Journal of hepato-biliary-pancreatic surgery最新文献

{"title":"Assessment of hepatic reserve for indication of hepatic resection: how I do it.","authors":"Ronnie T Poon,&nbsp;Sheung Tat Fan","doi":"10.1007/s00534-004-0945-0","DOIUrl":"https://doi.org/10.1007/s00534-004-0945-0","url":null,"abstract":"<p><p>The perioperative outcome of hepatic resection has improved remarkably in recent years with improved surgical techniques and perioperative care. As a result, the indications of hepatic resection have been extended to include patients with borderline liver function, especially those with associated cirrhosis. For such patients, proper preoperative assessment of liver function reserve is essential to ensure a low incidence of postoperative liver failure and mortality. In our center, routine preoperative assessment of hepatic function reserve in all patients includes clinical assessment, liver biochemistry, coagulation profile, platelet count, and Child-Pugh classification. The indocyanine green clearance test is routinely performed for patients with chronic liver disease. For patients with cirrhosis undergoing major hepatectomy, computed tomography volumetry and laparoscopy are helpful in evaluating whether the remnant liver volume is adequate. In selected patients with small remnant liver, preoperative portal vein embolization can be employed to induce hypertrophy of the remnant liver even in the presence of chronic hepatitis and mild cirrhosis. Careful assessment of comorbid conditions of patients and meticulous surgical techniques to reduce bleeding and hypoxic injury to the remnant liver are complementary to the selection of patients with adequate liver function reserve, to minimize operative mortality.</p>","PeriodicalId":15992,"journal":{"name":"Journal of hepato-biliary-pancreatic surgery","volume":"12 1","pages":"31-7"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00534-004-0945-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24993986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How I do it: assessment of hepatic functional reserve for indication of hepatic resection.","authors":"Sung-Gyu Lee,&nbsp;Shin Hwang","doi":"10.1007/s00534-004-0949-9","DOIUrl":"https://doi.org/10.1007/s00534-004-0949-9","url":null,"abstract":"<p><p>Liver resection of up to 75% of the total liver volume (TLV) has been regarded as safe in normal livers, but this concept was challenged by the results of living donor hepatectomies. In normal livers or livers with resolved jaundice, hepatectomy of 65% of TLV may be safe, except for patients with an indocyanine green retention rate at 15 min (ICG R15) of over 15%, excessive hepatic steatosis, and age of over 70 years. However, the permissible extent of hepatectomy has been much restricted in cirrhotic livers because most post-hepatectomy liver failure (PHLF) has occurred in cirrhotic livers. Our routine protocols for the assessment of functional hepatic reserve (FHR) include biochemical liver function tests, ICG R15, Doppler ultrasonography, and triphasic liver computed tomogram (CT) with volumetry. Blood cell count and gastroesophageal endoscopic findings are taken into consideration for cirrhotic livers, as well as age, diabetes, cardiopulmonary function, and general performance. Preoperative portal vein embolization has been used for safe hepatectomy even in cirrhotic livers. We think that any cirrhotic liver showing optimal FHR should have a remnant liver of 40% of TLV to prevent PHLF. ICG R15 and triphasic CT with volumetry have been the most useful methods for assessment of FHR and determination of hepatectomy extent in our institution.</p>","PeriodicalId":15992,"journal":{"name":"Journal of hepato-biliary-pancreatic surgery","volume":"12 1","pages":"38-43"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00534-004-0949-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24994494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The significance of intraoperative Doppler ultrasonography in evaluating hepatic arterial flow when assessing the indications for the Appleby procedure for pancreatic body cancer.","authors":"Ichiro Hirai,&nbsp;Wataru Kimura,&nbsp;Masahiro Kamiga,&nbsp;Masaomi Mizutani,&nbsp;Akiko Takeshita,&nbsp;Toshihiro Watanabe,&nbsp;Akira Fuse","doi":"10.1007/s00534-004-0939-y","DOIUrl":"https://doi.org/10.1007/s00534-004-0939-y","url":null,"abstract":"<p><strong>Background/purpose: </strong>The Appleby procedure has been used in the surgical treatment of advanced gastric cancer. This procedure consists of a combined resection of the whole of the stomach, the body and tail of the pancreas, and the spleen, as well as resection of the celiac artery. This procedure can also be used for operative resection of cancer of the body of the pancreas. The hepatic arterial flow is supplied from the arcade of the supramesenteric artery. In the past, the extent of hepatic arterial flow after the celiac artery had been clamped was evaluated by finger palpation. However, this is not an objective method.</p><p><strong>Methods: </strong>Here, we describe two patients with pancreatic body cancer, in one of whom the Appleby procedure was followed. However, in the other, this operation could not be performed because the residual blood supply to the liver would have been inadequate. The hepatic arterial flow was assessed using intraoperative Doppler ultrasonography (US) of the intrahepatic artery (arterial flow of segment 3).</p><p><strong>Results: </strong>In case 1 (a 45-year-old man), the hepatic arterial flow prior to clamping of the celiac artery was 68.4 cm/s, and this flow was reduced to 22.1 cm/s after the clamping. The color and consistency of the liver surface remained good. Because there was adequate hepatic arterial flow after the celiac artery was clamped, the Appleby procedure was performed. However, in case 2 (a 65-year-old man), the hepatic arterial flow after the celiac artery had been clamped was reduced from 47.9 cm/s to 14.3 cm/s. The liver surface became dark and the liver shrank. In addition, there were various preoperative medical conditions in this patient. We decided not to proceed with the Appleby procedure.</p><p><strong>Conclusions: </strong>Intraoperative Doppler US measurement of the hepatic arterial flow is a useful technique, particularly in combination with the assessment of the color and tension of the liver, the age of the patient, and the extent of preoperative comorbidity, in determining whether an Appleby procedure is feasible.</p>","PeriodicalId":15992,"journal":{"name":"Journal of hepato-biliary-pancreatic surgery","volume":"12 1","pages":"55-60"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00534-004-0939-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24994497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of laparoscopic distal pancreatectomy for the treatment of pancreatic disease.","authors":"Toshifumi Matsumoto,&nbsp;Seitaro Hirano,&nbsp;Kazuhiro Yada,&nbsp;Yoshihisa Himeno,&nbsp;Kohei Shibata,&nbsp;Masanori Aramaki,&nbsp;Katsunori Kawano,&nbsp;Seigo Kitano","doi":"10.1007/s00534-004-0930-7","DOIUrl":"https://doi.org/10.1007/s00534-004-0930-7","url":null,"abstract":"<p><strong>Background/purpose: </strong>There are a few reports of laparoscopic distal pancreatectomy in the literature. We describe our experience with laparoscopic distal pancreatectomy and evaluate the safety and efficacy of the procedure in light of other reported findings.</p><p><strong>Methods: </strong>A retrospective study was performed of all patients who underwent laparoscopic distal pancreatectomy between April 1996 and December 2002 at Oita University Faculty of Medicine.</p><p><strong>Results: </strong>Laparoscopic distal pancreatectomy was attempted in seven patients (three men and four women) with a mean age of 65 years. One patient was converted to open surgery, and two patients required a hand-assistance procedure. There were no complications in any patients. Median operation time for all seven patients was 300 min, and median blood loss was 330 ml. Median postoperative hospital stay was 12 days (range, 7 to 21 days).</p><p><strong>Conclusions: </strong>Our limited results, together with reported outcomes, suggest that laparoscopic distal pancreatectomy is safe and effective for selected patients. The potential advantages of this procedure include reduced morbidity and reduced hospital stay.</p>","PeriodicalId":15992,"journal":{"name":"Journal of hepato-biliary-pancreatic surgery","volume":"12 1","pages":"65-70"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00534-004-0930-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24994499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of hepatic reserve for the indication of hepatic resection: how I do it.","authors":"Gian Massimo Gazzaniga,&nbsp;Stefano Cappato,&nbsp;Fiorenza E Belli,&nbsp;Claudio Bagarolo,&nbsp;Marco Filauro","doi":"10.1007/s00534-004-0946-z","DOIUrl":"https://doi.org/10.1007/s00534-004-0946-z","url":null,"abstract":"<p><p>Despite the careful selection of cirrhotic patients with hepatic neoplasms, liver resection for these patients remains associated with greater risk than in patients without underlying liver disease. The most rational indications for resective surgery in patients with hepatic neoplasms and cirrhosis are nonprogressive cirrhosis and good functional reserve. Therefore, evaluation of hepatic reserve is mandatory for hepatectomy candidates. Because of the complexity of hepatic function, a single, reliable liver function test is not yet available. However, a good multifactorial system that combines several elements (clinical, laboratory, functional, and volumetric evaluation) does provide sufficient data for determining the safe limits of hepatectomy.</p>","PeriodicalId":15992,"journal":{"name":"Journal of hepato-biliary-pancreatic surgery","volume":"12 1","pages":"27-30"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00534-004-0946-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24993985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features and management of bile leaks after laparoscopic cholecystectomy.","authors":"Taizo Kimura,&nbsp;Kennji Suzuki,&nbsp;Yasuhiko Umehara,&nbsp;Akihiro Kawabe,&nbsp;Hidetoshi Wada","doi":"10.1007/s00534-004-0935-2","DOIUrl":"https://doi.org/10.1007/s00534-004-0935-2","url":null,"abstract":"<p><strong>Background/purpose: </strong>Leakage of bile is one of the troublesome complications after laparoscopic cholecystectomy.</p><p><strong>Methods: </strong>The present study reviewed our experience with this complication, in order to analyze its characteristics and proper management.</p><p><strong>Results: </strong>Postoperative bile leaks occurred in 23 of 1365 patients (1.7%) undergoing laparoscopic cholecystectomy from July 1990 to May 2002, with the policy of routine operative cholangiography and routine drainage of the gallbladder bed. These patients could be divided into four types. In type 1 (17 patients), bile leakage stopped spontaneously within 3 days (subclinical group). In type 2 (3 patients), the leak continued for longer than 3 days but was controlled by an endoscopic nasobiliary drainage (ENBD tube; minor-leakage group). In type 3 (2 patients), bile leakage continued for longer than 3 days and required open repair (major-leakage group). In type 4 (1 patient), bile leakage started several days after surgery (delayed-leakage group).</p><p><strong>Conclusions: </strong>It is thought that better understanding of these four types of bile leakage should help in the proper management of this complication.</p>","PeriodicalId":15992,"journal":{"name":"Journal of hepato-biliary-pancreatic surgery","volume":"12 1","pages":"61-4"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00534-004-0935-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24994498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test.","authors":"Hiroshi Imamura,&nbsp;Keiji Sano,&nbsp;Yasuhiko Sugawara,&nbsp;Norihiko Kokudo,&nbsp;Masatoshi Makuuchi","doi":"10.1007/s00534-004-0965-9","DOIUrl":"https://doi.org/10.1007/s00534-004-0965-9","url":null,"abstract":"<p><p>Preoperative assessment of liver function and prediction of postoperative remaining functional liver parenchymal mass and reserve is of paramount importance to minimize surgical risk, especially in patients with hepatocellular carcinoma (HCC), the majority of whom have liver cirrhosis as a complication. We have established a decision tree for deciding the safe limit of hepatectomy based on three variables: whether ascites is present, the serum total bilirubin level, and the indocyanine green retention rate at 15 minutes (ICGR-15), an indicator of sinusoidal capillarization. In patients who show a sign of decompensated cirrhosis as reflected by an elevated bilirubin value or uncontrollable ascites, hepatectomy is not indicated. In patients without ascites and with normal bilirubin level, the ICGR-15 value becomes the main determinant for the resectability and hepatectomy procedure. Incorporation of ICGR-15 into the decision tree enables patients conventionally classified into Child-Turcotte-Pugh class A or score 5-6 to be subdivided into several groups in which various hepatectomy procedures are feasible: enucleation, limited resection, segmentectomy, mono- to bisectoriectomy, and trisectriectomy. During strict application of this decision tree to 1429 consecutive hepatectomies, of which 685 were performed on HCC patients, during the last 10 years, we encountered only a single mortality.</p>","PeriodicalId":15992,"journal":{"name":"Journal of hepato-biliary-pancreatic surgery","volume":"12 1","pages":"16-22"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00534-004-0965-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24993983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic hepatectomy with the hook blade of ultrasonic coagulating shears and bipolar cautery with a saline irrigation system.","authors":"Toshiya Kamiyama,&nbsp;Nobuaki Kurauchi,&nbsp;Takahito Nakagawa,&nbsp;Kazuaki Nakanishi,&nbsp;Hirohumi Kamachi,&nbsp;Michiaki Matsushita,&nbsp;Satoru Todo","doi":"10.1007/s00534-004-0934-3","DOIUrl":"https://doi.org/10.1007/s00534-004-0934-3","url":null,"abstract":"<p><strong>Background: </strong>The number of patients who have undergone laparoscopic hepatectomy is small, and the operative procedure is not yet well established.</p><p><strong>Methods: </strong>We performed laparoscopic hepatectomy in eight patients, using the hook blade of ultrasonic coagulating shears, and bipolar cautery with a saline irrigation system, with minilaparotomy. The operative time, blood loss, and postoperative hospital stay of patients with laparoscopic left lateral segmentectomy were compared with these parameters in ten patients who had had a left lateral segmentectomy with laparotomy.</p><p><strong>Results: </strong>The laparoscopic hepatectomies included seven left lateral segmentectomies and one nonanatomical partial resection of the lateral segment. The mean duration of the operation in these eight patients was 181.1 +/- 44.6 min. The mean amount of blood loss was 177.6 +/- 129.1 ml. Postoperative complications consisted of two cases of bleeding. The mean postoperative hospital stay in all eight patients was 9.88 +/- 4.36 days. The mean duration of operation (185.9 +/- 46.0 min) and mean postoperative hospital stay (9.47 +/- 4.61 days) in the seven patients with laparoscopic left lateral segmentectomies were significantly shorter than these parameters (255.7 +/- 59.4 min and 24.6 +/- 8.82 days) in the ten patients who had had left lateral segmentectomies with laparotomy. The mean amount of blood loss (160.0 +/- 128.9 ml) in the laparoscopic series was less than that (318.5 +/- 192.2 days) in the patients who had had laparotomy.</p><p><strong>Conclusions: </strong>Laparoscopic hepatectomy with the ultrasonic coagulating shears and bipolar cautery with minilaparotomy was safe, and less invasive than the open procedure, for minor hepatectomy procedures such as left lateral segmentectomy.</p>","PeriodicalId":15992,"journal":{"name":"Journal of hepato-biliary-pancreatic surgery","volume":"12 1","pages":"49-54"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00534-004-0934-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24994496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatographic findings in idiopathic acute pancreatitis.","authors":"T. Kamisawa, N. Egawa, G. Matsumoto, K. Tsuruta, A. Okamoto, Tomomi Okamoto","doi":"10.1016/S0016-5107(04)00961-7","DOIUrl":"https://doi.org/10.1016/S0016-5107(04)00961-7","url":null,"abstract":"","PeriodicalId":15992,"journal":{"name":"Journal of hepato-biliary-pancreatic surgery","volume":"28 1","pages":"99-102"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85400086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extensive resections for colorectal liver metastases.","authors":"Alessandro Ferrero,&nbsp;Roberto Polastri,&nbsp;Andrea Muratore,&nbsp;Daria Zorzi,&nbsp;Lorenzo Capussotti","doi":"10.1007/s00534-002-0792-9","DOIUrl":"https://doi.org/10.1007/s00534-002-0792-9","url":null,"abstract":"<p><strong>Background/purpose: </strong>Mortality and morbidity rates after liver resections have decreased with better surgical techniques and perioperative care. The aim of this study was to evaluate the short- and longterm results in patients who had undergone extensive hepatectomies.</p><p><strong>Methods: </strong>From January 1985 to December 2000, 237 patients underwent 275 liver resections for colorectal metastases. Extensive liver resections were defined as follows: technical reasons (extended hepatectomies, associated vascular resections); disease extent (diameter, >>10 cm; number, >>5; associated extrahepatic resection). The total number of extensive liver resections was 74. There were 51 radical resections (68.9%), while in the nonextensive resections group, 152 resections were radical (90.7%; P = 0.1).</p><p><strong>Results: </strong>Postoperative mortality (60 days) was 1.6% (1.3% in the extensive resections group; P = 0.3), while morbidity was 22.7% (31% in the extensive resections group vs 19% in the nonextensive resections group; P = 0.1). One-, 3-, and 5-year overall actuarial survival rates were 91.8%, 44.9%, and 25.3%. The survival rates of patients who underwent an extensive resection were similar to those in the nonextensive resections group.</p><p><strong>Conclusions: </strong>Technical difficulties and neoplastic extension are not, nowadays, a contraindication for hepatectomy for colorectal liver metastases, unless a radical resection is performed. Mortality and morbidity rates after liver resections have decreased with better surgical techniques and perioperative care. The aim of this study was to evaluate the short- and longterm results in patients who had undergone extensive hepatectomies.</p>","PeriodicalId":15992,"journal":{"name":"Journal of hepato-biliary-pancreatic surgery","volume":"11 2","pages":"92-6"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00534-002-0792-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24505011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}