BACKGROUND Hilar cholangiocarcinoma(HC)is a good adaptation certificate of hepatic arterectomy,and hepatic arterectomy is conductive to the radical resection of cholangiocarcinoma,which simplifies the operation and he...BACKGROUND Hilar cholangiocarcinoma(HC)is a good adaptation certificate of hepatic arterectomy,and hepatic arterectomy is conductive to the radical resection of cholangiocarcinoma,which simplifies the operation and helps with a combined resection of the peripheral portal tissue.With continuous development of surgical techniques,especially microsurgical technique,vascular invasion is no longer a contraindication to surgery in the past 10 years.However,hepatic artery reconstruction after hepatic arterectomy has been performed to treat liver tumor in many centers with better results,but it is rarely applied in advanced HC.AIM To determine the prognosis of patients with advanced HC after hepatic artery resection and reconstruction.METHODS A total of 98 patients with HC who underwent radical operation in our hospital were selected for this retrospective analysis.According to whether the patients underwent hepatic artery resection and reconstruction or not,they were divided into reconstruction(n=40)and control(n=58)groups.The traumatic indices,surgical resection margin,liver function tests before and after the operation,and surgical complications were compared between the two groups.RESULTS Operation time,blood loss,hospital stay,and gastrointestinal function recovery time were higher in the reconstruction group than in the control group(P<0.05);The R0 resection rates were 90.00%and 72.41%in the reconstruction and control groups,respectively(P<0.05).Serum alanine aminotransferase was lower in the reconstruction group on day one and three postoperatively,whereas serum aspartate aminotransferase was lower on the third day(P<0.05).Preoperatively,the Karnofsky performance status scores were similar between the groups(P>0.05),but was higher in the reconstruction group(P<0.05)two weeks postoperatively.There was no difference in the complication rate between the two groups(27.50%vs 32.67%,P>0.05).Two-year survival rate(42.50%vs 39.66%)and two-year survival time(22.0 mo vs 23.0 mo)were similar between the groups(P>0.05).CONCLUSION Radical surgery combined with reconstruction after hepatic artery resection improves R0 resection rate and reduces postoperative liver injury in advanced HC.However,the operation is difficult and the effect on survival time is not clear.展开更多
Calcification of the portal venous system is a rare entity that can be incidentally discovered during computed tomography (CT). We describe a case of extensive calcifications in the portal venous system in a middle-ag...Calcification of the portal venous system is a rare entity that can be incidentally discovered during computed tomography (CT). We describe a case of extensive calcifications in the portal venous system in a middle-aged male patient with hepatocellular carcinoma (HCC). This patient presented with epigastric pain that had no obvious origin prior to admission. Laboratory examinations were positive for hepatitis B surface antigen and α-fetoprotein, and severe esophageal and gastric varices were detected during gastroscopy. Abdominal X-ray plain film showed well-defined linear and track-like calcification, with irregular margins directed along the course of the portal venous system. CT revealed extensive calcifications along the course of the portal, splenic, superior mesenteric and gastroesophageal veins. He underwent splenectomy 22 years ago due to splenomegaly and partial hepatectomy seven months before because of HCC of low-grade differentiation, confirmed by pathology. Finally, the patient was diagnosed with postoperative recurrent HCC and extensive portal venous system calcification after selective hepatic angiography under digital subtraction angiography.展开更多
文摘BACKGROUND Hilar cholangiocarcinoma(HC)is a good adaptation certificate of hepatic arterectomy,and hepatic arterectomy is conductive to the radical resection of cholangiocarcinoma,which simplifies the operation and helps with a combined resection of the peripheral portal tissue.With continuous development of surgical techniques,especially microsurgical technique,vascular invasion is no longer a contraindication to surgery in the past 10 years.However,hepatic artery reconstruction after hepatic arterectomy has been performed to treat liver tumor in many centers with better results,but it is rarely applied in advanced HC.AIM To determine the prognosis of patients with advanced HC after hepatic artery resection and reconstruction.METHODS A total of 98 patients with HC who underwent radical operation in our hospital were selected for this retrospective analysis.According to whether the patients underwent hepatic artery resection and reconstruction or not,they were divided into reconstruction(n=40)and control(n=58)groups.The traumatic indices,surgical resection margin,liver function tests before and after the operation,and surgical complications were compared between the two groups.RESULTS Operation time,blood loss,hospital stay,and gastrointestinal function recovery time were higher in the reconstruction group than in the control group(P<0.05);The R0 resection rates were 90.00%and 72.41%in the reconstruction and control groups,respectively(P<0.05).Serum alanine aminotransferase was lower in the reconstruction group on day one and three postoperatively,whereas serum aspartate aminotransferase was lower on the third day(P<0.05).Preoperatively,the Karnofsky performance status scores were similar between the groups(P>0.05),but was higher in the reconstruction group(P<0.05)two weeks postoperatively.There was no difference in the complication rate between the two groups(27.50%vs 32.67%,P>0.05).Two-year survival rate(42.50%vs 39.66%)and two-year survival time(22.0 mo vs 23.0 mo)were similar between the groups(P>0.05).CONCLUSION Radical surgery combined with reconstruction after hepatic artery resection improves R0 resection rate and reduces postoperative liver injury in advanced HC.However,the operation is difficult and the effect on survival time is not clear.
文摘Calcification of the portal venous system is a rare entity that can be incidentally discovered during computed tomography (CT). We describe a case of extensive calcifications in the portal venous system in a middle-aged male patient with hepatocellular carcinoma (HCC). This patient presented with epigastric pain that had no obvious origin prior to admission. Laboratory examinations were positive for hepatitis B surface antigen and α-fetoprotein, and severe esophageal and gastric varices were detected during gastroscopy. Abdominal X-ray plain film showed well-defined linear and track-like calcification, with irregular margins directed along the course of the portal venous system. CT revealed extensive calcifications along the course of the portal, splenic, superior mesenteric and gastroesophageal veins. He underwent splenectomy 22 years ago due to splenomegaly and partial hepatectomy seven months before because of HCC of low-grade differentiation, confirmed by pathology. Finally, the patient was diagnosed with postoperative recurrent HCC and extensive portal venous system calcification after selective hepatic angiography under digital subtraction angiography.
