Résumé
PURPOSE: In western countries, the reported incidence of deep vein thrombosis (DVT) after total hip arthroplasty (THA) ranges from 12 to 23% when an accepted form of prophylaxis is used but when it is not, it ranges from 48 to 70%. However, the incidence of postoperative DVT in Asia has always been considerably lower (20~30%) and compare to western countries and no clear indication for prophylaxis has been suggested. The aim of this study was to document the incidence of DVT among Koreans, and to find the correlation between DVT and its risk factors after total hip arthroplasty. METHOD: 196 patients, who underwent THA from 2002 to 2004, were evaluated to figure out the incidence of DVT and its correlation with well known risk factors, such as age, body mass index (BMI), gender, preoperative coagulation assays (platelet, PT and aPTT) and operation time. All patients wore elastic compression stockings, and early ambulation was encouraged. Venography or Doppler sonography was obtained routinely between 7th and 10th postoperative days. RESULT: The incidence of DVT and pulmonary embolism following THA was 12.6% (25 cases) and 0.5% (1 case), respectively. The mean age of the patients evaluated was 49. 12 cases showed thrombi in the muscle branch below the knee, 9 cases in the posterior tibial vein and 4 cases in the veins above the knee. Age and aPTT were statistically significant with a higher incidence of DVT (P<0.05). However, no correlation between DVT and other factors, such as PT, platelet count, transfusion rate, operation time and BMI, was identified. CONCLUSION: The incidence of DVT in our study was 12.6%. Age and the preoperative aPTT level were significantly associated with the development of DVT after THA.
Sujets)
Humains , Arthroplastie , Arthroplastie prothétique de hanche , Asie , Indice de masse corporelle , Lever précoce , Incidence , Genou , Phlébographie , Numération des plaquettes , Embolie pulmonaire , Facteurs de risque , Bas de contention , Veines , Thrombose veineuseRésumé
BACKGROUND/AIMS: A hepatectomy for liver metastases from colorectal cancer has recently received general acceptance as a safe, potentially curative treatment modality due to its low surgical mortality and significant improvement of survival rates after resection. However, criteria for the selection of patients and treatment modalities remains controversial. The aim of study was to determine the prognostic factors. in patients who had undergone a hepatic resection for metastatic colorectal cancer. METHODS: Twenty-four patients who had underdone initial hepatic resection for liver metastases from colorectal cancer between 1992 and 2002 were analyzed with regard to clinical and pathological parameters. The survival rate was calculated using the Kaplan-Meier method and Cox regression hazard model. The mean follow up period was 37 months. RESULTS: The overall 5-year survival rate was 29.3%, with a mean survival of 39 months. There were 10 (41.3%) and 14 (58.7%) cases of synchronous and metachronous metastasis, respectively. The 5-year survival rate was shown to be significantly lower in patients with more than 4 metastases (p=0.01), bilobar metastasis (p=0.02) and vascular invasion (p=0.01). The number of hepatic metastases (p= 0.02) has been demonstrated as an independent factor for the 5-year survival. CONCLUSION: Patients with multiple, bilobar hepatic metastases and vascular invasion demonstrated a poor survival rate. Therefore, in patients with poor prognostic factors, curative surgical resection, accompanied by a multimodality treatment, is necessary for an improved survival.
Sujets)
Humains , Tumeurs colorectales , Études de suivi , Hépatectomie , Foie , Mortalité , Métastase tumorale , Modèles des risques proportionnels , Taux de survieRésumé
PURPOSE: Biliary stones, situated in the proximal sites from the confluence level of the right and left main bile ducts, are considered to be intrahepatic stones. Synonyms include hepatolithiasis and recurrent pyogenic cholangitis. The exact etiology of this condition is unknown, but it causes serious problems, such as obstructive jaundice, cholangitis and liver abscesses and so on. Hepatic resection is the treatment of choice for intrahepatic stones. With improving techniques in hepatobiliary surgery and aggressive surgical treatment, the outcome of intrahepatic stones has improved. The aim of this study was to evaluate the clinical outcomes after a hepatectomy for intrahepatic stones. METHODS: 77 patients underwent hepatic resections due to intrahepatic stones at the Department of Surgery, Kyung-Hee University between January 1996 and December 2002. The surgical outcome and follow-up were analyzed by a retrospective clinical review. RESULTS: The gender ratio of the patients was 1: 1.9 male to female, with a mean age of 54-years. The most common preoperative symptom was RUQ pain (81.8%). Concomitant diseases were common bile duct stones (53.2%), gallstones (23.4%), liver abscesses (7.8%), malignant neoplasms (6.5%) and choledochal cysts (5.2%). Nineteen patients (24.7%) had a history of cholecystectomy and 2 (2.6%) had had a hepatectomy at other hospitals due to intrahepatic stones. The stone locations were the right hemi-liver 18.2%, the left hemi-liver 66.2%, especially the left lateral section 44.2%, and bilaterally 15.6%. The operation methods were as follows; a right hemihepatectomy in 11 patients (14.3%), a posterior sectionectomy in 3 (3.9%), a left hemihepatectomy in 14 (18.2%), a lateral sectionectomy in 42 (54.5%), segmental resections at both lobes in 7 (9.1%) and biliary-enteric bypass in 24 (31.2%). The most common complication was wound infection (26.0%). Two patients had remaining stones and 1 had recurrent stones 4 years later. The morbidity and mortality were 42.9 and 1.3%, respectively. With a mean follow-up period of 49.6 months, 59 patients (76.6%) were free of symptoms. 15 patients (19.5%) had mild to moderate RUQ discomfort or pain, but no detectable stones on radiological studies. 3 patients (3.9%) needed admission for severe symptoms, one due to recurrent stones, but the others had no abnormal findings. CONCLUSION: There was low mortality, despite the high complication rates with hepatic resections for intrahepatic stones. Low rates of remaining stones and recurrence of intrahepatic stones can be achieved.