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Chinese Medical Journal ; (24): 2081-2090, 2021.
Article in English | WPRIM | ID: wpr-887596


BACKGROUND@#High-frequency irreversible electroporation (H-FIRE) is a novel, next-generation nanoknife technology with the advantage of relieving irreversible electroporation (IRE)-induced muscle contractions. However, the difference between IRE and H-FIRE with distinct ablation parameters was not clearly defined. This study aimed to compare the efficacy of the two treatments in vivo.@*METHODS@#Ten Bama miniature swine were divided into two group: five in the 1-day group and five in the 7-day group. The efficacy of IRE and H-FIRE ablation was compared by volume transfer constant (Krans), rate constant (Kep) and extravascular extracellular volume fraction (Ve) value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), size of the ablation zone, and histologic analysis. Each animal underwent the IRE and H-FIRE. Temperatures of the electrodes were measured during ablation. DCE-MRI images were obtained 1, 4, and 7 days after ablation in the 7-day group. All animals in the two groups were euthanized 1 day or 7 days after ablation, and subsequently, IRE and H-FIRE treated liver tissues were collected for histological examination. Student's t test or Mann-Whitney U test was applied for comparing any two groups. One-way analysis of variance (ANOVA) test and Welch's ANOVA test followed by Holm-Sidak's multiple comparisons test, one-way ANOVA with repeated measures followed by Bonferroni test, or Kruskal-Wallis H test followed by Dunn's multiple comparison test was used for multiple group comparisons and post hoc analyses. Pearson correlation coefficient test was conducted to analyze the relationship between two variables.@*RESULTS@#Higher Ve was seen in IRE zone than in H-FIRE zone (0.14 ± 0.02 vs. 0.08 ± 0.05, t = 2.408, P = 0.043) on day 4, but no significant difference was seen in Ktrans or Kep between IRE and H-FIRE zones at all time points (all P > 0.05). For IRE zone, the greatest Ktrans was seen on day 7, which was significantly higher than that on day 1 (P = 0.033). The ablation zone size of H-FIRE was significantly larger than IRE 1 day (4.74 ± 0.88 cm2vs. 3.20 ± 0.77 cm2, t = 3.241, P = 0.009) and 4 days (2.22 ± 0.83 cm2vs. 1.30 ± 0.50 cm2, t = 2.343, P = 0.041) after treatment. Apoptotic index (0.05 ± 0.02 vs. 0.73 ± 0.06 vs. 0.68 ± 0.07, F = 241.300, P  0.05). Electrode temperature variations were not significantly different between the two zones (18.00 ± 3.77°C vs. 16.20 ± 7.45°C, t = 0.682, P = 0.504). The Ktrans value (r = 0.940, P = 0.017) and the Kep value (r = 0.895, P = 0.040) of the H-FIRE zone were positively correlated with the number of hepatocytes in the ablation zone.@*CONCLUSIONS@#H-FIRE showed a comparable ablation effect to IRE. DCE-MRI has the potential to monitor the changes of H-FIRE ablation zone.

Animals , Contrast Media , Electroporation , Follow-Up Studies , Liver/surgery , Magnetic Resonance Imaging , Swine
Article in Chinese | WPRIM | ID: wpr-880447


The methods of monitoring the thermal ablation of tumor are compared and analyzed in recent years. The principle method results and insufficient of ultrasound elastography and quantitative ultrasound imaging are discussed. The results show that ultrasonic tissue signature has great development space in the field of real-time monitoring of thermal ablation, but there are still some problems such as insufficient monitoring accuracy difficulty in whole-course monitoring and insufficient

Catheter Ablation , Elasticity Imaging Techniques , Humans , Hyperthermia, Induced , Liver/surgery , Neoplasms/surgery , Ultrasonography
Rev. Col. Bras. Cir ; 48: e20202784, 2021. tab
Article in English | LILACS | ID: biblio-1155372


ABSTRACT Objective: the aim of this study was to identify associated factors with the increased length of hospital stay for patients undergoing surgical treatment for liver trauma, and predictors of mortality as well as the epidemiology of this trauma. Methods: retrospective study of 191 patients admitted to the Cajuru University Hospital, a reference in the treatment of multiple trauma patients, between 2010 and 2017, with epidemiological, clinicopathological and therapeutic variables analyzed using the STATA version 15.0 program. Results: most of the included patients were men with a mean age of 29 years. Firearm injury represents the most common trauma mechanism. The right hepatic lobe was injured in 51.2% of the cases, and hepatorraphy was the most commonly used surgical correction. The length of hospital stay was an average of 11 (0-78) days and the length of stay in the intensive care unit was 5 (0-52) days. Predictors for longer hospital stay were the mechanisms of trauma, hemodynamic instability at admission, number of associated injuries, degree of liver damage and affected lobe, used surgical technique, presence of complications, need for reoperation and other surgical procedures. Mortality rate was 22.7%. Conclusions: the study corroborated the epidemiology reported by the literature. Greater severity of liver trauma and associated injuries characterize patients undergoing surgical treatment, who have increased hospital stay due to the penetrating trauma, hemodynamic instability, hepatic packaging, complications and reoperations.

RESUMO Objetivo: identificar fatores associados ao aumento do tempo de hospitalização de pacientes submetidos a tratamento cirúrgico por trauma hepático e descrever preditores de mortalidade, assim como a epidemiologia desse trauma. Métodos: estudo retrospectivo de 191 pacientes admitidos no Hospital Universitário Cajuru, referência no atendimento de politraumatizados, no período entre 2010 e 2017, com variáveis epidemiológicas, clinicopatológicas, terapêuticas analisadas por meio do programa STATA versão 15.0. Resultados: maioria dos pacientes incluídos eram homens com média de idade de 29 anos. Ferimento por arma de fogo representou o mecanismo de trauma mais comum. O lobo hepático direito foi lesado em 51,2% dos casos e hepatorrafia foi a correção cirúrgica mais empregada. O tempo de internamento hospitalar foi em média de 11(0-78) dias e o tempo de internação em unidade de terapia intensiva de 5 (0-52) dias. Preditores de maior tempo de hospitalização foram mecanismo de trauma, instabilidade hemodinâmica à admissão, número de lesões associadas, grau da lesão hepática e lobo acometido, técnica cirúrgica empregada, presença de complicações, necessidade de reoperação e outros procedimentos cirúrgicos. Taxa de mortalidade foi de 22,7%. Conclusões: o estudo corroborou a epidemiologia descrita na literatura. Maior gravidade do trauma hepático e das lesões associadas caracterizam os pacientes submetidos ao tratamento cirúrgico, que apresentam aumento de tempo de hospitalização devido a trauma penetrante, instabilidade hemodinâmica, tamponamento hepático, complicações e reoperações.

Humans , Male , Adult , Wounds, Gunshot , Firearms , Trauma Centers , Injury Severity Score , Retrospective Studies , Hospitalization , Length of Stay , Liver/surgery , Liver/injuries
Chinese Journal of Surgery ; (12): 835-840, 2020.
Article in Chinese | WPRIM | ID: wpr-878273


Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can speed up the regeneration of future liver remnant (FLR) in short period of time, and offer a chance for surgical resection for patients without sufficient FLR. However, ALPPS still remains controversy due to its high perioperative morbidity and mortality, as well as the uncertain long-term oncological benefits. How to solve these problems is the key to ensure the safety of surgery.This article focus on the indication selection, liver function reserve evaluation and timing to perform the second stage surgery, surgical mode evolution and comparison with portal venous embolization/portal venous ligation+two-stage hepatectomy.

Embolization, Therapeutic , Hepatectomy/methods , Humans , Ligation , Liver/surgery , Liver Neoplasms/surgery , Liver Regeneration , Portal Vein/surgery , Treatment Outcome
ABCD arq. bras. cir. dig ; 33(1): e1484, 2020. tab, graf
Article in English | LILACS | ID: biblio-1088501


ABSTRACT Background: Hepatectomies promote considerable amount of blood loss and the need to administrate blood products, which are directly linked to higher morbimortality rates. The blood-conserving hepatectomy (BCH) is a modification of the selective vascular occlusion technique. It could be a surgical maneuver in order to avoid or to reduce the blood products utilization in the perioperative period. Aim: To evaluate in rats the BCH effects on the hematocrit (HT) variation, hemoglobin serum concentration (HB), and on liver regeneration. Methods: Twelve Wistar rats were divided into two groups: control (n=6) and intervention (n=6). The ones in the control group had their livers partially removed according to the Higgins and Anderson technique, while the rats in the treatment group were submitted to BCH technique. HT and HB levels were measured at day D0, D1 and D7. The rate between the liver and rat weights was calculated in D0 and D7. Liver regeneration was quantitatively and qualitatively evaluated. Results: The HT and HB levels were lower in the control group as of D1 onwards, reaching an 18% gap at D7 (p=0.01 and p=0.008, respectively); BCH resulted in the preservation of HT and HB levels to the intervention group rats. BCH did not alter liver regeneration in rats. Conclusion: The BCH led to beneficial effects over the postoperative HT and serum HB levels with no setbacks to liver regeneration. These data are the necessary proof of evidence for translational research into the surgical practice.

RESUMO Racional: As hepatectomias compreendem considerável perda sanguínea e utilização de hemoderivados, o que diretamente estão relacionados com maior morbimortalidade. A hepatectomia hemoconservadora (HH) é modificação da técnica de oclusão vascular seletiva em hepatectomia. Ela pode ser alternativa cirúrgica para evitar ou diminuir o uso de hemoderivados no perioperatório. Objetivo: Avaliar os efeitos da HH sobre o volume globular (VG), concentração de hemoglobina (HB) e sobre a regeneração hepática em ratos. Métodos: Dois grupos de ratos Wistar foram constituídos: controle (n=6) e intervenção (n=6). Os do grupo controle foram submetidos à hepatectomia parcial de Higgins e Anderson e os do grupo Intervenção à HH. VG e HB foram medidos nos dias D0, D1 e D7. A relação peso do fígado/peso do rato foi calculada em D0 e D7. A regeneração hepática foi analisada qualitativamente e quantitativamente. Resultados: Houve diminuição dos níveis de VG e HB nos ratos do grupo controle a partir de D1, atingindo decréscimo de 18% em D7 (p=0,01 e p=0,008 respectivamente); a HH permitiu a manutenção dos níveis de VG e HB nos ratos do grupo intervenção. A HH não alterou a regeneração hepática. Conclusão: HH resultou em níveis maiores de VG e HB pós-operatórios sem alterar a regeneração hepática. Pode-se considerar estes dados como a prova necessária para a translação à pesquisa clinicocirúrgica.

Animals , Male , Rats , Veins/physiology , Hepatectomy/methods , Liver/surgery , Liver/blood supply , Liver Regeneration , Portal Vein/surgery , Postoperative Period , Blood Volume/physiology , Hepatic Veno-Occlusive Disease/physiopathology , Hemoglobins/analysis , Rats, Wistar , Hematocrit
Acta cir. bras ; 34(6): e201900607, 2019. tab, graf
Article in English | LILACS | ID: biblio-1019264


Abstract Purpose Coleus forskohlii Briq., a medicinal plant originally from India, has been indicated against heart disease, expiratory disorders, convulsions, and hepatic changes, among others. In view of the broad pharmacological potential of the plant and the scarce information about its effects, the objective of the present study was to investigate the effect of its use for pretreatment of partially hepatectomized rats. Methods The animals were divided into two experimental groups: Control (CG) receiving physiological saline for 10 days before partial hepatetctomy, and Treated (TG) receiving 40 mg Coleus forskohlii/kg/day for 10 days before partial hepatectomy. The treatments were performed by gastric gavage. After the surgical procedure, treatment was continued according to the following groups: CG 24 h, CG 48 h, TG 24 h, and TG 48 hs, and liver tissue and intracardiac blood samples were obtained for histological and biochemical analysis, respectively. Results No significant differences were observed in mitotic or apoptotic index or in the concentrations of the enzymes AST, ALT and alkaline phosphatase, and no areas of fibrosis were detected. Conclusion Treatment with Coleus forskohlii did not interfere with the course of hepatic hyperplasia.

Animals , Male , Rats , Plant Extracts/administration & dosage , Plectranthus/chemistry , Hepatectomy/methods , Liver/pathology , Aspartate Aminotransferases/blood , Biomarkers/blood , Hepatocytes/drug effects , Alanine Transaminase/blood , Alkaline Phosphatase/blood , Hyperplasia/drug therapy , Liver/surgery , Liver/drug effects
Acta cir. bras ; 33(11): 975-982, Nov. 2018. tab, graf
Article in English | LILACS | ID: biblio-973472


Abstract Purpose: To discuss the use of models of hepatic retraction by laparoscopy, to present a new Hepatic Retractor (HR) and to evaluate its practicality, efficacy and safety in Esophageal Hiatus Exposure (EHE). Methods: Experimental cross - sectional study with a quantitative character. It was carried out in the Laboratory of Health Training of Christus University Center. The sample consisted of 12 livers of adult pigs weighing between 30 and 45 kg. A circular-shaped HR, 5 cm diameter and deformable materials was developed with a polypropylene cloth, metallic guide wire, epidural needle plastic guide and nylon string. The practicality of HR management was measured by the time required to use the instrument, efficacy by exposure to the operative field and safety by macroscopic assessment of liver damage. Results: The average time to complete the procedure was 3.24 minutes and reached less than 2 minutes after 12 repetitions. In eight experiments the maximum degree of EHE was obtained. No macroscopic lesions were observed. Conclusion: The use of HR described can broaden the operative field, without causing macroscopic liver lesions and prolonging the surgical time.

Animals , Male , Surgical Instruments , Laparoscopy/instrumentation , Liver/surgery , Reference Values , Swine , Cross-Sectional Studies , Reproducibility of Results , Models, Animal , Equipment Design , Operative Time
Clinics ; 73: e289, 2018. tab, graf
Article in English | LILACS | ID: biblio-952809


OBJECTIVE: The prognosis of patients with biliary atresia undergoing Kasai portoenterostomy is related to the timing of the diagnosis and the indication for the procedure. The purpose of the present study is to present a practical flowchart based on 257 children who underwent Kasai portoenterostomy. METHODS: We conducted a retrospective cohort study of patients who underwent Kasai portoenterostomy between 1981 and 2016. RESULTS: During the first period (1981 to 2009), 230 infants were treated, and the median age at the time of surgery was 84 days; jaundice was resolved in 77 patients (33.5%). During the second period, from 2010 to 2016, a new diagnostic approach was adopted to shorten the wait time for portoenterostomy; an ultrasonography examination suggestive of the disease was followed by primary surgical exploration of the biliary tract without complementary examination or liver biopsy. Once the diagnosis of biliary atresia was confirmed, a portoenterostomy was performed during the same surgery. During this period, 27 infants underwent operations; the median age at the time of surgery was 66 days (p<0.001), and jaundice was resolved in 15 patients (55.6% - p=0.021), with a survival rate of the native liver of 66.7%. CONCLUSION: Primary surgical exploration of the biliary tract without previous biopsy was effective at improving the prognostic indicators of patients with biliary atresia undergoing Kasai portoenterostomy.

Humans , Male , Female , Infant, Newborn , Infant , Biliary Atresia/surgery , Portoenterostomy, Hepatic/methods , Time Factors , Biliary Atresia/mortality , Biliary Atresia/pathology , Brazil/epidemiology , Portoenterostomy, Hepatic/mortality , Survival Rate , Retrospective Studies , Age Factors , Liver Transplantation/methods , Liver Transplantation/mortality , Treatment Outcome , Kaplan-Meier Estimate , Jaundice, Neonatal/surgery , Jaundice, Neonatal/pathology , Liver/surgery , Liver/pathology
Braz. j. med. biol. res ; 51(4): e6062, 2018. graf
Article in English | LILACS | ID: biblio-889069


Liver resection is the standard treatment for any liver lesion. Laparoscopic liver resection is associated with lower intra-operative blood loss and fewer complications than open resection. Access to the posterior part of the right liver lobe is very uncomfortable and difficult for surgeons due the anatomic position, especially when employing laparoscopic surgery. Based on these experiences, a new laparoscopic device was developed that is capable of bending its long axis and allowing the application of radiofrequency energy in areas that were not technically accessible. The device is equipped with four telescopic needle electrodes that cause tissue coagulation after the delivery of radiofrequency energy. Ex vivo testing was performed in 2012 and 2014 at the University Hospital, Ostrava, on a porcine liver tissue. The main goal of this testing was to verify if the newly proposed electrode layout was suitable for sufficient tissue coagulation and creating a safety zone around lesions. During the ex vivo testing, the material of needle electrodes was improved to achieve the lowest possibility of adhesion. The power supply was adjusted from 20 to 120 W and the ablation time, which varied from 10 to 110 s, was monitored. Subsequently, optimal power delivery and time for coagulation was determined. This experimental study demonstrated the feasibility and safety of the newly developed device. Based on the ex vivo testing, LARA-K1 can create a safety zone of coagulation. For further assessment of the new device, an in vivo study should be performed.

Humans , Catheter Ablation/instrumentation , Laparoscopy/instrumentation , Equipment Design , Hemostasis, Surgical/instrumentation , Hepatectomy/instrumentation , Liver/surgery , Laparoscopy/methods , Hepatectomy/methods
Int. j. morphol ; 35(4): 1525-1539, Dec. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-893165


RESUMEN: El hígado es un órgano sólido, de gran relevancia para la fisiología. Es asiento potencial de lesiones tumorales quísticas y sólidas; benignas y malignas (primarias y secundarias); razón por la cual, conocer su anatomía radiológica y quirúrgica es muy relevante. Los antecedentes históricos comienzan con Berta en 1716, quien fue el primero en realizar una resección hepática; en 1888, Lagenbuch fue el primero el realizar una resección hepática programada. En 1889, Keen realizó la primera lobectomía hepática izquierda, seguido de Webde, en 1910, quien ejecutó la primera lobectomía hepática derecha. Más tarde, Couinaud, en 1957, realizó ua descripción completa de la anatomía segmentaria del hígado, dando una mejor comprensión quirúrgica de la morfología hepática, para su abordaje en distintas patologías. Un hito fundamental en el desarrollo del estudio del hígado, fue el establecimiento de la "Clasificación de Brisbane", por parte del Comité Científico de la Asociación Internacional Hepatobilio-Pancreática, poniendo fin a la confusión terminológica establecida entre los términos franceses y anglosajones. Y desde el ámbito anatómico, se destaca la aparición de Terminologia Anatomica, por parte del Programa Federativo Internacional de Terminologia Anatomica (FIPAT) dependiente de la Federación Internacional de Asociaciones de Anatomistas (IFAA), quienes dentro de la misma, establecieron los términos anatómicos correspondientes al hígado. El objetivo de este manuscrito, es entregar un resumen esquemático de la anatomía quirúrgica y radiológica del hígado, que fundamentan las diferentes opciones de resecciones hepáticas.

SUMMARY: The liver is a solid organ which is most relevant for physiology. It is a potential site for cystic and solid (primary and secondary) benign and malignant tumor lesions. Therefore, thorough knowledge of its radiological and surgical anatomy is important. Historical background of liver resections began with Berta in 1716, who was the first to carry out the procedure. In 1888, Lagenbuch performed the first programmed liver resection and subsequently, in 1889 Keen performed the very first left hepatic lobectomy, followed by Webde in 1910, who performed the first right hepatic lobectomy. Later in 1957, Couinaud recorded a complete description of the segmental anatomy of the liver, providing a greater surgical understanding of the hepatic morphology, for approach in various pathologies. A fundamental milestone in the development of the liver study was the establishment of the "Brisbane Classification" by the Scientific Committee of the International Hepatobiliary-Pancreatic Association, which ended previous confusion between the French and Anglo-Saxon terminology. Furthermore, within the scope of anatomy, the introduction of Terminología Anatómica, by the International Federative Program of Anatomical Terminology (FIPAT) which depends on the International Federation of Associations of Anatomists ( IFAA), established the anatomical terms for the liver The objective of this manuscript is to provide a schematic summary of the surgical and radiological anatomy of the liver, on which the different options for liver resections are based.

Humans , Hepatectomy , Liver/anatomy & histology , Liver/diagnostic imaging , Liver/surgery
Acta cir. bras ; 32(8): 673-679, Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-886232


Abstract Purpose: To analyze the use of this sponge in pediatric patients undergoing split-liver transplantation. Methods: Retrospective study, including 35 pediatric patients undergoing split-liver transplantation, divided into two groups according to the use of the sponge: 18 patients in Group A (no sponge) and 17 in Group B (with sponge). Results: The characteristics of recipients and donors were similar. We observed greater number of reoperation due to bleeding in the wound area in Group A (10 patients - 55.5%) than in Group B (3 patients - 17.6%); p = 0.035. The median volume of red blood cells transfused in Group A was significantly higher (73.4 ± 102.38 mL/kg) than that in Group B (35.1 ± 41.67 mL/kg); p = 0.048. Regarding bile leak there was no statistical difference. Conclusion: The use of the human fibrinogen and thrombin sponge, required lower volume of red blood cell transfusion and presented lower reoperation rates due to bleeding in the wound area.

Humans , Male , Female , Infant , Fibrinogen/therapeutic use , Hemostatics/therapeutic use , Thrombin/therapeutic use , Surgical Sponges , Liver Transplantation/methods , Hemostasis, Surgical/methods , Reoperation , Reproducibility of Results , Retrospective Studies , Blood Loss, Surgical/prevention & control , Liver Transplantation/adverse effects , Treatment Outcome , Erythrocyte Transfusion , Statistics, Nonparametric , Surgical Wound/drug therapy , Hepatectomy/methods , Liver/surgery
Einstein (Säo Paulo) ; 15(2): 178-185, Apr.-June 2017. tab, graf
Article in English | LILACS | ID: biblio-891376


ABSTRACT Objective To analyze the influence of portal vein ligation in hepatic regeneration by immunohistochemical criteria. Methods Ten pigs divided into two groups of five animals underwent hepatectomy in two stages, and the groups were differentiated by ligation or not of the left portal vein tributary, which is responsible for vascularization of the left lateral and medial lobes of the pig liver. Five days after the procedure, the animals underwent liver biopsies for further analysis of histological and immunohistochemical with marker Ki67. Results The group submitted to hepatectomy with vascular ligation showed an increase of approximately 4% of hepatocytes in regeneration status, as well as a greater presence of Kupffer and inflammatory cells as compared to control. Conclusion As a result of positive cell replication observed through the Ki67 marker, we can suspect that the ligation of a tributary of the portal vein associated with liver resection promoted a greater stimulus of liver regeneration when compared to liver resection alone.

RESUMO Objetivo Analisar a influência da ligadura da tributária da veia porta no estímulo regenerativo hepático por meio de critérios imuno-histoquímicos. Métodos Dez suínos, divididos em dois grupos de cinco animais, foram submetidos à hepatectomia em dois estágios, sendo que os grupos foram diferenciados pela ligadura ou não da tributária da veia porta, responsável pela vascularização dos lobos lateral e medial esquerdos do fígado do suíno. Cinco dias após o procedimento, os animais foram reabordados para retirada de amostras hepáticas para posterior análise de histológica e imunoistoquímica com o marcador Ki67. Resultados O grupo submetido à hepatectomia com ligadura vascular apresentou incremento de 4% aproximadamente de hepatócitos em processo de regeneração, bem como grande número de células de Kupffer e células inflamatórias, quando comparado ao controle. Conclusão Em virtude da análise positiva da replicação celular observada por meio do marcador Ki67, pode-se observar que a ligadura de uma tributária da veia porta promoveu um maior estímulo de regeneração hepática, efeito observado com menor intensidade no grupo submetido apenas à ressecção hepática.

Animals , Portal Vein/surgery , Parenchymal Tissue/surgery , Hepatectomy/methods , Liver/surgery , Liver Regeneration , Swine , Random Allocation , Ki-67 Antigen/metabolism , Hepatocytes/metabolism , Models, Animal , Parenchymal Tissue/pathology , Leukocytes , Ligation/methods , Liver/pathology
Acta cir. bras ; 32(3): 194-202, Mar. 2017. tab, graf
Article in English | LILACS | ID: biblio-837694


Abstract Purpose: To investigate the effects of lycopene and resveratrol pretreatment on hepatic hyperplasia in partially hepatectomized rats. Methods: The lycopene group and the resveratrol group received 40 mg/kg/day of lycopene or resveratrol, respectively (dissolved in olive oil or in saline solution, respectively) and administered via a gastric tube for 30 days. The partially hepatectomzed (PH) control groups received saline or olive oil via a gastric tube for 30 days, respectively, and the normal control group received no treatment. Liver tissue and intracardiac blood samples were obtained 24, 36 or 48 h after PH. Results: No areas of fibrosis were detected. No significant changes in mitotic index, in the number of apoptosis events or in aspartate aminotransferase and alanine aminotransferase levels were observed. Conclusions: Lycopene and resveratrol pretreatment did not interfere on hepatic hyperplasia in partially hepatectomized rats.

Animals , Male , Stilbenes/pharmacology , Carotenoids/pharmacology , Hepatectomy/methods , Liver/surgery , Liver/drug effects , Antioxidants/pharmacology , Aspartate Aminotransferases/blood , Time Factors , Reproducibility of Results , Treatment Outcome , Rats, Wistar , Apoptosis/drug effects , Oxidative Stress/drug effects , Alanine Transaminase/blood , Liver/enzymology , Liver/pathology , Liver Regeneration/drug effects , Mitotic Index
Rev. chil. cir ; 69(1): 89-93, feb. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-844332


La mortalidad de la cirugía resectiva hepática es de 1-2%. Mejorar esto requerirá optimizar detalles que involucran a todos los encargados del cuidado de estos pacientes. El primero de estos puntos es la evaluación de la función hepática postoperatoria. Diversos métodos han sido utilizados para tratar de estimarla, sin resultados concluyentes respecto a cuál es el más adecuado. Estudios que evalúan la cantidad de parénquima residual y su relación con el desarrollo de falla hepática postoperatoria recomiendan que en presencia de un hígado sano debería quedar 20-25% del volumen hepático, 30-60% en casos de condiciones que deterioran la funcionalidad, y 40-70% en casos de cirrosis. El aporte de volumen y su relación con la morbilidad, el sangrado y el desarrollo de insuficiencia renal han sido muy estudiados. La restricción del volumen y el mantenimiento de presiones venosas bajas aparecen como estrategias recomendadas, pero no deben comprometer la perfusión sistémica. A diferencia de lo observado en pacientes críticos, especialmente sépticos, el uso de almidones aparece como una alternativa segura en pacientes sanos sometidos a procedimientos resectivos o trasplante hepático. Las alteraciones de exámenes de coagulación deben ser evaluadas y corregidas cuando corresponda, idealmente a través de métodos que permitan identificar la causa. El tromboelastograma aparece como una alternativa adecuada. La administración profiláctica de hemocomponentes no está indicada, pudiendo ser origen de morbilidad. La analgesia debe ser optimizada, siendo la peridural una buena alternativa en presencia de hígado sano y en procedimientos no mayores de una lobectomía.

The mortality of liver resection surgery is 1-2%. Improve this will require optimizing details involving all caregivers of these patients. The first of these points is the evaluation of postoperative liver function. Various methods have been used to estimate it, without conclusive results regarding what is the most appropriate. Several studies evaluating the amount of residual parenchyma and its relationship to the development of postoperative liver failure recommend that in the presence of a healthy liver should be 20-25% of liver volume, 30-60% in cases of conditions that impair the functionality and 40-70% in cases of cirrhosis. The contribution of fluids administration and its relationship with morbidity, bleeding and development of renal failure have been studied. The volume restriction, maintenance of low central venous pressures appear as recommended strategies but must not compromise systemic perfusion that can determine organ dysfunction. Unlike what was observed in critically ill patients, the use of starches appears as a safe alternative in healthy patients and those undergoing liver transplantation. Alterations in coagulation tests should be evaluated, ideally through methods that allow to identify the cause. The thromboelastography appears as a suitable alternative. Prophylactic administration of blood components is not indicated and can be a source of morbidity. Analgesia should be optimized, being epidural analgesia a good alternative in the presence of healthy liver and procedures involving no more than a lobectomy.

Humans , Hepatectomy/methods , Hepatectomy/mortality , Liver/surgery , Hemostasis, Surgical , Intraoperative Complications/prevention & control , Liver Failure/prevention & control
Yonsei Medical Journal ; : 195-205, 2017.
Article in English | WPRIM | ID: wpr-126256


PURPOSE: Adequate hemostasis is important for postoperative outcomes of abdominal surgery. This study evaluated the hemostatic effects and accompanying histopathological changes of a novel oxidized regenerated cellulose, SurgiGuard®, during abdominal surgery. MATERIALS AND METHODS: Ten pigs underwent wedge resection of the spleen (1×1 cm) and liver (1.5×1.5 cm). The resected surface was covered with Surgicel® fabric or fibril type (Group A) or SurgiGuard® fabric or fibril type (Group B). Surgicel® and SurgiGuard® were randomized for attachment to the resected surface by fabric type (n=5) or fibril type (n=5). Blood loss was measured 5, 7, and 9 min after resection. Pigs were necropsied 6 weeks postoperatively to evaluate gross and histopathological changes. RESULTS: There was no significant difference in total blood loss between groups [spleen fabric: Group A vs. Group B, 4.38 g (2.74–6.43) vs. 3.41 g (2.46–4.65), p=0.436; spleen fibril: Group A vs. Group B, 3.44 g (2.82–6.07) vs. 3.60 g (2.03–6.09), p=0.971; liver fabric: Group A vs. Group B, 4.51 g (2.67–10.61) vs. 6.93 g (3.09–9.95), p=0.796; liver fibril: Group A vs. Group B, 3.32 g (2.50–8.78) vs. 3.70 g (2.32–5.84), p=0.971]. Histopathological analysis revealed no significant difference in toxicities related to Surgicel® or SurgiGuard® [inflammation, fibrosis, foreign bodies, and hemorrhage (spleen: p=0.333, 0.127, 0.751, and 1.000; liver: p=0.155, 0.751, 1.000, and 1.000, respectively)]. CONCLUSION: SurgiGuard® is as effective and non-toxic as Surgicel® in achieving hemostasis after porcine abdominal surgery.

Animals , Blood Loss, Surgical/statistics & numerical data , Cellulose, Oxidized/therapeutic use , Hemostasis, Surgical/methods , Hemostatics/therapeutic use , Liver/surgery , Random Allocation , Spleen/surgery , Swine
Arq. bras. med. vet. zootec ; 68(6): 1581-1585, nov.-dez. 2016. ilus
Article in English | LILACS, VETINDEX, LILACS, VETINDEX | ID: biblio-827919


An omphalocele is a defect in the closure of the abdominal wall during the embryonic stage, preventing the return of some abdominal organs to the cavity. In stillborn animals, the involvement of the liver in the omphalocele has been reported. The aim of the present study is to report the success of a partial liver resection in a female bovine at two days of age which presented an omphalocele at birth. Surgical intervention was indicated to reduce and suture the abdominal wall. During the surgical procedure, the presence of hard, reddish tissue was noted inside the sac covered by the amniotic membrane, with characteristics consistent with hepatic parenchyma. Due to the impossibility of reducing the contents added to the suggestion of tissue infection, we elected to perform a partial resection. The histopathological examination confirmed that the resected tissue was of the hepatic parenchyma. Antibiotic and systemic anti-inflammatory therapies were performed post-surgery. Fifteen days after surgery, infection was detected at the surgical site in addition to abdominal wound dehiscence; surgical reintervention was performed. On physical examination, carried out 4 months after the second operation, the heifer presented normal development for the species. In conclusion, omphalocele may contain liver. Ectopic liver is an extremely rare condition. Surgical treatment in the presented case focused on umbilicus with exploration of the abdominal cavity appeared to be sufficient.(AU)

A onfalocele é um defeito no fechamento da parede abdominal durante a fase embrionária, não permitindo o retorno de alguns órgãos abdominais à cavidade. O envolvimento do fígado em onfalocele tem sido relatado, porém em animais natimortos. Com o presente estudo, objetiva-se relatar uma ressecção parcial do fígado realizada com sucesso em uma fêmea bovina com dois dias de idade apresentando onfalocele ao nascimento. Foi indicada a intervenção cirúrgica para a redução e rafia da parede abdominal. Durante o procedimento cirúrgico, notou-se, no interior do saco recoberto pela membrana amniótica, a presença de tecido firme, de coloração avermelhada, com características compatíveis com parênquima hepático. Devido à impossibilidade de redução do conteúdo e sugestão de infecção do tecido encontrado, optou-se pela ressecção parcial dele. O exame histopatológico confirmou tratar-se de parênquima hepático o tecido resseccionado. No pós-cirúrgico, realizaram-se terapias antibiótica e antiinflamatória sistêmicas. Após 15 dias do procedimento cirúrgico, foi detectada infecção do sítio operatório e deiscência da sutura abdominal, sendo realizada reintervenção cirúrgica. No exame físico, realizado no animal após quatro meses da segunda intervenção cirúrgica, constatou-se desenvolvimento normal para a espécie. Conclui-se que o fígado pode ser conteúdo da onfalolocele, sendo uma condição extremamente rara. O tratamento cirúrgico no caso apresentado, com exploração da cicatriz umbilical e da cavidade abdominal, foi suficiente.(AU)

Animals , Female , Cattle , Hepatectomy/veterinary , Hernia, Umbilical/veterinary , Liver/surgery , Parenchymal Tissue
ABCD arq. bras. cir. dig ; 29(4): 236-239, Oct.-Dec. 2016. tab, graf
Article in English | LILACS | ID: biblio-837538


ABSTRACT Background: Surgical strategy to increase the number of liver transplants in the pediatric population is the ex-situ liver transection (reduction or split). However, it is associated with complications such as hemorrhage and leaks. The human fibrinogen and thrombin sponge is useful for improving hemostasis in liver surgery. Aim: Compare pediatric liver transplants with ex-situ liver transection (reduction or split) with or without the human fibrinogen and thrombin sponge. Methods: Was performed a prospective analysis of 21 patients submitted to liver transplantation with ex-situ liver transection with the application of the human fibrinogen and thrombin sponge in the wound area (group A) and retrospective analysis of 59 patients without the sponge (group B). Results: The characteristics of recipients and donors were similar. There were fewer reoperations due to bleeding in the wound area in group A (14.2%) compared to group B (41.7%, p=0.029). There was no difference in relation to the biliary leak (group A: 17.6%, group B: 5.1%, p=0.14). Conclusion: There was a lower number of reoperations due to bleeding of the wound area of ​​the hepatic graft when the human fibrinogen and thrombin sponge were used.

RESUMO Racional: Estratégia cirúrgica para aumentar o número de transplantes hepáticos na população pediátrica é a transecção hepática ex-situ (redução ou split). No entanto, ela está associada com complicações, tais como hemorragia e fístulas. A esponja de fibrinogênio e trombina humana é útil para melhorar a hemostasia nas operações hepáticas. Objetivo: Comparar transplantes hepáticos pediátricos com transecção hepática ex-situ (redução ou split) com ou sem a esponja de fibrinogênio e trombina humana. Métodos: Foi realizada análise prospectiva de 21 pacientes submetidos ao transplante de fígado com transecção hepática ex-situ com a aplicação da esponja de fibrinogênio e trombina humana na área cruenta (grupo A) e análise retrospectiva de 59 pacientes sem a esponja (grupo B). Resultados: As características dos receptores e doadores eram semelhantes. Observou-se menor número de reoperações devido à hemorragia na área da cruenta no grupo A (14,2%) em comparação com o grupo B (41,7%, p=0,029). Não houve diferença em relação à fístula biliar (grupo A: 17,6%, grupo B: 5,1%, p=0,14). Conclusão: Houve menor número de reoperações por sangramento da área cruenta do enxerto hepático quando a esponja de fibrinogênio e trombina humana foi utilizada.

Humans , Child , Fibrinogen/administration & dosage , Surgical Sponges , Liver Transplantation , Surgical Wound/drug therapy , Hepatectomy/methods , Liver/surgery , Thrombin/administration & dosage , Prospective Studies , Retrospective Studies
Rev. Col. Bras. Cir ; 43(2): 110-116, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-782924


ABSTRACT Objective: to evaluate the effectiveness of an collagen-based adhesive associated with fibrinogen and thrombin in experimental liver injuries in rats. Methods: we randomly divided 30 Wistar rats into three groups: A, B and C. All underwent a standard liver traumatic injury. In group A, the lesion was treated with the adhesive; in group B, with conventional, absorbable suture; group C received no treatment. We analyzed the time of hemostasis, mortality, occurrence of adhesions and any histological changes. Results: there was no statistical difference in relation to mortality (p=0.5820). The adhesive treated group showed the lowest hemostasis times (p=0.0573, odds ratio 13.5) and lower incidence of adhesions (p=0.0119). The histological alterations of the Groups A and B were similar, with foreign body granuloma formation separating the adhesive material and the hepatic stroma suture. Conclusion: the collagen adhesive associated with fibrinogen and thrombin was effective in treating experimental hepatic injury, providing a lower incidence of adhesions between the liver and surrounding structures.

RESUMO Objetivo: avaliar a eficácia de um adesivo a base de colágeno associado ao fibrinogênio e trombina, no trauma hepático experimental em ratos. Métodos: toram incluídos no estudo 30 ratos Wistar, igualmente divididos aleatoriamente em três grupos: A, B e C. Todos foram submetidos à lesão traumática hepática padronizada. No grupo A, a lesão foi tratada com o adesivo, no grupo B, com sutura convencional com fio absorvível, e no grupo C, não houve tratamento da lesão. Foram analisados o tempo de hemostasia, mortalidade, ocorrência de aderências e eventuais alterações histológicas. Resultados: os resultados mostraram que não houve diferença estatística em relação à mortalidade (p=0,5820). O grupo tratado com adesivo apresentou os menores tempos de hemostasia (p=0,0573 e odds ratio 13,5) e menor ocorrência de aderências (p=0,0119). Microscopicamente as alterações histológicas dos grupos A e B foram semelhantes, com a formação de granuloma de corpo estranho separando o material do adesivo e do fio de sutura do estroma hepático. Conclusão: o adesivo de colágeno associado ao fibrinogênio e trombina foi eficaz no tratamento do trauma hepático experimental, proporcionado menor ocorrência de aderências entre o fígado e as estruturas vizinhas.

Animals , Male , Rats , Tissue Adhesives , Fibrinogen , Thrombin , Collagen , Liver/surgery , Liver/injuries , Hemostatics , Random Allocation , Rats, Wistar
Rev. Col. Bras. Cir ; 43(2): 124-128, Mar.-Apr. 2016. tab
Article in English | LILACS | ID: lil-782922


ABSTRACT Objective: to analyze the chemical components of the smoke from electrocautery from coagulating muscle and liver tissues of pigs. Methods: we collected smoke produced by electrocautery applied to porcine tissue in previously evacuated bottles, with qualitative and quantitative analysis of the compounds present through the hyphenated technique gas chromatography / mass spectrometry. Results: there was a majority of decanal aldehyde in the fumes from the subcutaneous, muscle and liver tissues. Fumes of subcutaneous and muscular tissues also showed the presence of hexanal and phenol. In the fumes of subcutaneous and liver tissues we also found toluene and limonene and, finally, nonanal smoke was present in the muscle and liver tissues. Conclusion: there is increasing evidence showing that smoke from electrocautery used in subcutaneous, muscle and liver tissue is harmful to human health. Thus, there is need to reduce exposure to it or wear masks with filters capable of retaining these particles.

RESUMO Objetivo: analisar quimicamente os componentes da fumaça do eletrocautério, provenientes da coagulação de tecidos, muscular e hepático de suino. Métodos: coleta de fumaça produzida por eletrocauterização de tecido porcino em frascos previamente evacuados com análise qualitativa e quantitativa dos compostos presentes, através de técnica hifenada, cromatografia a gás/espectrometria de massas. Resultados: houve presença majoritária do aldeído decanal nas fumaças provenientes dos tecidos subcutâneo, muscular e hepático. Fumaças dos tecidos subcutâneo e muscular mostraram também a presença de hexanal e fenol. Nas fumaças dos tecidos subcutâneo e hepático foram encontrados ainda tolueno e limoneno e, por fim, nonanal estava presente nas fumaças dos tecidos muscular e hepático. Conclusão: há número crescente de evidências mostrando que fumaça proveniente de eletrocauterização de tecidos subcutâneo, muscular e hepático é nociva à saúde de seres humanos. Portanto, há necessidade de reduzir a exposição a ela ou usar máscara com filtro capaz de reter essas partículas.

Smoke/analysis , Electrocoagulation , Gas Chromatography-Mass Spectrometry , Swine , Muscle, Skeletal/surgery , Subcutaneous Tissue/surgery , Liver/surgery