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Routine use of a transanastomotic stent is unnecessary for hepatojejunostomy in liver transplantation

Chinese Medical Journal 2012年第14期125卷 2411-2416页

作者： WANG Gen-shu YANG Yang JIANG Nan FU Bin-sheng LI Hua LI Shi-hui JIN Hai YANG Jian-xu ZHANG Jian CHEN Gui-hua Liver Transplantation Center Department of Hepatic Surgery

Background The use of transanastomotic stents for Roux-en-Y hepatojejunostomy （RYHJ） in liver transplantation （LT） remains controversial. The aim of this retrospective study was to assess the role of transanastomotic stent for RYHJ in LT. Methods RYHJ for biliary reconstruction in LT was performed in 52 patients. Twenty-five patients had bile duct reconstruction by RYHJ with transanastomotic stents （S group）, while 27 patients underwent the same procedure without transanastomotic stents （non-S group）. The two groups were compared in terms of post-LT biliary complications and survival. Results The incidences of bile leakage, anastomotic stricture, non-anastomotic stricture, biliary sludge/lithiasis and biliary infection were 12% （3/25）, 9.5% （2/21）, 23.5% （4/17）, 11.8% （2/17）, and 24% （6/25）, respectively in the S group, and 0, 0, 20.0% （5/25）, 10.0% （2/20）, and 16.7% （4/24）, respectively in the non-S group. One and three year survival rates were 48.0% （12/25） and 34.0% （8/23）, respectively, in the S group and 57.7% （15/26） and 38.9% （7/18）, respectively, in the non-S group. There was no significant difference between the two groups in terms of the incidence of various biliary complications and survival （P 〉0.05）. Conclusion The routine use of transanastomotic stents is not necessary for RYHJ for biliary reconstruction in LT.

关键词： hepatojejunostomy liver transplantation, stent

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Current role of palliative interventions in advanced pancreatic cancer

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World Journal of Gastrointestinal Surgery 2018年第7期10卷 75-83页

作者： Chelsey C Ciambella Rachel E Beard Thomas J Miner Department of Surgical Oncology Warren Alpert Medical School Brown University

Pancreatic adenocarcinoma is the third leading cause of cancer death in the United States. Unfortunately, at diagnosis, most patients are not candidates for curative resection. Surgical palliation, a procedure performed with the intention of relieving symptoms or improving quality of life, comes to the forefront of management. This article reviews the palliative management of unresectable pancreatic cancer, including obstructive jaundice, duodenal obstruction and pain control with celiac plexus block. Although surgical bypasses for both biliary and duodenal obstructions usually achieve good technical success, they result in considerable perioperative morbidity and mortality, even when performed laparoscopically. The effectiveness of selfexpanding metal stents for biliary drainage is excellent with low morbidity. Surgical gastrojejunostomy for duodenal obstruction appears to be best for patients with a life expectancy of greater than 2 mo while endoscopic stenting has been shown to be feasible with good symptom relief in those with a shorter life expectancy. Regardless of the palliative procedure performed, all physicians involved must be adequately trained in end of life management to ensure the best possible care for patients.

关键词： Surgical palliation Duodenal obstruction hepatojejunostomy Gastrojejunostomy Endoscopic stenting Malignant ascites Celiac block Palliative triangle Pancreatic cancer Obstructive jaundice

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Iatrogenic bile duct injury with loss of confluence

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World Journal of Gastrointestinal Surgery 2015年第10期7卷 254-260页

作者： Miguel-Angel Mercado Mario Vilatoba Alan Contreras Pilar Leal-Leyte Eduardo Cervantes-Alvarez Juan-Carlos Arriola Bruno-Adonai Gonzalez Surgery Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán PECEM Facultad de MedicinaUniversidad Nacional Autónoma de México

AIM: To describe our experience concerning the surgical treatment of Strasberg E-4(Bismuth Ⅳ) bile duct injuries. METHODS: In an 18-year period, among 603 patients referred to our hospital for surgical treatment of complex bile duct injuries, 53 presented involvement of the hilar confluence classified as Strasberg E4 injuries. Imagenological studies, mainly magnetic resonance imaging showed a loss of confluence. The files of these patients were analyzed and general data were recorded, including type of operation and postoperative outcome with emphasis on postoperative cholangitis, liver function test and quality of life. The mean time of follow-up was of 55.9 ± 52.9 mo(median = 38.5, minimum = 2, maximum = 181.2). All other patients with Strasberg A, B, C, D, E1, E2, E3, or E5 biliary injuries were excluded from this ***: Patients were divided in three groups: G1(n = 21): Construction of neoconfluence + Roux-en-Y hepatojejunostomy. G2(n = 26): Roux-en-Y portoenterostomy. G3(n = 6): Double(right and left) Rouxen-Y hepatojejunostomy. Cholangitis was recorded in two patients in group 1, in 14 patients in group 2, and in one patient in group 3. All of them required transhepatic instrumentation of the anastomosis and six patients needed live ***: Loss of confluence represents a surgicalchallenge. There are several treatment options at different stages. Roux-en-Y bilioenteric anastomosis(neoconfluence, double-barrel anastomosis, portoenterostomy) is the treatment of choice, and when it is technically possible, building of a neoconfluence has better outcomes. When liver cirrhosis is shown, liver transplantation is the best choice.

关键词： Bile duct injury hepatojejunostomy Biliary repair

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