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可切除原发性肝癌破裂出血急诊肝切除与TACE后二期肝切除的临床研究
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作者 黎官印 彭勇 +1 位作者 马海 田云鸿 《中国普外基础与临床杂志》 CAS 2020年第1期48-52,共5页
目的探讨可切除原发性肝癌破裂出血行急诊肝切除与经导管动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)后二期肝切除的疗效及预后。方法回顾性分析南充市中心医院2010年1月至2016年1月期间收治的可切除原发性肝癌破... 目的探讨可切除原发性肝癌破裂出血行急诊肝切除与经导管动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)后二期肝切除的疗效及预后。方法回顾性分析南充市中心医院2010年1月至2016年1月期间收治的可切除原发性肝癌破裂出血患者共42例,其中行急诊(入院24~48 h)肝切除术24例,行TACE后二期(TACE后1~2周)手术18例,比较2组患者的术中出血量和输血量、围术期死亡率、术后肝功能不全的发生率、术后1年肝癌复发或腹腔转移率以及术后1年及3年生存率。结果行急诊肝切除术患者和TACE后二期手术患者的术前一般资料比较差异无统计学意义(P>0.050)。行急诊肝切除术患者的术中出血量和输血量均明显多于TACE后二期手术患者(P=0.028、P=0.017),二者间的围术期死亡率(P=0.489)、肝功能不全发生率(P=1.000)、1和3年生存率(P=0.650、P=0.463)及1年复发率(P=0.601)比较差异均无统计学意义,均未发现腹腔种植转移。结论对于可切除原发性肝癌破裂出血行急诊肝切除与TACE后二期肝切除均安全有效,应根据患者的具体情况选择合适的治疗方案。 展开更多
关键词 原发性肝癌 自发性破裂出血 肝切除术 经导管动脉化疗栓塞术
低中心静脉压在肝脏切除手术中的应用现状
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作者 许钊 玉红 梁鹏 《中国普外基础与临床杂志》 CAS 2020年第1期107-112,共6页
目的探讨肝脏切除手术中不同降低中心静脉压(CVP)的方法及策略。方法通过文献检索,对目前低CVP的定义、实现方法、相关并发症及对预后的影响及其在肝脏手术中最合适CVP的相关研究进行了回顾总结。结果低CVP在肝脏切除术中已经得到了广... 目的探讨肝脏切除手术中不同降低中心静脉压(CVP)的方法及策略。方法通过文献检索,对目前低CVP的定义、实现方法、相关并发症及对预后的影响及其在肝脏手术中最合适CVP的相关研究进行了回顾总结。结果低CVP在肝脏切除术中已经得到了广泛应用,其减少术中出血、降低围术期输血的作用已经得到了肯定。目前实现低CVP的方法众多,包括麻醉药物、血管活性药物、限制性液体输注、肝下下腔静脉钳夹、低通气量等,没有围术期最佳策略的定论。目前仍缺乏其对患者远期预后影响的研究。术中维持CVP为2.1~3 mm Hg (1 mm Hg=0.133 kPa)可能较为适宜,一旦肝脏实质横断等主要操作结束,应立即恢复患者的血流动力学状态。结论肝脏切除手术中低CVP的应用可以减少围术期出血及输血,但其对患者的远期预后不得而知,在特定人群应用需谨慎。 展开更多
关键词 肝脏切除术 低中心静脉压 预后
三种肝切除术治疗肝细胞癌患者的临床疗效对比分析 预览
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作者 菅学强 宋春国 李伟 《中华普外科手术学杂志(电子版)》 2020年第1期90-93,共4页
目的探讨3D腹腔镜下肝切除术治疗肝细胞癌的近远期疗效。方法回顾性分析2014年1月至2016年12月收治的肝细胞癌患者96例,根据术式不同分为3D组32例,2D组47例和开腹组17例。采用SPSS 13.0进行数据分析,术中术后相关指标、血清生物学指标... 目的探讨3D腹腔镜下肝切除术治疗肝细胞癌的近远期疗效。方法回顾性分析2014年1月至2016年12月收治的肝细胞癌患者96例,根据术式不同分为3D组32例,2D组47例和开腹组17例。采用SPSS 13.0进行数据分析,术中术后相关指标、血清生物学指标计量资料以(x±s)表示,多组比较采用方差分析;术后并发症、肿瘤复发率及生存率比较采用χ2检验,P<0.05差异有统计学意义。结果3D组术中失血量、术后引流管时间、切口长度及术后住院时间均小于2D腹腔镜组及开腹组(P<0.05);3D组并发症发生率(9.4%)低于2D组(19.1%)及开腹组(47.1%),P<0.05;术后第3天,ET、IL-6、IL-8、CRP血浆水平均下降,3D组<2D组<开腹组(P<0.05);术后1年无复发生存率、术后1年生存率、术后2年无复发生存率、术后2年生存率三组差异无统计学意义(P>0.05)。结论3D腹腔镜下肝切除术治疗肝细胞癌患者术后炎症反应较轻,机体损伤小,近期疗效显著,远期疗效相当,具有较高的临床价值。 展开更多
关键词 肝细胞 腹腔镜 肝切除术 疗效比较研究
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Fingolimod(FTY720)improves postoperative cognitive dysfunction in mice subjected to D-galactose-induced aging 预览
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作者 Jie Zhang Bin Xiao +1 位作者 Chen-Xu Li Yi Wang 《中国神经再生研究:英文版》 SCIE CAS CSCD 2020年第7期1308-1315,共8页
Neurocognitive dysfunction is a common postoperative complication,especially in older adult patients.Fingolimod(FTY720)is a sphingosine-1-phosphate receptor modulator that has been found to be neuroprotective in sever... Neurocognitive dysfunction is a common postoperative complication,especially in older adult patients.Fingolimod(FTY720)is a sphingosine-1-phosphate receptor modulator that has been found to be neuroprotective in several animal models of central nervous system disease.However,few reports have examined whether FTY720 could mitigate postoperative cognitive dysfunction.In this study,we investigated whether FTY720 could prevent postoperative neurocognitive impairment in mice subjected to D-galactose-induced aging.We induced an accelerated model of aging by administering an intraperitoneal injection of D-galactose.Subsequently,we performed a partial hepatolobectomy under sevoflurane anesthesia.FTY720(1 mg/kg)was administered intraperitoneally 3 hours before and 24 hours after anesthesia and surgery.Our results indicated that anesthesia and surgery significantly impaired spatial memory in the Y-maze test 6 hours after surgery.We also found that problem solving ability and long-term memory in the puzzle box test on postoperative days 2–4 were significantly improved by FTY720 treatment.Immunohistochemical staining and western blot assay demonstrated that FTY720 significantly inhibited microglial activation in the hippocampal CA1 region of mice 6 hours and 3 days after anesthesia,and down-regulated the expression of synaptic-related proteins postsynaptic density protein 95 and GluR2 in the hippocampus.These results indicate that FTY720 improved postoperative neurocognitive dysfunction in mice subjected to D-galactose-induced aging.This study was approved by the Experimental Animal Ethics Committee of the Third Xiangya Hospital of Central South University of China(approval No.LLSC(LA)2016-025)on September 27,2016. 展开更多
关键词 D-GALACTOSE fengomod(FTY720) HEPATECTOMY MICROGLIA nerve regeneration postoperative neurocognitive dysfunction SEVOFLURANE
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肝细胞癌切除术后影响手术部位感染的危险因素 预览
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作者 王明 李明 +5 位作者 郑振江 李川 蒋利 杨家印 张抒 文天夫 《检验医学与临床》 CAS 2020年第2期202-205,共4页
目的探讨影响肝细胞癌(简称肝癌)切除术后手术部位感染的危险因素。方法选取2012年2月至2018年2月在四川大学华西医院肝脏外科行肝癌切除术的患者1 319例作为研究对象,收集、分析患者围术期临床资料,探讨影响术后手术部位感染的独立危... 目的探讨影响肝细胞癌(简称肝癌)切除术后手术部位感染的危险因素。方法选取2012年2月至2018年2月在四川大学华西医院肝脏外科行肝癌切除术的患者1 319例作为研究对象,收集、分析患者围术期临床资料,探讨影响术后手术部位感染的独立危险因素。结果 1 319例行肝癌切除术的患者中,82例(6.2%)发生手术部位感染,其中表浅切口感染37例(2.8%),深部切口感染16例(1.2%),器官/腔隙感染29例(2.2%)。围术期空腹血糖>6.1mmol/L、手术时间、术中出血量、术后胆漏是影响手术部位感染发生的独立危险因素。肝癌切除范围明显影响手术部位感染(P<0.05),以及器官/腔隙感染(P<0.05)。手术部位感染明显影响住院时间(P<0.05)和围术期病死率(P=0.021)。结论围术期血糖控制情况、手术时间、术中失血量、术后胆漏是影响手术部位感染的独立危险因素。肝癌切除范围明显影响手术部位感染,特别是影响器官/腔隙感染的独立危险因素。手术部位感染导致住院时间延长,围术期病死率升高。 展开更多
关键词 肝细胞癌 手术部位感染 肝癌切除术 危险因素
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手术切除、射频消融及海扶刀治疗结直肠癌肝转移患者的不同预后比较 预览
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作者 徐缨龙 胡建容 +2 位作者 李世红 于澜 李云涛 《实用医院临床杂志》 2020年第1期103-106,共4页
目的比较肝切除术(HR),射频消融(RFA)和海扶刀(HIFU)在结直肠癌肝转移(CRLM)治疗中的不同预后。方法我院经HR、RFA及HIFU治疗的CRLM患者71例,提取患者临床一般资料、诊断、治疗、病理结果、随访无复发生存率(RFS)和总生存率(OS)进行分... 目的比较肝切除术(HR),射频消融(RFA)和海扶刀(HIFU)在结直肠癌肝转移(CRLM)治疗中的不同预后。方法我院经HR、RFA及HIFU治疗的CRLM患者71例,提取患者临床一般资料、诊断、治疗、病理结果、随访无复发生存率(RFS)和总生存率(OS)进行分析。结果41例HR,20例RFA,10例HIFU进行了有效随访。HR和RFA组及HR和HIFU组的复发模式差异有统计学意义(P<0.05)。HR组与HIFU组OS、RFS差异有统计学意义(P<0.05),HR组与RFA组OS、RFS差异无统计学意义(P>0.05)。多因素分析显示转移灶的治疗和肝转移灶数目是预后的独立预测因子。结论RFA治疗结直肠癌肝转移的疗效与HR相似,HIFU治疗结直肠癌肝转移的疗效低于HR治疗结直肠癌肝转移的疗效。 展开更多
关键词 结直肠癌肝转移 肝切除术 射频消融 海扶刀 生存率
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负压引流对肝癌肝切除术后患者手术部位感染的预防效果分析 预览
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作者 班开河 《当代医学》 2020年第3期56-58,共3页
目的探讨负压引流技术对肝癌肝切除术后患者手术部位感染的预防效果。方法选取2016年11月至2018年10月本院收治的72例肝癌手术患者作为研究对象。根据是否实施负压引流将患者分为常规组和负压引流组,各36例。两组患者均实施肝癌肝切除术... 目的探讨负压引流技术对肝癌肝切除术后患者手术部位感染的预防效果。方法选取2016年11月至2018年10月本院收治的72例肝癌手术患者作为研究对象。根据是否实施负压引流将患者分为常规组和负压引流组,各36例。两组患者均实施肝癌肝切除术,常规组给予厄他培南抗感染及相应对症治疗,负压引流组在常规组基础上给予皮下持续负压引流。比较两组术后切口及器官组织感染情况、脂肪液化情况、拆线时间、引流拔管时间及住院治疗时间。结果负压引流组引流拔管时间为(7.64±1.12)d;治疗后,负压引流组拆线时间及住院治疗时间均少于常规组(P<0.05);负压引流组切口感染率(5.55%)、器官/腔隙感染率(2.78%)、脂肪液化率(5.55%)及总并发症发生率(13.89%)均低于常规组(22.22%、16.67%、25.00%、63.89%)(P<0.05)。结论负压吸引可缩短肝癌肝切除术后患者拆线时间及住院治疗时间,降低手术切口感染、器官/腔隙感染以及脂肪液化的发生率,值得临床推广应用。 展开更多
关键词 负压引流技术 肝癌 肝切除术 术后感染
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Treatment and prognosis of hepatic epithelioid hemangioendotheliomabased on SEER data analysis from 1973 to 2014 预览
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作者 O Kyu Noh Soon Sun Kim +5 位作者 Min Jae Yang Sun Gyo Lim Jae Chul Hwang Hyo Jung Cho Jae Youn Cheong Sung Won Cho 《国际肝胆胰疾病杂志:英文版》 SCIE CAS CSCD 2020年第1期29-35,共7页
Background: Hepatic epithelioid hemangioendothelioma (HEH) is a rare tumor of vascular origin with an unknown etiology, a low incidence, and a variable natural course. We evaluated the management and prognosis of HEH ... Background: Hepatic epithelioid hemangioendothelioma (HEH) is a rare tumor of vascular origin with an unknown etiology, a low incidence, and a variable natural course. We evaluated the management and prognosis of HEH from the Surveillance, Epidemiology and End Results (SEER) program and changes in treatment modalities of HEH over 30 years. Methods: From 1973 to 2014 in the SEER database, we selected patients diagnosed with HEH. We analyzed the clinical characteristics, patterns of management, and clinical outcomes of patients with HEH. Results: We identi ed 79 patients with HEH (median age: 54.0 years;male to female ratio: 1:2.6). The initial extent of disease was local in 22 (27.8%) patients, regional metastasis in 22 (27.8%), distant metas-tasis in 31 (39.2%) and unknown in 4 (5.1%). The median size of primary tumor was 3.85 cm (interquartile range, 2.50 7.93 cm). Among 74 patients with available management data, the most common manage-ment was no treatment (29/74, 39.2%), followed by chemotherapy only (22/74, 29.7%), liver resection-based (13/74, 17.6%), and transplantation-based therapy (6/74, 8.1%). The 5-year cancer-speci c survival rate was 57.8%. Patients who underwent surgical treatment had signi cantly higher survival than those who underwent non-surgical treatment (5-year survival;88% vs. 49%, P=0.019). Multivariate analysis revealed that surgical therapy was the only independent prognostic factor for survival (hazard ratio: 0.20, P=0.040). Conclusions: Resection or liver transplantation is worth considering for treatment of patients with HEH. 展开更多
关键词 HEMANGIOENDOTHELIOMA EPITHELIOID SEER program Liver transplantation HEPATECTOMY Liver neoplasms
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加速康复外科在肝叶切除围术期中的应用 预览
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作者 杨杰 何琴 +2 位作者 黄平 洪咏梅 梁潇 《全科护理》 2020年第4期438-441,共4页
[目的]探讨加速康复外科在肝叶切除术围术期中应用效果。[方法]将实行肝叶切除的98例病人按照随机数字表法分为试验组和对照组,试验组病人围术期实施快速康复外科模式,对照组实施传统围术期管理模式,比较两组病人肛门首次排气时间、首... [目的]探讨加速康复外科在肝叶切除术围术期中应用效果。[方法]将实行肝叶切除的98例病人按照随机数字表法分为试验组和对照组,试验组病人围术期实施快速康复外科模式,对照组实施传统围术期管理模式,比较两组病人肛门首次排气时间、首次排便时间、最低蛋白指数、清蛋白恢复时间、住院总费用、住院时间及术后首次下床时间、首次饮水时间、拔除尿管时间、拔除引流管时间、术后输入液体量及并发症。[结果]试验组病人术后首次肛门排气、排便时间、术后清蛋白恢复时间、住院时间、住院总费用均明显早于对照组(P<0.05);试验组病人术后最低蛋白指数明显高于对照组(P<0.05)。[结论]加速康复外科能够促进肝叶切除病人术后早期恢复,减少并发症,缩短住院时间,降低住院费用,节约医疗成本。 展开更多
关键词 肝叶切除术 加速康复外科 围术期
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控制性低中心静脉压技术在腹腔镜肝切除术中的应用效果 预览
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作者 淦勤 《中国当代医药》 2020年第2期62-64,共3页
目的探讨控制性低中心静脉压技术在腹腔镜肝切除术中的应用效果。方法选取2014年10月~2019年1月我院肝胆胰外科接诊的100例腹腔镜肝切除术患者作为研究对象,随机分为对照组和观察组,每组各50例。对照组患者行正常中心静脉压技术,观察组... 目的探讨控制性低中心静脉压技术在腹腔镜肝切除术中的应用效果。方法选取2014年10月~2019年1月我院肝胆胰外科接诊的100例腹腔镜肝切除术患者作为研究对象,随机分为对照组和观察组,每组各50例。对照组患者行正常中心静脉压技术,观察组患者行控制性低中心静脉压技术。比较两组患者的手术相关指标、肝肾功能、以及术前术后的血气分析指标。结果观察组患者的总出血量、术中出血量均少于对照组,切肝时间短于对照组,差异有统计学意义(P<0.05)。术前1 d,两组患者的总胆红素、血肌酐、丙氨酸转氨酶和血尿素氮水平比较,差异无统计学意义(P>0.05);术后1 d,两组患者的总胆红素、血肌酐、丙氨酸转氨酶和血尿素氮水平均高于术前1 d,且观察组均低于对照组,差异有统计学意义(P<0.05)。术后1 d,两组患者的血气酸碱度(pH)、血氧饱和度(SpO2)比较,差异无统计学意义(P>0.05);观察组患者的氧分压(PaO2)、剩余碱(BE)均低于对照组,碳酸氢根(HCO^-3)高于对照组,差异有统计学意义(P<0.05)。结论控制性低中心静脉压技术在腹腔镜肝切除中不仅能减少出血量,缩短切肝时间,促进肝肾功能恢复,且能减少对动脉血气指标的影响,值得在临床上大力推广。 展开更多
关键词 控制性低中心静脉压技术 腹腔镜 肝切除
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International consensus statement on robotic hepatectomy surgery in 2018 预览
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作者 Rong Liu Go Wakabayashi +19 位作者 Hong-Jin Kim Gi-Hong Choi Anusak Yiengpruksawan Yuman Fong Jin He Ugo Boggi Roberto I Troisi Mikhail Efanov Daniel Azoulay Fabrizio Panaro Patrick Pessaux Xiao-Ying Wang Ji-Ye Zhu Shao-Geng Zhang Chuan-Dong Sun Zheng Wu Kai-Shan Tao Ke-Hu Yang Jia Fan Xiao-Ping Chen 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第12期1432-1444,共13页
The robotic surgical system has been applied in liver surgery. However, controversies concerns exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surger... The robotic surgical system has been applied in liver surgery. However, controversies concerns exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. To promote the development of robotic hepatectomy, this study aimed to evaluate the current status of robotic hepatectomy and provide sixty experts’ consensus and recommendations to promote its development. Based on the World Health Organization Handbook for Guideline Development, a Consensus Steering Group and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations.The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 22 topics were prepared analyzed and widely discussed during the 4 meetings. Based on the published articles and expert panel opinion, 7 recommendations were generated by the GRADE method using an evidence-based method, which focused on the safety, feasibility, indication, techniques and cost-effectiveness of hepatectomy. Given that the current evidences were low to very low as evaluated by the GRADE method, further randomized-controlled trials are needed in the future to validate these recommendations. 展开更多
关键词 MINIMALLY INVASIVE SURGERY ROBOTIC HEPATECTOMY Laparoscopic HEPATECTOMY HEPATECTOMY resection Consensus STATEMENT
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Outcomes of staged hepatectomies for liver malignancy 预览
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作者 Naif A Albati Ali A Korairi +2 位作者 Ibrahim Al Hasan Helayel K Almodhaiberi Abdullah A Algarni 《世界肝病学杂志:英文版(电子版)》 2019年第6期513-521,共9页
Liver malignancies are the fifth most common cause of death worldwide.Surgical intervention with curative intent is the treatment of choice for liver tumors as it provides long-term survival.However,only 20%of patient... Liver malignancies are the fifth most common cause of death worldwide.Surgical intervention with curative intent is the treatment of choice for liver tumors as it provides long-term survival.However,only 20%of patients with metastatic liver lesions can be managed by curative liver resection.In most of the cases,hepatectomy is not feasible because of insufficient future liver remnant(FLR).Two-stage hepatectomy is advocated to achieve liver resection in a patient who is considered to not be a candidate for resection.Procedures of staged hepatectomy include conventional two-stage hepatectomy,portal vein embolization,and associating liver partition and portal vein ligation for a staged hepatectomy.Technical success is high for each of these procedures but variable between them.All the procedures have been reported as being effective in achieving a satisfactory FLR and completing the second-stage resection.Moreover,the overall survival and disease-free survival rates have improved significantly for patients who were otherwise considered nonresectable;yet,an increase in the morbidity and mortality rates has been observed.We suggest that this type of procedure should be carried out in high-flow centers and through a multidisciplinary approach.An experienced surgeon is key to the success of those interventions. 展开更多
关键词 Staged HEPATECTOMY PORTAL VEIN EMBOLIZATION PORTAL VEIN LIGATION Colorectal LIVER metastasis Hepatocellular carcinoma Associated LIVER partition and PORTAL VEIN LIGATION for staged HEPATECTOMY
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Outcomes of central hepatectomy versus extended hepatectomy 预览
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作者 Jenny Chan Luke Bradshaw +9 位作者 Nezor Houli Laurence Weinberg Marcos V Perini Michael Fink Vijayaragavan Muralidharan Graham Starkey Robert Jones Bao Zhong Wang Christopher Christophi Mehrdad Nikfarjam 《国际肝胆胰疾病杂志:英文版》 SCIE CAS CSCD 2019年第3期249-254,共6页
Background: Central hepatectomy(CH) is more difficult than extended hepatectomy(EH) and is associated with greater morbidity. In this modern era of liver management with aims to prevent posthepatectomy liver failure(P... Background: Central hepatectomy(CH) is more difficult than extended hepatectomy(EH) and is associated with greater morbidity. In this modern era of liver management with aims to prevent posthepatectomy liver failure(PHLF), there is a need to assess outcomes of CH as a parenchyma-sparing procedure for centrally located liver tumors. Methods: A total of 178 major liver resections performed by specialist surgeons from two Australian tertiary institutions between June 2009 and March 2017 were reviewed. Eleven patients had CH and 24 had EH over this study period. Indications and perioperative outcomes were compared between the groups. Results: The main indication for performing CH was colorectal liver metastases. There was no perioperative mortality in the CH group and four(16.7%) in the EH group( P = 0.285). No group differences were found in median operative time [CH vs. EH: 450 min(290–840) vs. 523 min(310–860), P = 0.328], intraoperative blood loss [850 mL(40 0–150 0) vs. 650 mL(10 0–20 0 0), P = 0.746] or patients requiring intraoperative blood transfusion [1(9.1%) vs. 7(30.4%), P = 0.227]. There was a trend towards fewer hepatectomyspecific complications in the CH group [3(27.3%) vs. 13(54.2%), P = 0.167], including PHLF(CH vs. EH: 0 vs. 29.2%, P = 0.072). Median length of stay was similar between groups [CH vs. EH: 9 days(5–23) vs. 12 days(4–85), P = 0.244]. Conclusions: CH has equivalent postoperative outcomes to EH. There is a trend towards fewer hepatectomy-specific complications, including PHLF. In appropriate patients, CH may be considered as a safe parenchyma-sparing alternative to EH. 展开更多
关键词 CENTRAL HEPATECTOMY Mesohepatectomy CENTRAL bisectionectomy CENTRAL bisegmentectomy EXTENDED HEPATECTOMY
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精准肝切除在肝癌手术中的应用研究 预览
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作者 郭勇 蒲邦明 +2 位作者 喻淋淋 方超 高源 《基层医学论坛》 2019年第28期4022-4024,共3页
目的研究精准肝切除在肝癌手术中的应用效果。方法将我院收治的肝癌患者83例平均分为2组,对照组患者行常规肝切除手术,观察组患者行精准肝切除手术。观察2组患者的手术时间、术中失血量、术后ALB值以及切除肝脏体积。结果观察组手术时间... 目的研究精准肝切除在肝癌手术中的应用效果。方法将我院收治的肝癌患者83例平均分为2组,对照组患者行常规肝切除手术,观察组患者行精准肝切除手术。观察2组患者的手术时间、术中失血量、术后ALB值以及切除肝脏体积。结果观察组手术时间(164.14±20.14)min、术中失血量(184.17±10.75)m L、术后ALB值(30.78±0.21)g/L、切除肝脏体积(75.47±10.24)cm3,并发症发病率为11.90%,均优于对照组(P<0.05)。结论精准肝切除手术能够缩短手术时间,降低患者手术中的痛苦,提高预后,降低并发症发生率。 展开更多
关键词 肝癌 常规切除 精准肝切除 疗效对比
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重视肝切除的核心策略:血流控制和切面确定
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作者 刘荣 刘渠 《中华外科杂志》 CAS CSCD 北大核心 2019年第7期500-502,共3页
选择恰当的出血控制技术和确定断肝平面是肝切除手术的核心技术环节,不仅关系到手术的顺利实施,更能够影响患者的预后。预先控制拟切除肝脏的血管,用防止出血的风险预先控制理念代替术中止血的传统理念能够有效控制肝切除术中出血。综... 选择恰当的出血控制技术和确定断肝平面是肝切除手术的核心技术环节,不仅关系到手术的顺利实施,更能够影响患者的预后。预先控制拟切除肝脏的血管,用防止出血的风险预先控制理念代替术中止血的传统理念能够有效控制肝切除术中出血。综合应用缺血线引导、术中超声定位技术、目标肝段门静脉染色技术、荧光染色技术、循肝静脉技术及三维可视化技术有助于在术中准确判定拟切除肝脏边界并引导手术断肝平面。 展开更多
关键词 肝切除术 解剖 出血控制 切除平面 手术入路
Current status of associating liver partition with portal vein ligation for staged hepatectomy:Comparison with two-stage hepatectomy and strategies for better outcomes 预览
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作者 Kin Pan Au Albert Chi Yan Chan 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第43期6373-6385,共13页
Since its introduction in 2012,associating liver partition with portal vein ligation for staged hepatectomy(ALPPS)has significantly expanded the pool of candidates for liver resection.It offers patients with insuffici... Since its introduction in 2012,associating liver partition with portal vein ligation for staged hepatectomy(ALPPS)has significantly expanded the pool of candidates for liver resection.It offers patients with insufficient liver function a chance of a cure.ALPPS is most controversial when its high morbidity and mortality is concerned.Operative mortality is usually a result of posthepatectomy liver failure and can be minimized with careful patient selection.Elderly patients have limited reserve for tolerating the demanding operation.Patients with colorectal liver metastasis have normal liver and are ideal candidates.ALPPS for cholangiocarcinoma is technically challenging and associated with fair outcomes.Patients with hepatocellular carcinoma have chronic liver disease and limited parenchymal hypertrophy.However,in selected patients with limited hepatic fibrosis satisfactory outcomes have been produced.During the inter-stage period,serum bilirubin and creatinine level and presence of surgical complication predict mortality after stage II.Kinetic growth rate and hepatobiliary scintigraphy also guide the decision whether to postpone or omit stage II surgery.The outcomes of ALPPS have been improved by a combination of technical modifications.In patients with challenging anatomy,partial ALPPS potentially reduces morbidity,but remnant hypertrophy may compare unfavorably to a complete split.When compared to conventional two-stage hepatectomy with portal vein embolization or portal vein ligation,ALPPS offers a higher resection rate for colorectal liver metastasis without increased morbidity or mortality.While ALPPS has obvious theoretical oncological advantages over two-stage hepatectomy,the long-term outcomes are yet to be determined. 展开更多
关键词 Associating liver partition with portal vein ligation for staged hepatectomy Two-stage hepatectomy Patient selection Surgical outcomes
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ALPPS在合并轻中度肝纤维化肝细胞癌患者中的应用分析
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作者 刘春红 邓明武 +8 位作者 邱思远 朱洪涛 许邦仁 洪晓明 纪任 吴国际 陈智仁 张丹图 卢宠茂 《中华肝胆外科杂志》 CAS CSCD 北大核心 2019年第11期806-808,共3页
目的探讨联合肝脏离断和门静脉结扎的二步肝切除术(ALPPS)在轻度、中度肝纤维化的肝细胞癌患者中的应用价值。方法回顾性分析2014年4月至2017年12月香港大学深圳医院肝胆胰外科14例行ALPPS的原发性肝癌患者资料,其中男性9例,女性5例,平... 目的探讨联合肝脏离断和门静脉结扎的二步肝切除术(ALPPS)在轻度、中度肝纤维化的肝细胞癌患者中的应用价值。方法回顾性分析2014年4月至2017年12月香港大学深圳医院肝胆胰外科14例行ALPPS的原发性肝癌患者资料,其中男性9例,女性5例,平均年龄51(26~71)岁,Child-Pugh均为A级。分析患者肝纤维化程度、手术情况以及术后并发症等。结果14例肝癌患者均成功完成二步肝切除术,1例患者二步手术后因肝功能衰竭死亡。无纤维化4例患者,两手术间隔平均9.0 d,剩余肝体积增长率平均为58%。轻度纤维化5例,两手术间隔平均11.2 d,剩余肝体积增长率平均46%。中度纤维化5例,两手术间隔平均12.8 d,剩余肝体积增长率平均45.6%。14例患者术后发生并发症4例,2例肝功能衰竭,1例肠梗阻,1例肝腹水。结论ALPPS用于Child-Pugh A级合并轻度、中度肝纤维化肝细胞癌治疗安全可行。 展开更多
关键词 肝硬化 肝细胞 肝切除术 联合肝脏离断和门静脉结扎的二步肝切除术
Reappraisal of Hepatocellular Adenoma from Federal Health System, Rio de Janeiro, Brazil 预览
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作者 Reinaldo Fernandes Klaus Steinbruck +9 位作者 Danielle B. Delai lia R. N. Souza Igor Duque Daniel Barbosa Marcelo Enne Renato Cano Marcelo D’Oliveira Luiza Maciel Giuliano Bento 《器官移植外科学期刊(英文)》 2019年第1期1-10,共10页
Background: Hepatocellular adenoma is a rare liver tumor that may require surgical treatment in cases of hemorrhage or suspicion of malignant lesions. Aim: To analyze data from patients who underwent hepatectomy for h... Background: Hepatocellular adenoma is a rare liver tumor that may require surgical treatment in cases of hemorrhage or suspicion of malignant lesions. Aim: To analyze data from patients who underwent hepatectomy for hepatocellular adenoma (HCA) in Rio de Janeiro, Brazil. Methods: From January 2005 to March 2019, sixty-nine patients with HCA underwent hepatectomy at centers in Rio de Janeiro. They were included in the analysis patients undergoing hepatectomy with pathological diagnosis of hepatocellular adenoma and excluded patients with hepatectomy with anatomopathological diagnosis other than hepatocellular adenoma, mainly nodular focal hyperplasia. Data related to patients, tumor and surgery were analyzed retrospectively. Results: Sixty patients (87%) were female and nine were male. Among women, 83% had a history of contraceptive use;among men, only one had an androgen intake history. Overall mean age was 36.4 years (15 - 49), with men older than women (33.9 ± 8.14 years vs. 40.4 ± 6.27 years;P = 0.02). Forty one patients reported abdominal pain, associated or not to other symptoms;32% had an episode of hemorrhage;28 were asymptomatic with an incidental radiological finding. In total, 45 patients presented only one lesion and overall mean size was 8.1 cm (2 - 31);tumors were larger among men (mean size 12.9 ± 9.86 cm vs. 7.7 ± 4.58 cm;P = 0.009). Twenty one surgeries were laparoscopic. Hepatocellular carcinoma (HCC) was identified in three specimens and the incidence was higher among men (22.2% vs. 1.6%;P = 0.042) and in tumors larger than 20 cm (66.6% vs. 0.02%). There was no perioperative mortality. Two of the three patients with HCC died with extrahepatic recurrence;the remaining patient is well after 36 months. Overall mean follow-up time was 14.2 months (2 - 76). Conclusion: Male patients with HCA were older and had larger tumors when compared to females. Incidence of HCC was higher among men and in lesions larger than 20 cm. Male patients with HCA should be treated more aggressively than females. 展开更多
关键词 HEPATOCELLULAR ADENOMA HEPATOCELLULAR CARCINOMA HEPATECTOMY
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外科医生面对肝癌术后复发的无奈及作为
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作者 姜洪池 《中国实用外科杂志》 CSCD 北大核心 2019年第10期1025-1026,共2页
尽管部分肝癌病人行根治性切除术后可无瘤生存数十年,但多数病人虽经外科医师不懈努力,却在术后不久复发甚至出现远处转移,此情况令外科医生感到无奈及沮丧。然而,对于此类病人,外科医师依然需要而且应该有所作为,包括规范化实施初次及... 尽管部分肝癌病人行根治性切除术后可无瘤生存数十年,但多数病人虽经外科医师不懈努力,却在术后不久复发甚至出现远处转移,此情况令外科医生感到无奈及沮丧。然而,对于此类病人,外科医师依然需要而且应该有所作为,包括规范化实施初次及再次肝切除手术,严格遵守无瘤原则,联合射频消融、经导管动脉化疗栓塞等方法进行多学科综合治疗,甚至进行肝移植手术。 展开更多
关键词 肝癌 术后复发 肝切除 多学科综合治疗协作组
巨块型肝癌联合肝脏分隔和门静脉结扎的二步肝切除术后门静脉血流动力学变化与剩余肝脏体积增生的相关性 预览
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作者 卢婷婷 徐邦浩 +3 位作者 文张 郭雅 李智贤 王斯达 《中国医学影像学杂志》 CSCD 北大核心 2019年第4期273-276,281共5页
目的探讨联合肝脏分隔和门静脉结扎的二步肝切除术(ALPPS)Ⅰ期术后门静脉血流动力学变化与剩余肝脏体积增生的相关性。资料与方法回顾性分析成功施行ALPPS手术的 6例患者的临床资料,通过彩色多普勒超声测量各时期门静脉直径、最大血流速... 目的探讨联合肝脏分隔和门静脉结扎的二步肝切除术(ALPPS)Ⅰ期术后门静脉血流动力学变化与剩余肝脏体积增生的相关性。资料与方法回顾性分析成功施行ALPPS手术的 6例患者的临床资料,通过彩色多普勒超声测量各时期门静脉直径、最大血流速度,分析 ALPPS-Ⅰ期门静脉血流动力学变化与剩余肝体积增生的相关性。结果6例患者术后剩余肝平均增生率为36.11%±24.08%。Pearson相关分析发现,ALPPS-Ⅰ期术后第3天门静脉主干直径(r=0.745,P=0.045)及门静脉血流量(r=0.742,P=0.046)、第5天门静脉左支直径(r=0.906,P=0.006)及血流速度(r=0.792,P=0.030)、血流量(r=0.841,P=0.018)与Ⅰ期术后剩余肝脏体积的增生率存在明显相关性。结论ALPPS-Ⅰ期术后患者门静脉血流动力学与剩余肝脏体积的增生存在一定的相关性,其血流动力学的检测可能有助于预测ALPPS-Ⅰ期术后剩余肝体积增生情况。 展开更多
关键词 肝肿瘤 肝切除术 结扎术 门静脉 超声检查 多普勒 彩色 血流动力学 增生
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