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Pyogenic liver abscess:An audit of 10 years’experience

World Journal of Gastroenterology 2011年第12期17卷 1622-1630页

作者： tony cy pang Thomas Fung Jaswinder Samra Thomas J Hugh Ross C Smith Upper Gastrointestinal Surgical Unit Royal North Shore HospitalUniversity of SydneySt Leonards NSW 2065Australia

AIM:To describe our own experience with pyogenic liver abscesses over the past 10 years and investigate the risk factors associated with failure of initial percutaneous ***:A retrospective study of records of 63 PLA patients presenting between 1998 and 2008 to Australian tertiary referral centre,were *** and hydatid abscesses were ***,clinical,radiological,and microbiological characteristics,as well as surgical/radiological interventions,were ***:Sixty-three patients(42 males,21 females) aged 65(±14) years[mean±(SD) ]had prodromal symptoms for a median(interquartile range;IQR) of 7(5-14) *** 59%of patients were febrile at presentation;however,the serum C-reactive protein was elevated in all 47 in whom it was *** function tests were non-specifically abnormal.67%of patients had a solitary abscess,while 32%had>3 abscesses with a median(IQR) diameter of 6.3(4-9) *** organisms were:Streptococcus milleri 25%,Klebsiella pneumoniae 21%,and Escherichia coli 16%.A presumptive cryptogenic cause was most common (34%).Four patients died in this series:one from sepsis,two from advanced cancer,and one from acute myocardial *** initial procedure was radiological aspiration±drainage in 54 and surgery in two patients.17%underwent surgical management during their *** hypoalbuminaemia[mean (95%CI) :32(29-35) g/L vs 28(25-31) g/L,P=0.045] on presentation was found to be the only factor related to failure of initial percutaneous therapy on univariate ***:PLA is a diagnostic challenge,because the presentation of this condition is *** antibiotics and radiological drainage in the first instance allows resolution of most PLAs;However,a small proportion of patients still require surgical drainage.

关键词： Pyogenic liver abscess Image guided drainage Surgical drainage C-reactive protein Hypoalbuminaemia

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Surgical management of hepatocellular carcinoma

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World Journal of Hepatology 2015年第2期7卷 245-252页

作者： tony cy pang Vincent WT Lam Department of Surgery Westmead Hospital Western Clinical School Sydney Medical School University of Sydney

Hepatocellular carcinoma(HCC) is the second most common cause of death from cancer worldwide. Standard potentially curative treatments are either resection or transplantation. The aim of this paper is to provide an overview of the surgical management of HCC, as well as highlight current issues in hepatic resection and transplantation. In summary, due to the relationship between HCC and chronic liver disease, the management of HCC depends both on tumourrelated and hepatic function-related considerations. As such, HCC is currently managed largely through nonsurgical means as the criteria, in relation to the above considerations, for surgical management is still largelyrestrictive. For early stage tumours, both resection and transplantation offer fairly good survival outcomes(5 years overall survival of around 50%). Selection therefore would depend on the level of hepatic function derangement, organ availability and local expertise. Patients with intermediate stage cancers have limited options, with resection being the only potential for cure. Otherwise, locoregional therapy with transarterial chemoembolization or radiofrequency ablation are viable options. Current issues in resection and transplantation are also briefly discussed such as laparoscopic resection, ablation vs resection, anatomical vs non-anatomical resection, transplantation vs resection, living donor liver transplantation and salvage liver transplantation.

关键词： Hepatocellular carcinoma Liver surgery Liver resection Liver transplantation Laparoscopic liversurgery

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