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Risk factors and prevention of biliary anastomotic complications in adult living donor liver transplantation

World Journal of Gastroenterology 2007年第31期13卷 4236-4241页

作者： Satoshi Yamamoto Yoshinobu Sato Hiroshi Oya Hideki Nakatsuka Takashi Kobayashi Yoshiaki Hara Takaoki Watanabe Isao Kurosaki Katsuyoshi Hatakeyama division of Digestive and general surgery Niigata University Graduate School of Medical and Dental Sciences Niigata Japan

To evaluate risk factors of biliary anastomotic complications （BACs） and outcomes according to type of biliary reconstruction. METHODS： A total of 33 consecutive adult living donor liver transplantation （LDLT） were reviewed, 17 of which had undergone Duct-to-Duct anastomosis （D-D）. The remaining 16 patients received Roux-en-Y anastomosis （R-Y）. The perioperative factors, such as the type of graft and the number of graft bile ducts, were analyzed retrospectively. RESULTS： The overall incidence of BACs was 39.4%. The incidence of BACs was significantly higher in the patients with than without neoadjuvant chemotherapy （71.4% vs 10%, P = 0.050）. There was no significant difference in the incidence of biliary leakage in patients with D-D vs. those with R-Y. The incidence of biliary strictures following the healing of biliary leakage was significantly higher in D-D （60%） than in R-Y （0%）（P = 0.026）. However, the incidence of BACs related bacteremia was significantly higher in R-Y than in D-D （71.4% vs 0%, P = 0.008）. In D-D, use of T-tube stent remarkably reduced the incidence of 8ACs, compared with straight tube stent （0% vs 50%, P = 0.049）. CONCLUSION： Our experience showed an increase of BACs related bacteremia in the patients with R-Y. Therefore, D-D might be a preferred biliary reconstruction. However, the surgical refinement of D-D should be required because of the high incidence of biliary strictures. Use of the T-tube stent might lead to a significant reduction of BACs in D-D.

关键词： Living donor Liver transplantation Biliaryanastomotic complication Duct-to-Duct anastomosis Roux-en-Y anastomosis

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Contrast-free endoscopic stent insertion in malignant biliary obstruction

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World Journal of Gastroenterology 2007年第29期13卷 3973-3976页

作者： Giovanni D De Palma Giovanni Lombardi Maria Rega Immacolata Simeoli Stefania Masone Saverio Siciliano Francesco Maione Francesca Salvatori Antonio Balzano Giovanni Persico Department of general surgery Oncologic Surgery and Advanced Technologies-Center for Technical Innovation in Surgery University of Naples Federico Ⅱ School of Medicine Naples Italy division of Gastroenterology General Hospital A. Cardarelli Naples Italy

AIM： To present a case series of MRCP-guided endoscopic biliary stent placement, performed entirely without contrast injection. METHODS： Contrast-free endoscopic biliary drainage was attempted in 20 patients with malignant obstruction, unsuitable for resection on the basis of tumor extent or medical illness. MRCP images were used to confirm the diagnosis of tumor, to exclude other biliary diseases and to demonstrate the stenoses as well as dilation of proximal liver segments. The procedure was carried out under conscious sedation. Patients were placed in the left lateral decubitus position. The endoscope was inserted, the papilla identified and cannulated by a papiUotome. A guide wire was inserted and guided deeply into the biliary tree, above the stenosis, by fluoroscopy. A papillotomy approximately 1 cm. long was performed and the papillotome was exchanged with a guiding-catheter. A 10 Fr＇ Amsterdam-type plastic stent, 7 to 15 cm long, was finally inserted over the guide wire/ guiding catheter by a pusher tube system. RESULTS： Successful stent insertion was achieved in all patients. There were no major complications. Successful drainage, with substantial reduction in bilirubin levels, was achieved in all patients. CONCLUSION： This new method of contrast-free endoscopic stenting in malignant biliary obstruction is a safe and effective method of palliation. However＇ a larger, randomized study comparing this new approach with the standard procedure is needed to confirm the findings of the present study.

关键词： Endoscopic retrograde cholangiopancreatography Biliary stenoses Biliary drainage Endoscopy Stents

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Hepatic schwannoma:Imaging findings on CT,MRI and contrast-enhanced ultrasonography

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World Journal of Gastroenterology 2012年第35期18卷 4967-4972页

作者： Yu Ota Kazunobu Aso Kenji Watanabe Takahiro Einama Koji Imai Hidenori Karasaki Ryuji Sudo Yosui Tamaki Mituyoshi Okada Yosihiko Tokusashi Toru Kono Naoyuki Miyokawa Masakazu Haneda Masahiko Taniguchi Hiroyuki Furukawa division of Metabolism and Biosystemic Science Department of MedicineAsahikawa Medical University division of Gastroenterologic and general surgery Department of SurgeryAsahikawa Medical University Department of Pathology Asahikawa Medical University

A primary benign schwannoma of the liver is extremely rare and is difficult to preoperatively discriminate from a malignant *** compared the imaging and pathological findings,and examined the possibility of preoperatively diagnosing a benign liver schwannoma.A 72-year-old woman was admitted to our hospital because of a 4.6-cm mass in the liver.A malignant tumor was suspected,and a right hepatectomy was *** this,the diagnosis of a primary benign schwannoma of the liver was made through pathological ***-enhanced ultrasonography(CEUS) with Sonazoid showed minute blood flows into the septum and solid areas of the tumor in the vascular phase;most likely due to increased arterial flow associated with infiltration of chronic inflammatory *** the postvascular phase,CEUS showed contrast defect of cystic areas and delayed enhancement of solid areas;most likely due to aggregation of *** discriminating between a benign and malignant schwannoma of the liver is difficult,surgery is generally ***,the two key findings from CEUS may be useful in discriminating ancient schwannoma by recognizing the hemorrhage involved in the secondary degeneration and aggregation of siderophores.

关键词： Liver schwannoma Contrast-enhanced ul-trasonography Liver resection

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Station 10 lymph node dissections in laparoscopic-assisted spleen-preserving radical gastrectomy for advanced proximal gastric cancer

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Chinese Journal of Cancer Research 2013年第4期25卷 465-467页

作者： Yong Li Junjiang Wang The First division of general surgery Department Guangdong Academy of Medical SciencesGuangdong Genreral Hospital

D2 gastric resection has been increasingly recognized as the optimal surgical treatment for advanced gastric cancer. Dissection of the station 10 splenic lymph nodes is required in the treatment of advanced proximal gastric cancer. Based on vascular anatomy and anatomical plane of fascial space, integrated with our experience in station 10 splenic lymph node dissection in open surgery and proven skills of laparoscopic operation, we have successfully mastered the surgical essentials and technical keypoints in laparoscopic-assisted station 10 lymph node dissection.

关键词： Stomach neoplasm laparoscopy lymph node excision splenic hilar

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Ultrasound-targeted microbubble destruction in gene therapy: A new tool to cure human diseases

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Genes & Diseases 2017年第2期4卷 64-74页

作者： Jun Wu Ren-Ke Li Toronto general Research Institute Division of Cardiovascular SurgeryUniversity Health NetworkTorontoOntarioCanada division of Cardiac surgery Department of SurgeryUniversity of TorontoTorontoOntarioCanada

Human gene therapy has made significant advances in less than two *** this short period of time,gene therapy has proceeded from the conceptual stage to technology development and laboratory research,and finally to clinical trials for the treatment of a variety of deadly *** disease,cancer,and stroke are leading causes of death *** advances in medical,interventional,radiation and surgical treatments,the mortality rate remains high,and the need for novel therapies is *** therapy provides an efficient approach to disease *** advances in gene therapy have been made for genetic disorders,including severe combined immune deficiency,chronic granulomatus disorder,hemophilia and blindness,as well as for acquired diseases,including cancer and neurodegenerative and cardiovascular ***,lack of an efficient delivery system to target cells as well as the difficulty of sustained expression of transgenes has hindered advancements in gene *** targeted microbubble destruction(UTMD)is a promising approach for target-specific gene delivery,and it has been successfully investigated for the treatment of many diseases in the past *** this paper,we review UTMD-mediated gene delivery for the treatment of cardiovascular diseases,cancer and stroke.

关键词： Gene therapy Cardiovascular diseases Cancer Stroke UTMD

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Extended central hepatectomy with preservation of segment 6 for patients with centrally located hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2015年第1期14卷 63-68页

作者： Mahmoud Abdelwahab Ali Jung-Fang Chuang Chee-Chien Yong Chih-Chi Wang Chi-Ying Lin Chao-Long Chen division of general surgery Department of SurgeryKaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Department of surgery PingT ung Christian Hospital

BACKGROUND： In order to preserve functional liver parenchyma, extended central hepatectomy （segments 4, 5, 7 and 8 resection） was proposed for the management of centrally located hepatocellular carcinoma invading the right and middle hepatic veins, reconstructing segment 6 outflow in the absence of the thick inferior right hepatic vein. The present study was to describe our surgical techniques of extended central ***： Between 2008 and 2012, 5 patients with centrally located hepatocellular carcinoma invading or in the vicinity of the right and middle hepatic veins underwent extended central hepatectomy. The thick inferior right hepatic vein was preserved during dissection. Gore-Tex graft was used for segment 6 outflow reconstruction in the absence of the thick inferior right hepatic ***： The mean future remnant liver volume for segments 2 and 3 was 28% versus 45% on segment 6 preservation. The mean tumor diameter was 7.4 cm. The thick inferior right hepatic vein was found in 1 patient. Outflow reconstruction from segment 6 was performed in 4 patients. Postoperative complications included bile leakage （1 patient）, pleural effusion （2） and liver failure （1）. The rate of graft patency was 75%. There was no perioperative ***： Extended central hepatectomy is a safe alternative for extended hepatic resection in selected patients attempting to preserve the functional liver parenchyma.

关键词： hepatectomy hepatic vein thrombosis hepatocellular carcinoma liver cirrhosis liver imaging

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Is anoplasty superior to scar revision surgery for posthemorrhoidectomy anal stenosis?Six years of experience

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World Journal of Clinical Cases 2022年第22期10卷 7698-7707页

作者： Yu-Tse Weng Kuan-Jung Chu Kuan-Hsun Lin Chun-Kai Chang Jung-Cheng Kang Chao-Yang Chen Je-Ming Hu Ta-Wei Pu division of Plastic and Reconstructive surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan National Defense Medical Center Taipei 114Taiwan division of Thoracic surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan division of Plastic and Reconstructive surgery Department of SurgeryZuoying BranchKaohsiung Armed Forces General HospitalKaohsiung 813Taiwan division of Colon and Rectal surgery Department of SurgeryTaiwan Adventist HospitalTaipei 105Taiwan division of Colon and Rectal surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan division of Colon and Rectal surgery Department of SurgerySongshan branchTri-Service General HospitalNational Defense Medical CenterTaipei 105Taiwan

BACKGROUND Anal stenosis is a rare but frustrating condition that usually occurs as a complication of *** severity of anal stenosis can be classified into three categories:mild,moderate,and *** are two main surgical treatments for this condition:scar revision surgery and anoplasty;however,no studies have compared these two approaches,and it remains unclear which is preferrable for stenoses of different *** To compare the outcomes of scar revision surgery and double diamond-shaped flap *** Patients with mild,moderate,or severe anal stenosis following hemorrhoidectomy procedures who were treated with either scar revision surgery or double diamond-shaped flap anoplasty at our institution between January 2010 and December 2015 were investigated and *** severity of stenosis was determined via anal examination performed digitally or using a Hill-Ferguson *** explored patient characteristics included age,sex,preoperative severity of anal stenosis,preoperative symptoms,and preoperative adjuvant therapy;moreover,their postoperative quality of life was measured using a 10-point *** underwent proctologic follow-up examinations one,two,and four weeks after *** We analyzed 60 consecutive patients,including 36 men(60%)and 24 women(40%).The mean operative time for scar revision surgery was significantly shorter than that for double diamondshaped flap anoplasty(10.14±2.31[range:7-15]min vs 21.62±4.68[range:15-31]min;Psurgery than after anoplasty(2.1±0.3 vs 2.9±0.4 d;P<0.001).Postoperative satisfaction was categorized into four groups:45 patients(75%)reported excellent satisfaction(scores of 8-10),13(21.7%)reported good satisfaction(scores of 6-7),two(3.3%)had no change in satisfaction(scores of 3-5),and none(0%)had scores indicating poor satisfaction(1-2).As such,most patients were satisfied wi

关键词： Anal canal Anoplasty Scar revision Stenosis surgery-induced tissue adhesions Surgical flaps

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Role of ileostomy in restorative proctocolectomy

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World Journal of Gastroenterology 2012年第15期18卷 1703-1707页

作者： Gianluca Pellino Guido Sciaudone Silvestro Canonico Francesco Selvaggi division of general surgery Second University of Naples42-80122 NaplesItaly

Restorative proctocolectomy(RP) is the treatment of choice in patients affected with refractory ulcerative colitis or familial adenomatous *** in elective settings is often performed in 2 stages,fashioning an ileostomy which is closed 2-3-mo *** is still debated whether omitting ileostomy could offer advantages in the management of patients undergoing RP.

关键词： Restorative proctocolectomy Ileostomy Ulcerative colitis Familial adenomatous polyposis Ileopouch-anal anastomosis

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Intrathoracic caudate lobe of the liver:A case report and literature review

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World Journal of Gastroenterology 2014年第17期20卷 5147-5152页

作者： Ying-Yi Chen Tsai-Wang Huang Hung Chang Hsian-He Hsu Shih-Chun Lee division of Thoracic surgery Department of Surgery Department of Radiology Tri-Service General HospitalNational Defense Medical Center

Heterotopic supradiaphragmatic livers are rare. A total of 23 cases of primary supradiaphragmatic livers have been reported in the literature. The clinical presentations of heterotopic supradiaphragmatic liver are variable. The simultaneous detection of intrathoracic accessory liver and pulmonary sequestration is extremely rare, and only one case has previously been reported. It is difficult to make a correct diagnosis preoperatively. We presented a 53-year-old woman with complaints of an intermittent, productive cough and dyspnea for two months that was refractory to medical treatment. She had no previous history of trauma or surgery. A chest radiograph only showed a widening of the mediastinum. Contrast-enhanced computed tomography of the chest revealed a well-circumscribed homogenous soft-tissue mass, approximately 4.35 cm × 2.5 cm × 6.14 cm in size, protruding through the right diaphragmatic crura to the right pleural cavity, attached to the inferior vena cava, esophagus and liver. There was no conclusive diagnosis before surgery. After the operation, we discovered that this patient was the first case of a supradiaphragmatic heterotopic liver, which passed through the inferior vena cava foramen and was coincidentally combined with an intralobar pulmonary sequestration that was found intraoperatively. We discussed its successful management with surgical resection via a thoracic approach and reviewed the published literature.

关键词： Intrathoracic liver Pulmonary sequestration Supradiaphragmatic ectopic liver

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Xanthogranulomatous cholecystitis mimicking gallbladder cancer and causing obstructive cholestasis

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Hepatobiliary & Pancreatic Diseases International 2012年第5期11卷 549-552页

作者： Paulo N Martins Patricia Sheiner Marcelo Facciuto Department of surgery Transplant DivisionMassachusetts General HospitalHarvard Medical School Department of surgery Division of Hepatobiliary Surgery and TransplantationNew York Medical College division of Transplantation Mount Sinai Hospital

BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder that can mimic gallbladder carcinoma. METHODS: We present the case of a 35-year-old Hispanic male complaining of right upper quadrant pain and jaundice for 2 months prior to admission. He denied a history of fever, nausea/ vomiting, and weight loss. The past medical history was relevant only for diabetes. He had no previous history of jaundice or previous operations. RESULTS: CA19-9 was slightly elevated (52 U/mL). Abdominal ultrasonography showed an irregular thickening of the gallbladder wall and no gallstones were detected. CT scan also revealed an irregular thickening of the wall of the gallbladder body suggestive of malignancy. At laparotomy, the mass was adherent to the duodenum and colon, and although the frozen section biopsy was negative, the intraoperative findings were suggestive of malignancy, and the patient underwent left liver trisegmentectomy, resection of the common bile duct and Roux-en-Y hepaticojejunostomy. Pathological examination unexpectedly revealed XGC without malignancy. CONCLUSIONS: Preoperative and intraoperative differential diagnosis of XGC from gallbladder carcinoma remains a challenge when it is associated with inflammatory involvement of surrounding tissues. Since gallbladder carcinoma and XGC may coexist, radical resection is justified when malignancy cannot be completely ruled out.

关键词： xanthogranulomatous cholecystitis gallbladder cancer obstructive cholestasis

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