BACKGROUND Liver transplant(LT)candidates face a heightened risk of infection both pre-and post-transplant,owing to immunosuppressive therapy and complications from chronic liver disease.Infections during the pre-tran...BACKGROUND Liver transplant(LT)candidates face a heightened risk of infection both pre-and post-transplant,owing to immunosuppressive therapy and complications from chronic liver disease.Infections during the pre-transplant period,such as lymphorrhea-induced cellulitis,can cause significant delays in transplantation and increase mortality while on the waiting list.Lymphorrhea,characterized by substantial lymphatic leakage and recurrent skin infections,presents a significant challenge in managing patients who are already immunocompromised.Effective preoperative infection control is critical to enhancing the prospects for a successful liver transplantation.CASE SUMMARY We report the case of a 50-year-old female diagnosed with Hepatitis C virusrelated cirrhosis(Child-Pugh C)and recurrent cellulitis due to lymphorrhea in her left lower leg.She suffered repeated episodes of cellulitis over five years,which prevented her from undergoing LT.Initial conservative treatments were unsuccessful in managing the lymphatic leakage and accompanying infections.In February 2019,she underwent supermicrosurgical lymphaticovenous anastomoses(LVA)to address her lymphorrhea.This procedure,which created multiple lymphatic-venous connections in the lower limb,led to significant improvements in her condition.After the LVA,she experienced no further episodes of cellulitis.Eighteen months later,she successfully underwent a deceased donor liver transplantation.Postoperative complications,including a wound hematoma,were effectively managed,and she was discharged 3 months post-operation.At her 3-year follow-up,her liver function was stable,with no recurrence of cellulitis.CONCLUSION Despite numerous challenges,the patient achieved a successful recovery with satisfactory graft function and was free from lymphorrhea/lymphedema in her left lower limb 3 years post-transplantation.This case underscores the importance of robust infection control during both the pre-and post-transplantation phases and highlights the potential of LVA as a treatment option for managing lymphorrhea and infections in patients with liver cirrhosis.展开更多
A peritoneovenous shunt has become one of the most effi cient procedures for intractable ascites due to liver cirrhosis.A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular car...A peritoneovenous shunt has become one of the most effi cient procedures for intractable ascites due to liver cirrhosis.A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular carcinoma that was successfully treated by the placement of a peritoneovenous shunt is presented.A 72-year-old Japanese man underwent partial resection of the liver for hepatocellular carcinoma associated with hepatitis C viral infection.After hepatectomy,a considerable amount of ascites ranging from 800-4600 mL per day persisted despite conservative therapy,including numerous infusions of albumin and plasma protein fraction and administration of diuretics.Since the patient's general condition deteriorated,based on the diagnosis of intractable hepatic lymphorrhea,a subcutaneous peritoneovenous shunt was inserted.The patient's postoperative course was uneventful and the ascites decreased rapidly,with serum total protein and albumin levels and hepatic function improving accordingly.For intractable ascites due to hepatic lymphorrhea after hepatectomy,we recommend the placement of a peritoneovenous shunt as a procedure that can provide immediate effectiveness without increased surgical risk.展开更多
Background:Postoperative complications,particularly those involving lymphatic drainage,remain a significantchallenge for patients undergoing axillary lymphadenectomy(ALND)as part of breast cancer surgery.Thesecomplica...Background:Postoperative complications,particularly those involving lymphatic drainage,remain a significantchallenge for patients undergoing axillary lymphadenectomy(ALND)as part of breast cancer surgery.Thesecomplications can delay the initiation of adjuvant therapies,increase healthcare costs,and negatively affectpatients’quality of life.This study evaluated the use of a latex-based tissue adhesive(LTA)as an intraoperativestrategy to prevent seroma formation and prolonged lymphorrhea following axillary dissection.Methods:In this prospective study,65 female patients diagnosed with stage Ⅱb-Ⅲ breast cancer and clinicallyconfirmed axillary lymph node involvement were enrolled.Participants were divided into two groups.The studygroup(n=33)received an intraoperative application of LTA without drainage,while the control group(n=32)underwent standard ALND with placement of a silicone vacuum drain.Postoperative outcomes assessed includedlymphatic drainage volume,number of aspirations,duration of lymphorrhea,length of hospital stay,and incidence of complications.Results:Use of the LTA significantly reduced both the volume and duration of postoperative lymphorrhea.Bypostoperative day 10,the average wound exudate volume in the LTA group was 8.2±3.3 mL,compared to54.1±3.9 mL in the control group—an 84.8%reduction.The LTA group also experienced shorter hospital staysand fewer cases of postoperative seroma requiring intervention.Conclusion:LTA appears to be a safe,effective,and practical intraoperative technique for preventing lymphaticcomplications after ALND.Its use may reduce dependence on drainage systems,shorten hospitalization,andsupport earlier initiation of adjuvant therapies,ultimately improving surgical outcomes and patient recovery.展开更多
文摘BACKGROUND Liver transplant(LT)candidates face a heightened risk of infection both pre-and post-transplant,owing to immunosuppressive therapy and complications from chronic liver disease.Infections during the pre-transplant period,such as lymphorrhea-induced cellulitis,can cause significant delays in transplantation and increase mortality while on the waiting list.Lymphorrhea,characterized by substantial lymphatic leakage and recurrent skin infections,presents a significant challenge in managing patients who are already immunocompromised.Effective preoperative infection control is critical to enhancing the prospects for a successful liver transplantation.CASE SUMMARY We report the case of a 50-year-old female diagnosed with Hepatitis C virusrelated cirrhosis(Child-Pugh C)and recurrent cellulitis due to lymphorrhea in her left lower leg.She suffered repeated episodes of cellulitis over five years,which prevented her from undergoing LT.Initial conservative treatments were unsuccessful in managing the lymphatic leakage and accompanying infections.In February 2019,she underwent supermicrosurgical lymphaticovenous anastomoses(LVA)to address her lymphorrhea.This procedure,which created multiple lymphatic-venous connections in the lower limb,led to significant improvements in her condition.After the LVA,she experienced no further episodes of cellulitis.Eighteen months later,she successfully underwent a deceased donor liver transplantation.Postoperative complications,including a wound hematoma,were effectively managed,and she was discharged 3 months post-operation.At her 3-year follow-up,her liver function was stable,with no recurrence of cellulitis.CONCLUSION Despite numerous challenges,the patient achieved a successful recovery with satisfactory graft function and was free from lymphorrhea/lymphedema in her left lower limb 3 years post-transplantation.This case underscores the importance of robust infection control during both the pre-and post-transplantation phases and highlights the potential of LVA as a treatment option for managing lymphorrhea and infections in patients with liver cirrhosis.
文摘A peritoneovenous shunt has become one of the most effi cient procedures for intractable ascites due to liver cirrhosis.A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular carcinoma that was successfully treated by the placement of a peritoneovenous shunt is presented.A 72-year-old Japanese man underwent partial resection of the liver for hepatocellular carcinoma associated with hepatitis C viral infection.After hepatectomy,a considerable amount of ascites ranging from 800-4600 mL per day persisted despite conservative therapy,including numerous infusions of albumin and plasma protein fraction and administration of diuretics.Since the patient's general condition deteriorated,based on the diagnosis of intractable hepatic lymphorrhea,a subcutaneous peritoneovenous shunt was inserted.The patient's postoperative course was uneventful and the ascites decreased rapidly,with serum total protein and albumin levels and hepatic function improving accordingly.For intractable ascites due to hepatic lymphorrhea after hepatectomy,we recommend the placement of a peritoneovenous shunt as a procedure that can provide immediate effectiveness without increased surgical risk.
文摘Background:Postoperative complications,particularly those involving lymphatic drainage,remain a significantchallenge for patients undergoing axillary lymphadenectomy(ALND)as part of breast cancer surgery.Thesecomplications can delay the initiation of adjuvant therapies,increase healthcare costs,and negatively affectpatients’quality of life.This study evaluated the use of a latex-based tissue adhesive(LTA)as an intraoperativestrategy to prevent seroma formation and prolonged lymphorrhea following axillary dissection.Methods:In this prospective study,65 female patients diagnosed with stage Ⅱb-Ⅲ breast cancer and clinicallyconfirmed axillary lymph node involvement were enrolled.Participants were divided into two groups.The studygroup(n=33)received an intraoperative application of LTA without drainage,while the control group(n=32)underwent standard ALND with placement of a silicone vacuum drain.Postoperative outcomes assessed includedlymphatic drainage volume,number of aspirations,duration of lymphorrhea,length of hospital stay,and incidence of complications.Results:Use of the LTA significantly reduced both the volume and duration of postoperative lymphorrhea.Bypostoperative day 10,the average wound exudate volume in the LTA group was 8.2±3.3 mL,compared to54.1±3.9 mL in the control group—an 84.8%reduction.The LTA group also experienced shorter hospital staysand fewer cases of postoperative seroma requiring intervention.Conclusion:LTA appears to be a safe,effective,and practical intraoperative technique for preventing lymphaticcomplications after ALND.Its use may reduce dependence on drainage systems,shorten hospitalization,andsupport earlier initiation of adjuvant therapies,ultimately improving surgical outcomes and patient recovery.
