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Hepatobiliary & Pancreatic Diseases International 2008年第1期7卷 82-85页

作者： harsheet sethi Parthi Srinivasan Gabriele Marangoni Andreas Prachalias Mohamed Rela Nigel Heaton Institute of Liver Studies Kings College London School of Medicine at Kings College HospitalDenmark HillLondon SE5 9RSUK

BACKGROUND: hronic liver disease has been considered a contraindication to radical surgery for intra-abdominal tumors because of the risk of decompensation. METHODS: In a retrospective analysis of all patients undergoing pancreaticoduodenectomy for cancer treated from January 2000 to December 2006 at our center, 4 patients were identified with operable pancreatic tumors and well-compensated chronic liver disease. The preoperative staging, decompression of the biliary tree, liver biopsy, Child-Turcot-Pugh and MELD scores were ***: All patients underwent pancreaticoduodenectomy successfully with minimal blood loss, and no peri-operative blood transfusions or liver decompensation. There was no postoperative mortality. Two patients received adjuvant chemotherapy. One patient died with recurrent disease at 18 months, one is alive with disease recurrence, and two are alive and disease ***: Patients with pancreatic cancer and well-compensated chronic liver disease should routinely be considered for radical surgery at specialist hepatobiliary centres with expertise available to manage complex liver disease.

关键词： pancreaticoduodenectomy Whipple's cirrhosis chronic liver disease portal hypertension

Liver resection in liver transplant recipients

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Hepatobiliary & Pancreatic Diseases International 2008年第6期7卷 590-594页

作者： Gabriele Marangoni Walid Faraj harsheet sethi Mohamed Rela Paolo Muiesan Nigel Heaton King's College London School of Medicine at King's College Hospital Institute of Liver StudiesDenmark Hill SE5 9RS University Hospital Birmingham EdgbastonB15 2TH

BACKGROUND:Liver resection after liver transplantation is a relatively uncommon *** for liver resection include hepatic artery thrombosis(HAT),non- anastomotic biliary stricture(ischemic biliary lesions), liver abscess,liver trauma and recurrence of hepatocellular carcinoma(HCC).Organ shortage and lower survival after re-transplantation have encouraged us to make attempts at graft salvage. METHODS:Eleven resections at a mean of 59 months after liver transplantation were made over 18 *** for liver resection included HCC recurrence in 4 patients, ischemic cholangiopathy,segmental HAT,sepsis and infected hematoma in 2 each,and ischemic segmentⅣafter split liver transplantation in 1. RESULTS:There was no perioperative *** included one re-laparotomy for small bowel perforation, one bile leak treated conservatively,one right subphrenic collection,one wound infection and 5 episodes of Gram- negative *** patient underwent re-transplantation 4 months after resection for chronic *** were 3 deaths,two from HCC recurrence and one from post- transplant lymphoproliferative *** overall mean follow-up after resection was 48 months. CONCLUSIONS:Liver resection in liver transplant recipients is safe,and has good outcome in selected patients and avoids re-transplantation in the majority of patients. Recipients with recurrent HCC in graft may benefit from resection,but cure is uncommon.

关键词： liver transplantation liver resection hepatocellular carcinoma recurrence

Non-functioning well-differentiated neuroendocrine tumor of the extrahepatic bile duct:an unusual suspect?

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Hepatobiliary & Pancreatic Diseases International 2007年第5期6卷 549-552页

作者： harsheet sethi Mansoor Madanur Parthi Srinivasan Bernard Portmann Nigel Heaton Mohamed Rela Department of Hepatobiliary and Transplant Surgery Kings College HospitalDenmark HillLondon SE5 9RSUK Department of Histopathology Kings College HospitalDenmark HillLondon SE5 9RSUK

BACKGROUND:Neuroendocrine tumors(NETs)arising in the biliary tree are extremely rare,and 37 cases were identified in the English literature. METHODS:A well-differentiated NET was found arising from the junction of the cystic and common hepatic ducts, in a 51-year-old male presenting with pedal edema and weight loss with abnormal liver enzymes and a normal serum bilirubin *** mass was seen on radiological imaging and biopsy of the liver was suggestive of an early cholangiopathy.A bile leak complicating the liver biopsy led to an ERCP that demonstrated a filling defect suggestive of a mass in the common bile duct(CBD). RESULTS:He underwent a successful excision of the tumor with a Roux-en-Y *** diagnosis of NET was made on histological and immunohistochemical analysis of the resected *** remains well and disease free 22 months after surgery. CONCLUSIONS:Recognition of biliary NET continues to be a challenge and an increased awareness of these tumors in rare sites will result in optimal management of these tumors.

关键词： carcinoid neuroendocrine tumor biliary common bile duct

Pseudoaneurysm following laparoscopic cholecystectomy

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Hepatobiliary & Pancreatic Diseases International 2007年第3期6卷 294-298页

作者： Mansoor Ahmed Madanur Narendra Battula harsheet sethi Rahul Deshpande Nigel Heaton Mohamed Rela Institute of Liver Studies Kings College Hospital Denmark HillLondon SE5 9RSUK

BACKGROUND:Laparoscopic cholecystectomy(LC)is the operation of choice for removal of the gallbladder. Unrecognized bile duct injuries present with biliary peritonitis and systemic *** has been shown to cause damage to the vascular wall and therefore delay the healing of injured arteries leading to pseudoaneurysm *** to deal with bile leak and secondary infection may result in pseudoaneurysm formation. This study was to report the incidence and outcomes of pseudoaneurysm in patients with bile leak following LC referred to our hospital. METHODS:A retrospective analysis of our prospectively maintained liver database using pseudoaneurysm, bile leak and bile duct injury following laparoscopic cholecystectomy from January 2000 to December 2005 was performed. RESULTS:A total of 86 cases were referred with bile duct injury and bile leak following LC and of these,4 patients (4.5%)developed hepatic artery pseudoaneurysm(HAP) presenting with haemobilia in 3 and massive intra- abdominal bleed in *** visceral angiography confirmed pseudoaneurysm of the right hepatic artery in 2 cases,cystic artery stump in one and an intact but ectatic hepatic artery with surgical clips closely applied to the right hepatic artery at the origin of the cystic artery in the fourth *** hemostasis was achieved in 3 patients with coil embolization and the fourth patient required emergency laparotomy for severe bleeding and hemodynamic instability due to a ruptured right hepatic *** the 3 patients treated with coil embolization, 2 developed late strictures of the common hepatic duct. . (CHD)requiring hepatico-jejunostomy and one developed a stricture of left hepatic *** the 4 patients are alive at a median follow up of 17 months(range 1 to 65)with normal liver function tests. CONCLUSIONS:HAP is a rare and potentially life- threatening complication of *** and subsequent infection are reported to be associated with pseudoaneurysm *** du

关键词： laparoscopic cholecystectomy bile leaks infection hepatic artery pseudoaneurysm

Selective embolization for bleeding visceral artery pseudoaneurysms in patients with pancreatitis

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Hepatobiliary & Pancreatic Diseases International 2010年第6期9卷 634-638页

作者： harsheet sethi Praveen Peddu Andreas Prachalias Pauline Kane John Karani Mohamed Rela Nigel Heaton Department of Hepatobiliary Surgery Institute ofLiver Studies Kings College London School of Medicine at Kings College Hospital Department of Hepatobiliaryand Interventional Radiology Institute ofLiver StudiesKings College London School of Medicine at Kings College Hospital

BACKGROUND:Pancreatitis is associated with arterial complications in 4%-10%of patients,with untreated mortality approaching 90%.Timely intervention at a specialist center can reduce the mortality to 15%.We present a single institution experience of selective embolization as first line management of bleeding pseudoaneurysms in pancreatitis. METHODS:Sixteen patients with pancreatitis and visceral artery pseudoaneurysms were identified from searches of the records of interventional angiography from January 2000 to June *** visceral artery aneurysms and pseudoaneurysms arising as a result of post-operative pancreatic or biliary leak were excluded from the study. RESULTS:In 50%of the patients,bleeding complicated the initial presentation of *** was the offending agent in 10 patients,gallstones in 3,trauma,drug-induced and idiopathic pancreatitis in one *** 16 patients had a contrast CT scan and 15 underwent coeliac axis angiography. The pseudoaneurysms ranging from 0.9 to 9.0 cm affected the splenic artery in 7 patients:hepatic in 3,gastroduodenal and right gastric in 2 each,and left gastric and pancreatico-duodenal in 1 *** patient developed spontaneous thrombosis of the *** patients had effective coil embolization of the *** patient needed surgical exclusion of the pseudoaneurysm following difficulty in accessing the coeliac axis *** were no episodes of re-bleeding and no in-hospital mortality. CONCLUSIONS:Pseudoaneurysms are unrelated to the severity of pancreatitis and major hemorrhage can occur irrespective of their ***-existent portal hypertension and sepsis increase the risk of *** and selective coil embolization is a safe and effective way to arrest the hemorrhage.

关键词： pseudoaneurysm embolization acute pancreatitis chronic pancreatitis vascular complications