检索结果-南通市图书馆

Utility of plasma D-dimer for diagnosis of venous thromboembolism after hepatectomy

World Journal of Clinical Cases 2024年第2期12卷 276-284页

作者： Taiichiro Miyake Hiroaki Yanagimoto daisuke tsugawa Masayuki Akita Riki Asakura Keisuke Arai Toshihiko Yoshida Shinichi So Jun Ishida Takeshi Urade Yoshihide Nanno Kenji Fukushima Hidetoshi Gon Shohei Komatsu Sadaki Asari Hirochika Toyama Masahiro Kido Tetsuo Ajiki Takumi Fukumoto Division of Hepato-Biliary-Pancreatic Surgery Department of SurgeryKobe University Graduate School of MedicineKobe 650-0017HyogoJapan

BACKGROUND Venous thromboembolism(VTE)is a potentially fatal complication of hepatectomy.The use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative bleeding.Therefore,we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after hepatectomy.AIM To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after hepatectomy.METHODS The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively analyzed.Patients were divided into two groups according to whether or not they developed VTE after hepatectomy,as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower extremities.Clinicopathological factors,including demographic data and perioperative D-dimer values,were compared between the two groups.Receiver operating characteristic curve analysis was performed to determine the D-dimer cutoff value.Univariate and multivariate analyses were performed using logistic regression analysis to identify significant predictors.RESULTS In total,234 patients who underwent hepatectomy were,of whom(5.6%)were diagnosed with VTE following hepatectomy.A comparison between the two groups showed significant differences in operative time(529 vs 403 min,P=0.0274)and blood loss(530 vs 138 mL,P=0.0067).The D-dimer levels on postoperative days(POD)1,3,5,7 were significantly higher in the VTE group than in the non-VTE group.In the multivariate analysis,intraoperative blood loss of>275 mL[odds ratio(OR)=5.32,95%confidence interval(CI):1.05-27.0,P=0.044]and plasma D-dimer levels on POD 5≥21μg/mL(OR=10.1,95%CI:2.04-50.1,P=0.0046)were independent risk factors for VTE after hepatectomy.CONCLUSION Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the postoperative period.

关键词： Hepatectomy Malignant tumor Postoperative complication D-dimer Early diagnosis Venous thromboembolism

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Benefits and limitations of middle bile duct segmental resection for extrahepatic cholangiocarcinoma

引用

Hepatobiliary & Pancreatic Diseases International 2020年第2期19卷 147-152页

作者： Masayuki Akita Tetsuo Ajiki Kimihiko Ueno daisuke tsugawa Motofumi Tanaka Masahiro Kido Hirochika Toyama Takumi Fukumoto Department of Hepato-Biliary-Pancreatic Surgery Kobe University Graduate School of MedicineKobe650-0017Japan

Background:Pancreaticoduodenectomy(PD)is a standardized strategy for patients with middle and distal bile duct cancers.The aim of this study was to compare clinicopathological features of bile duct segmen-tal resection(BDR)with PD in patients with extrahepatic cholangiocarcinoma.Methods:Consecutive cases with extrahepatic cholangiocarcinoma who underwent BDR(n=21)or PD(n=84)with achievement of R0 or R1 resection in Kobe University Hospital between January 2000 and December 2016 were enrolled in the present study.Results:Patients who underwent PD were significantly younger than those receiving BDR.The frequency of preoperative jaundice,biliary drainage and cholangitis was not significantly different between the two groups.The duration of surgery was longer and there was more intraoperative bleeding in the PD than in the BDR group(553 vs.421 min,and 770 vs.402 mL;both PClavien-DindoⅢa)were observed in the PD group(46%vs.10%,P<0.01).Postoperative hospital stay was also longer in that group(30 vs.19 days,P=0.02).Pathological assessment revealed that tumors were less advanced in the BDR group but the rate of lymph node metastasis was similar in both groups(33%in BDR and 48%in PD,P=0.24).The rate of R0 resection was significantly higher in the PD group(80%vs.38%,P<0.01).Adjuvant chemotherapy was more frequently administered to patients in the BDR group(62%vs.38%,P=0.04).Although 5-year overall survival rates were similar in both groups(44%for BDR and 51%for PD,P=0.72),in patients with T1 and T2,the BDR group tended to have poorer prognosis(44%vs.68%at 5-year,P=0.09).Conclusions:BDR was comparable in prognosis to PD in middle bile duct cancer.Less invasiveness and lower morbidity of BDR justified this technique for selected patients in a poor general condition.

关键词： Cholangiocarcinoma Middle bile duct resection Pancreaticoduodenectomy

来源：

维普期刊数据库

同方期刊数据库评论

在线全文

学校读者我要写书评

暂无评论

Risk factors for occult metastasis detected by inflammation-based prognostic scores and tumor markers in biliary tract cancer

引用

World Journal of Clinical Cases 2021年第32期9卷 9770-9782页

作者： Yu Hashimoto Tetsuo Ajiki Hiroaki Yanagimoto daisuke tsugawa Kenta Shinozaki Hirochika Toyama Masahiro Kido Takumi Fukumoto Department of Surgery Division of Hepato-Biliary-Pancreatic SurgeryKobe University Graduate School of MedicineKobeHyogo 650-0017Japan

BACKGROUND Radiological detection of small liver metastasis or peritoneal metastasis is still difficult,and some patients with biliary tract cancer(BTC)are unresectable after laparotomy.Staging laparoscopy may help avoid unnecessary laparotomy.However,which category of BTC is amenable with staging laparoscopy remains unclear.AIM To clarify the risk factors for occult metastasis in patients with BTC.METHODS Medical records of patients with BTC who underwent surgery at our institution between January 2008 and June 2014 were retrospectively reviewed.The patients were divided into two groups,according to resection or exploratory laparotomy(EL).Preoperative laboratory data,including inflammation-based prognostic scores and tumor markers,were compared between the two groups.Prognostic importance of detected risk factors was also evaluated.RESULTS A total of 236 patients were enrolled in this study.Twenty-six(11%)patients underwent EL.Among the EL patients,there were 16 cases of occult metastasis(7 liver metastases and 9 abdominal disseminations).Serum carcinoembryonic antigen level,carbohydrate antigen 19-9 level,neutrophil-lymphocyte ratio and modified Glasgow prognostic score were significantly higher in the EL group than in the resected group,and these factors were prognostic.Among these factors,carcinoembryonic antigen>7 ng/mL was the most useful to predict occult metastasis in BTC.When patients have more than three of these positive factors,the rate of occult metastasis increases.CONCLUSION Inflammation-based prognostic scores and tumor markers are useful in detecting occult metastasis in BTC;based on these factors,staging laparoscopy may reduce the rate of EL.

关键词： Biliary tract cancer Staging laparoscopy Neutrophil-lymphocyte ratio Modified Glasgow prognostic score Carbohydrate antigen 19-9 Carcinoembryonic antigen

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

欢迎您,

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

在线全文

在线全文

在线全文

请选择保存的检索档案：

请选择收藏分类：

通借通还

欢迎您,

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

在线全文

在线全文

在线全文

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：