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Hepatic veins as a site of clot formation following liver resection
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作者 Emmanuel Buc Safi Dokmak +4 位作者 Magaly Zappa Marie Helene Denninger Dominique Charles Valla Jacques Belghiti Olivier Farges 《World Journal of Gastroenterology》 SCIE CAS CSCD 2011年第3期403-406,共4页
Pulmonary embolism occurs more frequently after hepatectomy than previously thought but is infrequently associated with peripheral deep vein thrombosis. In this paper, we report 2 cases of postoperative hepatic vein t... Pulmonary embolism occurs more frequently after hepatectomy than previously thought but is infrequently associated with peripheral deep vein thrombosis. In this paper, we report 2 cases of postoperative hepatic vein thrombosis after liver resection. Both patients had undergone major hepatectomy of a non-cirrhotic liver largely exposing the middle hepatic vein. Clots were incidentally found in the middle hepatic vein 4 and 17 d after surgery despite routine systemic thrombo-prophylaxis with low molecular weight heparin. Coagulation of the transition plan in a context of mutation of the prothrombin gene and inflammation induced biloma were the likely predisposing conditions. Clots disappeared following curative anticoagulation. We conclude that thrombosis of hepatic veins may occur after liver resection and is a potential source of pulmonary embolism. 展开更多
关键词 HEPATECTOMY hepatic veins THROMBOSIS Pulmonary embolism ANTICOAGULANTS
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Complete resection of the hepatic veins: The role of right inferior vein
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作者 emanuele felli roberto l.meniconi +2 位作者 marco colasanti giovanni vennarecci giuseppe m.ettorre 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2018年第1期88-90,共3页
To the editor:In the recent years liver surgery has been dramatically improved because of technical and technological innovations,perioperative and intraoperative intensive care,better knowledge of liver physiology an... To the editor:In the recent years liver surgery has been dramatically improved because of technical and technological innovations,perioperative and intraoperative intensive care,better knowledge of liver physiology and early recognition and treatment of postoperative complications.Last but not least,liver anatomy,though not 展开更多
关键词 The role of right inferior vein Complete resection of the hepatic veins
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Clinical studies on inferior right hepatic veins 被引量:7
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作者 Xing, Xue Li, Hong Liu, Wei-Guo 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2007年第6期579-584,共6页
BACKGROUND: Many small veins are called accessory, short hepatic veins in addition to the right, middle and left hepatic veins. The size of these veins varied from a pinhole to 1 cm; the size of inferior right hepatic... BACKGROUND: Many small veins are called accessory, short hepatic veins in addition to the right, middle and left hepatic veins. The size of these veins varied from a pinhole to 1 cm; the size of inferior right hepatic veins (IRHVs) is thicker than that of short hepatic veins or more than 1 cm. occasionally. Adults have a higher incidence rate of the IRHV. DATA SOURCES: A literature search of the PubMed database was conducted and research articles were reviewed. RESULTS: The size of IRHVs is related to the size of the right hepatic vein, i.e. the larger the diameter of the right hepatic vein, the smaller the diameter of the IRHVs, and vice versa. The IRHVs are divided into superior, medial and inferior groups, separately named the superior, medial and inferior right hepatic veins according to the position of the IRHV entering the inferior vena cava. The superior right hepatic vein mainly drains the superior part of segment VII, and the medial right hepatic vein drains the middle part of segment VII. A thicker IRHV mainly drains segment VI and the inferior part of segment VII and a thinner IRHV drains the inferior part of segment V. CONCLUSIONS: The clinical significance of these studies on IRHVs is varied: (1) Hepatic caudate lobe resection could be introduced after study on the veins of that lobe. (2) It is very important to identify the draining region of the IRHV for guiding hepatic segmentectomy. The postero-inferior area of the right lobe can be preserved along with the hypertrophic IRHV even if the entire main right hepatic vein is resected during segmentectomy of VII and VIII with right hepatic vein resection for patients with primary liver cancer. (3) The ligation of the major hepatic vein for the treatment of juxtahepatic vein injury is recommended because of severe hemorrhagic shock and difficulty in exposure. (4) It is very helpful to decide therapeutic modalities for Budd-Chiari syndrome. 展开更多
关键词 hepatic vein inferior right hepatic vein HEPATECTOMY ANATOMY hepatic vein injury
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Hepatic veins anatomy and piggy-back liver transplantation 被引量:4
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作者 Ying-Zi Ming,Ying Niu,Ming-Jie Shao,Xing-Guo She and Qi-Fa Ye Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology,The Third Xiangya Hospital,Central South University,Changsha 410013,China 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2012年第4期429-433,共5页
BACKGROUND:The piggy-back caval anastomosis technique is widely used in orthotopic liver transplantation although it carries an increased risk of complications,including outflow obstruction and Budd-Chiari syndrome.Th... BACKGROUND:The piggy-back caval anastomosis technique is widely used in orthotopic liver transplantation although it carries an increased risk of complications,including outflow obstruction and Budd-Chiari syndrome.The aim of this study is to clarify the anatomy and variations of hepatic veins(HVs) draining into the inferior vena cava(IVC),and to classify the surgical techniques of piggy-back liver transplantation(PBLT) based on the anatomy of HVs which can reduce the occurrence of complications.METHODS:PBLT was performed in 248 consecutive cases at our hospital from January 2004 to August 2011.The anatomy of recipients’ HVs was determined when removing the native diseased livers.Both anatomy of HVs and short HVs draining into the IVC were recorded.These data were collected and analyzed.RESULTS:We classified anatomic variations of HVs in the 248 livers into five types according to the way of drainage into the IVC:type I(trunk type of left and middle HVs),142(57.3%) patients;type II(trunk type of right and middle HVs),54(21.8%);type III(trunk type of left,middle and right HVs),14(5.6%);type IV(non-trunk type of left,middle and right HVs),of which,type IVa,16(6.5%),in the same horizontal plane;type IVb,18(7.3%),in different horizontal planes;and type V(segment type),4(1.6%).The patients whose HVs anatomy belonged to types I,II and III underwent classical piggy-back liver transplantation.Type IVa patients had classical PBLT via HV venoplasty prior to piggy-back anastomosis,while type IVb patients and type V patients could only have modified PBLT.CONCLUSION:This study demonstrates that HVs can be classified according to the anatomy of their drainage into the IVC and we can use this classification to choose the best operative approach to PBLT. 展开更多
关键词 hepatic vein CLASSIFICATION piggy-back liver transplantation
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Novel procedure for hepatic venous outflow block after liver resection:A case report
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作者 Hisanobu Higashi Yuta Abe +7 位作者 Kodai Abe Yutaka Nakano Masayuki Tanaka Shutaro Hori Yasushi Hasegawa Hiroshi Yagi Minoru Kitago Yuko Kitagawa 《World Journal of Clinical Cases》 SCIE 2024年第29期6320-6326,共7页
BACKGROUND Postoperative complications like remnant hepatic vein(HV)outflow block and liver torsion can occur after right hepatectomy.Hepatic falciform ligament fixation is typically used to prevent liver torsion.We r... BACKGROUND Postoperative complications like remnant hepatic vein(HV)outflow block and liver torsion can occur after right hepatectomy.Hepatic falciform ligament fixation is typically used to prevent liver torsion.We report a novel procedure to manage outflow block.CASE SUMMARY An 80-year-old man developed HV outflow block after remnant right hepatectomy,despite liver fixation and intraoperative HV flow check.He had a history of cholangiocellular carcinoma and had undergone posterior segmentectomy and choledojejunostomy.The falciform ligament fixation was inadequate to maintain liver position.Emergency surgery was performed,using an omental flap and mobilized right side colon with ileocecal region to prevent liver dislocation due to intraabdominal adhesion.His postoperative course was uneventful.CONCLUSION This is the first report providing a novel surgical procedure when the falciform ligament is insufficient for remnant liver fixation. 展开更多
关键词 HEPATECTOMY Postoperative complications Budd-Chiari syndrome hepatic vein outflow block Emergency surgery Case report
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Early control of short hepatic portal veins in isolated or combined hepatic caudate lobectomy 被引量:11
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作者 Wan-Yee Lau 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2012年第4期377-382,共6页
BACKGROUND:Caudate lobectomy has long been considered technically difficult.This study aimed to elaborate the significance of early control of short hepatic portal veins(SHPVs) in isolated hepatic caudate lobectomy or... BACKGROUND:Caudate lobectomy has long been considered technically difficult.This study aimed to elaborate the significance of early control of short hepatic portal veins(SHPVs) in isolated hepatic caudate lobectomy or in hepatic caudate lobectomy combined with major partial hepatectomy,and to describe the anatomical characteristics of SHPVs.METHODS:The data of 117 patients who underwent either isolated or combined caudate lobectomy by the same team of surgeons from 2005 to 2009 were retrospectively analyzed.From 2005 to 2007(group A,n=55),we carried out early control of short hepatic veins(SHVs) only;from 2008 to 2009(group B,n=62),we carried out early control of both SHVs and SHPVs.The two groups were compared to evaluate which surgical procedure was better.A detailed anatomical study was then carried out on the last 25 consecutive patients in group B to study the number and distribution of SHPVs during surgery.RESULTS:Patients in group B had less intra-operative blood loss,less impairment of liver function,shorter postoperative hospital stay,fewer postoperative complications and required less blood transfusion(P<0.05).The number of SHPVs in the 25 patients was 183,with 7.3±2.7 per patient.The diameters of SHPVs were 1 to 4 mm.On average,3.4 SHPVs/patient came from the left portal vein,2.2 from the bifurcation,1.4 from the right portal vein,and 0.3 from the main portal vein.On average,3.3 SHPVs/patient supplied segment I of the liver,0.4 for segment II,2.1 for segment IV,1.4 for segment V and 0.1 for segment VI.CONCLUSION:Early control of SHPVs in isolated or combined hepatic caudate lobectomy may be a useful method to decrease surgical risk and improve postoperative recovery. 展开更多
关键词 short hepatic portal vein caudate lobe ANATOMY
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Simultaneous portal and hepatic vein embolization is better than portal embolization or ALPPS for hypertrophy of future liver remnant before major hepatectomy: A systematic review and network meta-analysis 被引量:6
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作者 Paschalis Gavriilidis Gabriele Marangoni +1 位作者 Jawad Ahmad Daniel Azoulay 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2023年第3期221-227,共7页
Background:Post-hepatectomy liver failure(PHLF)is the Achilles’heel of hepatic resection for colorectal liver metastases.The most commonly used procedure to generate hypertrophy of the functional liver remnant(FLR)is... Background:Post-hepatectomy liver failure(PHLF)is the Achilles’heel of hepatic resection for colorectal liver metastases.The most commonly used procedure to generate hypertrophy of the functional liver remnant(FLR)is portal vein embolization(PVE),which does not always lead to successful hypertrophy.Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has been proposed to overcome the limitations of PVE.Liver venous deprivation(LVD),a technique that includes simultaneous portal and hepatic vein embolization,has also been proposed as an alternative to ALPPS.The present study aimed to conduct a systematic review as the first network meta-analysis to compare the efficacy,effectiveness,and safety of the three regenerative techniques.Data sources:A systematic search for literature was conducted using the electronic databases Embase,PubMed(MEDLINE),Google Scholar and Cochrane.Results:The time to operation was significantly shorter in the ALPPS cohort than in the PVE and LVD cohorts by 27 and 22 days,respectively.Intraoperative parameters of blood loss and the Pringle maneuver demonstrated non-significant differences between the PVE and LVD cohorts.There was evidence of a significantly higher FLR hypertrophy rate in the ALPPS cohort when compared to the PVE cohort,but non-significant differences were observed when compared to the LVD cohort.Notably,the LVD cohort demonstrated a significantly better FLR/body weight(BW)ratio compared to both the ALPPS and PVE cohorts.Both the PVE and LVD cohorts demonstrated significantly lower major morbidity rates compared to the ALPPS cohort.The LVD cohort also demonstrated a significantly lower 90-day mortality rate compared to both the PVE and ALPPS cohorts.Conclusions:LVD in adequately selected patients may induce adequate and profound FLR hypertrophy before major hepatectomy.Present evidence demonstrated significantly lower major morbidity and mortality rates in the LVD cohort than in the ALPPS and PVE cohorts. 展开更多
关键词 Portal vein embolization hepatic vein embolization Future liver remnant ALPPS
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Balloon-occluded retrograde transvenous obliteration for treatment of congenital intrahepatic portosystemic venous shunt:A case report
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作者 Shenggan Lin Zhenyu Xu +4 位作者 Zhuoyang Fan Wei Zhang Guowei Yang Sheng Qian Rong Liu 《Journal of Interventional Medicine》 2023年第1期49-51,共3页
Congenital intrahepatic portosystemic venous shunt(CPSVS), a rare vascular malformation, has been described in both children and adults and can lead to severe neurophysiological complications. However, a standard ther... Congenital intrahepatic portosystemic venous shunt(CPSVS), a rare vascular malformation, has been described in both children and adults and can lead to severe neurophysiological complications. However, a standard therapeutic protocol for CPSVS has not been elucidated. With the advantage of minimally invasive techniques,transcatheter embolization has been used to treat CPSVS. The condition is challenging to manage, especially in patients with large or multiple shunts, through which rapid blood flow can cause ectopic embolism. Here, we describe a case of CPSVS with a large shunt that was successfully treated with balloon-occluded retrograde transvenous obliteration with interlocking detachable coils. 展开更多
关键词 hepatic vein Portal vein Vascular malformations Endovascular procedures Balloon occlusion
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Computed tomography perfusion in differentiating portal hypertension: A correlation study with hepatic venous pressure gradient
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作者 Jian Dong Yu Zhang +5 位作者 Yi-Fan Wu Zhen-Dong Yue Zhen-Hua Fan Chun-Yan Zhang Fu-Quan Liu Lei Wang 《World Journal of Gastrointestinal Surgery》 SCIE 2023年第4期664-673,共10页
BACKGROUND Hepatic venous pressure gradient(HVPG)is the gold standard for diagnosis of portal hypertension(PH),invasiveness and potential risks in the process of measurement limited its widespread use.AIM To investiga... BACKGROUND Hepatic venous pressure gradient(HVPG)is the gold standard for diagnosis of portal hypertension(PH),invasiveness and potential risks in the process of measurement limited its widespread use.AIM To investigate the correlation of computed tomography(CT)perfusion parameters with HVPG in PH,and quantitatively assess the blood supply changes in liver and spleen parenchyma before and after transjugular intrahepatic portosystemic shunt(TIPS).METHODS Twenty-four PH related gastrointestinal bleeding patients were recruited in this study,and all patients were performed perfusion CT before and after TIPS surgery within 2 wk.Quantitative parameters of CT perfusion,including liver blood volume(LBV),liver blood flow(LBF),hepatic arterial fraction(HAF),spleen blood volume(SBV)and spleen blood flow(SBF),were measured and compared before and after TIPS,and the quantitative parameters between clinically significant PH(CSPH)and non-CSPH(NCSPH)group were also compared.Then the correlation of CT perfusion parameters with HVPG were analyzed,with statistical significance as P<0.05.RESULTS For all 24 PH patients after TIPS,CT perfusion parameters demonstrated decreased LBV, increased HAF, SBV and SBF, with no statistical difference in LBF. Compared withNCSPH, CSPH showed higher HAF, with no difference in other CT perfusion parameters. HAFbefore TIPS showed positive correlation with HVPG (r = 0.530, P = 0.008), while no correlation wasfound in other CT perfusion parameters with HVPG and Child-Pugh scores.CONCLUSIONHAF, an index of CT perfusion, was positive correlation with HVPG, and higher in CSPH thanNCSPH before TIPS. While increased HAF, SBF and SBV, and decreased LBV, were found afterTIPS, which accommodates a potential non-invasive imaging tool for evaluation of PH. 展开更多
关键词 Portal hypertension Transjugular intrahepatic portosystemic shunt hepatic vein pressure gradient PERFUSION Computed tomography
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A Budd-Chiari Syndrome Due to C Protein Deficiency: A Case Report at YaoundéGeneral Hospital (Cameroon)
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作者 Antonin Wilson Ndjitoyap Ndam Gilles Gael Aghoagni Gouajio +5 位作者 Armel Awana Tenone Danah Larry Tangie Ngek Mathurin Kowo Firmin Andoulo Ankouane Elie Claude Ndjitoyap Ndam 《Open Journal of Gastroenterology》 CAS 2024年第4期117-124,共8页
Primary Budd-Chiari syndrome (BCS) is a spontaneously fatal disease characterized by an obstruction of the hepatic venous outflow tract due to thrombosis or a primary disease of the venous wall. The primary form of BC... Primary Budd-Chiari syndrome (BCS) is a spontaneously fatal disease characterized by an obstruction of the hepatic venous outflow tract due to thrombosis or a primary disease of the venous wall. The primary form of BCS is extremely rare. This is a disease mainly affecting young adults of both sexes. Clinical manifestations are variable;they can be asymptomatic, acute, or subacute but mostly chronic. Several causes have been identified, such as myeloproliferative syndrome, antiphospholipid syndrome, paroxysmal nocturnal hemoglobinuria, and inherited thrombotic disorders. Data on primary BCS in Sub-Saharan Africa is rare as most publications available are case reports. In these reports, the causes are unknown with poor prognosis in most cases often leading to patient death. We herein present a case report of a male patient diagnosed with a primary BCS at Yaoundé General Hospital (Cameroon) caused by a Protein C deficiency who presented with ascites decompensating liver cirrhosis. Treatment was based on anticoagulants, diuretics and laxatives administration. Two years after the diagnosis, the patient is alive with clinical and paraclinical improvement. 展开更多
关键词 Budd-Chiari Syndrome hepatic veins Liver Cirrhosis Protein C Deficiency Cameroon
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Successful embolization of an intrahepatic portosystemic shunt using balloon-occluded retrograde transvenous obliteration:A case report 被引量:1
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作者 Hidemasa Saito Satoru Murata +5 位作者 Fumie Sugihara Tatsuo Ueda Daisuke Yasui Izumi Miki Hiromitsu Hayashi Shin-Ichiro Kumita 《World Journal of Clinical Cases》 SCIE 2022年第6期2023-2029,共7页
BACKGROUND A congenital intrahepatic portosystemic shunt(IPSVS)is a rare vascular abnormality that is characterized by an anomalous intrahepatic venous tract that connects the intrahepatic portal vein with the hepatic... BACKGROUND A congenital intrahepatic portosystemic shunt(IPSVS)is a rare vascular abnormality that is characterized by an anomalous intrahepatic venous tract that connects the intrahepatic portal vein with the hepatic venous system.Hepatic encephalopathy is an indication for IPSVS embolization,which is technically challenging because rapid blood flow through shunts can induce the migration of embolization material to systemic veins.This case report discusses the efficacy of percutaneous balloon-occluded retrograde transvenous obliteration for treating patients with IPSVSs.CASE SUMMARY A 75-year-old woman presented with a six-month history of repeated hepatic encephalopathy due to an IPSVS without liver cirrhosis.We successfully embolized the IPSVS using percutaneous balloon-occluded retrograde transvenous obliteration with interlocking detachable coils.After the procedure,the patient exhibited no symptoms of hepatic encephalopathy for 14 mo.CONCLUSION Balloon-occluded retrograde transvenous obliteration with detachable coils can be effective for the endovascular treatment of an IPSVS. 展开更多
关键词 hepatic veins Portal vein hepatic encephalopathy Endovascular procedures EMBOLIZATION THERAPEUTIC Case report
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Precise hepatectomy guided by the middle hepatic vein 被引量:78
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作者 Sheung-Tat Fan 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2007年第4期430-434,共5页
The middle hepatic vein (MHV) lies in the midplane of the liver. The classical teaching of right or left hepatectomy is transection of liver I cm to the right or left wall of the MHV in order to avoid bleeding. Howeve... The middle hepatic vein (MHV) lies in the midplane of the liver. The classical teaching of right or left hepatectomy is transection of liver I cm to the right or left wall of the MHV in order to avoid bleeding. However, guidance of liver transection is lost if the course of the MHV is not known. By exposing the MHV early in the phase of liver transection and following its course to the inferior vena cava, a precise liver transection plane could be obtained. Such technique has the potential of achieving adequate tumor-free resection margin, avoiding damage to intrahepatic portal pedicles, preserving venous drainage and functional liver tissue, and less postoperative infection. 展开更多
关键词 middle hepatic vein HEPATECTOMY
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Glissonian approach combined with major hepatic vein first for laparoscopic anatomic hepatectomy 被引量:14
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作者 De-Cai Yu Xing-Yu Wu +1 位作者 Xi-Tai Sun Yi-Tao Ding 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2018年第4期316-322,共7页
Background: Laparoscopic anatomic hepatectomy remains challenging because of the complex interior structures of the liver. Our novel strategy includes the Glissonian approach and the major hepatic vein first, which se... Background: Laparoscopic anatomic hepatectomy remains challenging because of the complex interior structures of the liver. Our novel strategy includes the Glissonian approach and the major hepatic vein first, which serves to define the external and internal landmarks for laparoscopic anatomic hepatectomy.Methods: Eleven cases underwent laparoscopic anatomic hepatectomy, including three right hepatectomies, three left hepatectomies, three right posterior hepatectomies, and two mesohepatectomies. The Glissonian approach was used to transect the hepatic pedicles as external demarcation. The major hepatic vein near the hepatic portal was exposed and served as the internal landmark for parenchymal transection. The liver parenchyma below and above the major hepatic vein was transected along the major hepatic vein. Fifty-nine subjects were used to compare the distance between the major hepatic vein and secondary Glisson pedicles among different liver diseases.Results: The average operative time was 327 min with an estimated blood loss of 554.55 m L. Only two patients received three units of packed red blood cells. The others recovered normally and were discharged on postoperative day 7. The distance between right posterior Glissonian pedicle and right hepatic vein was shorter in the patients with cirrhosis than that without cirrhosis, and this distance was even shorter in patients with hepatocellular carcinoma.Conclusion: The Glissonian approach with the major hepatic vein first is easy and feasible for laparoscopic anatomic hepatectomy, especially in patients with hepatocellular carcinoma and cirrhosis. 展开更多
关键词 HEPATECTOMY LAPAROSCOPY Liver diseases Surgical procedures Major hepatic vein
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Management of the middle hepatic vein and its tributaries in right lobe living donor liver transplantation 被引量:11
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作者 Yu, Peng-Fei Wu, Jian Zheng, Shu-Sen 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2007年第4期358-363,共6页
BACKGROUND: Left liver graft from a small donor will not meet the metabolic demands of a larger adult recipient. To overcome the problem of graft size insufficiency, living donor liver transplantation (LDLT) using the... BACKGROUND: Left liver graft from a small donor will not meet the metabolic demands of a larger adult recipient. To overcome the problem of graft size insufficiency, living donor liver transplantation (LDLT) using the right lobe has become a standard method for adult patients. As the drainage of the median sector (segments V, VIII and IV) is mainly by the middle hepatic vein (MHV), the issue of whether the MHV should or should not be taken with the graft or whether the MHV tributaries (V5, V8) should be reconstructed in the recipient remains to be settled. DATA SOURCES: An English-language literature search was conducted using MEDLINE (1985-2006) on right lobe living donor liver transplantation, middle hepatic vein, vein graft, hepatic venoplasty and other related subjects. RESULTS: Some institutions had proposed their policy for the management of the MHV and its tributaries. Dominancy of the hepatic vein, graft-to-recipient weight ratio, and remnant liver volume as well as the donor-to-recipient body weight ratio, the volume of the donor's right lobe to the recipient's standard liver volume and the size of MHV tributaries are the major elements for the criteria of inclusion of the MHV, while for the policy of MHV tributaries reconstruction, the proportion of congestive area and the diameter of the tributaries are the critical elements. Optimal vein grafts such as recipient's portal vein and hepatic venoplasty technique have been used to obviate hepatic congestion and venous drainage disturbance. CONCLUSIONS: Taking right liver grafts with the MHV trunk (extended right lobe grafts) or performing the MHV tributaries reconstruction in modified right lobe grafts, according to the criteria proposed by the institutions with rich experience, can solve the congestion problem of the right paramedian sector and help to improve the outcomes of the patients. The additional use of optimal vein grafts and hepatic venoplasty also can guarantee excellent venous drainage. 展开更多
关键词 right lobe living donor liver transplantation middle hepatic vein vein graft hepatic venoplasty
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Computed tomography findings in fatal cases of enormous hepatic portal venous gas 被引量:9
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作者 Siu-Cheung Chan Yung-Liang Wan +3 位作者 Yun-Chung Cheung Shu-Hang Ng Alex Mun-Ching Wong Koon-Kwan Ng 《World Journal of Gastroenterology》 SCIE CAS CSCD 2005年第19期2953-2955,共3页
AIM: To assess the computed tomography (CT) findings in the patients with hepatic portal venous gas (HPVG) who presented with a short fatal clinical course in our hospital in order to demonstrate if there was any sign... AIM: To assess the computed tomography (CT) findings in the patients with hepatic portal venous gas (HPVG) who presented with a short fatal clinical course in our hospital in order to demonstrate if there was any sign for prediction.METHODS: Between January 1997 and December 2000, CT scan of the abdomen was performed on 949 patients with acute abdominal pain in our emergency department.Five patients were found having HPVG. The CT images and clinical presentations of all these five patients were reviewed. RESULTS: In reviewing the CT findings of the cases, HPVG in bilateral hepatic lobes, abnormal gas in the superior mesenteric veins, small bowel intramural gas, and bowel distension were observed in all patients. Dry gas in multiple branches of the mesenteric vein was also revealed in all cases. All the patients expired due to irreversible septic shock within 48 h after their initial clinical presentation in emergency room. Two patients had acute pancreatitis with grade D and E Balthazar classification and they expired within 24 h due to progressing septic shock under aggressive medical treatment and life support. Two patients with underlying end stage renal disease expired within 48 h even though emergent surgical intervention was undertaken. The excited bowels revealed severe ischemic change. One patient expired only a few hours after the CT examination. CONCLUSION: HPVG is a diagnostic clue in patients with acute abdominal conditions, and CT is the most specific diagnostic tool for its evaluation. The dry mesenteric veins are the suggestive fatal sign, especially for the deteriorating patients, with the direct effect on gastrointestinal perfusion. 展开更多
关键词 hepatic portal vein INTESTINES ISCHEMIA Computed tomography
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Doppler study of hepatic vein in cirrhotic patients:Correlation with liver dysfunction and hepatic hemodynamics 被引量:8
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作者 KC Sudhamshu Shoiichi Matsutani +2 位作者 Hitoshi Maruyama Taro Akiike Hiromitsu Saisho 《World Journal of Gastroenterology》 SCIE CAS CSCD 2006年第36期5853-5858,共6页
AIM: To elucidate the significance of Doppler measurements of hepatic vein in cirrhotic patients and to correlate with liver dysfunction and hepatic hemodynamics. METHODS: One hundred patients with liver cirrhosis and... AIM: To elucidate the significance of Doppler measurements of hepatic vein in cirrhotic patients and to correlate with liver dysfunction and hepatic hemodynamics. METHODS: One hundred patients with liver cirrhosis and 60 non-cirrhotic controls were studied. Doppler waveforms were obtained from right hepatic vein and flow velocity measured during quiet respiration. Doppler measurements were also obtained from portal trunk, right portal vein and proper hepatic artery. RESULTS: Hepatic vein waveforms were classified into three classical patterns. Flat waveform was uncommon. Mean hepatic vein velocity was significantly higher in cirrhotic patients (12.7 ± 6.4 vs 5.1 ± 2.1 and 6.2 ± 3.2 cm/s; P < 0.0001). The poorer the grade of cirrhosis, the higher was the mean velocity. Maximum forward velocity was never greater than 40 cm/s in controls. Degree of ascites was found to be highly correlated with mean velocity. “Very high” group (≥ 20 cm/s) presented clinically with moderate to massive ascites. Correlations between right portal flow and mean velocity was significant (P < 0.0001, r = 0.687). CONCLUSION: Doppler waveforms of hepatic vein, which is independent of liver dysfunction, should be obtained during normal respiration. Mean hepatic vein velocity reflects the change in hepatic circulation associated with progression of liver cirrhosis. It can be used as a new parameter in the assessment of liver cirrhosis. 展开更多
关键词 hepatic vein hepatic vein velocity Doppler ultrasound
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Efficacy of middle hepatic vein reconstruction in adult right-lobe living donor liver transplantation 被引量:7
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作者 Peng, Ci-Jun Wang, Xiao-Fei +6 位作者 Li, Bo Wei, Yong-Gang Yan, Lu-Nan Wen, Tian-Fu Yang, Jia-Yin Wang, Wen-Tao Zhao, Ji-Chun 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2010年第2期135-138,共4页
BACKGROUND: Congestion of the right anterior segment may lead to graft dysfunction in right-lobe living donor liver transplantation (LDLT) without a middle hepatic vein (MHV) trunk. Selective reconstruction of MHV tri... BACKGROUND: Congestion of the right anterior segment may lead to graft dysfunction in right-lobe living donor liver transplantation (LDLT) without a middle hepatic vein (MHV) trunk. Selective reconstruction of MHV tributaries with the interposition of vascular grafts has been introduced to overcome this problem. However, there is still no consensus on the definite criteria of MHV reconstruction. METHODS: LDLT patients were reviewed to evaluate the effects of MHV reconstruction. From March 2005 to September 2008 in our transplantation center, 120 consecutive LDLTs were performed using a right-lobe graft without a MHV. Excluding 11 patients, among the remainder, 73 (67%) had reconstructed MHV tributaries, and the others 36 (33%) did not. The values of liver functional index and liver graft regeneration ratio were compared between the two groups. RESULTS: There was a prolonged period of liver functional recovery in patients with small-for-size grafts and a graft-recipient weight ratio (GRWR) <1.0%, and without MHV reconstruction. The ratio of liver regeneration 1 month postoperatively in reconstruction cases was 81%, versus 78% in patients without reconstruction (P=0.352), but among small-for-size grafts, there was a significant difference between the two groups (95% vs. 80%). CONCLUSION: Our study shows that reconstruction of MHV tributaries is not necessary in all patients, but is beneficial for patients with GRWR <1.0%. (Hepatobiliary Pancrent Dis Int 2010; 9: 135-138) 展开更多
关键词 middle hepatic vein RECONSTRUCTION living donor liver transplantation interposition vascular conduits
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Prognostic value of the neutrophil-to-lymphocyte ratio for hepatocellular carcinoma patients with portal/hepatic vein tumor thrombosis 被引量:5
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作者 Shao-Hua Li Qiao-Xuan Wang +6 位作者 Zhong-Yuan Yang Wu Jiang Cong Li Peng Sun Wei Wei Ming Shi Rong-Ping Guo 《World Journal of Gastroenterology》 SCIE CAS 2017年第17期3122-3132,共11页
AIM To investigate whether the preoperative neutrophil-tolymphocyte ratio(NLR) could predict the prognosis of hepatocellular carcinoma(HCC) patients with portal/hepatic vein tumor thrombosis(PVTT/HVTT) after hepatecto... AIM To investigate whether the preoperative neutrophil-tolymphocyte ratio(NLR) could predict the prognosis of hepatocellular carcinoma(HCC) patients with portal/hepatic vein tumor thrombosis(PVTT/HVTT) after hepatectomy.METHODS The study population included 81 HCC patients who underwent hepatectomy and were diagnosed with PVTT/HVTT based on pathological examination. The demographics, laboratory analyses, and histopathology data were analyzed.RESULTS Overall survival(OS) and disease-free survival(DFS) were determined in the patients with a high(> 2.9) and low(≤ 2.9) NLR. The median OS and DFS duration in the high NLR group were significantly shorter than those in the low NLR group(OS: 6.2 mo vs 15.7 mo, respectively, P = 0.007; DFS: 2.2 mo vs 3.7 mo, respectively, P = 0.039). An NLR > 2.9 was identified as an independent predictor of a poor prognosis of OS(P = 0.034, HR = 1.866; 95%CI: 1.048-3.322) in uni-and multivariate analyses. Moreover, there was a significantly positive correlation between the NLR and the Child-Pugh score(r = 0.276, P = 0.015) and the maximum diameter of the tumor(r = 0.435, P < 0.001). Additionally, the NLR could enhance the prognostic predictive power of the CLIP score for DFS in these patients. CONCLUSION The preoperative NLR is a prognostic predictor after hepatectomy for HCC patients with PVTT/HVTT. NLR > 2.9 indicates poorer OS and DFS. 展开更多
关键词 Hepatocellular carcinoma Portal/hepatic vein tumor thrombosis Neutrophil-to-lymphocyte ratio PROGNOSIS
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Hepatic segmentectomy combined with major hepatic vein resection for preserving remnant liver lobe 被引量:4
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作者 Xing, Xue Li, Hong Liu, Wei-Guo 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2008年第2期165-168,共4页
BACKGROUND: Impairment of liver function is the most serious complication that occurs after liver resection or in cirrhotic liver. Postoperative hepatic failure, which is mainly preceded by insufficient remnant liver ... BACKGROUND: Impairment of liver function is the most serious complication that occurs after liver resection or in cirrhotic liver. Postoperative hepatic failure, which is mainly preceded by insufficient remnant liver function and/or postoperative septic complications, is the major cause of hospital mortality. This study was undertaken to evaluate hepatic segmentectomy combined with major hepatic vein (MHV) resection for preserving the remnant liver lobe in the treatment of resectable primary liver cancer. METHODS: From 1997 to 2007, six patients with primary liver cancer underwent hepatic segmentectomy with MHV resection, and three patients with hepatic vein injury had ligation of the MHV. The remnant liver lobe was preserved after hepatic segmentectomy combined with MHV resection or ligation. RESULTS: The preserved liver lobe with normal structure could maintain hepatic function and showed no evidence of atrophy or swelling after hepatic segmentectomy combined with MHV resection or ligation. CONCLUSIONS: After the right inferior hepatic vein is confirmed, and the MHV is occluded experimentally before hepatic segmentectomy combined with MHV resection, progressively deteriorating congestion does not occur in the preserved segment. Ligation or resection of the two MHVs must be avoided in patients with hepatic cirrhosis who have to undergo hepatic segmentectomy combined with MHV resection. Ligation of the MHV in patients with juxtahepatic vein injury is a simple and effective therapeutic modality. 展开更多
关键词 liver resection NEOPLASM hepatic vein LIGATION surgical treatment
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Color Doppler ultrasonographic assessment of the risk of injury to major branch of the midddle hepatic vein during laparoscopic cholecystectomy 被引量:4
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作者 Bai-Yong Shen Hong-Wei Li +5 位作者 Man Chen Min-Hua Zheng Lu Zang Shao-Min Jiang Jian-Wen Li Yu Jiang the Department of Surgery, Ruijin Hospital, Shanghai Second Medical University, Shanghai 200025, China Department of Ultrasonography, Ruijin Hospital, Shanghai Second Medical University, Shanghai 200025, China 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2003年第1期126-130,共5页
OBJEGTIVE: To investigate the causes of hemorrhage from the gallbladder bed during laparoscopic cholecystectomy. METHODS: 617 patients who had received laparoscopic cholecystectomy from September, 2000 to March, 2001 ... OBJEGTIVE: To investigate the causes of hemorrhage from the gallbladder bed during laparoscopic cholecystectomy. METHODS: 617 patients who had received laparoscopic cholecystectomy from September, 2000 to March, 2001 at this hospital were reviewed retrospectively. Ninety-one of these patients were selected randomly for prospective observation. Color Doppler ultrasound was used to examine the cause of venous hemorrhage from the gallbladder bed during laparoscopic cholecystectomy and to examine the anatomic relationship between the gallbladder bed and the branches of the middle hepatic vein in 91 patients preoperatively. RESULTS: A large branch of the middle hepatic vein extended closely behind the gallbladder bed in all 91 patients. The mean distance between the closest point (C point) of this branch to the gallbladder bed was 5.0±4.6 mm. The branch of the middle hepatic vein was completely adherent to the gallbladder bed in 14 (15.38%) of the 91 patients. The distance between this branch and the gallbladder bed was within I mm in 10 (10.99%) of the 91 patients. The inside diameter at C point of this branch was 3.2±1.1 mm. The C point was found on the left side of the longitudinal axis of the gallbladder in 31 (34.66%) of the 91 patients, on the right side in 39 patients (42.86%), just on the axis in 21 patients (23.08%). The venous blood flow rate at the C point was 9.9±3.3 cm/s. CONCLUSIONS: A large branch of the middle hepatic vein passes behind the gallbladder. The inside diameter of this branch is relatively larger. The bleeding of this branch during operation can only be stopped by transfixion. The closest point of this vein to the gallbladder is mostly situated on the right side of the longitudinal axis of the gallbladder. Patients with large branches of the middle hepatic vein close to the gallbladder bed are at risk of hemorrhage during laparoscopic cholecystectomy and should be identified preoperatively with ultrasound. 展开更多
关键词 CHOLECYSTECTOMY gallbladder bed HEMORRHAGE middle hepatic vein
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