ABSTRACT
INTRODUÇÃO: Variações na anatomia da artéria hepática são comuns, com incidência de 20-50%. No transplante hepático, reconstruções durante a operção de bandeja são frequentemente necessárias para proporcionar anastomoses arteriais adequadas. O uso de "patch" é frequente, visando reduzir a incidência de complicações. Entretanto, quando está presente a variação da artéria hepática direita, ramo da artéria mesentérica superior, a reconstrução ocasionalmente produz torções e problemas de fluxo. MÉTODOS: Descreve-se uma técnica cirúrgica alternativa para reconstrução da variação da artéria hepática direita usando um "patch de Carrel" da artéria mesentérica superior. O "patch" é anastomosado no coto da artéria esplênica permitindo orientação vertical e bom fluxo sanguíneo. RESULTADOS: Entre 120 transplantes hepáticos, quatro casos consecutivos de variação da artéria hepática direita foram reconstruídas utilizando essa técnica. Todos eles apresentaram patência e bom fluxo no pós-operatório. CONCLUSÃO: A técnica proposta mostra-se interessante método alternativo para reconstrução da variação da artéria hepática direita no transplante hepático.
INTRODUCTION: Variations on the anatomy of the hepatic artery are common, with incidence of 20-50%. In liver transplantation, back-table reconstruction is often necessary for an easier and prompt arterial anastomosis and so, the use of arterial patches has been related to lower the incidence of complications. However, when a right hepatic artery variation from the superior mesenteric artery is present, the reconstruction occasionally produces twisting and flow problems. METHODS: Is described a surgical alternative for right hepatic artery variation reconstruction using a Carrel-patch from the superior mesenteric artery. The patch is anastomosed with the splenic artery stump to allow vertical orientation and improve blood flow. RESULTS: Among 120 liver transplants, four consecutive cases of right hepatic artery variation were reconstructed using this technique. All of them showed good flow and patency in postoperative period. CONCLUSION: The proposed technique proved to be an interesting alternative for the reconstruction of right hepatic artery variation in liver transplantation.
Subject(s)
Humans , Hepatic Artery/surgery , Liver Transplantation/methods , Hepatic Artery/anatomy & histology , Incidence , Practice Guidelines as Topic , Vascular Surgical Procedures/methodsABSTRACT
Resection of the caudate lobe (segment I- dorsal sector, segment IX- right paracaval region, or both) is often technically difficult due to the lobe's location deep in the hepatic parenchyma and because it is adjacent to the major hepatic vessels (e.g., the left and middle hepatic veins). A literature search was conducted using Ovid MEDLINE for the terms "caudate lobectomy" and "anterior hepatic transection" (AHT) covering 1992 to 2007. AHT was used in 110 caudate lobectomies that are discussed in this review. Isolated caudate lobectomy was performed on 28 (25.4 percent) patients, with 11 case (11 percent) associated with hepatectomy, while 1 (0.9 percent) was associated with anterior segmentectomy. Complete caudate lobectomy was performed on 82 (74.5 percent) patients. Hepatocellular carcinoma was observed in 106 (96.3 percent) patients, while 1 (0.9 percent) had hemangioma and 3 (2.7 percent) had metastatic caudate tumors. AHT was used in 108 (98.1 percent) caudate resections, while AHT associated with a right-sided approach was performed in 2 (1.8 percent) cases. AHT is recommended for tumors located in the paracaval portion of the caudate lobe (segment IX). AHT is usually a safe and potentially curative surgical option.
Subject(s)
Humans , Carcinoma, Hepatocellular/surgery , Hepatectomy/methods , Liver Neoplasms/surgeryABSTRACT
A hemorragia digestiva baixa é uma complicaçäo que com frequência pode acometer pacientes leucêmicos submetidos a tratamento quimioterápico. Qualquer segmento do trato gastrointestinal pode estar acometido nestas situaçöes, sendo no entanto o cólon direito o principal sítio dos processos inflamatórios. Relatamos um caso de paciente portador de úlcera hemorrágica de cólon direito como complicaçäo de quimioterapia no tratamento da doença leucêmica. Discutimos a etiologia dessa lesäo, assim como suas dificuldades diagnósticas e opçöes terapêuticas frente à urgência hemorrágica