Adult polycystic liver disease (PCLD) is an autosomal dominant condition commonly associated with autosomal dominant polycystic kidney disease (ADPKD). However in the last decade, it has been recognized that there is ...Adult polycystic liver disease (PCLD) is an autosomal dominant condition commonly associated with autosomal dominant polycystic kidney disease (ADPKD). However in the last decade, it has been recognized that there is a distinct form of autosomal dominant PCLD that arises without concomitant ADPKD. Early knowledge of the pathogenesis was gained from the study of hepatic cysts in patients with ADPKD. Bile duct overgrowth after embryogenesis results in cystic hepatic dilatations that are known as biliary microhamartomas or von Meyenburg complexes. Further dilatation arises from cellular proliferation and fluid secretion into these cysts. There is a variable, broad spectrum of manifestations of PCLD. Although PCLD is most often asymptomatic, massive hepatomegaly can lead to disabling symptoms of abdominal pain, early satiety, persistent nausea, dyspnea, ascites, biliary obstruction, and lower body edema. Complications of PCLD include cyst rupture and cyst infection. Also, there are associated medical problems, especially intracranial aneurysms and valvular heart disease, which clinicians need to be aware of and evaluate in patients with PCLD. In asymptomatic patients, no treatment is indicated for PCLD. In the symptomatic patient, surgical therapy is the mainstay of treatment tailored to the extent of disease for each patient. Management options include cyst aspiration and sclerosis, open or laparoscopic fenestration, liver resection with fenestration, and liver transplantation. The surgical literature discussing treatment of PCLD, including techniques, outcomes, and complication rates, are summarized in this review.展开更多
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
目的:探讨完全腹腔镜解剖性肝切除术的应用价值。方法:回顾分析为38例肝疾病患者施行腹腔镜下解剖性肝切除术的临床资料。结果:38例手术均获成功,其中左肝内胆管结石21例,肝癌15例,肝血管瘤1例,肝局灶性结节性增生1例。20例单纯行腹腔...目的:探讨完全腹腔镜解剖性肝切除术的应用价值。方法:回顾分析为38例肝疾病患者施行腹腔镜下解剖性肝切除术的临床资料。结果:38例手术均获成功,其中左肝内胆管结石21例,肝癌15例,肝血管瘤1例,肝局灶性结节性增生1例。20例单纯行腹腔镜肝切除术(laparoscopic hepatectomy,LH),6例联合行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC),9例联合行胆总管切开探查术(laparoscopic common bile duct exploration,LCBDE),3例联合行LC+LCBDE。解剖性肝切除术包括左外叶切除(Ⅱ+Ⅲ段)23例,左内叶切除(Ⅳ段)2例(左外叶已切除),左半肝切除(Ⅱ+Ⅲ+Ⅳ段)9例,Ⅴ段切除3例,Ⅵ段切除1例。单纯解剖性肝切除术手术时间平均(170±20)min,联合LC时平均(190±27)min,联合LCBDE平均(220±45)min,联合LC+LCBDE平均(240±23)min。术中出血量平均(350±86)ml。术后无胆漏、出血等并发症发生。术后1～3 d肛门排气,5～11 d痊愈出院。随访36例6～24个月,除1例于术后1年因肿瘤复发转移死亡外,余者健在,无复发、转移,结石患者无再发。结论:腹腔镜解剖性肝切除术较好地解决了腹腔镜下肝段以上肝切除术的出血、气栓等问题,可安全用于肝段及半肝切除术,可在很大程度上取代开腹手术。展开更多
基金Supported by an educational grant from Novartis Pharma-ceuticals
文摘Adult polycystic liver disease (PCLD) is an autosomal dominant condition commonly associated with autosomal dominant polycystic kidney disease (ADPKD). However in the last decade, it has been recognized that there is a distinct form of autosomal dominant PCLD that arises without concomitant ADPKD. Early knowledge of the pathogenesis was gained from the study of hepatic cysts in patients with ADPKD. Bile duct overgrowth after embryogenesis results in cystic hepatic dilatations that are known as biliary microhamartomas or von Meyenburg complexes. Further dilatation arises from cellular proliferation and fluid secretion into these cysts. There is a variable, broad spectrum of manifestations of PCLD. Although PCLD is most often asymptomatic, massive hepatomegaly can lead to disabling symptoms of abdominal pain, early satiety, persistent nausea, dyspnea, ascites, biliary obstruction, and lower body edema. Complications of PCLD include cyst rupture and cyst infection. Also, there are associated medical problems, especially intracranial aneurysms and valvular heart disease, which clinicians need to be aware of and evaluate in patients with PCLD. In asymptomatic patients, no treatment is indicated for PCLD. In the symptomatic patient, surgical therapy is the mainstay of treatment tailored to the extent of disease for each patient. Management options include cyst aspiration and sclerosis, open or laparoscopic fenestration, liver resection with fenestration, and liver transplantation. The surgical literature discussing treatment of PCLD, including techniques, outcomes, and complication rates, are summarized in this review.
基金supported by grants from the National Natural Science Foundation of China(81372455)Jiangsu Provincial Medical Talent
文摘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.
文摘目的:探讨完全腹腔镜解剖性肝切除术的应用价值。方法:回顾分析为38例肝疾病患者施行腹腔镜下解剖性肝切除术的临床资料。结果:38例手术均获成功,其中左肝内胆管结石21例,肝癌15例,肝血管瘤1例,肝局灶性结节性增生1例。20例单纯行腹腔镜肝切除术(laparoscopic hepatectomy,LH),6例联合行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC),9例联合行胆总管切开探查术(laparoscopic common bile duct exploration,LCBDE),3例联合行LC+LCBDE。解剖性肝切除术包括左外叶切除(Ⅱ+Ⅲ段)23例,左内叶切除(Ⅳ段)2例(左外叶已切除),左半肝切除(Ⅱ+Ⅲ+Ⅳ段)9例,Ⅴ段切除3例,Ⅵ段切除1例。单纯解剖性肝切除术手术时间平均(170±20)min,联合LC时平均(190±27)min,联合LCBDE平均(220±45)min,联合LC+LCBDE平均(240±23)min。术中出血量平均(350±86)ml。术后无胆漏、出血等并发症发生。术后1～3 d肛门排气,5～11 d痊愈出院。随访36例6～24个月,除1例于术后1年因肿瘤复发转移死亡外,余者健在,无复发、转移,结石患者无再发。结论:腹腔镜解剖性肝切除术较好地解决了腹腔镜下肝段以上肝切除术的出血、气栓等问题,可安全用于肝段及半肝切除术,可在很大程度上取代开腹手术。
