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Extended left hepatectomy associated with resection of the vena cava and suprahepatic veins by in situ perfusion to treat intrahepatic cholangiocarcinoma. 用原位灌注法切除腔静脉和肝上静脉以治疗肝内胆管癌的扩大左肝切除术。
Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-02-29 Epub Date: 2024-01-12 DOI: 10.14701/ahbps.23-102
Caroline Celestino Girão Nobre, Raquel Lima Sampaio, Ana Clemilda Marques Ximenes, Gustavo Rego Coelho, José Huygens Parente Garcia

Cholangiocarcinoma is a heterogeneous group of aggressive tumors that correspond to the second most common primary liver tumor. They can be classified according to their anatomical position concerning the biliary tree, and each subtype demonstrates different behavior and treatment. A 38-year-old male patient presenting solely right lumbar pain was diagnosed with a 7 cm hepatic tumor involving segments I, Iva, and VIII associated with involvement of the hepatic veins. He underwent a bloc resection of hepatic segments I, II, III, IV, partial V, partial VII, and VIII; right, middle, and left hepatic veins; and inferior vena cava segment, with perfusion of the remaining liver in situ with a preservation solution. As the patient had a large accessory inferior right hepatic vein draining the remaining liver, no reimplantation of hepatic veins was necessary. He remained clinically stable in outpatient follow-up, with excellent performance status-current survival of 2 years 6 months after surgical treatment.

胆管癌是一类异质性侵袭性肿瘤,是第二大最常见的原发性肝肿瘤。胆管癌可根据其在胆管树上的解剖位置进行分类,每种亚型的表现和治疗方法都不尽相同。一名 38 岁的男性患者仅表现为右腰部疼痛,被诊断为 7 厘米肝肿瘤,累及 I、Iva 和 VIII 段,并伴有肝静脉受累。他接受了肝I、II、III、IV段、部分V段、部分VII段和VIII段;右、中、左肝静脉;以及下腔静脉段的整体切除术,并在原位用保存液灌注剩余肝脏。由于患者有一条大的右肝下静脉附属血管引流剩余的肝脏,因此无需再植入肝静脉。在门诊随访中,他的临床状况一直保持稳定,表现良好,手术治疗后存活了 2 年 6 个月。
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引用次数: 0
Early mobilization and delayed arterial ligation (EMDAL) as a surgical technique for splenectomy and shunt surgery in portal hypertension. 将早期动员和延迟动脉结扎术(EMDAL)作为门脉高压症脾切除术和分流手术的外科技术。
Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-02-29 Epub Date: 2024-01-05 DOI: 10.14701/ahbps.23-080
Harilal S L, Biju Pottakkat, Kalayarasan Raja, Senthil Gnanasekaran

Backgrounds/aims: Splenectomy is the most frequently performed procedure as definitive management or as part of shunt surgery or devascularization in portal hypertension. Splenectomy is technically challenging because of the frequent coexistence of multiple collateral varices, splenomegaly, poor liver function, and thrombocytopenia. Early arterial ligation and late mobilization (EALDEM) is the traditional method for splenectomy in portal hypertension. Early spleen mobilization offers good control of the hilum. We aim to compare the effect of the early mobilization and delayed arterial ligation (EMDAL) technique with that of the conventional splenectomy technique in patients with portal hypertension.

Methods: During the study period from September 2011 to September 2022, 173 patients underwent surgical intervention for portal hypertension at our institution. Among these patients, 114 underwent the conventional method of splenectomy (early arterial ligation and late splenic mobilization) while 59 underwent splenectomy with the EMDAL technique. Demographics were compared between the two groups. Intraoperative and postoperative outcomes were analyzed using the Mann-Whitney test in each group. A minimum follow-up of 12 months was performed in each group.

Results: Demographics and type of surgical procedure were comparable in the two surgical method groups. Median blood loss was higher in the conventional group than in the EMDAL method. The median duration of surgery was comparable in the two surgical procedures. Clavien-Dindo grade III/IV complications were reported more frequently in the conventional group.

Conclusions: The splenic hilum can be controlled well and bleeding can be minimised with early mobilization and delayed arterial ligation.

背景/目的:脾切除术是门静脉高压症最常采用的治疗方法,也是分流手术或去血管术的一部分。脾切除术在技术上具有挑战性,因为常常同时存在多个侧支静脉曲张、脾肿大、肝功能差和血小板减少。早期动脉结扎和晚期脾动员(EALDEM)是门静脉高压症脾切除术的传统方法。早期脾脏动员能很好地控制脾门。我们旨在比较早期动员和延迟动脉结扎(EMDAL)技术与传统脾切除技术在门静脉高压症患者中的效果:在 2011 年 9 月至 2022 年 9 月的研究期间,我院共有 173 名门静脉高压症患者接受了手术治疗。在这些患者中,114 人接受了传统的脾脏切除术(早期动脉结扎和晚期脾脏移动),59 人接受了 EMDAL 技术的脾脏切除术。两组患者的人口统计学特征进行了比较。每组患者的术中和术后结果均采用 Mann-Whitney 检验进行分析。每组至少随访12个月:结果:两组患者的人口统计学和手术类型相当。传统方法组的中位失血量高于 EMDAL 方法组。两种手术方法的中位手术时间相当。传统手术组出现 Clavien-Dindo III/IV 级并发症的频率更高:结论:通过早期动员和延迟动脉结扎,可以很好地控制脾门,并最大限度地减少出血。
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引用次数: 0
Outcomes of liver transplantation for hepatocellular carcinoma: Experiences from a Vietnamese center. 肝细胞癌肝移植的疗效:越南中心的经验。
Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-02-29 Epub Date: 2024-01-09 DOI: 10.14701/ahbps.23-072
Khai Viet Ninh, Dang Hai Do, Trung Duc Nguyen, Phuong Ha Tran, Tuan Hoang, Dung Thanh Le, Nghia Quang Nguyen

Backgrounds/aims: Liver transplantation (LT) provides a favorable outcome for patients with hepatocellular carcinoma (HCC) and was launched in Vietnam in 2004. In this study, we evaluated the short-term and long-term outcomes of LT and its risk factors.

Methods: This retrospective study analyzed HCC patients who underwent LT at Viet Duc University hospital, Vietnam, from 01/2012-03/2022. The following data were gathered: demographics, virus infection, tumor characteristics, alpha-fetoprotein (AFP) level, Child-Pugh and MELD scores, selection criteria, type of LT, complications, 30-day mortality, and disease-free and overall survival (DFS and OS).

Results: Fifty four patients were included, the mean age was 55.39 ± 8.46 years. Nearly 90% had hepatitis B virus-related HCC. The median (interquartile range) AFP level was 16.2 (88.7) ng/mL. The average MELD score was 10.57 ± 5.95; the rate of Child-Pugh A and B were 70.4% and 18.5%, respectively. Nearly 40% of the patients were within Milan criteria, brain-dead donor was 83.3%. Hepatic and portal vein thrombosis occurred in 0% and 1.9%, respectively; hepatic artery thrombosis 1.9%, biliary leakage 5.6%, and postoperative hemorrhage 3.7%. Ninety-day mortality was 5.6%. Five-year DFS and OS were 79.3% and 81.4%, respectively. MELD score and Child-Pugh score were predictive factors for DFS and OS (p < 0.05). In multivariate analysis, Child-Pugh score was the only significant factor (p < 0.05).

Conclusions: In Vietnam, LT is an effective therapy for HCC with an acceptable complication rate, mortality rate, and good survival outcomes, and should be further encouraged.

背景/目的:肝移植(LT)为肝细胞癌(HCC)患者提供了良好的治疗效果,越南于 2004 年开展了肝移植手术。在这项研究中,我们评估了肝移植的短期和长期疗效及其风险因素:这项回顾性研究分析了 2012 年 1 月至 2022 年 3 月期间在越南越德大学医院接受 LT 治疗的 HCC 患者。研究收集了以下数据:人口统计学、病毒感染、肿瘤特征、甲胎蛋白(AFP)水平、Child-Pugh 和 MELD 评分、选择标准、LT 类型、并发症、30 天死亡率、无病生存率和总生存率(DFS 和 OS):共纳入 54 名患者,平均年龄(55.39±8.46)岁。近90%的患者患有与乙肝病毒相关的HCC。AFP水平中位数(四分位数间距)为16.2(88.7)纳克/毫升。平均 MELD 评分为 10.57 ± 5.95;Child-Pugh A 和 B 比率分别为 70.4% 和 18.5%。近 40% 的患者符合米兰标准,脑死亡供体占 83.3%。肝血栓和门静脉血栓发生率分别为0%和1.9%;肝动脉血栓发生率为1.9%,胆漏发生率为5.6%,术后出血发生率为3.7%。90天死亡率为5.6%。五年 DFS 和 OS 分别为 79.3% 和 81.4%。MELD 评分和 Child-Pugh 评分是 DFS 和 OS 的预测因素(P < 0.05)。在多变量分析中,Child-Pugh 评分是唯一显著的因素(P < 0.05):结论:在越南,LT 是治疗 HCC 的有效方法,其并发症发生率、死亡率和存活率均可接受,应进一步推广。
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引用次数: 0
Outcomes of laparoscopic choledochotomy using cholangioscopy via percutaneous-choledochal tube for the treatment of hepatolithiasis and choledocholithiasis: A preliminary Vietnamese study. 使用胆道镜经皮胆管进行腹腔镜胆总管切开术治疗肝结石和胆总管结石的疗效:越南初步研究。
Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-02-29 Epub Date: 2023-12-20 DOI: 10.14701/ahbps.23-085
Loi Van Le, Quang Van Vu, Thanh Van Le, Hieu Trung Le, Khue Kim Dang, Tuan Ngoc Vu, Anh Hoang Ngoc Nguyen, Thang Manh Tran

Backgrounds/aims: Hepatolithiasis and choledocholithiasis are frequent pathologies and unfortunately, with the current treatment strategies, the recurrence incidence is still high. This study aimed to assess the outcomes of laparoscopic choledochotomy using cholangioscopy via the percutaneous-choledochal tube for the treatment of hepatolithiasis and choledocholithiasis in Vietnamese patients.

Methods: A cross-sectional study of patients with hepatolithiasis and/or choledocholithiasis who underwent laparoscopic choledochotomy using intraoperative cholangioscopy via percutaneous-choledochal tube at the Department of Hepatopancreatobiliary Surgery, 108 Military Central Hospital, from June 2017 to March 2020.

Results: A total of 84 patients were analyzed. Most patients were females (56.0%) with a median age of 55.56 years. Among them, 41.8% of patients had previous abdominal operations, with 33.4% having choledochotomy. All patients underwent successful laparoscopic common bile duct exploration followed by T-tube drainage without needing to convert to open surgery. Most patients (64.3%) had both intrahepatic and extrahepatic stones. The rate of stones ≥ 10 mm in diameter was 64.3%. Biliary strictures were observed in 19.1% of patients during cholangioscopy. Complete removal of stones was achieved in 54.8% of patients. Intraoperative complications were encountered in two patients, but there was no need to change the strategy. The mean operating time was 121.85 ± 30.47 minutes. The early postoperative complication rate was 9.6%, and all patients were managed conservatively. The residual stones were removed through the T-tube tract by subsequent choledochoscopy in 34/38 patients, so the total success rate was 95.2%.

Conclusions: Laparoscopic choledochotomy combined with cholangioscopy through the percutaneous-choledochal tube is a safe and effective strategy for hepatolithiasis and/or choledocholithiasis, even in patients with a previous choledochotomy.

背景/目的:肝胆管结石和胆总管结石是常见的病变,遗憾的是,在目前的治疗策略下,复发率仍然很高。本研究旨在评估越南患者使用经皮胆总管胆道镜进行腹腔镜胆总管切开术治疗肝结石和胆总管结石的效果:对2017年6月至2020年3月在108军中心医院肝胆胰外科接受腹腔镜胆总管切开术的肝胆管结石和/或胆总管结石患者进行横断面研究:共对84名患者进行了分析。大多数患者为女性(56.0%),中位年龄为 55.56 岁。其中,41.8%的患者曾进行过腹部手术,33.4%的患者进行过胆总管切开术。所有患者都成功接受了腹腔镜胆总管探查术,随后进行了T管引流,无需转为开腹手术。大多数患者(64.3%)既有肝内结石,也有肝外结石。结石直径≥10毫米的比例为64.3%。19.1%的患者在胆道镜检查中发现胆道狭窄。54.8%的患者完全清除了结石。两名患者出现了术中并发症,但无需改变策略。平均手术时间为(121.85 ± 30.47)分钟。术后早期并发症发生率为9.6%,所有患者均接受了保守治疗。34/38例患者的残余结石通过随后的胆道镜检查经T型管道取出,因此总成功率为95.2%:结论:腹腔镜胆总管切开术联合经皮胆总管胆道镜检查是治疗肝结石和/或胆总管结石的一种安全有效的方法,即使是既往接受过胆总管切开术的患者也不例外。
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引用次数: 0
Solid pseudopapillary epithelial neoplasm of pancreas in pregnancy: A case report and review of literature. 妊娠期胰腺实性假乳头状上皮肿瘤:病例报告和文献综述
Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-02-29 Epub Date: 2023-12-29 DOI: 10.14701/ahbps.23-083
R K Hanumantha Naik, Anbalagan Amudhan, ArunKumar Ashokkumar, Anbarasu Inbasekaran, Selvaraj Thangasamy, Jeswanth Sathyanesan

The solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is an uncommon tumor that accounts for approximately 1%-2% of exocrine pancreatic neoplasms. It predominantly affects female in their second and third decades of life. In this case report, we present a clinical scenario of a 21-year-old pregnant woman who incidentally discovered a solid cystic lesion in her pancreas, exhibiting features suggestive of SPEN. The patient underwent surgery during the second trimester. Management of pregnant females with SPEN poses challenges due to the absence of definitive treatment guidelines, particularly in determining the ideal timing for surgical intervention. Notably, during pregnancy, the presence of a small SPEN does not necessarily require immediate resection. However, if the tumor is of significant size, it can give rise to complications such as tumor rupture, multivisceral resection, recurrence, spontaneous abortion, intrauterine growth restriction, or premature delivery if not addressed. In the existing literature, a common finding is that approximately two-thirds of pregnant females with SPEN underwent surgery in the second trimester, often without complications for the mother or fetus. All these tumors were larger than 8 cm. The decision to operate before or after birth can be individualized based on team discussion. However, delay in surgery may lead to larger tumors and higher risks like bleeding, rupture, multivisceral resection, and recurrence. Therefore, second-trimester surgery seems safer, and lessens dangers, emergency surgery, and tumor recurrence.

胰腺实性假乳头状上皮肿瘤(SPEN)是一种不常见的肿瘤,约占胰腺外分泌肿瘤的 1%-2%。它主要影响女性的第二和第三个十年的生活。在本病例报告中,我们介绍了一名 21 岁孕妇的临床情况,她偶然发现自己的胰腺中有一个实性囊性病变,其特征提示为 SPEN。患者在妊娠后三个月接受了手术。由于缺乏明确的治疗指南,尤其是在确定手术干预的理想时机方面,对患有 SPEN 的孕妇的管理面临挑战。值得注意的是,在妊娠期间,出现小的 SPEN 不一定需要立即切除。但是,如果肿瘤较大,如不及时处理,可能会引起肿瘤破裂、多脏器切除、复发、自然流产、宫内生长受限或早产等并发症。现有文献的一个共同发现是,约三分之二的 SPEN 孕妇在妊娠后三个月接受了手术,通常不会给母亲或胎儿带来并发症。所有这些肿瘤都大于 8 厘米。在分娩前或分娩后进行手术的决定可根据团队讨论的情况而定。然而,延迟手术可能会导致肿瘤增大,以及出血、破裂、多脏器切除和复发等更高风险。因此,第二胎手术似乎更安全,可减少危险、紧急手术和肿瘤复发。
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引用次数: 0
Postoperative fluid therapy in enhanced recovery after surgery for pancreaticoduodenectomy. 胰十二指肠切除术术后输液疗法可促进术后恢复。
Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-02-29 Epub Date: 2024-01-12 DOI: 10.14701/ahbps.23-084
Sharnice Koek, Johnny Lo, Rupert Ledger, Mohammed Ballal

Backgrounds/aims: Optimal intravenous fluid management during the perioperative period for patients undergoing pancreaticoduodenectomy (PD) within the framework of enhanced recovery after surgery (ERAS) is unclear. Studies have indicated that excessive total body salt and water can contribute to the development of oedema, leading to increased morbidity and extended hospital stays. This study aimed to assess the effects of an intravenous therapy regimen during postoperative day (POD) 0 to 2 in PD patients within ERAS.

Methods: A retrospective interventional cohort study was conducted, and it involved all PD patients before and after implementation of ERAS (2009-2017). In the ERAS group, a targeted maintenance fluid regimen of 20 mL/kg/day with a sodium requirement of 0.5 mmoL/kg/day was administered. Outcome measures included the mmol of sodium and chloride administered, length of stay, and morbidity (postoperative pancreatic fistula, POPF; acute kidney injury, AKI; ileus).

Results: The study included 169 patients, with a mean age of 64 ± 11.3 years. Following implementation of the intravenous fluid therapy protocol, there was a significant reduction in chloride and sodium loading. However, in the multivariable analysis, chloride administered (mmoL/kg) did not independently influence the length of stay; or rates of POPF, ileus, or AKI (p > 0.05).

Conclusions: The findings suggested that a postoperative intravenous fluid therapy regimen did not significantly impact morbidity. Notably, there was a trend towards reduced length of stay within an increasingly comorbid patient cohort. This targeted fluid regimen appears to be safe for PD patients within the ERAS program. Further prospective research is needed to explore this area.

背景/目的:在加强术后恢复(ERAS)的框架内对接受胰十二指肠切除术(PD)的患者进行围手术期静脉输液管理的最佳方案尚不明确。研究表明,体内盐分和水分过多会导致水肿,从而增加发病率并延长住院时间。本研究旨在评估术后第0至2天(POD)静脉治疗方案对ERAS内PD患者的影响:本研究进行了一项回顾性干预队列研究,涉及ERAS实施前后(2009-2017年)的所有PD患者。在ERAS组中,目标维持液体方案为20毫升/千克/天,钠需求量为0.5毫摩尔/千克/天。结果测量包括钠和氯的毫摩尔用量、住院时间和发病率(术后胰瘘、急性肾损伤、回肠炎):研究共纳入 169 名患者,平均年龄(64 ± 11.3)岁。实施静脉输液治疗方案后,患者的氯化物和钠负荷量明显减少。然而,在多变量分析中,氯化物用量(mmoL/kg)并不单独影响住院时间、POPF、回肠梗阻或 AKI 的发生率(P > 0.05):研究结果表明,术后静脉输液治疗方案对发病率没有明显影响。值得注意的是,在合并症日益增多的患者群中,住院时间有缩短的趋势。在ERAS项目中,这种有针对性的输液方案对腹膜透析患者似乎是安全的。还需要进一步的前瞻性研究来探索这一领域。
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引用次数: 0
Gastric salvage after venous congestion during major pancreatic resections: A series of three cases. 胰腺大部切除术中静脉充血后的胃救治:三例系列病例。
Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-02-29 Epub Date: 2023-12-28 DOI: 10.14701/ahbps.23-089
Ravi Chandra Reddy, Vikram Chaudhari, Amit Chopde, Abhishek Mitra, Dushyant Jaiswal, Shailesh V Shrikhande, Manish S Bhandare

Pancreatic resections, depending on the location of the tumor, usually require division of the vasculature of either the distal or proximal part of the stomach. In certain situations, such as total pancreatectomy and/or with splenic vein occlusion, viability of the stomach may be threatened due to inadequate venous drainage. We discuss three cases of complex pancreatic surgeries performed for carcinoma of the pancreas at a tertiary care center in India, wherein the stomach was salvaged by reimplanting the veins in two patients and preserving the only draining collateral in one case after the gastric venous drainage was compromised. The perioperative and postoperative course in these patients and the complications were analyzed. None of these 3 patients developed any complication related to gastric venous congestion, and additional gastrectomy was avoided in all these patients. Re-establishment of the Gastric venous outflow after extensive pancreatic resections helps to avoid additional gastric resection secondary to venous congestive changes.

根据肿瘤位置的不同,胰腺切除术通常需要分割胃的远端或近端血管。在某些情况下,如全胰切除术和/或脾静脉闭塞,胃的存活可能会因静脉引流不足而受到威胁。我们讨论了印度一家三级医疗中心为胰腺癌患者实施的三例复杂胰腺手术,其中两例患者通过重新植入静脉挽救了胃,一例患者在胃静脉引流受阻后保留了唯一的引流侧支。对这些患者的围手术期和术后病程以及并发症进行了分析。这3名患者均未出现任何与胃静脉充血相关的并发症,而且都避免了额外的胃切除术。广泛胰腺切除术后重建胃静脉外流有助于避免因静脉充血变化而再次进行胃切除术。
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引用次数: 0
The impact of waiting time and delayed treatment on the outcomes of patients with hepatocellular carcinoma: A systematic review and meta-analysis. 等待时间和延迟治疗对肝细胞癌患者预后的影响:系统回顾和荟萃分析。
Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-02-29 Epub Date: 2023-12-14 DOI: 10.14701/ahbps.23-090
Feng Yi Cheo, Celeste Hong Fei Lim, Kai Siang Chan, Vishal Girishchandra Shelat

Hepatocellular carcinoma (HCC) is the sixth most diagnosed cancer worldwide. Healthcare resource constraints may predispose treatment delays. We aim to review existing literature on whether delayed treatment results in worse outcomes in HCC. PubMed, Embase, The Cochrane Library, and Scopus were systematically searched from inception till December 2022. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Secondary outcomes included post-treatment mortality, readmission rates, and complications. Fourteen studies with a total of 135,389 patients (delayed n = 25,516, no delay n = 109,873) were included. Age, incidence of male patients, Child-Pugh B cirrhosis, and Barcelona Clinic Liver Cancer Stage 0/A HCC were comparable between delayed and no delay groups. Tumor size was significantly smaller in delayed versus no delay group (mean difference, -0.70 cm; 95% confidence interval [CI]: -1.14, 0.26; p = 0.002). More patients received radiofrequency ablation in delayed versus no delay group (OR, 1.22; 95% CI: 1.16, 1.27; p < 0.0001). OS was comparable between delayed and no delay in HCC treatment (hazard ratio [HR], 1.13; 95% CI: 0.99, 1.29; p = 0.07). Comparable DFS between delayed and no delay groups (HR, 0.99; 95% CI: 0.75, 1.30; p = 0.95) was observed. Subgroup analysis of studies that defined treatment delay as > 90 days showed comparable OS in the delayed group (HR, 1.04; 95% CI: 0.93, 1.16; p = 0.51). OS and DFS for delayed treatment were non-inferior compared to no delay, but might be due to better tumor biology/smaller tumor size in the delayed group.

肝细胞癌(HCC)是全球第六大确诊癌症。医疗资源的限制可能会导致治疗延迟。我们旨在回顾现有文献,了解延迟治疗是否会导致 HCC 的预后更差。我们对 PubMed、Embase、The Cochrane Library 和 Scopus 进行了系统检索,检索时间从开始到 2022 年 12 月。主要结果为总生存期(OS)和无病生存期(DFS)。次要结果包括治疗后死亡率、再入院率和并发症。14项研究共纳入135,389名患者(延迟n=25,516,无延迟n=109,873)。延迟组和非延迟组的年龄、男性患者发病率、Child-Pugh B肝硬化和巴塞罗那临床肝癌0/A期HCC的发病率相当。延迟组与无延迟组相比,肿瘤体积明显较小(平均差异为-0.70厘米;95%置信区间[CI]:-1.14,0.26;P = 0.002)。与无延迟组相比,延迟组接受射频消融的患者更多(OR,1.22;95% 置信区间[CI]:1.16,1.27;P < 0.0001)。延迟和不延迟治疗 HCC 的 OS 相当(危险比 [HR],1.13;95% CI:0.99, 1.29;P = 0.07)。延迟和不延迟组的 DFS 具有可比性(HR,0.99;95% CI:0.75,1.30;P = 0.95)。对将延迟治疗定义为大于90天的研究进行的亚组分析显示,延迟治疗组的OS相当(HR,1.04;95% CI:0.93,1.16;P = 0.51)。与不延迟治疗相比,延迟治疗的OS和DFS并不劣于不延迟治疗,但这可能是由于延迟治疗组的肿瘤生物学特性更好/肿瘤体积更小。
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引用次数: 0
Parenchymal-sparing anatomical hepatectomy based on portal ramification of the right anterior section: A prospective multicenter experience with short-term outcomes. 基于右前段肝门横切的肝实质分离解剖性肝切除术:具有短期疗效的前瞻性多中心经验。
Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-02-29 Epub Date: 2023-12-28 DOI: 10.14701/ahbps.23-076
Truong Giang Nguyen, Thanh Khiem Nguyen, Ham Hoi Nguyen, Hong Son Trinh, Tuan Hiep Luong, Minh Trong Nguyen, Van Duy Le, Hai Dang Do, Kieu Hung Nguyen, Van Minh Do, Quang Huy Tran, Cuong Thinh Nguyen

Backgrounds/aims: Parenchymal-sparing anatomical hepatectomy (Ps-AH) based on portal ramification of the right anterior section (RAS) is a new technique to avoid unnecessarily transecting too much liver parenchyma, especially in cases of major anatomical hepatectomy.

Methods: We prospectively assessed 26 patients with primary hepatic malignancies having undergone major Ps-AH based on portal ramification of the RAS from August 2018 to August 2022 (48 months). The perioperative indications, clinical data, intra-operative index, pathological postoperative specimens, postoperative complications, and follow-up results were retrospectively evaluated.

Results: Among the 26 patients analyzed, there was just one case that had intrahepatic cholangiocarcinoma The preoperative level of α-Fetoprotein was 25.2 ng/mL. All cases (100%) had Child-Pugh A liver function preoperatively. The ventral/dorsal RAS was preserved in 19 and 7 patients, respectively. The mean surgical margin was 6.2 mm. The mean surgical time was 228.5 minutes, while the mean blood loss was 255 mL. In pathology, 5 cases (19.2%) had microvascular invasion, and in the group of HCC patients, 92% of all cases had moderate or poor tumor differentiation. Six cases (23.1%) of postoperative complications were graded over III according to the Clavien-Dindo system, including in three patients resistant ascites or intra-abdominal abscess that required intervention.

Conclusions: Parenchymal-sparing anatomical hepatectomy based on portal ramification of the RAS to achieve R0-resection was safe and effective, with favorable short-term outcomes. This technique can be used widely in clinical practice.

背景/目的:基于右前切面(RAS)肝门横切的肝实质保全解剖性肝切除术(Ps-AH)是一种新技术,可避免不必要地横切过多的肝实质,尤其是在解剖性肝切除术中:我们前瞻性地评估了2018年8月至2022年8月(48个月)期间接受基于RAS门脉横切的Ps-AH大手术的26例原发性肝恶性肿瘤患者。对围手术期适应症、临床资料、术中指标、术后病理标本、术后并发症及随访结果进行了回顾性评估:术前α-胎儿蛋白水平为 25.2 ng/mL。所有病例(100%)术前肝功能均为 Child-Pugh A。分别有19名和7名患者保留了腹侧/背侧RAS。平均手术切缘为 6.2 毫米。平均手术时间为 228.5 分钟,平均失血量为 255 毫升。病理结果显示,5 例(19.2%)患者有微血管侵犯,在 HCC 患者中,92% 的病例肿瘤分化程度为中度或较差。根据Clavien-Dindo系统,6例(23.1%)术后并发症超过III级,其中3例患者出现耐药性腹水或腹腔内脓肿,需要介入治疗:结论:基于RAS门脉分支的肝实质分离解剖性肝切除术实现了R0切除,安全有效,短期疗效良好。该技术可广泛应用于临床实践。
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引用次数: 0
Incidental double duct sign: Should we be worried? Results from a long-term follow-up study. 附带双管道标志:我们应该担心吗?长期随访研究的结果。
Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-02-29 Epub Date: 2023-11-02 DOI: 10.14701/ahbps.23-063
Lu Yao, Hoda Amar, Somaiah Aroori

Backgrounds/aims: Double duct sign (DDS) (dilated common bile and pancreatic duct) is synonymous with pancreatic head/peri-ampullary tumor (PHPAT). There is limited evidence on whether incidental DDS (I-DDS) is associated with an increased risk of malignancy. This study aimed to evaluate 5-year outcomes of I-DDS.

Methods: Patients were categorized according to their risk of malignancy. 'Low-risk' patients, including those with I-DDS between 2010 and 2015, were analyzed in this study. The primary outcome was incidence of PHPAT within five years of identification of DDS. Histology results from endoscopic ultrasound-guided biopsy were considered diagnostic. Secondary outcomes were incidence of benign causes, extent of follow-up investigations, and clinical indicators of malignancy in patients with DDS.

Results: Among 103 patients with DDS, 20 had I-DDS. Subsequent follow-up of these 20 patients found no patient with PHPAT, two (10%) patients with chronic pancreatitis, and 18 (90%) patients with no cause found. The median follow-up duration for 'low-risk' patients was 7.3 years (range, 6-11 years). The mean number of follow-up investigations per patient was two (range, 0-9). Investigations included computed tomography (n = 27), magnetic resonance cholangiopancreatography (n = 23), endoscopy (n = 16), and ultrasound (n = 14). Patients with jaundice were more likely to have malignancy (p < 0.01). Those with abdominal pain were more likely to have a benign cause (p < 0.01). Hyperbilirubinemia and/or deranged liver enzymes and raised CA19-9 were more likely to be associated with PHPAT (p < 0.01).

Conclusions: Patients with I-DDS have a low risk of developing PHPAT within five years.

背景/目的:双管征(DDS)(胆总管和胰管扩张)是胰头/壶腹周围肿瘤(PHPAT)的同义词。关于偶发性DDS(I-DDS)是否与恶性肿瘤风险增加有关的证据有限。本研究旨在评估I-DDS的5年疗效。方法:根据患者的恶性肿瘤风险对其进行分类本研究分析了低风险患者,包括2010年至2015年间患有I-DDS的患者。主要结果是在发现DDS后五年内PHPAT的发生率。内窥镜超声引导活检的组织学结果被认为是诊断性的。次要结果是DDS患者良性病因的发生率、随访范围和恶性临床指标。结果:103例DDS患者中,20例患有I-DDS。随后对这20名患者进行的随访中,没有发现PHPAT患者,两名(10%)患者患有慢性胰腺炎,18名(90%)患者没有发现病因。“低风险”患者的中位随访时间为7.3年(6-11年)。每位患者的平均随访次数为两次(范围为0-9)。研究包括计算机断层扫描(n=27)、磁共振胰胆管造影(n=23)、内窥镜检查(n=16)和超声检查(n=14)。黄疸患者更容易发生恶性肿瘤(p<0.01)。腹痛患者更有可能发生良性疾病(p<0.01),高胆红素血症和/或肝酶紊乱和CA19-9升高更可能与PHPAT有关(p<0.01)结论:I-DDS患者在五年内发生PHPAT的风险较低。
{"title":"Incidental double duct sign: Should we be worried? Results from a long-term follow-up study.","authors":"Lu Yao, Hoda Amar, Somaiah Aroori","doi":"10.14701/ahbps.23-063","DOIUrl":"10.14701/ahbps.23-063","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Double duct sign (DDS) (dilated common bile and pancreatic duct) is synonymous with pancreatic head/peri-ampullary tumor (PHPAT). There is limited evidence on whether incidental DDS (I-DDS) is associated with an increased risk of malignancy. This study aimed to evaluate 5-year outcomes of I-DDS.</p><p><strong>Methods: </strong>Patients were categorized according to their risk of malignancy. 'Low-risk' patients, including those with I-DDS between 2010 and 2015, were analyzed in this study. The primary outcome was incidence of PHPAT within five years of identification of DDS. Histology results from endoscopic ultrasound-guided biopsy were considered diagnostic. Secondary outcomes were incidence of benign causes, extent of follow-up investigations, and clinical indicators of malignancy in patients with DDS.</p><p><strong>Results: </strong>Among 103 patients with DDS, 20 had I-DDS. Subsequent follow-up of these 20 patients found no patient with PHPAT, two (10%) patients with chronic pancreatitis, and 18 (90%) patients with no cause found. The median follow-up duration for 'low-risk' patients was 7.3 years (range, 6-11 years). The mean number of follow-up investigations per patient was two (range, 0-9). Investigations included computed tomography (n = 27), magnetic resonance cholangiopancreatography (n = 23), endoscopy (n = 16), and ultrasound (n = 14). Patients with jaundice were more likely to have malignancy (<i>p</i> < 0.01). Those with abdominal pain were more likely to have a benign cause (<i>p</i> < 0.01). Hyperbilirubinemia and/or deranged liver enzymes and raised CA19-9 were more likely to be associated with PHPAT (<i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>Patients with I-DDS have a low risk of developing PHPAT within five years.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"53-58"},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10896684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Annals of hepato-biliary-pancreatic surgery
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