BACKGROUND The occurrence of long-term bilioenteric anastomotic stenosis can readily induce liver atrophy and hyperplasia,thereby causing significant alterations in the anatomical and morphological aspects of the live...BACKGROUND The occurrence of long-term bilioenteric anastomotic stenosis can readily induce liver atrophy and hyperplasia,thereby causing significant alterations in the anatomical and morphological aspects of the liver.This condition significantly hampers the accuracy of preoperative imaging diagnosis,while also exacerbating the complexity of surgical procedures and the likelihood of complications.CASE SUMMARY A 60-year-old female patient was admitted to the hospital presenting with recurring epigastric pain accompanied by a high fever.The patient had a history of cholecystectomy,although the surgical records were not accessible.Based on preoperative imaging and laboratory examination,the initial diagnosis indicated the presence of intrahepatic calculi,abnormal right liver morphology,and acute cholangitis.However,during the surgical procedure,it was observed that both the left and right liver lobes exhibited evident atrophy and thinness.Additionally,there was a noticeable increase in the volume of the hepatic caudate lobe,and the original bilioenteric anastomosis was narrowed.The anastomosis underwent enlargement subsequent to hepatectomy.As a consequence of the presence of remaining stones in the caudate lobe,the second stage was effectively executed utilizing ultrasound-guided percutaneous transhepatic catheter drainage.Following the puncture,three days elapsed before the drain tip inadvertently perforated the liver,leading to the development of biliary panperitonitis,subsequently followed by pulmonary infection.The patient and her family strongly refused operation,and she died.CONCLUSION The hepatic atrophy-hypertrophy complex induces notable alterations in the anatomical structure,thereby posing a substantial challenge in terms of imaging diagnosis and surgical procedures.Additionally,the long-term presence of hepatic fibrosis changes heightens the likelihood of complications arising from puncture procedures.展开更多
Background:Major hepatectomy in patients with colorectal liver metastases(CLM)and post-chemotherapy liver atrophy is associated with increased complications.Whether the performance of parenchymal-sparing hepatectomy(P...Background:Major hepatectomy in patients with colorectal liver metastases(CLM)and post-chemotherapy liver atrophy is associated with increased complications.Whether the performance of parenchymal-sparing hepatectomy(PSH)in those patients can be safer is unknown.Methods:Databases at two institutions were queried,and 74 CLM patients who underwent preoperative chemotherapy and curative PSH were reviewed.Pre-and post-chemotherapy total liver volumes(TLVs)were computed with Synapse 3D software,and the degree of atrophy was calculated as the difference in percentage.The cut-off value for significant degree of atrophy was set at 10%.Risk factors for post-chemotherapy liver atrophy were assessed using logistic regression,while multivariate analysis was computed to identify risk factors for postoperative complications.Results:With median CLM number of 6(range,1-20)and median CLM size of 3.3 cm(range,1-14 cm),all patients underwent complex PSH.The 90-day mortality was 1%;Clavien-Dindo>2 complications occurred in 17%,with 6(8%)post-hepatectomy liver failure(PHLF)events;33(45%)patients experienced≥10%post-chemotherapy atrophy,of which pre-chemotherapy TLV was the only independent predictor[odds ratio(OR)=1.741;95%confidence interval(CI):1.120-2.386;P=0.02].At multivariate analysis,none of the investigated variables showed significant association with PHLF or complications,which were not significantly increased in patients who experienced liver atrophy.Conclusions:As opposed to what observed after major hepatic resections,a significant degree of post-chemotherapy liver atrophy does not represent a source of postoperative complications in CLM patients undergoing PSH.展开更多
文摘BACKGROUND The occurrence of long-term bilioenteric anastomotic stenosis can readily induce liver atrophy and hyperplasia,thereby causing significant alterations in the anatomical and morphological aspects of the liver.This condition significantly hampers the accuracy of preoperative imaging diagnosis,while also exacerbating the complexity of surgical procedures and the likelihood of complications.CASE SUMMARY A 60-year-old female patient was admitted to the hospital presenting with recurring epigastric pain accompanied by a high fever.The patient had a history of cholecystectomy,although the surgical records were not accessible.Based on preoperative imaging and laboratory examination,the initial diagnosis indicated the presence of intrahepatic calculi,abnormal right liver morphology,and acute cholangitis.However,during the surgical procedure,it was observed that both the left and right liver lobes exhibited evident atrophy and thinness.Additionally,there was a noticeable increase in the volume of the hepatic caudate lobe,and the original bilioenteric anastomosis was narrowed.The anastomosis underwent enlargement subsequent to hepatectomy.As a consequence of the presence of remaining stones in the caudate lobe,the second stage was effectively executed utilizing ultrasound-guided percutaneous transhepatic catheter drainage.Following the puncture,three days elapsed before the drain tip inadvertently perforated the liver,leading to the development of biliary panperitonitis,subsequently followed by pulmonary infection.The patient and her family strongly refused operation,and she died.CONCLUSION The hepatic atrophy-hypertrophy complex induces notable alterations in the anatomical structure,thereby posing a substantial challenge in terms of imaging diagnosis and surgical procedures.Additionally,the long-term presence of hepatic fibrosis changes heightens the likelihood of complications arising from puncture procedures.
基金supported by the research grant AIRC 5x100021147 ISM.
文摘Background:Major hepatectomy in patients with colorectal liver metastases(CLM)and post-chemotherapy liver atrophy is associated with increased complications.Whether the performance of parenchymal-sparing hepatectomy(PSH)in those patients can be safer is unknown.Methods:Databases at two institutions were queried,and 74 CLM patients who underwent preoperative chemotherapy and curative PSH were reviewed.Pre-and post-chemotherapy total liver volumes(TLVs)were computed with Synapse 3D software,and the degree of atrophy was calculated as the difference in percentage.The cut-off value for significant degree of atrophy was set at 10%.Risk factors for post-chemotherapy liver atrophy were assessed using logistic regression,while multivariate analysis was computed to identify risk factors for postoperative complications.Results:With median CLM number of 6(range,1-20)and median CLM size of 3.3 cm(range,1-14 cm),all patients underwent complex PSH.The 90-day mortality was 1%;Clavien-Dindo>2 complications occurred in 17%,with 6(8%)post-hepatectomy liver failure(PHLF)events;33(45%)patients experienced≥10%post-chemotherapy atrophy,of which pre-chemotherapy TLV was the only independent predictor[odds ratio(OR)=1.741;95%confidence interval(CI):1.120-2.386;P=0.02].At multivariate analysis,none of the investigated variables showed significant association with PHLF or complications,which were not significantly increased in patients who experienced liver atrophy.Conclusions:As opposed to what observed after major hepatic resections,a significant degree of post-chemotherapy liver atrophy does not represent a source of postoperative complications in CLM patients undergoing PSH.
