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1.
B. Aussilhou M. Lesurtel A. Sauvanet O. Farges S. Dokmak N. Goasguen A. Sibert V. Vilgrain J. Belghiti 《Journal of gastrointestinal surgery》2008,12(2):297-303
Background Aim of this retrospective study was to compare induction of left liver hypertrophy after right portal vein ligation (PVL)
and right portal vein embolization (PVE) before right hepatectomy for liver metastases.
Materials and Methods Between 1998 and 2005, 18 patients underwent a PVE, whereas 17 patients underwent a PVL during a first stage laparotomy.
Results There was no complication related to PVE or PVL. After a similar interval time (7 ± 3 vs 8 ± 3 weeks), the increase of the
left liver volume was similar between the two groups (35 ± 38 vs 38 ± 26%). After PVE and PVL, right hepatectomy was performed
in 12 and 14 patients, respectively. Technical difficulties during the right hepatectomy were similar according to duration
of procedure (6.4 ± 1 vs 6.7 ± 1 h, p = 0.7) and transfusion rates (33 vs 28%, p = 0.7). Mortality was nil in both groups, and morbidity rates were respectively 58% for the PVE group and 36% for the PVL
group (p = 0.6).
Conclusion Right PVL and PVE result in a comparable hypertrophy of the left liver. During the first laparotomy of a two-step liver resection,
PVL can be efficiently and safely performed. 相似文献
2.
Cillo Umberto Gringeri Enrico Feltracco Paolo Bassi Domenico D’Amico Francesco E. Polacco Marina Boetto Riccardo 《Annals of surgical oncology》2015,22(8):2787-2788
Annals of Surgical Oncology - Laparoscopic microwave ablation and portal vein ligation for staged hepatectomy (LAPS) is a new technique with a first laparoscopic step available in cases of... 相似文献
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Suguru Yamashita Kiyoshi Hasegawa Michiro Takahashi Yosuke Inoue Yoshihiro Sakamoto Taku Aoki Yasuhiko Sugawara Norihiro Kokudo 《World journal of surgery》2013,37(3):622-628
Background
Although portal vein embolization (PVE) has been applied for surgical resection of colorectal liver metastases (CLM), the clinical usefulness of liver surgery following PVE for CLM remains unknown.Methods
A total of 115 patients were evaluated retrospectively. Among them, 49 underwent one-stage hepatectomy following PVE (PVE group). The remaining 66 patients underwent at least hemihepatectomy without PVE (non-PVE group). This analysis compared the short- and long-term outcomes between the PVE and non-PVE groups.Results
There were no deaths in either group. Using the Clavien–Dindo classification, the rates of postoperative morbidity ≥ grade 1 were 34.7 % in the PVE group and 25.0 % in the non-PVE group (p = 0.26). The 3-year overall survival rates were 54.6 and 64.5 % in the PVE and non-PVE groups, respectively (p = 0.89). The multivariate analysis the variable performance/nonperformance of PVE was not detected as an independent predictor of poor survival.Conclusions
Our one-stage hepatectomy policy of using PVE provides acceptable morbidity and favorable long-term outcomes. 相似文献4.
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Oldhafer KJ Donati M Maghsoudi T Ojdani? D Stavrou GA 《Journal of gastrointestinal surgery》2012,16(2):415-416
Introduction
The purpose of this study was to report on the feasibility of integrating 3D preoperative volumetry, portal vein transection and in situ split procedure. A 54-year-old female with now resectable colorectal liver metastasis (CRLM) (segments III, IVb, V–VIII) underwent a two-staged procedure. 相似文献8.
9.
Fernando Rotellar MD PhD Fernando Pardo MD Alberto Benito MD PhD Pablo Martí-Cruchaga MD Gabriel Zozaya MD Manuel Bellver MD 《Annals of surgical oncology》2014,21(1):165-166
Background
Laparoscopic right hepatectomy (LRH) is a complex but feasible procedure. Preoperative portal vein embolization (PVE) can add difficulties that warrant particular technical modifications. A LRH extended to middle hepatic vein after PVE is presented, with special attention paid to specific operative findings and to useful technical modifications.Methods
A 62-year-old female patient with a body mass index of 30.5 kg/m2 was diagnosed with a 3-cm unresectable centrally located intrahepatic cholangiocarcinoma with infiltration of the retrohepatic vena cava, segment VII portal branch, and adjacent to the middle hepatic vein and portal bifurcation. After four cycles of GEMOX, partial response was observed, disappearing vascular infiltration. PVE was required to perform an extended LRH. Consequently, during pedicle dissection, significant inflammation was found in the vicinity of the right portal vein. Thus, the section of the portal and biliary elements was delayed until the transection of the parenchyma reached the hilum. The opening of the parenchyma improved exposure, allowing the safe management of these structures individually.Results
The total operative time was 438 min. Three periods of 15-min pedicle occlusion resulted in <100 ml bleeding. Hospital stay was 4 days. Pathological examination revealed residual cholangiocarcinoma with intense posttreatment changes (pT1) and tumor-free margins. After an 18-month follow-up, the patient was alive and free of disease.Conclusions
LRH is feasible and safe, even after PVE. Nevertheless, periportal inflammation can hinder hilar dissection. In this setting, delaying section of portal and biliary elements until parenchymal transection reaches the hilar region may result in a useful and safe strategy. 相似文献10.
Chemotherapy With Bevacizumab Does Not Affect Liver Regeneration After Portal Vein Embolization in the Treatment of Colorectal Liver Metastases 总被引:1,自引:1,他引:0
Background Blockage of vascular endothelial growth factor (VEGF) in murine models has been shown to impair liver regeneration after partial
hepatectomy. The aim of this study was to evaluate the effects of chemotherapy with or without bevacizumab (monoclonal antibody
anti-VEGF) on liver regeneration after portal vein embolization (PVE) in the treatment of colorectal liver metastases and
its possible effect on postoperative outcome after major liver resection.
Methods Records of 65 consecutive patients treated with or without preoperative chemotherapy (with or without bevacizumab) and PVE
for colorectal liver metastases from September 1995 to February 2007 were reviewed from a prospective database. Future liver
remnant (FLR) volume, degree of FLR hypertrophy after PVE, morbidity, mortality, and survival were analyzed.
Results Preoperative PVE was performed after chemotherapy in 43 patients and without chemotherapy in 22 patients. Among the 43 patients
treated with chemotherapy, 26 received concurrent bevacizumab. After a median of 4 weeks after PVE, there was no difference
in FLR volume increase among patients treated with or without chemotherapy. Similarly, there was no statistically significant
difference in degree of FLR hypertrophy among patients treated without (mean, 10.1%) or with chemotherapy, with or without
bevacizumab (8.8% and 6.8%) (P = .11). Forty-eight (74%) of 65 patients underwent extended right or right hepatectomy after PVE. No differences in morbidity
and mortality were observed among patients treated with or without preoperative chemotherapy (with or without bevacizumab).
Conclusion Preoperative chemotherapy with bevacizumab does not impair liver regeneration after PVE. Liver resection can be performed
safely in patients treated with bevacizumab before PVE.
Presented at The Society of Surgical Oncology, 61st Annual Cancer Symposium, Chicago, IL, March 13–16, 2008. 相似文献
11.
目的探讨腹腔镜脾动脉结扎联合贲门周围血管离断治疗肝硬化门静脉高压的安全性及有效性。方法回顾性分析自2014年2月~2018年2月48例腹腔镜脾动脉结扎联合贲门周围血管离断术治疗肝硬化门静脉高压的临床资料。46例保守治疗止血成功后择期手术(Child-Pugh A级30例,Child-Pugh B级16例),内镜及药物止血失败行急诊手术2例(Child-Pugh C级)。结果48例均顺利实施完全腹腔镜手术。手术时间(104.7±4.2)min,术中出血量(106.0±16.4)ml。术中输血1例(2.1%)。无死亡,无术后输红细胞。术后住院时间(5.6±0.2)d。术后随访15~63个月,中位数42个月。1例(2.1%)术后34、47个月因门静脉高压性胃病黑便2次,保守治疗。其他患者均无呕血、黑便。结论在熟练掌握腹腔镜技术的基础上,腹腔镜脾动脉结扎联合贲门周围血管离断术治疗肝硬化门静脉高压安全、有效。 相似文献
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N. Elias T. Kawai D. S. C. Ko R. Saidi N. Tolkoff‐Rubin S. Wicky A. B. Cosimi M. Hertl 《American journal of transplantation》2013,13(10):2739-2742
Type 1 primary hyperoxaluria (PH1) causes renal failure, for which isolated kidney transplantation (KT) is usually unsuccessful treatment due to early oxalate stone recurrence. Although hepatectomy and liver transplantation (LT) corrects PH1 enzymatic defect, simultaneous auxiliary partial liver transplantation (APLT) and KT have been suggested as an alternative approach. APLT advantages include preservation of the donor pool and retention of native liver function in the event of liver graft loss. However, APLT relative mass may be inadequate to correct the defect. We here report the first case of native portal vein embolization (PVE) to increase APLT to native liver mass ratio (APLT/NLM‐R). Following initial combined APLT‐KT, both allografts functioned well, but oxalate plasma levels did not normalize. We postulated the inadequate APLT/NLM‐R could be corrected by trans‐hepatic native PVE. The resulting increased APLT/NLM‐R decreased serum oxalate to normal levels within 1 month following PVE. We conclude that persistently elevated oxalate levels after combined APLT‐KT for PH1 treatment, results from inadequate relative functional capacity. This can be reversed by partial native PVE to decrease portal flow to the native liver. This approach might be applicable to other scenarios where partial grafts have been transplanted to replace native liver function. 相似文献
14.
Thierry de Baere Christophe Teriitehau Frederic Deschamps Laurence Catherine Pramod Rao Antoine Hakime Anne Auperin Diane Goere Dominique Elias Lukas Hechelhammer 《Annals of surgical oncology》2010,17(8):2081-2089
Background
To analyze predictive factors of hypertrophy of the nonembolized future remnant liver (FRL) after transhepatic preoperative portal vein embolization (PVE) of the liver to be resected. 相似文献15.
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N Bellemann U Stampfl CM Sommer HU Kauczor P Schemmer BA Radeleff 《Digestive surgery》2012,29(3):236-242
Purpose: The purpose of this retrospective study was to evaluate the efficacy and safety of percutaneous transhepatic portal vein embolization (PVE) of the right liver lobe using Histoacryl/Lipiodol mixture to induce contralateral liver hypertrophy before right-sided (or extended right-sided) hepatectomy in patients with primarily unresectable liver tumors. Methods: Twenty-one patients (9 females and 12 males) underwent PVE due to an insufficient future liver remnant; 17 showed liver metastases and 4 suffered from biliary cancer. Imaging was performed prior to and 4 weeks after PVE. Surgery was scheduled for 1 week after a CT or MRI control. The primary study end point was technical success, defined as complete angiographical occlusion of the portal vein. The secondary study end point was evaluation of liver hypertrophy by CT and MRI volumetry and transfer to operability. Results: In all the patients, PVE could be performed with a Histoacryl/Lipiodol mixture (n = 20) or a Histoacryl/Lipiodol mixture with microcoils (n = 1). No procedure-related complications occurred. The volume of the left liver lobe increased significantly (p < 0.0001) by 28% from a mean of 549 ml to 709 ml. Eighteen of twenty-one patients (85.7%) could be transferred to surgery, and the intended resection could be performed as planned in 13/18 (72.3%) patients. Conclusion: Preoperative right-sided PVE using a Histoacryl/Lipiodol mixture is a safe technique and achieves a sufficient hypertrophy of the future liver remnant in the left liver lobe. 相似文献
17.
Y. Soejima T. Yoshizumi T. Ikegami N. Harimoto N. Harada S. Ito T. Motomura H. Uchiyama Y. Maehara 《Transplantation proceedings》2017,49(1):172-174
Reconstruction of multiple venous orifices of a right lobe graft is a time-consuming and troublesome procedure in right lobe living-donor liver transplantation. In the current study, we present a new venous reconstruction technique for a right lobe graft with multiple and complex hepatic vein (HV) orifices, in which procurement of the recipient's left portal vein was performed in situ to keep the anhepatic period to a minimum. All of the HV orifices were reconstructed together at the back table, while maintaining patency of the recipient's systemic and splanchnic circulation. A homologous vein graft and veno-venous bypass were not necessary. All HVs were patent during the follow-up and the patient was free from complications. In conclusion, the present technique is readily available for reconstruction of complex and multiple HV tributaries, while avoiding a long anhepatic time and the use of veno-venous bypass. 相似文献
18.
Luca Aldrighetti MD Carlo Pulitanò MD Marco Catena MD Marcella Arru MD Eleonora Guzzetti MD Jane Halliday MD Gianfranco Ferla MD 《Annals of surgical oncology》2009,16(5):1254-1254
Introduction Hepatocellular carcinoma (HCC) tends to invade the intrahepatic vasculature, especially the portal vein.1 The presence of portal vein tumor thrombus (PVTT) in patients with HCC is one of the most significant factors for a poor
prognosis.2
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5 The presence of macroscopic PVTT in patients with HCC is also a significant factor for poor prognosis, with a median survival
of <3 months without treatment.1 In surgically resected series, in patients with gross PVTT (PVTT in the portal trunk, its first-order branch, or its second-order
branch), the 3-year and 5-year survival rates are reportedly 15% to 28% and 0% to 17%, respectively.2
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5
Methods The patient was a 77-year-old woman with well-compensated hepatitis C virus–related cirrhosis (stage A6 according to Child-Pugh
classification) who sought care at our department for vague abdominal discomfort. Triphasic spiral computed tomographic scan
confirmed HCC 6 cm in diameter in the left lobe of the liver. In addition, portal vein tumor thrombosis of the left branch
that extended to the right portal vein was present.
Results The procedure included left hepatectomy and en-bloc portal vein thrombectomy with clamping of both the common portal vein
trunk and the right portal vein. The portal vein was incised at the bifurcation of the right and left portal veins, and the
thrombus was extracted from the incision in the portal vein. With this procedure, we were able to examine under direct vision
the exact extent of the portal vein thrombus, and we identified whether the tumor thrombus was adherent to the venous wall
or was freely floating in the venous lumen.
Portal clamping and length of operation were 16 and 330 minutes, respectively. Intraoperative blood loss was 550 mL. The
patient was discharged on postoperative day 6, and she was free of disease at 15 months after surgery.
Discussion Liver resection should be considered a valid therapeutic option for HCC with PVTT.
Electronic supplementary material The online version of this article (doi:) contains supplementary video material, which is available to authorized users.
Presented to Annual Meeting of the American Hepato-Pancreato-Biliary Association (AHPBA), Miami, Florida, USA, March 9-12,
2006. 相似文献
19.
《Liver transplantation》2000,6(6):805-809
Auxiliary liver transplantation for patients with fulminant hepatic failure supports the patient's failing liver for a period of time until the native liver (NL) has recovered and immunosuppression can be withdrawn. Auxiliary heterotopic liver transplantation (AHLT) with portal vein arterialization (PVA) has several advantages over auxiliary orthotopic liver transplantation: NL resection is not required, and the hepatic hilum is left untouched; thus, the chances of liver regeneration are optimal. The successful application of emergency AHLT with PVA in a young patient who developed toxic fulminant hepatic failure caused by tuberculostatic drugs is described. Two and one-half months after the procedure, the NL had completely regenerated; the graft was removed, and immunosuppression was suspended. (Liver Transpl 2000;6:805-809.) 相似文献
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