A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26,2023,at the Pakistan Kidney and Liver Institute&Research Centre(PKLI&RC)after initial con...A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26,2023,at the Pakistan Kidney and Liver Institute&Research Centre(PKLI&RC)after initial consultations with the experts.The Pakistan Society for the Study of Liver Diseases(PSSLD)and PKLI&RC jointly organised this meeting.This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma(hCCA).The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients.This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation.The diagnostic and staging workup includes high-quality computed tomography,magnetic resonance imaging,and magnetic resonance cholangiopancreato-graphy.Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis.However,histopathologic confirmation is not always required before resection.Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging.The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification.Selected patients with unresectable hCCA can be considered for liver transplantation.Adjuvant chemotherapy should be offered to patients with a high risk of recurrence.The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions.Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage.Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.展开更多
目的:探讨ASA(American society of anesthesiologists)分级系统在口腔外科门诊患者中应用的重要性。方法:回顾2003-04～2011-03期间在第四军医大学口腔医院口腔外科门诊出现突发事件的病例,分析并对比ASA分级系统的应用及预防应对措施...目的:探讨ASA(American society of anesthesiologists)分级系统在口腔外科门诊患者中应用的重要性。方法:回顾2003-04～2011-03期间在第四军医大学口腔医院口腔外科门诊出现突发事件的病例,分析并对比ASA分级系统的应用及预防应对措施采取前后口腔外科门诊突发事件的种类及发生率。结果:使用ASA分级系统并根据不同患者的分级情况采取相应的预防应对措施后,在口腔外科门诊突发事件的种类减少,发生率明显降低。结论:ASA分级系统可帮助医生预测患者的治疗风险,提前采取对应防治措施,有助于减少口腔外科门诊突发事件的种类并降低其发生率。展开更多
文摘A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26,2023,at the Pakistan Kidney and Liver Institute&Research Centre(PKLI&RC)after initial consultations with the experts.The Pakistan Society for the Study of Liver Diseases(PSSLD)and PKLI&RC jointly organised this meeting.This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma(hCCA).The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients.This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation.The diagnostic and staging workup includes high-quality computed tomography,magnetic resonance imaging,and magnetic resonance cholangiopancreato-graphy.Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis.However,histopathologic confirmation is not always required before resection.Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging.The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification.Selected patients with unresectable hCCA can be considered for liver transplantation.Adjuvant chemotherapy should be offered to patients with a high risk of recurrence.The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions.Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage.Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.
文摘目的:探讨ASA(American society of anesthesiologists)分级系统在口腔外科门诊患者中应用的重要性。方法:回顾2003-04～2011-03期间在第四军医大学口腔医院口腔外科门诊出现突发事件的病例,分析并对比ASA分级系统的应用及预防应对措施采取前后口腔外科门诊突发事件的种类及发生率。结果:使用ASA分级系统并根据不同患者的分级情况采取相应的预防应对措施后,在口腔外科门诊突发事件的种类减少,发生率明显降低。结论:ASA分级系统可帮助医生预测患者的治疗风险,提前采取对应防治措施,有助于减少口腔外科门诊突发事件的种类并降低其发生率。
