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1.
Wei AC Greig PD Grant D Taylor B Langer B Gallinger S 《Annals of surgical oncology》2006,13(5):668-676
Background Metastatic colorectal cancer is a major cause of cancer death in North America. Hepatic resection offers the potential for
cure in selected patients. We report the long-term outcomes of patients who underwent hepatic resection for colorectal metastases
over a 10-year period at a single hepatobiliary surgical oncology center.
Methods All patients who underwent liver resection for metastatic colorectal cancer between 1992 and 2002 were identified. Data were
retrospectively obtained through chart review. Major outcome variables were disease-free survival and overall survival. Risk
factors for disease recurrence and mortality were identified by multivariate analysis by using the Cox proportional hazard
method.
Results A total of 423 hepatectomies were performed for metastatic colorectal cancer. Most operations (n = 276; 65%) were major (four
or more segments) hepatectomies. Perioperative morbidity occurred in 74 (17%) patients. There were seven (1.6%) perioperative
deaths. The disease-free survival at 1, 5, and 10 years was 64%, 27%, and 22%, respectively. The overall survival at 1, 5,
and 10 years was 93%, 47%, and 28%, respectively. Multivariate analysis identified four negative predictive factors for overall
survival (hazard ratio; 95% confidence interval): a positive surgical margin (2.9; 1.5–5.3), large metastases (>5 cm; 1.5;
1.1–2.0), multiple metastases (1.4; 1.1–1.9), and age >60 years (1.4; 1.1–1.9).
Conclusions Hepatic resection for metastatic colorectal cancer is safe and provides good long-term overall survival rates of 47% at 5
years and 28% at 10 years. An aggressive approach is justified by the low operative mortality rate and good long-term survival,
even in individuals with multiple bilobar metastases. 相似文献
2.
Survival After Resection of Multiple Hepatic Colorectal Metastases 总被引:17,自引:1,他引:16
Background: Hepatic resection is potentially curative in selected patients with colorectal metastases. It is a widely held practice that multiple colorectal hepatic metastases are not resected, although outcome after removal of four or more metastases is not well defined.Methods: Patients with four or more colorectal hepatic metastases who submitted to resection were identified from a prospective database. Number of metastases was determined by serial sectioning of the gross specimen at the time of resection. Demographic data, tumor characteristics, complications, and survival were analyzed.Results: From August 1985 to September 1998, 155 patients with four or more metastatic tumors (range 4–20) underwent potentially curative resection by extended hepatectomy (39%), lobectomy (42%), or multiple segmental resections (19%). Operative morbidity and mortality were 26% and 1%, respectively. Actuarial 5-year survival was 23% for the entire group (median 5 32 months) and there were 12 actual 5-year survivors. On multivariate analysis, only number of hepatic tumors (P = .005) and the presence of a positive margin (P = .003) were independent predictors of poor survival.Conclusions: Hepatic resection in patients with four or more colorectal metastases can achieve long-term survival although the results are less favorable as the number of tumors increases. Number of hepatic metastases alone should not be used as a sole contraindication to resection, but it is clear that the majority of patients will not be cured after resection of multiple lesions.Presented at the 53rd Annual Meeting of the Society of Surgical Oncology, March 16–19, 2000, New Orleans. 相似文献
3.
M. Schiesser J. W. C. Chen G. J. Maddern R. T. A. Padbury 《Journal of gastrointestinal surgery》2008,12(6):1054-1060
Background Hepatic resection is the treatment of choice in patients with colorectal liver metastases. Perioperative morbidity is associated
with decreased long-term survival in several cancers. The aim of this study was to assess the impact of perioperative morbidity
and other prognostic factors on the outcome of patients undergoing liver resection for colorectal metastases.
Methods One hundred ninety seven patients undergoing liver resection with curative intent were investigated. The influence of prognostic
factors, such as complications, tumor stage, margins, age, sex, number of lesions, transfusion, portal inflow obstruction,
and era and type of resection, was assessed using univariate and multivariate analysis. Complications were graded using an
objective surgical complication classification.
Results The 5-year survival rate was 38%, with a median follow up of 4.5 years. The disease-free survival rate at 5 years was 23%.
The perioperative morbidity and mortality rates were 30 and 2.5%, respectively. The median survival of patients with perioperative
complications was 3.2 years, compared to 4.4 years in those patients without complications (p < 0.01). For patients with positive resection margins, the median survival was 2.1 years, compared 4.4 years in patients
with a margin (p = 0.019).
Conclusion Perioperative morbidity and a positive resection margin had a negative impact on long-term survival in patients following
liver resection for colorectal metastases.
This paper has been presented at the annual meeting of the Royal Australian College of Surgeons 2006 and was accepted for
oral presentation at the IHPBA 2006 meeting in Edinburgh. 相似文献
4.
Background Some reports support resection combined with cryotherapy for patients with multiple bilobar colorectal liver metastases (CRLM)
that would otherwise be ineligible for curative treatments. This series demonstrates long-term results of 415 patients with
CRLM who underwent resection with or without cryotherapy.
Methods Between April 1990 and January 2006, 291 patients were treated with resection only and 124 patients with combined resection
and cryotherapy. Recurrence and survival outcomes were compared. Kaplan-Meier and Cox-regression analyses were used to identify
significant prognostic indicators for survival.
Results Median length of follow-up was 25 months (range 1–124 months). The 30-day perioperative mortality rate was 3.1%. Overall median
survival was 32 months (range 1–124 months), with 1-, 3- and 5-year survival values of 85%, 45% and 29%, respectively. The
overall recurrence rates were 66% and 78% for resection and resection/cryotherapy groups, respectively. For the resection
group, the median survival was 34 months, with 1-, 3- and 5- year survival values of 88%, 47% and 32%, respectively. The median
survival for the resection/cryotherapy group was 29 months, with 1-, 3- and 5-year survival values of 84%, 43% and 24%, respectively
(P = 0.206). Five factors were independently associated with an improved survival: absence of extrahepatic disease at diagnosis,
well- or moderately-differentiated colorectal cancer, largest lesion size being 4 cm or less, a postoperative CEA of 5 ng/ml
or less and absence of liver recurrence.
Conclusions Long-term survival results of resection combined with cryotherapy for multiple bilobar CRLM are comparable to that of resection
alone in selected patients. 相似文献
5.
Background We investigated factors affecting 5-year survival in patients undergoing hepatic resection for colorectal cancer metastases,
including events long after initial hepatectomy. Although retrospective studies have demonstrated survival benefit of hepatectomy
for metastatic colorectal cancer, few have included sufficient 5-year survivors to identify survival-related factors throughout
the clinical course.
Methods We divided 156 patients with hepatectomy for colorectal cancer metastases into 5-year survivors (n = 64) and patients dying
before 5 years after hepatectomy (n = 92). Clinicopathologic data were compared retrospectively with respect to long-term
outcome.
Results By multivariate analysis, large liver tumors (adjusted relative risk, 2.029; P = .011), short tumor doubling time (1.809; P = .026), and origin from poorly differentiated primary adenocarcinoma (12.632; P = .001) compromised survival, whereas initial treatment-related variables did not. Although no difference was seen in initial
treatment-related variables between 5-year survivors with recurrence after hepatectomy and patients dying before 5 years,
repeat surgery was used more frequently in survivors (P < .001), typically with adjuvant chemotherapy.
Conclusions Reoperations for each recurrence of metastases, followed by additional chemotherapy, frequently resulted in long survival. 相似文献
6.
Yun Shin Chun Jean-Nicolas Vauthey Dario Ribero Matteo Donadon John T. Mullen Cathy Eng David C. Madoff David Z. Chang Linus Ho Scott Kopetz Steven H. Wei Steven A. Curley Eddie K. Abdalla 《Journal of gastrointestinal surgery》2007,11(11):1498-1505
Background
Two-stage hepatectomy has been proposed for patients with bilateral colorectal liver metastases (CLM). The aim of this study
was to compare the outcome of patients with CLM treated with preoperative chemotherapy followed by one- or two-stage hepatectomy.
Methods
From a prospective database, 214 consecutive patients who received preoperative systemic chemotherapy (fluoropyrimidine with
irinotecan or oxaliplatin) followed by planned one- or two-stage hepatectomy were retrospectively analyzed (1998–2006). In
patients undergoing two-stage procedures, minor hepatectomy (wedge or segmental resection[s]) was systematically performed
before major (more than three segments), second-stage hepatectomy. Preoperative portal vein embolization (PVE) was performed
if indicated.
Results
One- (group I) and two-stage(group II) hepatectomies were performed in 184 and 21 patients, respectively. Median number of
metastases in groups I and II were two (range 1–20) and seven (range 2–20). All patients in group II had bilateral disease
vs 39% in group I. Major hepatectomy was performed in all patients in group II and 79% in group I. PVE was performed in 18
group I and 12 group II patients without increase in morbidity. For group I, group II first stage, and group II second stage,
respectively, morbidity (24%, 24%, 43%), median hospital stay (7 days, 6 days, 6.5 days) and 30 days postoperative mortality
(2%, 0%, 0%) were not significantly different (P = NS). Median follow-up was 25 months; median survival has not been reached. One- and 3-year overall and disease-free survival
rates from the time of hepatic resection were 95% and 75%, 63% and 39%, respectively in group I; 95% and 86%, 70% and 51%,
respectively in group II (P = NS).
Conclusions
Two-stage hepatectomy with preoperative chemotherapy results in comparable morbidity and survival rates as one-stage hepatectomy.
This approach enables selection and treatment of patients with multiple, bilateral CLM who will benefit from aggressive surgery
with good outcomes.
Presented at the Society for Surgery of the Alimentary Tract 48th Annual Meeting, May 2007, Washington, DC. 相似文献
7.
Elias D Goere D Boige V Kohneh-Sharhi N Malka D Tomasic G Dromain C Ducreux M 《Annals of surgical oncology》2007,14(11):3188-3194
Background Dramatic responses to chemotherapy are occurring more and more frequently in patients with multiple colorectal liver metastases
(LMs), leading to resection. In a few patients, some LMs vanish on imaging studies, remain undetected during hepatectomy,
and are left in place, which defines the “missing LMs.” The aim of our study was to assess the long-term outcome of such “missing
LMs.”
Patients Between January 1999 and June 2004, among 228 patients treated for colorectal LMs, missing LMs were observed in 16 patients.
All the patients were operated within 4 weeks of imaging. Hepatic arterial infusion (HAI) with oxaliplatin was administrated
in 12 patients (75%): seven before hepatectomy and five after.
Results Overall, 69 missing LMs were diagnosed and left in place. Among the persistent LMs resected, a complete pathological response
was significantly more often observed in the group with preoperative HAI (6 of 7), than in the group without (2 of 9, P < .02). With a mean follow-up of 51 months (24–90), missing LMs did not reappear in 10 patients (62%). Adjuvant HAI was significantly
correlated with the definitive eradication of missing LMs (P < .01), as it was not a complete pathological response. The overall 3-year survival rate of these highly selected 16 patients
was 94%.
Conclusion Colorectal LMs under chemotherapy that vanish on high-quality imaging studies, remain undetected during hepatectomy, and are
left in place, are definitively cured in 62% of cases. This excellent result seems to be due to the administration of adjuvant
hepatic arterial infusion of chemotherapy and should stimulate new investigations. 相似文献
8.
Saiura A Yamamoto J Koga R Kokudo N Seki M Oya M Ueno M Kuroyanagi H Fujimoto Y Natori T Yamaguchi T Muto T 《World journal of surgery》2007,31(12):2378-2383
Background The prognosis of solitary liver metastasis involving the caudate lobe is unclear. This study analyzed the outcomes after resection
of the caudate lobe for solitary colorectal liver metastasis.
Methods We reviewed the records of 114 cases in which potentially curative hepatectomy were performed for solitary colorectal liver
metastasis. Solitary liver metastasis involving the caudate lobe was seen in 14 cases (Caudate group). The outcomes were compared
with those of the remaining 100 cases with metastasis in a site other than the caudate lobe (Other group).
Results No hospital deaths occurred. The 5-year survival rate for all cases was 61%. Recurrence-free and cumulative survivals were
similar in the two groups, as were the intraoperative blood loss, duration of operation, and postoperative hospital stay.
The distance of the surgical margin was significantly shorter in the Caudate group than in the Other group (0.6 mm vs. 6.6
mm; p = 0.001). A concomitant resection of the inferior vena cava was performed in four patients in the Caudate group but in no
patients in the Other group (p < 0.001).
Conclusions Despite a minimal surgical margin, the resection of solitary colorectal liver metastasis offers favorable short- and long-term
outcomes comparable to those for colorectal liver metastasis at other sites. 相似文献
9.
Kornprat P Jarnagin WR Gonen M DeMatteo RP Fong Y Blumgart LH D'Angelica M 《Annals of surgical oncology》2007,14(3):1151-1160
Background Hepatic resection is generally accepted as the only potential for long-term survival in patients with colorectal metastases
confined to the liver. Despite an unknown benefit, hepatic resection is playing an increasing role in patients with extensive
disease.
Methods A retrospective review of a prospectively maintained hepatobiliary surgical database was carried out. Outcome after hepatectomy
for four or more colorectal hepatic metastases was reviewed.
Results Between 1998 and 2002, out of a total of 584 patients, 98 (17%) with four or more colorectal hepatic metastases were resected.
Actuarial 5-year survival was 33% for the entire group, with seven actual 5-year survivors. There were no perioperative deaths,
and the perioperative morbidity was 28%. Positive margins and extrahepatic disease resection were independently associated
with poor outcome. The median disease-free survival was 12 months, with no actuarial disease-free survivors at 5 years. Recurrence
pattern, response to neoadjuvant chemotherapy, time to recurrence, and resection of recurrent disease were also associated
with outcome.
Conclusions Long-term survival can be achieved after resection of multiple colorectal metastases; however, because most patients will
experience recurrence of disease, effective adjuvant therapy and close follow-up is necessary. 相似文献
10.
Francesco Polistina Alessandro Fabbri Giovanni Ambrosino 《The Indian journal of surgery》2013,75(3):220-225
Resection is the only chance of cure for isolated liver metastases from colorectal cancer. In the case of extended parenchymal resections, one crucial point is the ischemic damage to the remnant liver. We report an alternative technique for extremely extended liver resections without total hilar clamping for borderline liver remnants. Two patients presented with invasion of the infrahepatic vena cava, both with an estimated live remnant ≤20 %. The crucial point of the technique is the absence of a portal triad clamping in under beating heart-extracorporeal circulation. In both patients resection margins were free of disease. No signs of liver insufficiency were noted. Survival was more than 2 years in both cases. We believe that aggressive treatment of liver colorectal metastases should be given to all suitable patients. This operation may be added to the techniques that can be offered to these patients. 相似文献
11.
Kanellos I Zacharakis E Demetriades H Christoforidis E Kanellos D Pramateftakis MG Betsis D 《Surgery today》2006,36(10):879-884
Purpose We measured carcinoembryonic antigen (CEA) levels in peripheral and portal venous blood, and bile from patients with colorectal
cancer, to determine its role in predicting hepatic metastases, local recurrence, and survival.
Methods The subjects were 73 patients who underwent curative surgery for colorectal cancer.
Results The median serum, bile, and portal CEA levels were significantly lower in 5-year survivors than in patients in whom hepatic
metastases or recurrent disease subsequently developed. The CEA level in portal blood and bile was a good indicator of hepatic
metastases, with sensitivity of 92% and 100%, respectively. However, the accuracy of any CEA measurement for predicting hepatic
metastases, local recurrence, or 5-year survival did not exceed 70%.
Conclusions None of these CEA measurements is accurate enough to be the basis of a management decision. Thus, we suggest that CEA measurement
be used to assist in the prediction of a high risk of the development of hepatic secondaries and that these patients are followed
up closely after curative resection. 相似文献
12.
Posner MC Niedzwiecki D Venook AP Hollis DR Kindler HL Martin EW Schilsky RL Goldberg RM Mayer RJ 《Annals of surgical oncology》2008,15(1):158-164
Background Patients with curatively resected colorectal cancer hepatic metastases often harbor occult metastatic disease and are at high
risk of experiencing recurrence. This patient cohort is ideally suited to test novel therapies such as immunotherapy. We treated
patients—post-hepatic resection—with anti-idiotype monoclonal antibody vaccines to the tumor-associated antigens carcinoembryonic
antigen (CeaVac) and human milk fat globule (TriAb), both of which are co-expressed in more than 90% of colorectal cancer
patients.
Methods Vaccinations commenced 6–12 weeks post-hepatic resection and consisted of four biweekly treatments of 2 mg CeaVac and TriAb,
then monthly treatments for 2 years, then on every other month for 3 years. The primary endpoint was to investigate the proportion
of patients recurrence-free at 2 years, and the objective of the study was to demonstrate that at least 58% would be recurrence-free
at this time to consider the regimen worthy of further study.
Results Between July 2001 and October 2004, 56 patients were accrued; 52 patients with margin-negative resection were eligible for
analysis. Hepatic lobectomy was performed in 56% of patients with a median of one metastasis (range 1–3). Of the 52 eligible
patients, 49 were evaluable for the primary end point. Median follow-up was 3.1 years. The proportion of patients recurrence-free
at 2 years was 39%, with a lower confidence bound (LCB) of 0.29. Median recurrence-free survival was 16 months. The 2-year
overall survival was 94% (95% CI, 0.81, 0.98). Only 10% of patients had documented grade-3 adverse events.
Conclusions Anti-idiotype monoclonal antibody vaccine therapy with CeaVac and TriAb as an adjuvant to curative resection of colorectal
cancer hepatic metastases is well tolerated but did not improve 2-year recurrence-free survival when compared with the expected
value of 40% reported for hepatic resection alone.
Presented in part at the 60th Annual Cancer Symposium of the Society of Surgical Oncology, March 15-18, 2007, Washington,
DC 相似文献
13.
Background We critically appraised the quantity and quality of current clinical evidence to demonstrate the efficacy and safety of repeat
hepatectomy for recurrent colorectal liver metastases (CRLM).
Methods Electronic searches for relevant studies published in peer-reviewed medical journals on repeat hepatectomy for recurrent CRLM
before January 2007 were performed on six databases. The quality of each included study was independently assessed. Clinical
effectiveness was synthesized through a narrative review with full tabulation of results of all included studies.
Results Seventeen studies with more than 20 patients were included for quality appraisal and data extraction. All 17 included articles
were observational cases series. The overall perioperative morbidity rate ranged from 7% to 30% and mortality rate varied
from 0% to 5%. The overall median survival since the repeat hepatectomy ranged from 23 to 56 months, with 3- and 5-year survival
of 24% to 68% and 21% to 49%, respectively. The median disease-free survival ranged from 9 to 52 months, with 3- and 5-year
disease-free survival of 16% to 68% and 16% to 48%, respectively.
Conclusions The current literature suggests that repeat hepatectomy is associated with a prolonged survival for recurrent CRLM and is
justified in selected patients because there is a lack of evidence for effective alternative treatments. 相似文献
14.
15.
Yoshiya Fujimoto Takayuki Akasu Seiichiro Yamamoto Shin Fujita Yoshihiro Moriya 《Journal of gastrointestinal surgery》2009,13(9):1643-1650
Background The prognosis of unresectable hepatic colorectal metastases is poor even if chemotherapy is administered. The purpose of this
study was to evaluate the long-term efficacy of hepatic arterial infusion (HAI) chemotherapy and hepatectomy following HAI
for such condition.
Methods Seventy-two patients with unresectable hepatic colorectal metastases received continuous HAI of 5-fluorouracil.
Results The overall response rate was 38%. The median survival of all patients was 18 months. The overall 3-year survival rate was
18%. Seven patients (10%) survived more than 58 months. Of the eight patients with a complete response, seven developed liver
and/or lung metastases, and of these, one patient undergoing additional hepatectomy has been disease-free and the other six
receiving chemotherapy died of disease. Another complete-response case died of liver abscess. Of the 19 patients with a partial
response, six could undergo hepatectomy after HAI. The overall 5-year survival rate of seven patients undergoing hepatectomy
was 71%, whereas for patients without hepatectomy, the rate was 0%.
Conclusions Most patients showing response after HAI for unresectable hepatic colorectal metastases had relapses. The long-term prognosis
of patients undergoing hepatectomy after HAI was favorable. Therefore, when HAI makes liver metastases resectable, they should
be resected. 相似文献
16.
Michelle L. DeOliveira Timothy M. Pawlik Ana L. Gleisner Lia Assumpcaom Gaspar J. Lopes-Filho Michael A. Choti 《Journal of gastrointestinal surgery》2007,11(8):970-976
Survival after resection of colorectal liver metastases has traditionally been associated with clinicopathologic factors.
We sought to investigate whether echogenicity of colorectal liver metastasis as assessed by intraoperative ultrasound (IOUS)
was a prognostic factor after hepatic resection. Prospective data on tumor IOUS appearance were collected in 84 patients who
underwent hepatic resection for colorectal liver metastasis. Images were digitally recorded, blindly reviewed, and scored
for echogenicity (hypo-, iso-, or hyperechoic). The median tumor number was 1 and the median tumor size was 5.0 cm. At the
time of surgery, the IOUS appearance of the colorectal liver metastases were hypoechoic in 35 (41.7%) patients, isoechoic
in 37 (44.0%) patients, and hyperechoic in 12 (14.3%) patients. Traditional clinicopathologic prognostic factors were similarly
distributed among the three echogenicity groups (all p > 0.05). Patients with a hypoechoic lesion had a significantly shorter median survival (30.2 months) compared with patients
who had either an isoechoic (53.2 months) or hyperechoic (42.3 months) lesion (p = 0.005). The 5-year survival after hepatic resection of colorectal liver metastasis was also associated with the echogenic
appearance of the lesion (hypoechoic 14.4 vs isoechoic 37.4 vs hyperechoic 46.2%) (p < 0.05). Intraoperative ultrasound echogenicity should be considered a prognostic factor after hepatic resection of metastatic
colorectal cancer.
This study was presented at the 47th annual meeting of The Society for Surgery of the Alimentary Tract, Los Angeles, CA, USA,
22 May 2006. 相似文献
17.
Five-Year Survival Following Hepatic Resection After Neoadjuvant Therapy for Nonresectable Colorectal [Liver] Metastases 总被引:9,自引:0,他引:9
Adam R Avisar E Ariche A Giachetti S Azoulay D Castaing D Kunstlinger F Levi F Bismuth F 《Annals of surgical oncology》2001,8(4):347-353
Background: Surgical resection is the most effective treatment for colorectal liver metastases but only a minority of patients are candidates for a potentially curative resection. Our experience with neoadjuvant chemotherapy followed by resection and five years survival analysis of the patients treated is presented.Methods: Between February of 1988 and September of 1996, 701 patients with unresectable colorectal liver metastases were treated with neoadjuvant chemotherapy. Four categories of nonresectable disease were defined: large size, ill location, multinodularity, and extrahepatic disease. Liver resection was performed in those patients whose disease became resectable. After resection, the patients were followed up every 3 months. A 5-year survival analysis by the different categories described was performed.Results: Ninety-five patients (13.5%) were found to be resectable on reevaluation and underwent a potentially curative resection. There was no perioperative mortality, and the complication rate was 23%. As of December of 1999, 87 patients have completed 5 years of follow-up. The overall 5-year survival is 35% from the time of resection and 39% from the onset of chemotherapy. Respective 5-year survival rates are 60% for large tumors, 49% for ill-located lesions, 34% for multinodular disease, and 18% for liver metastases with extrahepatic disease. In this latter category, however, a 35% 5-year survival was found when all the patients with extrahepatic disease were analyzed rather than only those for whom extrahepatic disease was the main cause of nonresectability.Conclusions: Neoadjuvant chemotherapy enables liver resection in some patients with initially unresectable colorectal metastases. Long-term survival is similar to that reported for a priori surgical candidates. 相似文献
18.
Hannes Neeff Wolfram Hörth Frank Makowiec Eva Fischer Andreas Imdahl Ulrich T. Hopt Bernward Passlick 《Journal of gastrointestinal surgery》2009,13(10):1813-1820
Introduction
Multimodal therapies (especially surgery of metastases and “aggressive” chemotherapy) in patients with metastases of colorectal cancers (CRC) are increasingly performed and may provide long-term survival in selected patients with more than one location of metastases. In the current literature, there are only few studies with relatively low patient numbers reporting on the outcome after resection of both hepatic and pulmonary metastases of CRC. We therefore evaluated survival of patients who underwent sequential resection of hepatic and pulmonary metastases under potentially curative intention. 相似文献19.
肝脏虚拟手术系统在肝右叶肿瘤手术中的临床应用 总被引:1,自引:2,他引:1
目的将新研发的肝脏虚拟手术系统(Li Virtue)应用于临床,制订合理的手术方案,降低手术风险,完成精准手术。方法应用Li Virtue系统对32例肝右叶肿瘤患者进行个体化分析,实现对肝脏精确测量、分割,测定各静脉的回流区域;直观显示肝内脉管的分布及变异情况;模拟肝切除的多种手术方式等,选择合理手术方案,并与术中实际情况进行对比。结果肝脏虚拟手术系统可对肝脏体积、区域分割、脉管吻合等情况进行快速准确的个性化分析;可模拟肝脏外科多种手术方式,有助于确定合理手术方案;与32例右肝肿瘤行肝切除术的术中对比,显示该系统虚拟性好,术前模拟结果准确,术中未损伤正常结构,降低了术中风险;所建立的模型也可在便携PC机上展示,方便于术中对照。结论Li Virtue系统有助于揭示个体肝脏的解剖特点,确定合理的手术方式,降低了手术风险,保证了手术安全。 相似文献
20.
Ai-Jun Li Ze-Ya Pan Wei-Ping Zhou Si-Yuan Fu Yuan Yang Gang Huang Lei Yin Meng-Chao Wu 《Journal of gastrointestinal surgery》2008,12(8):1383-1390
Background Selective hepatic vascular exclusion (SHVE) is an effective hepatic vascular exclusion in controlling both inflow and outflow
without interruption of caval flow, as it combines Pringle maneuver with extrahepatic selective occlusion of hepatic veins.
But SHVE has not been widely used due to difficulty in extrahepatic dissection of hepatic veins. When the tumor is very close
to the roots of the hepatic veins, dissecting the posterior wall of the hepatic vein may lead to rupture and massive bleeding
of the hepatic vein. With our experience, clamping hepatic veins with Satinsky clamps is a safer and easier occlusion method
by which the posterior wall of the hepatic veins does not need to be separated and encircled. In this report, we compared
the results of selective hepatic vascular occlusion with tourniquet and Satinsky clamp for major liver resection involving
the roots of the hepatic veins.
Methods Between January 2003 to June 2006, 180 patients who underwent major liver resection with SHVE were divided into two groups
according to different methods of hepatic vascular occlusion: occlusion with tourniquet (tourniquet group, n = 95) and occlusion with Satinsky clamp (Satinsky clamp group, n = 85). In the tourniquet group, the hepatic veins were encircled and occluded with tourniquet. In the Satinsky clamp group,
the hepatic veins were not encircled and clamped directly by Satinsky clamp.
Results Intraoperative and postoperative consequences of the patients were analyzed. The dissecting time for each hepatic vein was
significantly shorter in the Satinsky group (6.2 ± 2.4 min vs 18.3 ± 6.2 min) than in the tourniquet group. In the tourniquet
group, five hepatic veins (one right hepatic vein and four common trunk of left-middle hepatic veins) could not be dissected
and encircled because the tumors involved the cava hepatic junction, and another common trunk of the left-middle hepatic vein
had a small rupture during the dissection. These six patients then received successful occlusion with Satinsky clamp. There
was no difference between the two groups regarding the operation duration, ischemia time, intraoperative blood loss, and postoperative
complication rate.
Conclusion Both methods of the hepatic vein occlusion have the same effect on controlling hepatic vein bleeding, but occlusion with Satinsky
clamp is safer, easier, and consumes less time in dissecting.
Li Ai-Jun And Pan Ze-Ya contributed equally to this work. 相似文献