ObjectiveTo summarize a patient diagnosed as Bismuth type Ⅲa hilar cholangiocarcinoma who unerwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy, meanwhile we reviewed the current status of surgical treatment of hilar cholangiocarcinoma at home and abroad.MethodsTo retrospectively summarized and analyzed the clinical data of one case of Bismuth type Ⅲa hilar cholangiocarcinoma. The preoperative total bilirubin of this patient was 346.8 μmol/L, and this patient underwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy after reducing jaundice by percutaneous transhepatic biliary drainage (PTBD). Then we retrieved domestic and foreign related literatures.ResultsOperative time of this patient was about 290 min and intraoperative bleeding was about 350 mL. No intraoperative blood transfusion occurred. The results of pathological examination showed middle-differentiatied adenocarcinoma of hilar bile duct with negative tumor margins and no regional lymph node metastasis (0/14). The postoperative recovery was uneventful with hospital stay time of 9 days and without any complication. The patient had been followed-up in the outpatient department for 3 years,and was generally in good condition. The evidence of recurrence or metastasis wasn’t found.ConclusionsPre-operative biliary drainage can improve the safety of operation and reduce the incidence of postoperative complications, extend liver resection for the patient with Bismuth type Ⅲa hilar cholangiocarcinoma, which can improve R0 resection rate and extend postoperative survival.
Objective To review the advancement of surgical therapy for cavernous transformation of portal vein. Methods The relevant literatures on therapy for cavernous transformation of portal vein in recent years were collected and reviewed. Results The main symptoms of the patients are repeated haematemesis and hemafecia, hypersplenotrophy and hypersplenia. Most cases can be detected by ultrasonography or portal venography. Splenectomy and by-pass technique plus disconnection are the preferred operation. Conclusion Therapy for cavernous transformation of portal vein will be further developed.
【Abstract】Objective To investigate the appropriate reconstruction techniques of multidetectorrow spiral CT angiography (MDCTA) to depict the collateral vessels in cavernous transformation of the portal vein (CTPV) caused by tumor thrombosis of hepatocellular carcinoma (HCC). Methods MDCTA scanning was performed during the portal venous phase after intravenous contrast materials in 18 HCC patients with CTPV induced by tumor thrombosis. Raw data were reconstructed with thin slice thickness followed by 2D and 3D angiographic reconstruction methods, including maximum intensity projection(MIP), shade surface display （SSD） and volume rendering technique(VRT). Results MDCTA with MIP reconstruction accurately depicted both the tumor thrombus within the portal vein and the collateral vessels of CTPV including the biliary (cystic vein and pericholedochal veinous plexus) and the gastric (left and right gastric veins) branches. However, VRT and SSD methods did poorly in showing the tumor thrombus and the collateral vessels. Conclusion MDCTA with MIP reconstruction is the method of choice to evaluate the collateral vessels of CTPV.
【Abstract】ObjectiveTo summarize the study on the feasibility of celiac axis ligation. Methods Literatures about celiac axis ligation were reviewed retrospectively. ResultsCeliac axis branches included common hepatic artery， splenic artery， left gastric artery which had many variation and collateral flow between celiac and mesenteric vessels by gastroduodenal artery and pancreaticoduodenal artery. Celiac axis could be possibly ligated without obvious complications in patients who had celiac axis injuries, celiac artery aneurysms, upper gastrointestinal haemorrhage, excision of carcinoma around the celiac axis and portal hypertension. However, gallbladder necrosis or perforation, focal infarction of the liver even higher mortality had also been reported. ConclusionCeliac axis ligation should not be performed routinely, but it is surgically possible and may be a life saving approach in certain circumstances.
Objective To compare therapeutic effects of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and transcatheter arterial chemoembolization (TACE) on patients with advanced hepatocellular carcinoma. Methods Thirty-five patients with advanced hepatocellular carcinoma admitted in the Department of Hepatobiliary and Pancreatic Surgery of Shiyan Taihe Hospital Affiliated to Hubei University of Medicine from August 1, 2014 to August 1, 2015 were randomly divided into ALPPS group and TACE group, in which 17 cases treated by the ALPPS and 18 cases treated by the TACE. The survival, changes of liver function and life quality, postoperative complications and mortality were compared in these two groups. The follow-up was performed by the telephone and the outpatient. Results ① The baselines such as the age, gender, diameter of tumor, complications had no significant differences in these two groups (P>0.05). ② The changes of liver function and life quality after operation in the ALPPS group were significantly better than those in the TACE group (P<0.05). ③ The complications after operation were observed in 5 cases (there were 2 cases of bile leakage, 1 case of intraabdominal bleeding, 1 case of peritoneal effusion, and 1 case of pulmonary infection) in the ALPPS group, which in 13 cases (there were 6 cases of nausea and vomiting, 4 cases of liver function damage, 2 cases of granulocytopenia, 1 case of fever) in the TACE group. The rate of the overall complications in the ALPPS group was significantly lower than that in the TACE group (5/17versus 13/18, P=0.018). ④ The overall survival in the the ALPPS group was significantly better than that in the TACE group (P=0.024). During follow-up period, the deaths happened in 3 cases duo to hepatocellular carcinoma and 1 case duo to traffic accident, 1 case was lost on month 8, 12 cases were still alive in the ALPPS group; the deaths happened in 10 cases duo to hepatocellular carcinoma, 1 case duo to coronary disease, and 1 case duo to cerebral infarction, 6 cases were still alive in the TACE group. Conclusion Preliminary results of limited cases in this study show that ALPPS has a better effect than TACE on patients with advanced hepatocellular carcinoma.
Objective To evaluate the therapeutic efficacy of percutaneous transhepatic portal vein catheterization and thrombolysis on acute superior mesenteric vein thrombosis. Methods The treatment and therapeutic efficacy of 7 cases of acute superior mesenteric vein thrombosis underwent percutaneous transhepatic portal vein catheterization and thrombolysis under ultrasound guidance from August 2005 to April 2009 were analyzed. Results All the patients succeeded in portal vein catheterization and no bile leakage or abdominal bleeding occurred during the procedure. The clinical symptoms such as abdominal pain, abdominal distension， and passing bloody stool relieved were relieved and liquid diet began at postoperative of day 2-5. Emergency operation was done in one case and there was no intestinal fistula. The angiography after the operation showed that the majority of thrombosis were cleared and the blood of portal vein and superior mesenteric vein flowed smoothly. During the follow-up of 3 months to 3 years, all the patients’ status maintained well and no recurrence occurred. Conclusion Treatment of acute superior mesenteric vein thrombosis by percutaneous transhepatic portal vein thrombolysis is safe and effective.
ObjectiveTo investigate the effect of Rex surgery (superior mesenteric vein-left portal vein shunt) with internal jugular vein bypass on the anticoagulant factors and portal pressure in children with extrahepatic portal vein obstruction (EHPVO).MethodsFrom January 2014 to December 2018, children with EHPVO in Xi’an Children’s Hospital were retrospectively analyzed. All children underwent Rex surgery. The anticoagulant factors, blood routine indicators, and portal pressure-related indicators of all children were tested before and 1 year after Rex surgery, and the differences were compared. ResultsA total of 32 children were enrolled, and all children were followed up for 1 year after Rex surgery, and no follow-up was lost. Follow-up ultrasound examination 1 year after surgery showed that the portal vein blood flow in all children was unobstructed, and there was no venous thrombosis. The concentration of protein C, protein S and antithrombin Ⅲ activity of the children 1 year after surgery [(5.91±0.67) μg/mL, (2.43±0.34) μg/mL and (59.64±4.54)%, respectively] were all higher than those before surgery [(3.25±0.82) μg/mL, (2.02±0.37) μg/mL and (50.22±3.91)%, respectively], and the differences were statistically significant (P<0.05). There was no statistically significant difference in the concentration of antithrombin Ⅲ 1 year after surgery compared with that before surgery (P>0.05). The red blood cell count, hemoglobin concentration, white blood cell count and platelet count of the children 1 year after surgery [(4.61±0.17)×1012/L, (128.53±6.55) g/L, (6.09±0.72)×109/L and (104.88±5.74)×109/L, respectively] were all higher than those before surgery [(3.78±0.19)×1012/L, (105.53±5.31) g/L, (3.39±0.58)×109/L and (87.42±5.53)×109/L, respectively], and the differences were statistically significant (P<0.05). The diameter of the left portal vein 1 year after surgery was larger than that before surgery [(7.23±0.66) vs. (2.30±0.69) mm], the spleen volume was smaller than that before surgery [(55.74±4.07) vs. (67.21±4.22) cm3], and the portal vein pressure was lower than that before surgery [(23.37±1.27) vs. (35.29±1.36) cm H2O (1 cm H2O=0.098 kPa)], and the differences were statistically significant (P<0.05). ConclusionRex surgery with internal jugular vein bypass is beneficial to improving the level of anticoagulant factors in children with EHPVO, improving portal vein blood flow and pressure, and effectively relieving hypersplenism, which has a certain promotion value.
ObjectiveTo explore the application of the technique of liver venous deprivation (LVD) for two-stage radical hepatectomy in patient with liver cancer underlying hepatitis B virus infection.MethodsA 53 years old patient diagnosed with central primary liver cancer (Ⅴ/Ⅷ segment) could not receive standard right hepatectomy since his future liver remnant was insufficient, so the LVD was performed to induce FLR growth. The general condition and CT scan were repeated at 1-, 2- and 3-week after LVD, the FLR and FLR weigh/ body weight ratio were calculated.ResultsThe FLR and FLR weight/body weight ratio before LVD were 24.2% and 0.459%, the FLR at 1-, 2- and 3-week after LVD were 29.5%, 38.3% and 44.4% respectively, the FLR weight/body weight were 0.545%, 0.707% and 0.820% at 1-, 2- and 3-week after LVD. The standard right hepatectomy was undertaken successfully at 25 days after LVD and discharged safely.ConclusionThe LVD technique could induce a rapid and large FLR volume and offer opportunity for patients with insufficient FLR to receive two-stage radical hepatectomy, is a novel method to induce FLR growth effectively.
ObjectiveTo summarize the occurrence and development of hepatocirrhosis complicated with portal vein thrombosis (PVT), and summarize the status and prospect of anticoagulant treatment.MethodThe literatures and guidelines on the treatment of hepatocirrhosis complicated with PVT were collected and reviewed.ResultsPVT was one of the most common complications in patients with hepatocirrhosis. Its pathogenesis was complicated, and the coagulation function of patients with hepatocirrhosis was poor. In addition, patients with severe complications such as esophageal and gastric varicose bleeding (EVB) were often complicated. According to the current study, the formation of PVT was mainly related to the coagulation mechanism of patients, hemorheology changes of blood vessels, and their own factors. Treatment methods included drug therapy, interventional therapy, and surgical treatment. However, there was still controversy on anticoagulant therapy for hepatocirrhosis with PVT, and there was no complete consensus on anticoagulant indications, drug selection, course of treatment, and safety monitoring.ConclusionPVT should be treated with anticoagulant therapy under certain indications, but to ensure its safety and effectiveness, prospective large sample randomized controlled trials are still needed.
ObjectiveTo understand the effect of nitric oxide (NO) on the formation of hyperdynamic circulatory syndrome (HCS) and the influence of level of NO on HCS. MethodsAfter establishment of stable HCS in partial portal vein ligated rats,the quantity of NO in blood of portal vein and the activity of nitric oxide synthase (NOS) in liver were determined by pre and post injection of inhabitor of NOS (NGmethylLarginine) and hemodynamics was supervised simultaneously.ResultsThe quantity of NO was paralleled with the activity of NOS and was elevated markedly by 24 hours after operation and reached the top by 48 hours after surgery. These sequential changes were coincided with the dilation of general vascularture. There was a close relation between this changes and the formation of HCS.The quantity of NO and the activity of NOS were decreased significantly to the level of the control group after injection of NGmethylLarginine (LNMMA). LNMMA inhabited the activity of NOS and blocked the production of NO. HCS ameliorated obviously. ConclusionNO plays an important role in initiating the dilation of general vascularture and plays a critical role in the formation of HCS. HCS will be ameliorated obviously or be blocked completely by eliminating the effect of NO and the portal pressure will decreased significantly or recover to normal range.