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51.
F. Rotellar F. Pardo A. Benito P. Martí‐Cruchaga G. Zozaya L. Lopez F. Hidalgo B. Sangro I. Herrero 《American journal of transplantation》2013,13(12):3269-3273
The overriding concern in living donor liver transplantation is donor safety. A totally laparoscopic right hepatectomy without middle hepatic vein for adult living donor liver transplantation is presented. The surgical procedure is described in detail, focusing on relevant technical aspects to enhance donor safety, specifically the hanging maneuver and dynamic fluoroscopy‐controlled bile duct division. 相似文献
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临床上习惯将恶性肿瘤直接侵及或压迫肝外胆道致胆汁排出受阻而引起的黄疸称为恶性梗阻性黄疸,根据阻塞部位一般可分为高位胆道梗阻和低位胆道梗阻.高位胆道梗阻多指高位胆管癌,即肝门胆管癌,部分胆囊癌向肝管方向浸润发展,也可致胆道梗阻;后者系壶腹周围恶性肿瘤所致的梗阻,通常包括胰头癌、胆总管下端癌及壶腹癌等.低位胆道肿瘤的经典手术方式为胰十二指肠切除术,外科处理原则相对比较统一,而肝门胆管癌因其解剖部位特殊、切除范围不同、机体受累状态和相应的术前准备不同,以及术者技术经验等差异,在临床实际处理上存在着颇多问题和争议.本文结合国内外文献和我们的临床经验,拟就肝门胆管癌的术前相关准备尤其减黄问题作一讨论. 相似文献
54.
Philip A. Efron Tadashi Matsumoto Priscilla F. McAuliffe Philip Scumpia Ricardo Ungaro Shiro Fujita Lyle L. Moldawer David Foley Alan W. Hemming 《Journal of clinical immunology》2009,29(5):568-581
Introduction Patients undergoing major hepatectomy are at increased risk for post-operative morbidity and mortality, and changes in the
phenotype of effector cells may predispose these patients to infectious sequelae.
Methods To better understand post-hepatectomy immune responses, peripheral blood from 15 hepatectomy patients was drawn immediately
before and after liver resection and on post-operative days 1, 3, and 5. Circulating monocytes and dendritic cells were analyzed
by flow cytometry for quantity, phenotype, activation status, human leukocyte antigen DR (HLA-DR) expression, and toll-like
receptor-2 and -4 expression.
Results Major hepatectomy increased the numbers of activated CD16bright blood monocytes and the percentage of activated dendritic cells, although monocyte HLA-DR expression was reduced. These results
may represent both dysfunctional antigen presentation and pending anergy, as well as cellular priming of immune effector cells.
Better understanding of the alterations in innate immunity induced by hepatectomy may identify strategies to reduce infectious
outcomes. 相似文献
55.
Yukihiro Yokoyama Masato Nagino Hideki Nishio Tomoki Ebata Tsuyoshi Igami Yuji Nimura 《Journal of hepato-biliary-pancreatic sciences》2007,14(5):447-454
The clinical application of portal vein embolization (PVE) has contributed to improving the postoperative outcome of hilar cholangiocarcinoma. The enlarged nonembolized lobe after PVE protects the patient from postoperative hepatic failure, due to the increased functional reserve, and shortens the hospital stay. Although numerous reports have shown beneficial effects of PVE on postoperative outcome after extended hepatectomy, no randomized controlled study has been performed so far. It is urgent to establish a “gold standard” of PVE, because the indications, approach to the portal vein, types of embolic materials, and methods used to evaluate the function of the future liver remnant are variable among institutions. The indications and procedures of PVE for hilar cholangiocarcinoma may be different from those for hepatocellular carcinoma or colorectal metastasis, because, in many patients with hilar cholangiocarcinoma, biliary cancer is associated with biliary obstruction and cholangitis. This review article summarizes the contribution of PVE to the outcome of postoperative management in patients with hilar cholangiocarcinoma needing extended hepatectomy. We also describe our PVE procedure, which has been established from our experience of more than 240 cases of biliary cancer. Furthermore, the drawbacks of PVE, which may reduce the pool of candidates for surgery, are also discussed. 相似文献
56.
The interaction of [35S]methionine with hepatic tRNA in normal, carcinogen-treated, and partially hepatectomized rats was studied. tRNA was preferentially labeled following [35S]methionine (1.6 mCi, 25 mg/kg body wt) administration by intraperitoneal injection. The extent of [35S]methionine-tRNA interaction was impaired by partial hepatectomy and by conditions having a carcinogenic potential.Presented at the Proceedings of the International Meetings on Normal and Neoplastic Growth in Hepatology, Bari, Italy, June 1989.Supported by CNR, Progetti Finalizzati Chimica Fine ed Oncologia 相似文献
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目的 对东方肝胆外科医院原发性肝癌行肝切除术后使用人血白蛋白的情况进行合理性评价。 方法 回顾分析2012年6月至2013年6月期间150例原发性肝癌患者行肝切除术后应用人血白蛋白治疗的临床资料,比较患者术后应用人血白蛋白前后临床指标、生化指标,及人血白蛋白用药剂量相关因素分析,评价该院人血白蛋白的用药合理性。 结果 在统计的150份病历中,白蛋白总用量11 212.5 g(897瓶),总金额527 744元,占药品总费用的近20%,占住院总费用的近10%。患者在术后使用人血白蛋白后肝功能异常指标阳性率降低(P<0.05),人血白蛋白的使用剂量与患者用药前肝功能的Child-Pugh评分存在正相关(P<0.05)。 结论 该院原发性肝癌肝切除术后使用人血白蛋白较为合理,可达到预期的治疗效果。 相似文献
59.
To compare the clinical effect of Bulldog clamps with traditional Pringle for vascular occlusion during laparoscopic hepatectomy.One hundred ten patients were retrospectively investigated in this research from December 2014 to January 2019 in the second hospital of Anhui Medical University, who underwent laparoscopic liver resection using Bulldog (modified group, n = 54) and cotton tourniquet (traditional group, n = 56) for blocking the liver inflow-blood. Intraoperative blood loss, duration of the operation time, clamping time, postoperative outcomes were analyzed.All the operations were accomplished successfully without conversion to laparotomy, perioperative period clinical date was calculated. Intraoperative operative time, blood loss and resection sections had no statistical significance, but the clamping time (36.2 ± 5.6 vs 277.3 ± 88.4 s, P < .001) was significantly shorter in the bulldog group. Albumin, alanine aminotransferase, aspartate aminotransferase and serum total bilirubin had no statistical differences in postoperative day (POD) 1and 3, but POD 5 alanine aminotransferase (71.0 ± 46.8vs 105.8 ± 61.7IU/L P = .018) and aspartate aminotransferase (72.8 ± 39.7 vs 100.2 ± 16.7 IU/L P = .028). The postoperative hospital stays (7.02 ± 1.56 vs 8.50 ± 2.35 days P = .026) in bulldog group were lower than cotton group and differences had statistical significance. The C-reactive protein levels were significantly higher in the traditional group than in the modified group on POD 3 (46.3 ± 19.2 vs 57.7 ± 23.9 mg/L P = .019), and POD5 (13.3 ± 4.2 vs 17.5 ± 7.3 mg/L P = .001). There were 8 postoperative complications occurred in cotton group, while there was 5 in Bulldog group, all patients with complications were discharged after adequate drainage and symptomatic treatment.Bulldog is an effectively performed approach for vascular occlusion during laparoscopic hepatectomy than traditional Pringle maneuver. 相似文献
60.
Xiao-ke Ji Yuan-kang Xie Jun-qiao Zhong Qi-gang Xu Qi-qiang Zeng Yang Wang Qi-yu Zhang Yun-feng Shan 《Acta pharmacologica Sinica》2015,36(3):334-342