Objective: To investigate the variation of functions of the heart and lung during orthotopic liver transplan- tation (OLT). Methods: Pulmonary artery cannula and right radial artery cannula were indewelled before anae...Objective: To investigate the variation of functions of the heart and lung during orthotopic liver transplan- tation (OLT). Methods: Pulmonary artery cannula and right radial artery cannula were indewelled before anaesthesia and the parameters of hemodynamics in different pe- riods were monitored. Analysis of variance was used to reveal the variation among the groups. T hypothe- sis test in paired data was used to compare the preop- erative parameters with those in each period during operation and after operation respectively, and to compare the parameters immediately after operation with those in each period after operation respective- ly. Results: During the operation, heart rate increased, but blood pressure decreased significantly at the be- ginning of no-liver period, increased again in a short period and then increased progressively 12 h after op- eration. Pulmonary artery pressure (PAP) increased from before the no-liver period to 60 h after opera- tion. Pulmonary wedge pressure changed in accord- ance with the variation of PAP. Cardiac output was maintained at a high-output level from before opera- tion to 60 h after operation. Systemic vascular resist- ance (SVR) was within the normal limits before op- eration, whereas pulmonary vascular resistance (PVR) was lower than normal. In the no-liver peri- od during the operation, SVR decreased significant- ly. Both SVR and PVR increased progressively and returned to normal postoperatively. Conclusions: The patients undergoing OLT have a high cardiac output and Iow resistance obstacle be- fore and during the operation, and will recover grad- ually after operation. Monitoring hemodynamics during the peri-operative period is of significance in the prevention and treatment of pneumonedema and cardiac functional insufficiency.展开更多
Objective: To sum up the preliminary experience in living related liver transplantation (LRLT). Methods: A 9-month-old male infant with biliary atresia (BA) who had undergone an unsuccessful Kasai operation was define...Objective: To sum up the preliminary experience in living related liver transplantation (LRLT). Methods: A 9-month-old male infant with biliary atresia (BA) who had undergone an unsuccessful Kasai operation was defined as a candidate for LR- LT. The donor was his 30-year-old mother. Her la- teral lobe of the left liver was transplanted into the infant's body as the graft. The left branches of the portal vein, left hepatic artery and left hepatic vein of the graft were end-to-end anastomosed to the por- tal vein, hepatic artery proper and hepatic vein of the recipient respectively. Biliary drainage was re- established via Roux-en-Y operation. Results: The donor retained her liver function within 2 weeks after the operation. Steroid and FK506 were prescribed in immunosuppressive therapy for the re- cipient. The blood bilirubin level of the infant de- creased to normal 2 weeks after operation. No acute rejection occurred. Biliary leakage in the early peri- od after the transplantation was controlled by drain- age, and E. coli infection was effectively treated with antibiotics. The donor and recipient are in satisfacto- ry condition to the present. Conclusion: LRLT is advisable for children with bili- ary atresia.展开更多
Background： The Food and Drug Administration recently announced that the use of morcellation may cause fibroids or pelvic dissemination and metastasis of uterine sarcoma; therefore, the use of morcellation is limited...Background： The Food and Drug Administration recently announced that the use of morcellation may cause fibroids or pelvic dissemination and metastasis of uterine sarcoma; therefore, the use of morcellation is limited in the USA. A large sample study is necessary to assess the proportion of uterine malignant tumors found in patients with laparoscopic myomectomy. Methods： A national multicenter study was performed in China. From 2002 to 2014, 33,723 cases were retrospectively selected. We calculated the prevalence and recorded the clinical characteristics of the patients with malignancy after morcellation application. A total of 62 cases were finally pathologically confirmed as malignant postoperatively. Additionally, the medical records of the 62 patients were analyzed in details. Results： The proportion of postoperative malignancy after morcellation application was 0.18% （62/33,723） for patients who underwent laparoscopic myomectomy. Nearly 62.9% （39/62） of patients had demonstrated blood flow signals in the uterine fibroids before surgery. And, 23 （37.1%） patients showed rapid growth at the final preoperative ultrasound. With respect to the pathological types, 38 （61.3%） patients had detectable endometrial stromal sarcoma, 13 （21.0%） had detectable uterine leiomyosarcoma, only 3 （3.2%） had detectable carcinosarcoma, and 5 （8.1%） patients with leiomyoma had an undetermined malignant potential. Conclusions： The proportion of malignancy is low after using moreellation in patients who undergo laparoscopie myomectomy. Patients with fast-growing uterine fibroids and abnormal ultrasonic tumor blood flow should be considered for malignant potential, and morcellation should be avoided.展开更多
文摘Objective: To investigate the variation of functions of the heart and lung during orthotopic liver transplan- tation (OLT). Methods: Pulmonary artery cannula and right radial artery cannula were indewelled before anaesthesia and the parameters of hemodynamics in different pe- riods were monitored. Analysis of variance was used to reveal the variation among the groups. T hypothe- sis test in paired data was used to compare the preop- erative parameters with those in each period during operation and after operation respectively, and to compare the parameters immediately after operation with those in each period after operation respective- ly. Results: During the operation, heart rate increased, but blood pressure decreased significantly at the be- ginning of no-liver period, increased again in a short period and then increased progressively 12 h after op- eration. Pulmonary artery pressure (PAP) increased from before the no-liver period to 60 h after opera- tion. Pulmonary wedge pressure changed in accord- ance with the variation of PAP. Cardiac output was maintained at a high-output level from before opera- tion to 60 h after operation. Systemic vascular resist- ance (SVR) was within the normal limits before op- eration, whereas pulmonary vascular resistance (PVR) was lower than normal. In the no-liver peri- od during the operation, SVR decreased significant- ly. Both SVR and PVR increased progressively and returned to normal postoperatively. Conclusions: The patients undergoing OLT have a high cardiac output and Iow resistance obstacle be- fore and during the operation, and will recover grad- ually after operation. Monitoring hemodynamics during the peri-operative period is of significance in the prevention and treatment of pneumonedema and cardiac functional insufficiency.
文摘Objective: To sum up the preliminary experience in living related liver transplantation (LRLT). Methods: A 9-month-old male infant with biliary atresia (BA) who had undergone an unsuccessful Kasai operation was defined as a candidate for LR- LT. The donor was his 30-year-old mother. Her la- teral lobe of the left liver was transplanted into the infant's body as the graft. The left branches of the portal vein, left hepatic artery and left hepatic vein of the graft were end-to-end anastomosed to the por- tal vein, hepatic artery proper and hepatic vein of the recipient respectively. Biliary drainage was re- established via Roux-en-Y operation. Results: The donor retained her liver function within 2 weeks after the operation. Steroid and FK506 were prescribed in immunosuppressive therapy for the re- cipient. The blood bilirubin level of the infant de- creased to normal 2 weeks after operation. No acute rejection occurred. Biliary leakage in the early peri- od after the transplantation was controlled by drain- age, and E. coli infection was effectively treated with antibiotics. The donor and recipient are in satisfacto- ry condition to the present. Conclusion: LRLT is advisable for children with bili- ary atresia.
文摘Background： The Food and Drug Administration recently announced that the use of morcellation may cause fibroids or pelvic dissemination and metastasis of uterine sarcoma; therefore, the use of morcellation is limited in the USA. A large sample study is necessary to assess the proportion of uterine malignant tumors found in patients with laparoscopic myomectomy. Methods： A national multicenter study was performed in China. From 2002 to 2014, 33,723 cases were retrospectively selected. We calculated the prevalence and recorded the clinical characteristics of the patients with malignancy after morcellation application. A total of 62 cases were finally pathologically confirmed as malignant postoperatively. Additionally, the medical records of the 62 patients were analyzed in details. Results： The proportion of postoperative malignancy after morcellation application was 0.18% （62/33,723） for patients who underwent laparoscopic myomectomy. Nearly 62.9% （39/62） of patients had demonstrated blood flow signals in the uterine fibroids before surgery. And, 23 （37.1%） patients showed rapid growth at the final preoperative ultrasound. With respect to the pathological types, 38 （61.3%） patients had detectable endometrial stromal sarcoma, 13 （21.0%） had detectable uterine leiomyosarcoma, only 3 （3.2%） had detectable carcinosarcoma, and 5 （8.1%） patients with leiomyoma had an undetermined malignant potential. Conclusions： The proportion of malignancy is low after using moreellation in patients who undergo laparoscopie myomectomy. Patients with fast-growing uterine fibroids and abnormal ultrasonic tumor blood flow should be considered for malignant potential, and morcellation should be avoided.
