RESUMEN
Objective To discuss the application of the degree of portal systemic shunting in assessing the upper gastrointes-tinal bleeding in patients with hepatic schistosomiasis. Methods Thirty - three patients with upper gastrointestinal bleeding caused by hepatic schistosomiasis(a bleeding group)and 29 schistosomiasis cirrhosis patients without bleeding(a non-bleeding group)were enrolled as investigation subjects in Jinshan Hospital. The subjects were scanned by the 128 abdominal slice spiral CT. The portal systemic shunting vessels were reconstructed by using thin slab maximum intensity projection(TSMIP)and multi-planar reconstruction(MPR). The degrees of the shunting vessels of the subjects were evaluated and compared,and the relation-ship between upper gastrointestinal bleeding and the degree of the shunting was analyzed. Results In the bleeding group,the occurrence rates of the shunting vessels were found as follows:86.4% in left gastric varices,68.2% in short gastric varices, 50.0% in esophageal varices,50.0% in para-esophageal varices,37.9% in gastric varices,69.7% in gastric-renal varices, 51.5% in spleen-renal varices,25.8% in abdominal wall varices,15.2% in omentum varices,63.6% in para-splenic varices, 34.8% in umbilical varices,40.9% in retroperitoneal-paravertebral varices,and 36.4% in mesenteric varices. In the bleeding group,the occurrence rates and the degree of shunt were significantly higher than those in the non-bleeding group in esophageal varices,esophageal vein,left gastric vein and gastric varices(all P < 0.05). Conclusions CT portal vein reconstruction can accurately display the location,degree and walking of all kinds of shunting vessels. Esophageal varices,esophageal vein,left gastric vein and gastric varices can accurately predict the risk of upper gastrointestinal bleeding in patients with hepatic schisto-somiasis. The patents with higher degree of the shunting vessels have a higher risk of gastrointestinal bleeding.
RESUMEN
Objective To explore the clinical usage of allograft vessels for portal venous reconstruction during radical resection for pancreatic cancer.Methods We retrospectively analyzed clinical data of 14 patients who underwent pancreaticoduodenectomy with vascular resection (PDVR) and reconstruction by allograft vascular form June 2009 to May 2013.Results Patient's mean age was (59.1 ±10.4) years old.The mean diameter of tumors was (3.9 ± 1.3) cm,mean lcngth of resected vessels was (4.4 ±0.5)cm,and the R0 resection rate was 71.4％.The implanted vessels in 4 cases were allograft portal veins,and in the other 10 cases were allograft iliac arteries.In morphological classification,9 cases used straight vessels and 5 cases used Y shaped vessels.The overall median survival time of the group was (14.0 ± 3.0) months.The 1,2 year' s survival rate was 52.0％ and 40.0％,respectively.Conclusions Allograft vessels for portal venous reconstruction during PDVR have biological and structural advantages.
RESUMEN
As an essential technique involved in complicated liver surgery,portal vein reconstruction results in eradication of macro- or microscopic tumor residual on surgical margins when combined with precise hepatectomy,improving both the living quality and the survival rate of patients.The application of this reconstruction technique needs precise evaluation of pre-operational image data,clearly dissection of portal vessels and tremendous amount of collaborative effort by the surgery team. Other techniques performed during the surgical procedure include intra-operative ultrasound scan,revitalizing the cryopreserved vessels,and angioplasty.