To treat postoperative bleeding after hepato-pancreato-biliary surgery, interventional radiology has become essential. We report a case of coincidental pseudoan-eurysm and jejunal varices that were both successfully t...To treat postoperative bleeding after hepato-pancreato-biliary surgery, interventional radiology has become essential. We report a case of coincidental pseudoan-eurysm and jejunal varices that were both successfully treated by stent-grafts. After a pancreaticoduodenec-tomy, the patient developed a pseudoaneurysm in the hepatic artery and a stenosis in its periphery. After establishing hepatic arterial flow by placing stent-grafts over both the pseudoaneurysm and the stenosis, the pseudoaneurysm was embolized with microcoils. Nine months later, the patient developed jejunal varices caused by a severe stricture in the main trunk of the portal vein. Percutaneous transhepatic portography was performed and stent-grafts were placed over the stenotic segment. A venoplasty using stent-grafts nor-malized the portal blood flow and the jejunal varices vanished. Although stenosis occurred due to scarred tissues from leakage after pancreaticoduodenectomy, stent-grafts were useful for managing jejunal bleeding post-operatively.展开更多
Purpose: Central venous pressure (CVP) is considered to be unsuitable as preload parameter. Stroke volume variation (SVV) has recently been reported to be effective as a preload and fluid responsiveness parameter, and...Purpose: Central venous pressure (CVP) is considered to be unsuitable as preload parameter. Stroke volume variation (SVV) has recently been reported to be effective as a preload and fluid responsiveness parameter, and its usefulness for fluid management during living-donor liver transplantation (LDLT). However, use of SVV has not been reported in children. Our aim is to evaluate the use of SVV as a target parameter of circulating blood volume during pediatric LDLT. Methods: This retrospective study was conducted in 40 consecutive patients aged between 5 and 109 months who underwent elective LDLT. Twenty patients underwent LDLT without FloTrac? (C group) and the rest patients underwent LDLT with the FloTrac? monitoring (F group). As a fluid management target, CVP was maintained at 10 mmHg in the C group and SVV at 10% in the F group. We compared MAP and CVP at the times of the greatest decrease within 5 minutes after reperfusion. Results: MAP after reperfusion was significantly decreased in both groups (P < 0.01), with the magnitude of decrease significantly greater in the C group compared with the F group (P = 0.02). MAP before and after reperfusion did not significantly differ between the groups. After reperfusion, CVP was nearly the same in both groups, with that in the C group slightly decreased and nearly no change in the F group. SVV after reperfusion was significantly increased (P < 0.001). Conclusion: When used as a target parameter for fluid management during pediatric LDLT, hemodynamic changes was less when SVV was used as the parameter of circulating blood volume.展开更多
文摘To treat postoperative bleeding after hepato-pancreato-biliary surgery, interventional radiology has become essential. We report a case of coincidental pseudoan-eurysm and jejunal varices that were both successfully treated by stent-grafts. After a pancreaticoduodenec-tomy, the patient developed a pseudoaneurysm in the hepatic artery and a stenosis in its periphery. After establishing hepatic arterial flow by placing stent-grafts over both the pseudoaneurysm and the stenosis, the pseudoaneurysm was embolized with microcoils. Nine months later, the patient developed jejunal varices caused by a severe stricture in the main trunk of the portal vein. Percutaneous transhepatic portography was performed and stent-grafts were placed over the stenotic segment. A venoplasty using stent-grafts nor-malized the portal blood flow and the jejunal varices vanished. Although stenosis occurred due to scarred tissues from leakage after pancreaticoduodenectomy, stent-grafts were useful for managing jejunal bleeding post-operatively.
文摘Purpose: Central venous pressure (CVP) is considered to be unsuitable as preload parameter. Stroke volume variation (SVV) has recently been reported to be effective as a preload and fluid responsiveness parameter, and its usefulness for fluid management during living-donor liver transplantation (LDLT). However, use of SVV has not been reported in children. Our aim is to evaluate the use of SVV as a target parameter of circulating blood volume during pediatric LDLT. Methods: This retrospective study was conducted in 40 consecutive patients aged between 5 and 109 months who underwent elective LDLT. Twenty patients underwent LDLT without FloTrac? (C group) and the rest patients underwent LDLT with the FloTrac? monitoring (F group). As a fluid management target, CVP was maintained at 10 mmHg in the C group and SVV at 10% in the F group. We compared MAP and CVP at the times of the greatest decrease within 5 minutes after reperfusion. Results: MAP after reperfusion was significantly decreased in both groups (P < 0.01), with the magnitude of decrease significantly greater in the C group compared with the F group (P = 0.02). MAP before and after reperfusion did not significantly differ between the groups. After reperfusion, CVP was nearly the same in both groups, with that in the C group slightly decreased and nearly no change in the F group. SVV after reperfusion was significantly increased (P < 0.001). Conclusion: When used as a target parameter for fluid management during pediatric LDLT, hemodynamic changes was less when SVV was used as the parameter of circulating blood volume.
