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Objective To summarize the initial experience in application of mesohepatectomy for the treatment of central liver tumors while focusing on its indication, short-term and long-term prognosis and especially outlining its technical details. Methods The clinical data of 3 patients receiving mesohepatectomy from December 2007 to March 2009 in our hospital were retrospectively analyzed.The imaging characteristics were summarized to convey the indication details. The technique details of the operation were outlined so as to reduce blood loss or other complications during and after the operation. The post-operative course and follow-up data were also collected and analyzed. Results Two patients suffered from primary hepatocellular carcinoma with liver cirrhosis and the other from giant hemangioma. The tumors were located in Couinaud yegment Ⅳ and/or Ⅷ. The average blood loss and operative duration were 800 ml and 7 h, respectively. Blood liver function tests returned to normal within 7 days postoperatively and the patients were discharged after that. No complications occurred. The follow-up for 7-15 months showed that there was no recurrence. Conclusion Mesohepatectomy is the principal choice of treatment for centrally located liver tumors. For the safety and avoidance of complications, the doctor should abide by the concept of segment-oriented hepatectomy and apply the updated techniques such as CUSA (Cavitron ultrasonic surgical aspirator). For patients with compromised liver function, mesohepatectomy might be superior to extended bepatectomy. Thus, the application of mesohepatectomy should be expanded. Meanwhile, further investigation is needed for its full evaluation.
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Objective To summarize the experience in the diagnosis and treatment of elastofibroma dorsi,focusing on the clinical features,the specific radiological characteristics,and the typical pathological alterations.Methods Clinical data of 10 cases of pathologically confirmed elastofibroma dorsi from January 1997 to April 2008 were retrospectively reviewed.Results Most patients were female(8/10)in this series.All the lesions were located within the muscles in the subscapular region.There were 13 lesions in 10 cases(3 cases with bilateral involvement).Seven patients complained of pain and feeling of foreign body,and three were asymptomatic.The size of the masses was between 4 centimeters to 12 centimeters,averaging at(7.46 ±2.70)centimeters.Except for the early 3 cases,accurate diagnosis was made in all the other 7 cases before the histological exams solely based on the physical examination and imaging findings.Marginal excision was done for all the cases under general anesthesia.Fluid accumulation,as the only kind of complication was found in 3 cases which was resolved by repeated paracentesis.No recurrence was found during the follow-up period(4 months to 125 months,median 11 months).Conclusion Elastofibroma dorsi is a rare,pseudotumoral lesion usually found in elderly women.It is a very special type of soft tissue tumors that its diagnosis can usually be made solely on the basis of unique imaging characteristics and physical examination before the histological exam.Surgical marginal excision is the choice of treatment with good short-term and long-term results.
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Objective To evaluate the effects of different selection criteria on the prognosis of hepatocellular carcinoma(HCC)patients undergoing liver transplantation(LT)and to evaluate a new criterion.Methods A retrospective analysis was performed on 81 consecutive patients with HCC who underwent LT.The survival rates of the patients who met different criteria such as Milan.UCSF(University of California San Francisco UCSF).and Pittsburgh(Pitt)modified TNM criteria were calculated by KaplanMeier method,and the value of different criteria was evaluated.The Long-Rank test and COX proportional hazards regression model were performed to analyze the prognostic factors.the model of criteria was established according the most important prognostic factors.Using the Kaplan-Meier method,the suitable cut-offs of every variable ifl the model were found by comparing the survival and the number of the patients who met the cut-off,and considering the significant difference between the patients who met and exceed the cut-off at the same time.Resuits The 1,2,3-year accumulative survival rates of the 19 patients who met Milan criteria were 87.7%,87.7%,and 52.6%respectively:the 1,2,3-year disease free survival rates of them were 88.9%,72.7%,and 72.7%respectively.The 1,2.3-year accumulative survival rates of the 26 patients who met UCSF criteria were 87.2%,80.5%,and 55.2%respectively;the 1,2,3-year disease free survival rates of them were 84.1%,68.4%,and 68.4%respectively.With our new expanded criterion as of solitary tumor≤8 cm in diameter.or no more than 3 tumors,with the largest≤6 am,and a total tumor diameter≤10 cm.there was no significant difierence in 1,2,3-year sunrival rates and disease free survival rates(89.0%,81.8%,71.8%,and 81.9%,72.4%,72.4%.)as compared with Milan or UCSF criteria.but with this new criterion more patients(a=41)would be eligible for transplantation with a comparable long term survival.and the difference of the accumulative survival rates and disease free survival rates of the patients who met and exceed the new criteria was significant(P＜0.05).Conclusion The new indication is acceptable because the criteria does not adversely impact survival.
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Objective To study how to decrease the hospital cost of liver transplants. Methods Fifty-four(patients) who underwent liver transplantation at our hospital within 2 years were analyzed retrospectively. The hospital costs of the patients with different liver function before operation, the costs of the(ICU-dependent), as well as the costs of the non-survival group with the survival group were analyzed and compared. Results The average hospital cost of all the patients was about 340 000 yuan. The cost of(pharmacy), anesthesia,(disposable)(materials), transfusion and laboratory tests accounted for 86.9 percent. The(average) cost of Child grade C(patients) was about 410 000 yuan, was 130 000 yuan higher than that of grade A or B patients. The cost of the ICU-dependent was 240 000 yuan greater than that of the(ICU-independent). The(non-survival) group incurred an average cost of 130 000 yuan higher than the(survival) group. Conclusions For decreasing the hospital cost of liver transplants significantly,it is best to encouraging the patients to receive(liver)(transplants) under good conditions.
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Objective To assess the outcome of liver transplantation in patients over sixty years of age,in order to attempt to expand the indications of liver transplantation. Methods From August,2000 to January,2002, the clinical data of 36 patients who underwent liver transplantation in our department were analysed retrospectively. Of the 36 cases, the data (operating time, the length of hospitalization, rejection rate and ICU stay days after operation) of 5 patients whose age were ≥60 years (elderly group) and the data of 31 patients whose age were under 60 years (
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Objective To evaluate the accuracy of Doppler ultrasound (BUS), computer tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of hepatocellular carcinoma. Methods A total of 74 patients with hepatocellular carcinoma and cirrhosis who received a liver transplantation was included in this study. We compared the postoperative pathological results with preoperative imaging findings (BUS, CT, and MRI). An assessment was made in respect of the accuracy in tumor size (a diagnostic accordance was defined as
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Objective To discuss the causes,treatment and prophylaxis of surgical jaundice after laparoscopic cholecystectomy (LC). Methods A retrospective analysis was carried out in 16 cases of surgical jaundice consisting of 14 cases from this hospital out of 3 092 cases of LC from January 1994 to January 2002 and 2 cases transferred from other hospitals. Results Out of the 16 cases,residual bile duct stones were found in 9 cases,and bile duct injuries had taken place in 7 cases (2 cases of cystic duct stump leakage,3 cases of common bile/hepatic duct injuries and 2 cases of recurrent jaundice resulted from aberrant bile duct leakage).All the 16 cases were cured by surgery and no bile duct stricture occurred after surgical procedures. Conclusions Strict following indications of LC and normative surgical performance are the keys to the decrease of surgical jaundice after LC.The patient should be given active surgical intervention once surgical jaundice occurs.
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0 05) and incidence rate of postoperative complications (0 vs.0). Postoperative hospital stay in group experiment was longer than that in group control ((2 2?0 4)d vs. (2?0)d, t =2 958, P
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Objective:To investigate the risk and prognosis of orthotopic liver transplantation (OLT)for patients with advanced hepatocellular carcinoma(HCC)and those without liver tumor.Methods:The risk and prognosis of 21 cases of orthotopic liver transplantation for patients with HCC were retrospectively reviewed and the comparison was made between such patients and 19 others with non tumor caused end stage failures whose OLT procedures have been done at the same period.Results:Compared with the non tumor OLT recipients,the HCC patients have a better preoperative coagulation function.In accordance with this,the blood lose,the required transfusion and the total infusion during the operation were also less than those of non tumor OLT patients.The duration of hypotension induced by bleeding in HCC patients were also shorter than that in non tumor patients.There were more patients in HCC group with uneventful postoperative course than that in non tumor group.The perioperative mortality was also lower in HCC group.Although the recurrence of malignance affected the long term survival of HCC patients,the whole survival rate was similar to that of non tumor OLT patients.Conclusion:OLT remains an effective alternative for the advanced HCC patients for whom there was no other better choice.It is possible that some patients can get a long term survival and are free of the recurrence of the HCC after OLT treatment.
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Objective:To investigate the common reasons,clinical features and the strategy of management with postoperative bleeding in thorax and abdominal cavity in orthotopic liver transplantation(OLT).Methods:Data based on the 12 cases undergoing OLT in our hospital from August 2000 to January 2002 were collected and analyzed.Results:The most common reason for bleeding post OLT was staxis in abdominal cavity(n=5),then was as followed:the abdominal bleeding caused by hepatic artery thrombolytic therapy(n=3),liver biopsy(n=2),Tipps(n=1),surgical technical reason(n=1).In all 12 cases,re operation of laparotomy was needed in 6 because of the massive bleeding.Acute renal failure happened in 5,and 3 needed hemodialysis.Four patients died postoperatively from massive abdominal bleeding,and 3 caused directly by the acute renal failure.Conclusion:Bleeding in the thorax and abdominal cavity happens frequently after OLT,and staxis in abdominal is the most common reason.The correct management for bleeding is the key thing to prevent complications.It is important to pay close attention to perioperative improvement of coagulative capacity,control of massive bleeding and prevention of renal failure.
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Objective To study perioperative managements and clinical outcome of liver transplantation for hepatocellular carcinoma with thrombosis and cancer emboli in portal vein.Methods From July 2000 to December 2002, 10 cases of hepatocellular carcinoma having thrombosis or cancer emboli in portal vein before operation were subjected to orthotopic liver transplantation (OLT) in our hospital. Nine patients underwent anastomosis of low portal vein by end-to-end method after cleaning the thrombosis and emboli, and one underwent cavoportal hemitransposition.Results Nine of the 10 patients recovered without recurrence of portal thrombosis. One died of portal thrombosis recurrence on the 8th postoperative day and one died of infection on the 60th postoperative day. During the follow-up period of 3 to 31 months, hepatocellular cancer recurred in 7, 12, 13 and 25 months after operations in 4 patients. The remaining 4 patients survived without tumor recurrence.Conclusion Portal thrombosis and cancer emboli are not the absolute contraindications in liver transplantation. Appropriate managements can get satisfactory results.
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Objective To observe the changes in hypersplenism after orthotopic liver transplantation(OLT) and investigate the effect of OLT on hypersplenism. Methods Based on the clinical data of 14 eligible OLT patients operated on in our hospital during two and a half years, an analysis of the pre operative values of the thickness of the spleen, blood WBC and PLT count was made,and the postoperative pattern of changes of portal flow velocity was observed. Results Blood WBC and PLT count returned to normal 1 month after the operation, and the thickness of spleen reduced about 17.0% in the first month , but had no additional change at 1 year later. Portal flow velocity increased significantly 1 month after operation , then decreased slowly in the first year. Portal flow velocity , blood WBC and PLT count were all significantly related to the thickness of the spleen. Conclusions The high velocity of portal flow after OLT was mostly attributed to increased flow from the splenic vein; the main cause of the decrease in the level of blood WBC and PLT in hypersplenism before operation is augmentation of splenic volume; the recuperation of hypersplenism after OLT relies on the extent of reversion of splenic volume. It is not necessary to perform splenectomy in patients with hypersplenism when they receive OLT.
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Objective To investigate the long term result of orthotopic liver transplantation for advanced hepatocellular carcinoma, and to evaluate the predictability of Pittsburg scoring system. Methods 46 patients of advanced hepatocellular carcinoma received orthotopic liver transplantation in our center during October 2000 to December 2004. Data were collected and the 1-year and 3-year survival rates, were evaluated by Kaplan-Meier method. Based on the Pittsburg Scoring System, all cases were divided into 4 groups. The length of survival of each group was observed respectively, and differences were compared with Log-rank test. Results 3-year survival rate and tumor-free rate of all 46 patients were 46.7% and 38.8%, respectively. The mean tumor-free time was 27.7 months, and the mean survival time was 32.5 months. Among the 4 groups, no death or tumor relapse was detected in cases of grade 1 and grade 2 (group I) up to the present, whereas the 1-year tumor-free rate of grade 5(group IV) patients was only 12.5%, and no patient survived over 2 years. The 1-year and 3-year tumor-free rate among grade 3 and 4 (group II and III) patients were both about 65% and 40%, the mean tumor free time was about 32.5 and 24.3 months respectively, and there was no significant difference between 2 groups. In these two groups, the longest tumor free time was 58 months. Conclusions Some of the patients with advanced hepatocellular carcinoma still have the chance to survive tumor-free for a long time after liver transplantation. Pittsburg scoring system has more predictability than Milan criteria, especially in cases of grade 1, 2 and 5, but not so satisfactory in cases of grade 3 and 4.