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Objective To compare the efficacies of anatomic and nonanatomic mesohepatectomy for central type hepatocellular carcinoma.Methods The clinical data of 85 patients with central type hepatocellular carcinoma undergoing hepatectomies were retrospectively analysed.36 patients underwent anatomic mesohepatectomy and the other 49 patients did nonanatomic mesohepatectomy.The operative time,intraoperative blood loss,incidence of postoperative complications,postoperative drainage volume,time to flatus and length of postoperative stay between the two groups were compared.Results There were no significant differences in the general condition,organ function,tumor size and location between the two groups before operation (P ＞ 0.05).The intraoperative blood loss,incidence of postoperative complications,drainage volume were significantly less but the operative time longer in anatomic mesohepatectomy group than nonanatomic hepatectomy group (P ＜ 0.05).No differences between the two groups were found in regard to the time for flatus and length of postoperative hospital stay (P ＞ 0.05).Tumor recurrence developed in 7 cases in group A and 20 cases in group B (P ＜ 0.05).Conclusions Anatomic mesohepatectomy has the advantages of less surgical trauma,less exudation and complications in patients with central type hepatocellular carcinoma.
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BACKGROUND:Severe abdominal infection after liver transplantation is the serious perioperative complications in liver transplant recipients, and it is one of the major reasons of death or loss of liver function. OBJECTIVE:To investigate the etiology, diagnosis and treatment of severe abdominal infection after orthotopic liver transplantation. METHODS:The clinical data of 186 cases of abdominal infection that received orthotopic liver transplantation between March 2004 and November 2011 were retrospectively analyzed. RESULTS AND CONCLUSION:Among the 186 patients, 16 patients had severe abdominal infection. Among the 16 patients, five patients had the infection due to the biliary anastomotic leakage caused large effusion in the gap under liver;10 patients had infection due to the peripheral liver massive hematocele caused by liver transplant surgery wounds extensive bleeding;one patient had injection due to left subphrenic large effusion caused by lower esophagus fistula after transplantation. Twelve patients had second operation within 3 days after diagnose, and there was no death;four patients had second operation after diagnosed for 3 days, one patient dead due to multiple organ failure at 21 days after liver transplantation and 5 days after second surgery. The results show that severe abdominal infection after liver transplantation is one of the serious perioperative complications in liver transplant recipients, and active recovery, multiple organ support and removal of infected lesions with control ing surgery as wel as the adequate drainage and other comprehensive treatment measures are the key points for the treatment of severe abdominal infection after liver transplantation.
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Objective To study the experience in prevention and treatment of iatrogenic bile duct trauma(IBDT). Methods A retrospective study was made on the clinical data of 118 patients with iatrogenic bile duct trauma admitted to the Hunan Provincial People's Hospital from March 1990 to September 2000. Results 50.8% (60/118) of patients with IBDT resulted from the wrong identification of the anatomy of the Calot' Triangle during cholecystectomy. The clinical diagnosis of IBDT depended on the clinical findings, diagnostic abdominocentesis and image examination. The diagnostic rate of ultrasonography for IBDT was 93.2%(110/118). According to the injury site of bile duct, IBDT could be divided into 6 types, the most common type of IBDT was resection of partical hepatic duct and part common bile duct(type Ⅲ) which occurred in 83.9% (99/118) of the patients. The cure rate of IBCT was 100%(118/118) in this series due to the choice of operation according to the trauma type. Conclusions The key of prevention to IBDT lies in abiding by the princible of “identifying-cut-recognazing” during cholecystectomy. The choice for surgical operative procedure should agree with the trauma type.
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Objective To assess the causes and methods of surgical treatment of hepatolithiasis reoperation Methods The clinical data of 81 cases of hepatolith reoperation were analyzed retrospectively. Results The main causes of hepatolith reoperation include biliary stricture,biliary tract variation,cholangiocarcinoma, etc. The chief reoperation patterns were hepatic lobectomy, Roux-en-Y hepaticojejunostomy, and lobectomy combined with Roux-en-Y hepaticojejunostomy.A follow-up of 2 months to 12 months showed excellent (outcome) of 93.8% of cases. According to postoperative cholangiograph,the retained stone rate was 6.2%. Conclusions When treating cholelithiasis ,we should follow the following principles: remove stones, relieve biliary stricture, correct biliary variation, resect abnormal liver, and establish adeguate biliary drainage.