was identified. All dissections were performed laparoscopically with the Nissen fundoplication positioned cephalad to the aberrant left hepatic artery. Postoperatively, 2 patients (6%) have had evidence of wrap failure. The remainder of the patients has had normal radiographic studies or no clinical evidence of reflux during clinic visits. CONCLUSION: During laparoscopic Nissen fundoplication in neonates and children, an aberrant left hepatic artery may be encountered in approximately 15% of patients. When an aberrant left hepatic artery is identified, it should be preserved to avoid the potential risk of hepatic ischemic injury. 相似文献
10.
Samir Abu-Gazala Kim M. Olthoff David S. Goldberg Abraham Shaked Peter L. Abt 《Journal of gastrointestinal surgery》2016,20(4):765-771
Objective
Techniques that preserve the right hepatic artery and the common bile duct in continuity during the dissection may be associated with lower rates of biliary complications in living-donor liver transplants. This study sought to determine whether en bloc hilar dissections were associated with fewer biliary complications in living-donor liver transplants.Methods
This was a retrospective review of 41 adult LDLTs performed in a single, liver transplant center between February 2007 and September 2014. The primary outcome of interest was the occurrence of at least one of the following biliary complications: anastomotic leak, stricture, or biloma. The primary predictor of interest was the hilar dissection technique: conventional hilar dissection vs. en bloc hilar dissection.Results
A total of 41 LDLTs were identified, 24 had a conventional, and 17 an en bloc hilar biliary dissection. The occurrence of any biliary complication was significantly more common in the conventional hilar dissection group compared to the en bloc hilar dissection group (66.7 vs. 35.3 %, respectively, p?=?0.047). In particularly, anastomotic strictures were significantly more common in the conventional hilar dissection group compared to the en bloc hilar dissection group (54.2 vs 23.5 %., respectively, p?=?0.049).Conclusion
En bloc hilar dissection technique may decrease biliary complication rates in living donor liver transplants.11.
Background Endoscopic submucosal dissection (ESD), a new widely accepted method for treating early gastric cancer, was developed to increase
the en bloc rate, especially for lesions larger than 20 mm in diameter. This study aimed to evaluate the efficacy and safety
of ESD for colorectal epithelial neoplasms.
Methods From July 2006 to December 2007, ESD was indicated for patients with colorectal epithelial neoplasms larger than 20 mm in
diameter. The rates of curative en bloc resection, the procedure time, and the incidence of complications were investigated.
Results A total of 74 colorectal epithelial neoplasms were resected by ESD. The mean diameter of these lesions was 32.6 mm (range,
20–85 mm). The rate of en bloc resection was 93.2% (69/74), and the mean ESD procedure time was 110 min (range, 80–185 min).
None of patients had massive hemorrhage during ESD, and only one patient (1.4%) bled 8 days after ESD. Six patients experienced
perforation, and all except one recovered after several days of conservative treatment. The patient who did not recover underwent
urgent surgery. The perforation rate was 8.1% (6/74). All the patients were followed up. Healing of the artificial ulcer was
confirmed, and with no lesion residue or recurrence was found.
Conclusions The findings show ESD to be effective for colorectal epithelial neoplasm, making it possible to resect the whole lesion in
one piece and to provide precise histologic information. 相似文献
12.
Fumihiko Miura Takehide Asano Hodaka Amano Masahiro Yoshida Naoyuki Toyota Keita Wada Kenichiro Kato Eriko Yamazaki Susumu Kadowaki Makoto Shibuya Sawako Maeno Shigeru Furui Koji Takeshita Yutaka Kotake Tadahiro Takada 《Journal of Hepato-Biliary-Pancreatic Surgery》2009,16(1):56-63
Background/Purpose Intra-abdominal arterial hemorrhage is still one of the most serious complications after pancreato-biliary surgery. We retrospectively
analyzed our experiences with 15 patients in order to establish a therapeutic strategy for postoperative arterial hemorrhage
following pancreato-biliary surgery.
Methods Between August 1981 and November 2007, 15 patients developed massive intra-abdominal arterial bleeding after pancreato-biliary
surgery. The initial surgery of these 15 patients were pylorus-preserving pancreatoduodenectomy (PPPD) (7 patients), hemihepatectomy
and caudate lobectomy with extrahepatic bile duct resection or PPPD (4 patients), Whipple’s pancreatoduodenectomy (PD) (3
patients), and total pancreatectomy (1 patient). Twelve patients were managed by transcatheter arterial embolization and three
patients underwent re-laparotomy.
Results Patients were divided into two groups according to the site of bleeding: SMA group, superior mesenteric artery (4 patients);
HA group, stump of gastroduodenal artery, right hepatic artery, common hepatic artery, or proper hepatic artery (11 patients).
In the SMA group, re-laparotomy and coil embolization for pseudoaneurysm were performed in three and one patients, respectively,
but none of the patients survived. In the HA group, all 11 patients were managed by transcatheter arterial embolization. None
of four patients who had major hepatectomy with extrahepatic bile duct resection survived. Six of seven patients (85.7%) who
had pancreatectomy survived, although hepatic infarction occurred in four.
Conclusions Management of postoperative arterial hemorrhage after pancreato-biliary surgery should be done according to the site of bleeding
and the initial operative procedure. Careful consideration is required for indication of interventional radiology for bleeding
from SMA after pancreatectomy and hepatic artery after major hepatectomy with bilioenteric anastomosis. 相似文献
13.
Laura Llado Emilio Ramos Alex Bravo Carme Baliellas Kristel Mils Juli Busquets Alba Cachero Lluis Secanella Nuria Pelaez Emma Gonzalez‐Vilatarsana Joan Fabregat 《Transplant international》2019,32(10):1053-1060
Several techniques have been proposed for liver transplantation with inadequate hepatic artery (HA) anastomosis. We aimed to analyze outcomes of arterial reconstruction with the splenic artery (SA). This was a prospective study of our experience with recipients who underwent arterial anastomosis on the SA compared with patients who underwent standard HA. We included 54 patients in the SA group and 1405 in the HA group. Patients in SA group were more frequently retransplantation (31% vs. 8%; P = 0.001), required more transfusion (11 ± 12 vs. 6 ± 9.9 PRC; P = 0.001), had longer surgeries (424 ± 95 vs. 394 ± 102 min; P = 0.03), and longer hospital stays (28 ± 29 vs. 20 ± 18 days; P = 0.002). There were no differences in vascular and biliary complications (15% and 7%; P = 0.18; and 32% and 23%; P = 0.32), primary dysfunction (11% and 9%; P = 0.74), reoperation (12% and 10%; P = 0.61), postoperative mortality (13% and 7%; P = 0.12) and 5 years survival (66% vs. 63%; P = 0.71). Following primary transplantation, there were no differences. The outcomes of arterial reconstruction using the recipients' SA in adult liver transplantation are comparable to those for standard HA reconstruction after a first transplant. 相似文献
14.
Satoh S Okabe H Kondo K Tanaka E Itami A Kawamura J Nomura A Nagayama S Watanabe G Sakai Y 《Surgical endoscopy》2009,23(2):436-437
Background Lymph node dissection is a crucial procedure for curative resection of gastric cancer [1]. To avoid portal vein injury during laparoscopic extended lymph node dissection for gastric cancer, taping of the common
hepatic artery and subsequent confirmation of the portal vein have been recommended [2, 3]. This taping method, however, makes laparoscopic nodal dissection technically complicated. This study introduces a novel
procedure for safe and simple laparoscopic suprapancreatic nodal dissection without taping of the common hepatic artery.
Methods The authors’ novel, simplified method consists of four steps: (1) dissection along the cranial edge of the pancreas from right
to left, (2) dissection along the splenic artery with exposure of the left renal fascia, (3) dissection along the left gastric
and the common hepatic arteries, and (4) retraction of the lymph nodes surrounding the common and proper hepatic arteries
and their complete dissection from the portal vein. This procedure is reversely directed compared with conventional open gastrectomy
(i.e., the nodal dissection is from left to right). For this study, the lymph node stations and groups were defined according
to the 13th edition of the Japanese Classification for Gastric Carcinoma. The described procedures were performed for 58 consecutive
patients with gastric cancer. The indication for this operation is primary T1/T2 gastric cancer without clinical nodal metastasis.
Results In all cases, safely extended suprapancreatic lymph node dissection was successfully accomplished using the described technique.
A total of 43.5 ± 18 lymph nodes were retrieved, including 14.4 ± 6.3 second-tier lymph nodes. The overall number of retrieved
lymph nodes in this study was similar to that reported previously [4]. Postoperative morbidity occurred at a rate of 22.3%, and the mortality rate was 0%. There was no conversion to open surgery.
The mean blood loss was 127 ml (range, 0–490 ml), and the mean operative time was 289 min (range, 104–416 min) in the last
20 consecutive cases. To date, no tumor recurrence has been observed. The median postoperative observation period was 1.4
years (range, 0.4–2.4 years).
Conclusion The described novel procedure would be sufficient and convenient for dissection of the suprapancreatic lymph nodes.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献
15.
Advantage in using living donors with aberrant hepatic artery for partial liver graft arterialization 总被引:5,自引:0,他引:5
Sakamoto Y Takayama T Nakatsuka T Asato H Sugawara Y Sano K Imamura H Kawarasaki H Makuuchi M 《Transplantation》2002,74(4):518-521
BACKGROUND: In living-related partial liver transplantation, the feasibility and safety of using left-sided liver grafts from donors with aberrant hepatic arteries remains to be evaluated. METHODS: Between 1996 and 2000, we harvested left-sided liver grafts from 101 living donors. Hepatic arterial variation in the donors was classified into three types: type I (n=69), normal anatomy; type II (n=24), aberrant left hepatic artery arising from the left gastric artery; and type III (n=8), replaced right hepatic artery arising from the superior mesenteric artery. We performed arterial reconstructions using the donor's left hepatic artery in 70 cases (69 in type I, 1 in type II), an aberrant left hepatic artery in 24 cases (23 in type II, 1 in type III), and the common hepatic artery in 7 cases (all in type III). RESULTS: The diameter and length of the anastomosed hepatic artery were larger (2.5+/-0.7 vs. 2.0+/-0.8 mm, P=0.03) and longer (42.0+/-14.7 vs. 9.0+/-7.3 mm, P<0.0001) in cases in which the aberrant left hepatic artery or common hepatic artery was used for the anastomosis (n=31) than in those using the left hepatic artery (n=70). Hepatic arterial occlusion occurred in nine patients, with the incidence of occlusion tending to be lower in the former cases in which aberrant left or common hepatic arteries were used (3.2% vs. 11.4% for the left hepatic artery group, P=0.15). CONCLUSION: Because thicker and longer arterial branches can be obtained in left-sided liver grafts with aberrant hepatic arteries than in grafts with normal left hepatic arteries, their use is advantageous for safe arterialization in partial liver grafts. 相似文献
16.
Haomiao Li Alessandro Gasbarrini Michele Cappuccio Silvia Terzi Stefania Paderni Loris Mirabile Stefano Boriani 《European spine journal》2009,18(10):1423-1430
To evaluate the outcome of the excisional surgeries (en bloc/debulking) in spinal metastatic treatment in 10 years. A total
of 131 patients (134 lesions) with spinal metastases were studied. The postoperative survival time and the local recurrence
rate were calculated statistically. The comparison of the two procedures on the survival time, local recurrence rate, and
neurologic change were made. The median survival time of the en bloc surgery and the debulking surgery was 40.93 and 24.73 months,
respectively, with no significant difference. The significant difference was shown in the local recurrence rate comparison,
but not in neurological change comparison. 19.85% patients combined with surgical complications. The en bloc surgery can achieve
a lower local recurrence rate than the debulking surgery, while was similar in survival outcome, neurological salvage, and
incidence of complications. The risk of the excisional surgeries is high, however, good outcomes could be expected. 相似文献
17.
《Asian journal of surgery / Asian Surgical Association》2022,45(1):137-142
Backgrounds As a curative surgical procedure for pancreatic neck-body cancer with invasion to celiac artery (CA), the security and efficacy of distal pancreatectomy (DP) with en bloc resection of the celiac artery (DP-CAR) remain controversial. The purpose of this study was to identify the postoperative outcomes of DP-CAR.MethodsA retrospectively analysis between January 2010 and January2019 was performed in a single center. 21 patients who underwent DP-CAR and 71 patients who underwent traditional DP for pancreatic neck-body cancer were included. Postoperative morbidity, mortality, overall survival (OS) and disease-free survival (DFS) were evaluated.ResultsThere were no significant differences in major complications and mortality between two groups. The patients in DP-CAR group had more T4 tumor (61.9 vs 7.0%, P < 0.001). DP-CAR group had similar R0 resection compared with DP group (71.4% vs 87.3%, P = 0.090). The patients in DP-CAR group suffered more gastric ulcer, DGE and elevated levels of postoperative hepatic enzymes. OS (27.4 vs 32.6 months) and DFS (14.9 vs 19.5 months) between DP-CAR and DP groups were comparative (P = 0.305; P = 0.065).ConclusionsFor the patients who had pancreatic neck-body cancer with invasion to CA, DP-CAR is safety and could achieve satisfactory R0 resection, OS, and DFS. 相似文献
18.
Back-table arterial reconstructions in liver transplantation: single-center experience 总被引:1,自引:0,他引:1
Melada E Maggi U Rossi G Caccamo L Gatti S Paone G Reggiani P Brigati E Fassati LR 《Transplantation proceedings》2005,37(6):2587-2588
Anatomic variations of the arterial supply to donor liver grafts often require complex hepatic artery reconstructions on the back table. Therefore, because of the additional anastomoses, there is a greater risk of arterial thrombosis and graft loss. Among the 620 orthotopic liver transplantations (OLT) in 549 adult and pediatric patients performed from June 1983 through August 2004, the rates and types of donor hepatic artery variations (HAV) and the type of reconstructions were reviewed as well as the 1- and 5-year grafts and patient survival rates after OLT. At least 1 HAV was present in 133 liver grafts (21.4%). The most frequent variations were as follows: right hepatic artery (RHA) from superior mesenteric artery (SMA) (44 cases); RHA from aorta (4 cases); and RHA from SMA, combined with a left hepatic artery (LHA) from left gastric artery (3 cases). No graft was discarded. Fifty-six of 133 (42%) HAV required arterial reconstructions, generally a termino-terminal (TT) anastomosis between RHA and splenic artery (26 cases, 46.4%). Less frequently performed anastomoses were the "fold-over" technique (15 cases, 26.8%) and the anastomosis between the RHA and the gastro-duodenal artery (6 cases, 10.6%); rare reconstructions were performed in 9 cases (16.0%). The rate of hepatic artery thrombosis was 5.4% (3 of 56 OLT) in complex hepatic artery reconstructions and 2.2% in other grafts. One- and 5-years graft and patient actuarial survival rates have been respectively 73.2%- 71.4% in hepatic artery reconstructions and 78.6%-76.8% in the absence of an artery reconstruction, respectively. 相似文献
19.
Diagnosis and treatment of hepatic artery stenosis after orthotopic liver transplantation 总被引:5,自引:0,他引:5
Vignali C Bargellini I Cioni R Petruzzi P Cicorelli A Lazzereschi M Urbani L Filipponi F Bartolozzi C 《Transplantation proceedings》2004,36(9):2771-2773
PURPOSE: The purpose of this study was to evaluate the accuracy of Multidetector Computed Tomographic Angiography (MDCTA) to detect hepatic artery (HA) stenosis after orthotopic liver transplantation (OLT) and the efficacy of treatment using percutaneous transluminal angioplasty (PTA). MATERIALS AND METHODS: Twenty-two consecutive patients with OLT underwent MDCTA for evaluation of HA, followed by digital subtraction angiography (DSA) (gold standard). Source images (Ax) were processed, obtaining multiplanar reformations (MPRs), maximum intensity projections (MIPs), and volume renderings (VRs). Images were evaluated to identify the following: (1) arterial depiction (celiac axis, anastomosis, and left [LHA] and right [RHA] HA), (2) detection of stenoses, and (3) grading of stenoses. Indications for PTA were set at MDCTA and DSA, and PTA was performed when appropriate. RESULTS: MDCTA depicted the celiac axis and anastomoses in all patients; LHA and RHA were visualized in 21 of 22 patients with Ax, MPRs, and MIPs, and in 17 of 22 with VRs. All reconstruction modalities enabled correct diagnosis of celiac (n = 3) and anastomotic stenoses (n = 14). Of 6 LHA and RHA stenoses, 4 (66.7%) were visualized with Ax, MPRs, and VRs, and 5 (83.3%) were visualized with MIPs. Stenosis was overestimated in 9 (39.1%) cases with VRs and in 3 (13%) with the other modalities. PTA was performed in 8 cases, with 1 case of arterial dissection requiring re-OLT. At a median follow-up of 28 months, the primary and secondary patency rates were 71.4% (5 of 7) and 85.7% (6 of 7), respectively. CONCLUSIONS: MDCTA and accurate postprocessing enable confident depiction of the arterial anatomy and detection of stenosis after OLT. PTA is safe and allows allograft saving, at least until another suitable donor becomes available. 相似文献
20.
S. W. Cho J. W. Marsh D. A. Geller M. Holtzman H. Zeh III D. L. Bartlett T. C. Gamblin 《Journal of gastrointestinal surgery》2008,12(12):2141-2148
Introduction Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor for which en bloc resection offers the only chance of cure.
Due to its rarity, however, optimal strategies for the management of the primary tumor and subsequent recurrences are not
well defined.
Methods We performed a retrospective review of patients who underwent surgical resection of IVC leiomyosarcoma. We evaluated clinical
presentations, operative techniques, patterns of recurrence and survival.
Results From 1990 to 2008, nine patients (four females) were identified. Median age was 55 years (40–76). Presentations included abdominal
pain (n = 5), back pain (n = 2), leg swelling (n = 4) and abdominal mass (n = 2). Pre-operative imaging studies showed tumor location to be from the right atrium to renal veins (n = 1), retrohepatic (n = 5), and from hepatic veins to the iliac bifurcations (n = 3). En bloc resection included right nephrectomy (n = 5), right adrenalectomy (n = 4), pancreaticoduodenectomy (n = 1), right hepatic trisectionectomy (n = 1) and right hemicolectomy (n = 1). The IVC was ligated in six patients, and a prosthetic graft was used for IVC reconstruction in three patients. Resection
margins were negative in seven cases. Median length of stay was 12 days (range, 6–22 days). Major morbidity included renal
failure (n = 1) and there was one post-operative mortality. Five patients had leg edema post-operatively, four of whom had IVC ligation.
Median survival was 47 months (range, 1–181 months). Four patients had recurrence and the median time to recurrence was 14 months
(range, 3–25 months). Two patients underwent successful resection of recurrence.
Conclusions Curative resection of IVC leiomyosarcoma can lead to long-term survival. However, recurrence is common, and effective adjuvant
treatments are needed. In selected cases, aggressive surgical treatment of recurrence should be considered.
Presented at the Digestive Disease Week 2008, San Diego, CA, USA, May 2008.
Grant Support: NIH K12 HD 049109 (T.C.G.). 相似文献