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Duodenum-preserving local excision of a gastrointestinal stromal tumor

Hepatobiliary & Pancreatic Diseases International 2008年第2期7卷 214-216页

作者： chandika ah liyanage Sanjaya Abeygunawardhana Sumudu Kumarage Kemal I Deen Department of Surgery University of Kelaniya Medical School Ragama Sri Lanka

BACKGROUND:Duodenal gastrointestinal stromal tumors (GISTs) are rare. Because of the complex anatomy of the duodenum, the methods of resection of these tumors are controversial and diverse. METHODS:We report a case of a duodenal GIST in the anterolateral wall of the second part of the duodenum, which was successfully managed by local excision. The surgery was facilitated by preoperative mapping with Indian ink and navigation by endoscopy to assess the adequacy of resection and to avoid injury to the ampulla. RESULT:Reconstruction was successful with a duodeno-jejunostomy and protected by a nasoduodenal drain. CONCLUSION:The patient had no postoperative complications and the tumor was confirmed to be a GIST of the duodenum successful with an adequate resection margin.

关键词： gastrointestinal stromal tumor local excision, duodenum

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Clinical characteristics and outcome of hepatocellular carcinoma in alcohol related and cryptogenic cirrhosis: a prospective study

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Hepatobiliary & Pancreatic Diseases International 2015年第4期14卷 401-405页

作者： Rohan C Siriwardana Maduni A Niriella Anuradha S Dassanayake chandika liyanage Bhagya Gunathilaka Subani Jayathunge Hithanadura J de Silva Department of Surgery Faculty of Medicine University of Kelaniya Department of Medicine Faculty of Medicine University of Kelaniya Department of Pharmacology Faculty of Medicine University of Kelaniya

BACKGROUND： Non-alcoholic fatty liver disease （NAFLD） is becoming a leading cause of chronic liver disease. Hepato- cellular carcinoma （HCC） is one of its complications. Although the pathophysiology is unclear, it is reasonable to expect that cryptogenic cirrhosis related HCC （cryptogenic HCC） behaves differently to other types of HCC. This study prospectively compared patients with cryptogenic HCC and those with HCC related to alcoholic cirrhosis. METHODS： A total of 150 consecutive patients with HCC （89 cryptogenic HCC and 61 alcohol related HCC） referred to our unit over a 23-month period were studied. Their demographic data, liver function, tumor characteristics and outcomes were compared. RESULTS： Alcohol related HCC was seen only in males. Com- pared with cryptogenic HCC, alcohol related HCC had signifi- cantly higher aspartate aminotransferase/alanine aminotrans- ferase （AST/ALT） ratio （1.7 vs 1.4, P=0.002）, model for end- stage liver disease score （13 vs 11, P=0.018） and Child＇s score （7 vs 6, P=0.037）. No significant difference was seen in platelet counts, serum sodium and AST to platelet ratio index. Single nodular tumors were more common in cryptogenic HCC, while diffuse type tumors and macroscopic vascular invasion were common in alcohol related HCC. In patients who could not be offered any treatment because of advanced tumors or poor liver function, alcohol related HCC had a significantly lower median survival （5.3 months） compared with crypto- genic HCC （9.3 months, P=0.034）.CONCLUSIONS： Compared wtih cryptogenic HCC, alcohol related HCC had worse liver function and aggressive tumor morphology at presentation, and a higher proportion was untreatable. In patients who could not be treated, median sur- vival was lower in patients with alcohol related HCC than in those with cryptogenic HCC.

关键词： hepatocellular carcinoma liver diseases alcoholic fatty liver

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