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La neoplasia quística mucinosa (NQM) primaria de hígado es una neoplasia poco usual de tipo epitelial que se caracteriza por la formación de quistes y que típicamente no tienen comunicación con los ductos biliares. Representa menos del 5% de todas las lesiones quísticas del hígado y existen solo 250 casos en la literatura mundial. Presentamos el caso de una paciente mujer de 23 años con una lesión de 13,5 x 10,2 cm, hipodensa, lobulada, con múltiples tabiques de hasta 2,5 mm de espesor y pequeñas imágenes quísticas en su interior, que condiciona dilatación de la vía biliar intrahepática a predominio izquierdo y del colédoco. El estudio anatomopatológico concluyó que la tumoración correspondía a una neoplasia quística mucinosa de hígado.
Mucinous cystic neoplasm (MCN) of the liver is an unusual cyst-forming epithelial neoplasm, typically showing no communication with the bile ducts. This neoplasm represents less than 5% of all cystic lesions of the liver and there are only 250 cases in the world literature. We present the case of a 23-year-old female with a 13.5 x 10.2 cm lesion, hypodense, lobulated, with multiple septa up to 2.5 mm thick and small cystic images inside, which produces intrahepatic bile duct and common bile duct dilatation. The pathological study concluded that the tumor corresponded to a mucinous cystic neoplasm of the liver.
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Objective To explore the value of round ligament approach in the bile duct benign stricture near porta hepatis.Methods Data of 62 patients treated in Hunan Provincial People's Hospital from Mar 2016 to Mar 2018 were retrospectively analyzed.Results Hepatolithiasis was the cause of bile duct benign stricture in 37 cases,followed by iatrogenic injury (12 cases),cholangio-intestinal anastomotic restenosis (7 cases),cystic dilatation of bile duct (4 cases) and bridge-shaped calculus (2 cases).We get access to the strictured bile duct near porta hepatis by way of round ligament,and hilar cholangioplasty and bilioenteric anastomosis was done at the porta hepatis.The surgery lasted an average of 230.3 minutes and with an average 196.8 ml blood loss.By Clavien-Dindo scoring system,there were Grade Ⅰ complications in 32 cases,Grade Ⅱ complications in 3.On follow-up survey,there were 3 patients with reflux cholangitis.Condclsion Round ligament is a gateway to hilar bile duct benign stricture in an attempt to make hilar cholangioplasty.
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Objective To compare the clinical curative effect of partial hepatectomy combined with biliary intestinal anastomosis and T tube drainage in the treatment of intrahepatic stones.Methods 72 patients with intrahe-patic stones were selected and randomly divided into observation group and control group.The observation group received lobectomy of liver +bile duct jejunum anastomosis,the control group received lobectomy of liver +T tube drainage treatment.The operation time,intraoperative blood loss,functional exercise time,length of hospital stay, recurrence rate,clinical efficacy and complications were observed.Results The patients were followed up for 6 -12months.The operative time,blood loss,ambulation exercise time,length of hospital stay in the observation group were (158.29 ±32.53)min,(161.42 ±11.75)mL,(3.61 ±0.28)d,(5.31 ±1.17)d,which were significantly more than those in the control group[(127.57 ±26.38)min,(78.29 ±8.36)mL,(2.25 ±0.56)d,(4.86 ± 2.39)d].The recurrence rate of stone of the observation group during the postoperative follow -up was 5.56%, which was significantly lower than 16.67% of the control group (t =4.328,7.196,2.174,2.259,1.862,all P <0.05).The excellent and good rate of the observation group was 94.44%,which was higher than 83.33% of the control group,the difference was statistically significant (χ2 =1.257,P <0.05).6 cases in the observation group had complications (16.67%),including 1 case of incision infection,subphrenic infection in 2 cases,bile leakage in 2 cases,1 case of pulmonary infection.15 cases in the control group had postoperative complications (41.67%), including 3 cases of wound infection,bile leakage in 4 cases,3 cases of biliary tract bleeding,abdominal bleeding in 1 case,2 cases of pulmonary infection,subphrenic infection in 1 case,pleural effusion in 1 case,the difference between the two groups was significant (χ2 =2.291,P <0.05).Conclusion Liver resection is an effective method for treatment of intrahepatic bile duct stones,on the basis of liver resection by intestinal anastomosis in the treatment of intrahepatic bile duct stone long -term effect is better,which can effectively prevent recurrence of the intrahepatic bile duct stone and bile duct cancer,widely used in patients with indications for clinical physicians.
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Objective: To investigate the change of the micro- and ultramicro-structure of in- trahepatic bile duct after liver graft and the protection of hypoxic preconditioning. Methods: The model of orthotopic autologous liver transplantation was used, thirty SD rats were randomly divided into three groups. A: orthotopic autologous liver transplantation group; B: hypoxic preconditioning before operation group; C: sham operation group. The serum bilirubin ,the micro-structure of biliary epithelial cell and the ultramicro-structure of cholangiole were determined in three groups after 48hours after operation. Results: As compared with B group: the serum bilirubin increased (P
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Objective To evaluate the surgical treatment of splitting right hepatic duct with hepatolithiasis and stenosis. Methods The clinical data of 38 patients with splitting right hepatic duct and hepatolithiasis treated by operation were analyzed retrospectively. Results All the patients underwent operation. operative procedures were as follows: (1) in situ cholangioplasty of splitting right hepatic duct in 7 cases;(2) fenestration of splitting right hepatic with adjacent hepatic duct in 9 cases; (3) bilioplasty of splitting right hepatic duct with adjacent bile duct in 8 cases; (4) hepatic lobectomy or segmentectomy of splitting right hepatic duct in 14 cases. Postoperative complications developed in 6 cases, which were cured conservatively. There was no perioperative mortality. All patients were followed up for 5～16 years(averaged 9.2 years). Excellent rate was 78.9%,and residual stones were found in 26.3% of the patients . Conclusions Accurate localization and appropriate operation may get satisfactory result in treating patients with splitting right hepatic duct with hepatolithiasis and stenosis.
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Objective To assess the causes and methods of surgical treatment of hepatolithiasis reoperation Methods The clinical data of 81 cases of hepatolith reoperation were analyzed retrospectively. Results The main causes of hepatolith reoperation include biliary stricture,biliary tract variation,cholangiocarcinoma, etc. The chief reoperation patterns were hepatic lobectomy, Roux-en-Y hepaticojejunostomy, and lobectomy combined with Roux-en-Y hepaticojejunostomy.A follow-up of 2 months to 12 months showed excellent (outcome) of 93.8% of cases. According to postoperative cholangiograph,the retained stone rate was 6.2%. Conclusions When treating cholelithiasis ,we should follow the following principles: remove stones, relieve biliary stricture, correct biliary variation, resect abnormal liver, and establish adeguate biliary drainage.
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Objective Because of local infiltrated growth and spread,the operative resection of hilar (cholangiocacinoma) is very difficult. Recently,combined extended hepatectomy and vascular resection had been performed for treatment of hilar cholangiocarcinoma and has greatly increased the resection rate and survival rate.However, it is associated with high operative morbidity and mortality. The aim of this study is to explore a reasonable hepatic resection strategy, that is safe and beneficial for the patient. Method Sixteen (consecutive) cases of hilar cholangiocarcinoma with involvement of hilar vessels have been treated in our hospital since 1977. En bloc resection of the hilar tumor that included hepatic segment I,IV and involved blood (vessel), as well as hepato-duodenal ligament skeletonization was performed in 15 patients. Results All 15 cases were successfully operated on with a resection rate of 93.8%, and 12 cases with R_0 resection. The operative mortality and in-hospital mortality rate were 0. Temporary bile leak and abdominal infection (respectively) developed in 1 patienteach,with an overall morbidity of 13.3%,and both were cured by non-(operative) therapy. No case of liver failure occurred. Follow up showed the median survival was 22 months and 7 are still alive. Conclusions (1)The resection rate and survival rate for hilar cholangiocarcinoma could be improved by combination of liver and hilar vascular resection.(2)Hilar cholangiocarcinoma mainly spreads to the medial segment(S4) and caudate(S1), and these segments need to be resected in the combined (operation).(3)Although resection of the middle part of liver takes little more time than hemi-hepatectomy and trisegmentectomy, it could preserve more liver parenchyma and reduce postoperative morbidity (such as liver failure) and mortality rates.(4)The resection of the hilar blood vessel involved by tumor was necessary to improve the resection rate and cure rate. Reconstruction of the blood vessel was made selectively by taking the circumstances into consideration.
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Objective To study the value of various MR imaging techniques in the preoperative diagnosis and preoperative assessment of resectability in patients with hilar cholangiocarcinoma.Methods Seventy-eight (patients) with hilar cholangiocarcinoma were diagnosed by imaging of MRI/MRCP/MRA.Based on imaging (analysis) of the extent of local tumor invasion,vascular involvement,hepatic lobar atrophy and distant (metastasis),a preoperative imaging assessment of resectability was done in 78 patients.This preoperative (assessment) was compared with the surgical and pathological findings,so as to evaluate the imaging value in prediction of whether or not resection was feasible in patiens with hilar cholangiocarcinma.Results Of 21 (patients) with unresectable disease according to imaging evaluation, laparotomy was performed in 10 cases,and in all 10cases the tumor was proven not to be resectable at operation.Thus,the surgical and pathological (findings) were in accordance with the result of imaging.Surgical exploration was performed in 57 patients with potentially resectable disease according to imaging evaluation. In this group, the intra-operative diagnosis of the location and nature of tumor was to be in line with the preoperative assessment of imaging, The (diagnosis) accuracy rate was 100%, and 40 patients underwent resection,the resection rate was 70.2%. Of 40 (patients) with resection,29 patients underwent curative resection,the curative resection rate was (50.9)%;11 patients underwent palliative resection.The other 17 patients were found to have (unresectable) disease at laparotomy,including 3 portal venous involvement,5 hepatic arterial (invasion),7 metastatic disease,2 hepatic parenchymal massive involvement. These diseases were not found in pre-operative imaging evaluation.Conclusions MR multi-imaging techniques have high accuracy in the diagnosis of the location and nature of hilar cholangiocarcinoma,and could evaluate accurately the feasibility of resection in patients with hilar cholangiocarcinoma. The main causes of unresectability lie in metastasis of tumor and local vascular involvement.
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Objective To explore the factors related to effects and prognosis of surgical treatment of hilar cholangiocarcinoma.Methods The clinical data of 41 patients with hilar choIangiecarcinoma(HCCA) admitted in recent seven years were investigated and anlyzed retrospectively.Results Among 41 patients with HCCA,the accuracy rate of diagnosis by imaging technology was 95.1% before operation.Thirty-two cases were treated by surgical resection,of which 15 cases had radical resection and 17 cases had palliative resection,the total resection rate was 78.1%,and 9 cases had biliary internal drinage procedure.Two cases died during hospitilization.The rate of one-,three-and five-year survival for surgical resection was 70.0%,40.0% and 23.3% respectively,and for palliation drainage was 44.4%,11.1%,and 0%,respectively.The median survial time was 28 months and 8 months for surgical resction and palliation drainage,respectively.The difference between surgical resction and palliation drainage on survival rate and median survival time was signigicant(P
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Objective To evaluate the procedure of surgical treatment of intrahepatic biliary calculi with blood vessel variation in hepatic hilus. Method The clinical data of 57 patients with intrahepatic biliary calculi and blood vessel variation in hepatic hilus treated by biliary operation were retrospectively analyzed.Results The simply biliary operation was performed on 13 cases ; variant blood vessels were cut off and ligated in 14 cases;The bile duct and blood vessel across conversion operation were performed on 22 cases;and the intrahepatic cholangiojejunostomy was carried out in 8 cases. There were no severe postoperative complications and perioperative mortality.51 patients(89.6%) were followed up for 4 to 15 years with the exellent results in 43(84.3%)cases. There were residual stones in 7 cases,of them,5 patients had intermittent abdominal pain in the right upper quadrant; reoperation was performed on another 2 cases because of recurrent cholangitis. One died of variceal bleeding 1.5 years after operation. Conclusions In order to accomplish the complex operations of biliary tract and avoid ischemic damage of liver, proper operation should be chosen for patients with intrahepatic biliary calculi with blood vessel variation in hepatic hilus.
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Objective To evaluate retrospectively the methods and outcomes of surgical treatment of patients with intrahepatic cholelithiasis and biliary stricture.Methods The data of the surgical therapy of 165 cases of cholelithiasis and biliary stricture admitted between January 1995 and January 2003 were analyzed.Group A included 85 cases managed by various types of hepatectomy or hepatic segmental resection(HSR).In group A,40 patients underwent simultaneous cholangiojejunostomy,in 10 patients the dilated bile duct on(resected) surface of liver and bile duct of hepatic hilum were separately anastomosed to the jejunum by double stoma anostomosis,T-tube drainage was done in 21 cases and U-tube drainage in 14 cases.Group B(patients)(n=80) were treated by operation without HSR,included 23 cases with choledochotomy and stone removal plus T-tube drainage,15 cases with choledochotomy and stone removal plus U-tube drainage,42(cases) with choledochotomy and stone removal plus biliary-enteric anastomosis;in group B,plastic operation of the hepatic duct stricture was proforemed in 46 cases.Results In Group A,no operative death occurred.The cases were followed up after operation from 2 to 7 years,and showed residual calculus rate was 4.71%,and symptoms recurrence rate 3.53%.No patient was operated again.In Group B,no operative death(occurred).The cases were followed up from 2 to 7 years after operation,and residual stones were found in 12 cases,a residual calculus rate of 15.00%.After operation,10 cases complained of upper abdominal pain and(fever),with a symptoms recurrence rate of 12.5%.The residual stones of 5 cases were removed by fiber biliary(endoscopy),while 3 cases of the other 6 cases received hepatectomy.Conclusions The combined(hepatic) resection and other operation is an ideal and effective surgical method to treat hepatolithiasis.
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Objective To assess the therapeutic effect and opportune time of surgical treatment of hepaticolithiasis . Methods The clinical data of 92 patients with hepaticolithiasis who underwent surgical treatment were analyzed retrospectively. Results (1) The incidence of postoperative complications was 14.1% (13/92 cases), in choledochoscopy group it was 9.3%(4/43 cases) and in the non choledochoscopy group 18.4%(9/49 cases) ; in the emergency operation group it was 36%(9/25 cases) and in selective operation group 5.97%(4/67 cases) . (2) The incidence of residual stones was 22.9%(21/92 cases); in choledochoscopy group it was 13.9%(6/43 cases) and the non choledochoscopy group 30.6%(15/49 cases); in emergency surgery group it was 36%(9/25 cases) and in selective operation group 17.9%(12/67 cases).(3)One pationt died from ACST two days after operation . All of the patients were followed up for 4-10 years; there were 80 cases (86.9%) who had a good therapeutic outcome. Conclusions Logical surgical procedure associated with choledochoscopy and appropriate timing of surgical intervention can markedly improve the effect of surgical treatment of hepaticolithiasis and reduce the incidence of postoperative complications.