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<p><b>OBJECTIVE</b>To summarize the vascular and bile duct reconstruction experience in 40 cases of orthotopic liver transplantation in the southwest hepatobiliary surgery hospital.</p><p><b>METHODS</b>The clinical data of 40 cases of liver transplantation were analyzed retrospectively from Jan. 1999 to Nov. 2001.</p><p><b>RESULTS</b>Mortality rate of this group was 15.0%. Complications included: pulmonary infection (18 cases), MOSF (5 cases), intraperitoneal bleeding (4 cases), ARDS (8 cases), thrombus of hepatic artery (1 case), bile leakage (1 case), and cerebral hemorrhage (1 case). The longest survival time was 31 moths (1 case). There were 15 cases whose survival time was more than 1 year.</p><p><b>CONCLUSIONS</b>The key point of success of liver transplantation relies on excellent vascular and bile duct reconstruction technique.</p>
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Adult , Female , Humans , Male , Middle Aged , Biliary Tract , Blood Vessels , Liver Transplantation , Methods , Mortality , Postoperative Complications , Mortality , Plastic Surgery Procedures , Methods , Survival RateABSTRACT
Objective To evaluate the long term results of regular hepatic resection for hepatolithiasis.Methods Five hundred and fourteen patients with hepatolithiasis underwent hepatic resection from Jan. 1975 to Dec. 1998 in Southwest Hospital. The indications included stones confined to one segment or one lobe of the liver, significant atrophy of the portion of the liver harboring the stones from repeated episodes of obstruction and infection, multiple strictures of the ducts in the affected portion of the liver. Resection of S 2 and S 3 was performed in 284 patients, S 2, S 3 and S 4 in 98 patients, S 6 and S 7 in 26 patients, S 5, S 6, S 7 and S 8 in 37 patients; both of the left and right hepatic lobes were partially resected in 23 patients. Additional biliary procedures including choledochojejunostomy and common bile duct exploration were performed in 296 patients.Results The operative mortality was 2 1%, and the morbidity rate was 8 4%. The majority of complications were biliary fistulas (2 9%), subphrenic infection (4 5%), peritoneal abscesses (0 4%) and liver failure (0 6%). Long term follow up on 436 patients at a median of 9 1 years showed that 75 9% were symptom free, 14 5% had occassional mild attacks of cholangitis, 9 6% had severe cholangitis requiring further surgical intervention.Conclusion Anatomic hepatic resection is the most effective treatment and the therapy of choise to eradicate intrahapatic stone foci in cases of hepatolithiasis .
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Objective To evaluate the clinical application of Vater ampulla-duodenal conjunction resection in the treatment of periampullary carcinoma. Methods From January 2005 to July 2006, 15 patients underwent this modus operandi, including carcinoma of duodenal papilla (6 cases), Vater ampulla (5 cases) and lower part of common bile duct (4 cases). The descending part of duodenum, Vater ampulla, head of pancreas and common bile duct were excised en bloc followed by reconstruction of GI conduit. Result One patient died of stress ulcer 2 months postoperatively, the 14 patients recovered uneventfully without any major complications, and 3-16 months follow-up found no tumor recurrence. Conclusion Vater ampulla-duodenal conjunction resection as a new surgical procedure provides enough tumor margin clearance while causing less trauma than standard pancreatoduodenectomy in selected cases of periampullary carcinoma.
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Objective To summarize our experience in performing modified hepatic outflow tract reconstruction in liver transplantation. Methods The clinical data of 142 cases of liver transplantation from Jan 1999 to Aug 2003 were analyzed retrospectively. Results Sixteen patients died postoperatively, mortality rate of this group was 11.27%. No hepatic outflow obstruction developed in this group. Two postoperative recipients have survived for more than four years, five recipients have survived for more than three years, thirty four for more than two years, thirty eight for more than one year. Conclusion This procedure has the advantage of less technique-related complications and time-saving.
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Objective To investigate the causes, diagnosis and treatment of gastrolienal portal hypertension. Methods During recent 10 years, 32 cases of gastrolienal portal hypertension were admitted. Clinicopathological features were analyzed. Results The main causes of this entity was chronic pancreatitis or pseudocyst of the pancreas (14 cases), tuberculosis of lymph nodes in retroperitoneum (7 cases) , retroperitoneal malignant lymphoma (3 cases) and pancreatic tumors (8 cases). Definite diagnosis was made in all 32 cases during the hospitalization. Twenty cases underwent surgery including splenectomy (11 cases) , splenectomy plus portal-azygous disconnection (5 cases) , splenectomy plus distal pancreatectomy (4 cases) , endoscopic varicose vein ligation combined with partial splenic embolization (2 cases), and endoscopic varicose vein ligation ( 5 cases). Conclusion A definite diagnosis of gastrolienal portal hypertension lies in the surgeon's recognition of this entity. Splenectomy is the most effective symptomatic treatment.
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Objective To summarize twenty year experience in the surgical treatment of hilar cholangiocarcinoma(H CC) and explore the effective measuers for increase in resectional rate and reducing operative morbidity and mortality of H CC. Methods Clinicopathological data of 201 patients with H CC treated surgically in our center between 1978 and 1997 were analysed retrospectively. The resection rate, operative morbidity and mortality of the patients before and after December 1990 were compared. Results Of the 201 patients, 97 underwent resection(redical resection in 51; palliative in 46), 84 subjected to internal or external drainage and 20 only laparotomy. In 75 followed up patients, the 1,3,5 year survival rate was 95.45%, 40.91%, 13.64% in radical resection group, and 55%, 10%, 0% in palliative resection group respectively; whereas in unresectional internal and external drainage group, 1 year survival rate was 36%, noone survived for more than 3 years. All the patients with only laparotomy died within 3 months after operation. Comparation of the two stages revealed that the resection rate had been increased from 34.95% before December 1990 to 62.24% after December 1990, and the radical resection rate from 15.53% to 35.71%, meanwhile the operative morbidity and mortality decreased from 39.80% and 17.84% to 18.37% and 6.12% respectively. Conclusions Radical resection plays an important role for improving long term survival rate in patients with H CC. Appropriately perioperative care can reduce the operative morbidity and mortality.
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The hemorrheological changes were observed in 7 cases with portal hypertension after they were operated on with distal splenocaval shunt (DSCS). Similar cases with splenecto-my served as controls. It was found that blood hyperviscosity was slightly decreased after DSCS and the deformability of erythrocytes was improved from 7 to 14 days after DSCS. But blood hyperviscosity was significantly increased in the cases after splenectomy. Blood hyperviscosity was lower in the cases with DSCS than in those with splenectomy. Blood hyperviscosity , expressed mainly by the aggregation rate and deformability of erythrocytes, platelet count, etc, is dependent on the spleen. Since the spleen is preserved in DSCS so blood hyperviscosity is slightly decreased and complications due to blood hyperviscosity may be less in number after DSCS.
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Vascular disconnection around the gastroesophageal junction in 100 patients with portal hypertension and gastroesophageal varices resulted in such complications as ascites,peritoneal infection,recurrent gastrointestinal bleeding,gastric perforation,ischemic gastric necrosis,hepatic failure,multiple organ failure,etc in 41 patients (with a operative morbility of 41%).9 cases out of the 41 died because of peritoneal sepsis,massive bleeding and hepatic or multiple organ failure.Multiple organ failure was the most common cause of death.Grade III liver function and improper perioperative management were the associated factors responsible for the operative complications and death in these patients.
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Side-to-side meso-caval shunt is one of the peripheral porto-systemic shunts that can retain a part of the portal blood flow passing through the hepatic vascular bed. It has the advantages of simple operative maneuver and limited operative traumatism. Furthermore it can maintain the continuity of the inferior vena cave.This type of operation was performed on 24 patients with portal hypertension of different causes from 1963 to October, 1980- There was no immediate operative mortality. One case was complicated with chylous ascites postopera-tively. A second operation failed to correct the condition and the patient died of progressive exhaustion about one month later.Among the follow-up cases, four cases developed hepatoencephalopathy four to seven years later respectively; six cases developed recurrent digestive bleeding within 5 years after the shunt operation.The indications of this operation are: ( 1 ) slender body type;(2)no large amount of ascites; ( 3 ) bleeding after splenectomy; (4) no thrombosis or phlebitis of the superior mesenteric vein;(5)no enlargement of the pancreas; (6) a sufficient length of the main trunk of the superior mesenteric vein; ( 7 ) the distance between the superior mesenteric vein and the inferior vena cava is not too long.If there is a recent history of G-I bleeding, the coronary vein of the stomach should be ligated when the patient is being operated on. Whenever the anatomy of the regional veins is not suitable for this kind of operation, an interposing autogenous internal jugular vein graft had better be used.