ABSTRACT
In early stage after liver transplantation(LT), coagulation function of recipients stays in a fragile balance. Affected by a variety of complex mechanisms, blood is usually hypercoagulable. An imbalance between coagulation factors and physiological anticoagulants, elevated level of vWF, an occurrence of fibrinolysis inhibition and dosing of immunosuppressive agents cause a hypercoagulable state in an early stage after LT. Blood hypercoagulability may lead to such thrombotic complications as hepatic artery, portal vein and deep vein thromboses. Some studies have demonstrated that postoperative prophylactic anticoagulation has some effect in reducing the risks of early postoperative thrombosis. However, there is still a great lack of high-quality evidence. This review summarized the latest researches on early coagulation dysfunction, thrombosis and preventive anticoagulation after LT.
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Objective:To investigate the application value of "four doors of the liver" approach in the laparoscopic anatomical hepatectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 52 patients with liver cancer who were admitted to West China Hospital of Sichuan University from September 2018 to September 2019 were collected.Patients underwent laparoscopic anatomical hepatectomy by opening "four doors of the liver" approach. There were 36 males and 16 females, aged (53±16)years, with a range from 35 to 78 years. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up and survival. Follow-up using outpatient examination or telephone interview was conducted to detect the physical situations, liver function and recurrence of liver cancer in patients up to March 2020. Measurement data with normal distribution were represented as Mean± SD, and measurment data with skewed distribution were represented as M (range). Count data were expressed as absolute numbers or percentages. Results:(1) Surgical situations: all the 52 patients underwent laparoscopic anatomical hepatectomy successfully, without perioperative death. Eight and 8 patients underwent laparoscopic left hemihepatectomy and right hemihepatectomy by opening "the first door of the liver" respectively, the operation time of which was (151±31)minutes and (190±43)minutes, the volume of blood loss was (151±20)mL and (361±51)mL. Eight and 8 patients underwent laparoscopic left inner hepatic lobotomy and left outer hepatic lobotomy by opening "the second door of the liver" respectively, the operation time of which was (171±41)minutes and (90±26)minutes, the volume of blood loss was (221±31)mL and (111±21)mL. Eight and 8 patients underwent laparoscopic right posterior hepatic lobotomy and right anterior hepatic lobotomy by opening "the third door of the liver" respectively, the operation time of which was (172±29)minutes and (220±40)minutes, the volume of blood loss was volume of (351±41)mL and (451±47)mL. Four patients underwent laparoscopic hepatic caudate lobotomy by opening "the fourth door of the liver" , the operation time of which was (246±36)minutes, the volume of blood loss was (261±31)mL. None of the 52 patients had blood transfusion. (2) Postoperative situations: all the 52 patients recovered well after surgery, with no complications such as bleeding, biliary fistula, infection or liver failure. The duration of postoperative hospital stay was (7±4)days. (3) Follow-up and survival: all the 52 patients were followed up for 6-17 months, with a median follow-up time of 10 months. At 6 months after operation, all the 52 patients achieved of Eastern Cooperative Oncology Group performance status grade 1, Child-Pugh A of liver function, without tumor recurrence or metastasis. The overall survival rate was 100%(52/52).Conclusion:It is safe and feasible to perform laparoscopic anatomical hepatectomy by the "four doors of the liver" approach.
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Objective To analyze the complications of transvaginal natural orifice transluminal endoscopic surgery( TV-NOTES) nephrectomy, and to explore effective measures to prevent and manage those complication.Methods From May 2010 to January 2015, a total of 178 females who had been married and given birth underwent TV-NOTES nephrectomy in our center.The average age was 47 ( ranging 23 to 71 ) years and the average BMI was 23.6 ( ranging 14.7 to 31.9 ) kg/m2.Pathological diagnosis included 142 cases of non-functional kidneys, 29 cases of renal tumors ( T1 N0-1 M0 25 cases, T2 N0-1 M0 4 cases) , and 7 cases of renal tuberculosis.One hundred and sixty hybrid TV-NOTES nephrectomy procedures (simple in 132, radical in 28) and 18 pure TV-NOTES nephrectomy procedures (simple in 17, radical in 1) were performed.Intraoperative and postoperative complications were graded according to Satava and Clavien-Dindo grade classifications.The major complications and relative treatments were analyzed.Results Among the 178 TV-NOTES nephrectomy procedures, there were 40 ( 22.5%) complications occurred, including 13 (7.3%) major complications, in which there were 11 cases of intraoperative complications (6.2%),2 cases of postoperative complications (1.1%).All the complications were successfully managed using organ repair or resection, embolectomy, hemostasis, and so on.No intraoperative and postoperative deaths occurred.There was no significant difference in major complications between hybrid TV-NOTES and pure TV-NOTES nephrectomy (6.9%vs.11.1%, P=0.620).The intraoperative major complications in the early developmental stage of TV-NOTES nephrectomy were more than that of the late stage (20.0%vs.3.4%, P=0.004).There was no significant difference in postoperative complications between the early and late developmental stage of TV-NOTES nephrectomy (13.3%vs.10.8%, P=0.751).Conclusions TV-NOTES nephrectomy is safe and feasible, but there are some major complications worthy of attention.Personal prevent and treatment strategy should be considered.
ABSTRACT
Objective To investigate the clinical effect of fissure for ligamentum teres hepatic (LTH) approach in hepatectomy.Methods The method of cross-sectional study was adopted.The clinical data of the 85 patients undergoing hepatectomy through fissure for LTH approach who were admitted to the West China Hospital of Sichuan University from February 2009 to December 2013 were collected.Among all the 85 cases, there were 61 of hepatocellular carcinoma, 12 of intrahepatic bile duct stones, 6 of bile duct cellular carcinoma and 6 of metastatic hepatic carcinoma.The operations involved dissecting fissure for LTH, dealing with portal vein, hepatic artery and bile duct inside the fissure, lowering the hepatic portal, mutilating hepatic parenchyma, and undergoing the hepatic left lateral lobectomy, left hemihepatectomy, mesohepatectomy, hepatic left and/or right trisegmentectomy.Operation method, operation time, volume of intraoperative blood loss, intraoperative blood transfusion, postoperative drainage-tube removal time and complications were recorded.The follow-up including recurrence and metastasis of tumor and survival of patients was conducted by outpatient examination and telephone interview up to August 2015.Measurement data with normal distribution were presented as (x) ± s.Measurement data with skewed distribution were presented as M (range).The survival rate was caculated by Kaplan-Meier method.Results The 85 cases of hepatectomy were successfully completed through fissure for LTH approach, including 19 cases of hepatic left lateral lobectomy (9 with hepatocellular carcinoma, 6 with intrahepatic bile duct stones, 1 with bile duct cellular carcinoma, 3 with metastatic hepatic carcinoma), 20 cases of left hemihepatectomy (8 with hepatocellular carcinoma, 5 with intrahepatic bile duet stones, 4 with bile duct cellular carcinoma, 3 with metastatic hepatic carcinoma), 5 cases of left hemihepatectomy + caudate lobectomy (3 with hepatocellular carcinoma, 1 with intrahepatic bile duct stones, 1 with bile duct cellular carcinoma), 14 cases of meso-hepatectomy (14 with hepatocellular carcinoma) and 27 cases of hepatic left and/or right trisegmentectomy due to hepatocellular carcinoma (15 of hepatic left trisegmentectomy and 12 of hepatic right trisegmentectomy).No perioperative death occurred.The median operation time was 280 minutes (range, 95-430 minutes).The median volume of intraoperative blood loss was 450 mL (range, 200-3 200 mL).There were 18 cases of intraoperative blood infusion.The postoperative peritoneal drainage-tube removal time was 3 days (range, 2-5 days).Eleven patients with postoperative complications recovered after symptomatic conservative treatment, including 6 with lung infection, 4 with peritoneal effusion and 1 with abdominal infection.There was no case of intra-abdominal bleeding, bile leakage or hepatic failure.No patient died within 1 month after operation.Seventy-nine patients were followed up for a median time of 38 months (range, 18-53 months) with a follow-up rate of 92.9％ (79/85).The 1-year overall survival rate and l-year disease-free survival rate were 79.0％ and 65.0％, and the 3-year overall survival rate and 3-year disease-free survival rate were 56.0％ and 34.0％, respectively.Conclusion Hepatectomy through fissure for LTH approach is safe, effective and easily operable, with a good short-term outcome.