BACKGROUND: Recurrence of inflammation in the extrahepatic bile duct can lead to bile duct stenosis' obstructive jaundice and cavernous transformation of the portal vein. The latter can develop into extrahepatic p...BACKGROUND: Recurrence of inflammation in the extrahepatic bile duct can lead to bile duct stenosis' obstructive jaundice and cavernous transformation of the portal vein. The latter can develop into extrahepatic portal hypertension (PHT). It is difficult to establish the correct method for treating these conditions. METHODS: At another hospital, a 51-year-old man developed PHT as a result of endoscopic retrograde cholangiopancreatography and endoscopic nasobiliary drainage to relieve cholelithiasis and obstructive jaundice. We dealt with the biliary tract obstruction through percutaneous transhepatic cholangial drainage (PTCD), followed by selective devascularization and a shunt operation 2 weeks after the disappearance of jaundice. Three months after cholecystojejunostomy, there were no obvious changes around the bile duct. RESULT: The patient recovered uneventfully and was discharged 14 days after operation. CONCLUSION: For this patient, surgery in stages was the best choice. The most suitable method to decrease jaundice is PTCD.展开更多
BACKGROUND: Portal hypertension is a common diseasewith a high mortality and serious effect on the life quality ofpatients. Presently, shunt and disconnection are commonlyused for surgical treatment of portal hyperten...BACKGROUND: Portal hypertension is a common diseasewith a high mortality and serious effect on the life quality ofpatients. Presently, shunt and disconnection are commonlyused for surgical treatment of portal hypertension. The aimof this study was conducted to analyze the results of a modi-fied Sugiura procedure for the management of 160 cirrhoticpatients with portal hypertension.METHODS: The results of a modified Sugiura procedurefor the treatment of 160 cirrhotic patients with portal hyper-tension from January 1991 to July 2002 were retrospectivelyanalyzed.RESULTS: The operative mortality for the procedure waszero. Postoperative intra-abdominal bleeding was noted in2 patients, drowned lung in 1, pneumonia in 1, and splenicvenous thrombosis in 4. Of the 160 patients, 157 (98%)were followed up from 6 months to 11.5 years. Of the 157patients, only one died of hepatic coma 6 years after opera-tion, and 3 of rebleeding. The absolute and relative survivalrates were 97.5% (156/160) and 99% (159/160), respective-ly. The absolute and relative occurrence rates of hepatic co-ma were 2.5% (4/160) and 0.6% (1/157), respectively. Theabsolute and relative occurrence rates of rebleeding were3.8% (6/160) and 1.9% (3/157) , respectively. In 96 of 116Child B patients (82.8%), liver function improved frompreoperative class B to A 3 months after operation. Sixty-five patients were subjected to gastroscopy and 22 patients,esophageal barium photography 6 months after operation.Gastro-esophageal varices disappeared in 56 patients(64.4%, 56/87), obviously improved in 30 (34.5%, 30/87),and unchanged in 1 (1.2%, 1/87). The occurrence rate ofportal hypertensive gastropathy (PHG) was 13.9% (9/65).CONCLUSION: Our results showed that the modifiedSugiura procedure is effective in the treatment of portal hy-pertension, with a low rate of operative complication,bleeding recurrence, and hepatic coma.展开更多
Background:Extrahepatic portal vein obstruction(EHPVO)results in severe portal hypertension(PHT)leading to severely compromised quality of life.Often,pharmacological and endoscopic management is unable to solve this p...Background:Extrahepatic portal vein obstruction(EHPVO)results in severe portal hypertension(PHT)leading to severely compromised quality of life.Often,pharmacological and endoscopic management is unable to solve this problem.Restoring hepatic portal flow using meso-Rex bypass(MRB)may solve it.This procedure,uncommon in adult patients,is considered the treatment of choice for EHPVO in children.Methods:From 1997 to 2018,8 male and 6 female adults,with a median age of 51 years(range 22-66)underwent MRB procedure for EHPVO at the University Hospitals Saint-Luc in Brussels,Belgium.Symp-toms of PHT were life altering in all but one patient and consisted of repetitive gastro-intestinal bleedings,sepsis due to portal biliopathy,and/or severe abdominal discomfort.The surgical technique consisted in interposition of a free venous graft or of a prosthetic graft between the superior mesenteric vein and the Rex recess of the left portal vein.Results:Median operative time was 500 min(range 300-730).Median follow-up duration was 22 months(range 2-169).One patient died due to hemorrhagic shock following percutaneous transluminal interven-tion for early graft thrombosis.Major morbidity,defined as Clavien-Dindo score≥III,was 35.7%(5/14).Shunt patency at last follow-up was 64.3%(9/14):85.7%(6/7)of pure venous grafts and only 42.9%(3/7)of prosthetic graft.Symptom relief was achieved in 85.7%(12/14)who became asymptomatic after MRB.Conclusions:Adult EHPVO represents a difficult clinical condition that leads to severely compromised quality of life and possible life-threatening complications.In such patients,MRB represents the only and last resort to restore physiological portal vein flow.Although successful in a majority of patients,this procedure is associated with major morbidity and mortality and should be done in tertiary centers expe-rienced with vascular liver surgery to get the best results.展开更多
文摘BACKGROUND: Recurrence of inflammation in the extrahepatic bile duct can lead to bile duct stenosis' obstructive jaundice and cavernous transformation of the portal vein. The latter can develop into extrahepatic portal hypertension (PHT). It is difficult to establish the correct method for treating these conditions. METHODS: At another hospital, a 51-year-old man developed PHT as a result of endoscopic retrograde cholangiopancreatography and endoscopic nasobiliary drainage to relieve cholelithiasis and obstructive jaundice. We dealt with the biliary tract obstruction through percutaneous transhepatic cholangial drainage (PTCD), followed by selective devascularization and a shunt operation 2 weeks after the disappearance of jaundice. Three months after cholecystojejunostomy, there were no obvious changes around the bile duct. RESULT: The patient recovered uneventfully and was discharged 14 days after operation. CONCLUSION: For this patient, surgery in stages was the best choice. The most suitable method to decrease jaundice is PTCD.
文摘BACKGROUND: Portal hypertension is a common diseasewith a high mortality and serious effect on the life quality ofpatients. Presently, shunt and disconnection are commonlyused for surgical treatment of portal hypertension. The aimof this study was conducted to analyze the results of a modi-fied Sugiura procedure for the management of 160 cirrhoticpatients with portal hypertension.METHODS: The results of a modified Sugiura procedurefor the treatment of 160 cirrhotic patients with portal hyper-tension from January 1991 to July 2002 were retrospectivelyanalyzed.RESULTS: The operative mortality for the procedure waszero. Postoperative intra-abdominal bleeding was noted in2 patients, drowned lung in 1, pneumonia in 1, and splenicvenous thrombosis in 4. Of the 160 patients, 157 (98%)were followed up from 6 months to 11.5 years. Of the 157patients, only one died of hepatic coma 6 years after opera-tion, and 3 of rebleeding. The absolute and relative survivalrates were 97.5% (156/160) and 99% (159/160), respective-ly. The absolute and relative occurrence rates of hepatic co-ma were 2.5% (4/160) and 0.6% (1/157), respectively. Theabsolute and relative occurrence rates of rebleeding were3.8% (6/160) and 1.9% (3/157) , respectively. In 96 of 116Child B patients (82.8%), liver function improved frompreoperative class B to A 3 months after operation. Sixty-five patients were subjected to gastroscopy and 22 patients,esophageal barium photography 6 months after operation.Gastro-esophageal varices disappeared in 56 patients(64.4%, 56/87), obviously improved in 30 (34.5%, 30/87),and unchanged in 1 (1.2%, 1/87). The occurrence rate ofportal hypertensive gastropathy (PHG) was 13.9% (9/65).CONCLUSION: Our results showed that the modifiedSugiura procedure is effective in the treatment of portal hy-pertension, with a low rate of operative complication,bleeding recurrence, and hepatic coma.
基金approved by the Ethics Committee of the University Hospitals Saint-Luc in Brussels,Belgium(CEHF 2020/22JUL/374).
文摘Background:Extrahepatic portal vein obstruction(EHPVO)results in severe portal hypertension(PHT)leading to severely compromised quality of life.Often,pharmacological and endoscopic management is unable to solve this problem.Restoring hepatic portal flow using meso-Rex bypass(MRB)may solve it.This procedure,uncommon in adult patients,is considered the treatment of choice for EHPVO in children.Methods:From 1997 to 2018,8 male and 6 female adults,with a median age of 51 years(range 22-66)underwent MRB procedure for EHPVO at the University Hospitals Saint-Luc in Brussels,Belgium.Symp-toms of PHT were life altering in all but one patient and consisted of repetitive gastro-intestinal bleedings,sepsis due to portal biliopathy,and/or severe abdominal discomfort.The surgical technique consisted in interposition of a free venous graft or of a prosthetic graft between the superior mesenteric vein and the Rex recess of the left portal vein.Results:Median operative time was 500 min(range 300-730).Median follow-up duration was 22 months(range 2-169).One patient died due to hemorrhagic shock following percutaneous transluminal interven-tion for early graft thrombosis.Major morbidity,defined as Clavien-Dindo score≥III,was 35.7%(5/14).Shunt patency at last follow-up was 64.3%(9/14):85.7%(6/7)of pure venous grafts and only 42.9%(3/7)of prosthetic graft.Symptom relief was achieved in 85.7%(12/14)who became asymptomatic after MRB.Conclusions:Adult EHPVO represents a difficult clinical condition that leads to severely compromised quality of life and possible life-threatening complications.In such patients,MRB represents the only and last resort to restore physiological portal vein flow.Although successful in a majority of patients,this procedure is associated with major morbidity and mortality and should be done in tertiary centers expe-rienced with vascular liver surgery to get the best results.
