ABSTRACT
Objective To study hepatic blood flow exclusion for the resection of liver tumors involving hepatic hilar region. Methods The clinical data of 16 cases of liver tumors involving hepatic hilar region from January 2005 to March 2008 were retrospectively analyzed. Liver tumors were resected by the technique combining hepatic portal control ( Pringle's maneuver) and normothermie total hepatic vascular exclusion (NHVE). The relation of liver tumors to major vessels, episodes and durations of hepatic blood flow exclusion, intraoperative blood loss and blood transfusion, postoperative complications were analyzed. Results The technique combining Pringle's maneuver and NHVE was used in 16 cases. The mean episodes and durations of Pringle's maneuver were (3.8±1.6) min and (46.6±28.8) min, respectively. The mean episodes and durations of NHVE were (1.6±0.4) min and (23.5±8.2) min, respectively. The mean amount of intraoperativ blood loss was (1250±320) ml, blood transfusion (860±245) ml. Major hepatic vessel injuried were repaired intraoperatively including inferior vena cave in 4 cases, main hepatic veins in 2 cases and portal veins in 2 cases. The serum alanine transaminase(ALT) and bilirubin raised in different degrees after operation, and recovered gradually to normal level. There was no postoperative mortality and serious postoperative complications. Conclusions Alternative use of hepatic blood flow exclusion combining Pringle maneuver and NHVE reduces the time of total hepatic vascular exclusion, improves safety for resection of liver tumors involving hepatic hilar region.
ABSTRACT
Objective To compare the result of percutaneous or open drainage for muhilocular bacterial liver abscess. Methods The clinical data of 45 patients with multilocular bacterial liver abscess were reviewed retrospectively over the past 5 years. Twenty-one cases underwent B-us or CT-guided pereutaneons drainage (PD) and 24 received surgical drainage (SD) as the first-line treatment. The treatment outcomes in both groups were compared, and clinical end-points included time to defervescence, failure of treatment, secondary procedures, hospital stay, morbidity, and mortality. Results The time of defervesecnce was not statistically different between the two groups (4.85 day vs. 4.38 days, P＞0.05). However, patients in SD group suffered from less treatment failures (2 cases vs. 9 cases, P<0.05), less requirement for secondary procedures (1 cases vs. 11 cases,P<0.01), and shorter hospital stay (8 day vs. 11 days, P<0.05). There was no difference in morbidity or mortality rates between the two groups. Conclusions It was concluded that for multilocular liver abscess, SD provides better clinical outcomes than PD in terms of treatment success, number of secondary procedures, and hospital stay with comparable morbidity and mortality rates. SD should be considered as first-line treatment for multilocular bacterial liver abscesses.