完全右半肝-左半肝劈离式肝移植的临床应用:附四例报告

目的探讨完全右半肝-左半肝劈离式肝移植在成人-成人或成人-大体重儿童中的临床应用。方法回顾2019年1月至12月间首都医科大学附属北京友谊医院完成的4例完全右半肝-左半肝劈离式肝移植的供受者临床资料,分析劈离式肝移植的手术方式、冷缺血时间、手术时间、术中输血量,观察患者术后并发症及相关预后。结果4例完全右半肝-左半肝劈离式肝移植的受者包括3例成人和1例大体重儿童(45 kg),年龄范围14~48岁,体重范围45~61 kg,终末期肝病模型评分分别为21、12、41和30分。移植物质量与受者体质量比为0.85%~1.35%。冷缺血时间457~650 min,手术时长460~575 min。4例患者移植术后早期肝功能恢复顺利,均未出现小肝综合征。随访至术后6个月,其中1例出现胆道吻合口漏,经内镜逆行胰胆管造影术治疗后治愈;1例出现胆道狭窄,经皮肝穿刺胆道引流术治疗后反复胆道感染;1例术后6个月死于肺部感染。结论在严格病例选择的情况下,可以开展完全右半肝-左半肝劈离式肝移植。     

Preoperative Estimated Risk of Microvascular Invasion is Associated with Prognostic Differences Following Liver Resection Versus Radiofrequency Ablation for Early Hepatitis B Virus-Related Hepatocellular Carcinoma

Annals of Surgical Oncology - The aim of this study was to examine prognostic differences between liver resection (LR) and percutaneous radiofrequency ablation (PRFA) for hepatocellular carcinoma...     

Distal oblique osteotomy versus cheilectomy for moderate-advanced hallux rigidus: A 2-year propensity-score-matched study

BackgroundThe surgical treatment of moderate-advanced hallux rigidus is controversial. Cheilectomy is widely used but has recurrence rates of up to 30%. Dorsal oblique metatarsal osteotomy (DOO) has also shown good results, however, there is no study comparing outcomes of the DOO against cheilectomy.MethodsThis was a retrospective propensity score matched study based on registry data from a single tertiary institution. Between 2007 and 2017, all patients who had undergone dorsal cheilectomy or DOO for hallux rigidus were included. Patients with previous foot surgery, revision surgeries, and concomitant surgical procedures were excluded. Clinical outcomes, complication rates, revision rates and patient satisfaction were assessed at 2 years postoperatively.ResultsThere were 44 patients (34 cheilectomy, 10 DOO). After propensity score matching, 17 cheilectomy and all 10 DOO cases were selected for comparison. Patients in both groups had a significant improvement in visual analogue pain scores (VAS) and AOFAS 1st toe scores 2-years post-operatively (P < 0.001) with high levels of post-operative satisfaction (85.1%). Overall there were no statistically significant differences in post-operative scores, improvement in scores, complication rates, revision rates, and levels of patient satisfaction between groups.ConclusionsBoth the DOO and cheilectomy give similarly good outcomes for moderate-advanced hallux rigidus. Further studies are needed to elucidate differences in indications for each procedure.