BACKGROUND: This study was to clarify the high riskfactors for subphrenic infection (SI) after liver resection forpatients with hepatic malignancy.METHODS: Three hundred and sixty-eight patients whohad undergone hepat...BACKGROUND: This study was to clarify the high riskfactors for subphrenic infection (SI) after liver resection forpatients with hepatic malignancy.METHODS: Three hundred and sixty-eight patients whohad undergone hepatectomy from January 1985 throughJune 2002 were randomly divided into 2 groups accordingto resection of liver parenchyma, hepatic cirrhosis, primaryliver cancer, intraoperative blood loss, and subphrenicdrainage. The chi-square was used for statistical analysis.RESULTS: Thirteen patients (3.53%) of the 368 patientshad SI. The high-risk factors for SI after hepatectomy wererelated to resection of liver parenchyma and hepatic cirrho-sis ; but the course or stage of primary liver cancer was notrelated to the incidence of SI. Intraoperative blood loss ofover 1500 ml was found to be a significant risk factor forpostoperative SI. Adequate drainage of the subdiaphragmand the raw surface of the liver after operation was essentialto decreasing SI after liver resection.CONCLUSION: Inadequate subphrenic drainage maylargely contribute to SI in patients with hepatic malignancyundergoing hepatectomy apart from other factors. Com-prehensive measures should be taken to prevent the infec-tion after hepatectomy.展开更多
In order to identify the high risk factors that determine subphrenic infection after hepatectomy, 187 liver resections performed during January, 1985 to December, 1990 in Department of Surgery of Tongji Hospital were ...In order to identify the high risk factors that determine subphrenic infection after hepatectomy, 187 liver resections performed during January, 1985 to December, 1990 in Department of Surgery of Tongji Hospital were reviewed. Thirteen patients developed subphrenic infection with the incidence of subphrenic infection being 6. 95%. The results of retrospective study on 187 liver resections demonstrated that the high risk factors related to subphrenic infection after hepatectomy were as follows: (1) The extent of liver resection was associated with subphrenic infection.(2) The incidence of subphrenic infection after liver resection of primary liver cancer patients with hepatic cirrhosis was higher than that of non-cirrhotic patients. (3) Intraoperative estimated blood loss greater than 1500 ml was found to be a significant risk factor in the development of postoperative subphrenic infection.(4) Adequate postoperative drainage of subdiaphragm and the raw surface of the liver was one of critical factors of decreasing subphrenic infection after liver resection.展开更多
BACKGROUND Subphrenic carcinoma has been identified as a significant risk factor for the thermal ablation of intrahepatic tumors,resulting in a high rate of residual tumor recurrence.Some studies have proposed that co...BACKGROUND Subphrenic carcinoma has been identified as a significant risk factor for the thermal ablation of intrahepatic tumors,resulting in a high rate of residual tumor recurrence.Some studies have proposed that combination treatment with transarterial chemoembolization(TACE)followed by radiofrequency ablation is both feasible and safe for tumors in the subphrenic region.However,research specifically examining the therapeutic outcomes of combination therapy using TACE and microwave ablation(TACE-MWA)in subphrenic tumors is lacking.AIM To evaluate the efficacy and safety of TACE-MWA in patients with subphrenic hepatocellular carcinoma(HCC).METHODS Between December 2017 and December 2021,49 patients diagnosed with HCC≤6 cm,who received TACE-MWA,were included in this retrospective cohort study.These patients were classified into subphrenic and non-subphrenic groups based on the distance between the diaphragm and the tumor margin.The rates of local tumor progression(LTP),progression-free survival(PFS),and overall survival(OS)were compared between the two groups.Complications were evaluated by using a grading system developed by the Society of Interventional Radiology.RESULTS After a median follow-up time of 38 mo,there were no significant differences in LTP between the subphrenic and non-subphrenic groups(27.3%and 22.2%at 5 years,respectively;P=0.66),PFS(55.5%at 5 years in both groups;P=0.91),and OS(85.0%and 90.9%in the subphrenic and non-subphrenic groups at 5 years;P=0.57).However,a significantly higher rate of LTP was observed in subphrenic HCC>3 cm compared to those≤3 cm(P=0.085).The dosage of iodized oil[hazard ratio(HR):1.52;95%confidence interval(CI):1.11-2.08;P=0.009]and multiple tumors(HR:13.22;95%CI:1.62-107.51;P=0.016)were independent prognostic factors for LTP.There were no significant differences in complication rates between the two groups(P=0.549).CONCLUSION Combined TACE and MWA was practical and safe for managing subphrenic HCC.The efficacy and safety levels did not vary significantly when tumors outside the subphrenic region were treated.展开更多
The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amy...The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amylase.This pancreatic pleural effusion is also called a pancreatic pleural fistula.It is characterized by profuse pleural fluid and has a tendency to recur.Here we report a case of delayed internal pancreatic fistula with pancreatic pleural effusion emerging after splenectomy.From the treatment of this case,we conclude that the symptoms and signs of a subphrenic effusion are often obscure;abdominal computed tomography may be required to look for occult,intra-abdominal infection;and active conservative treatment should be carried out in the early period of this complication to reduce the need for endoscopy or surgery.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is one of the most frequent cancers and the main cause of cancer-related death worldwide.Ectopic HCC,an extremely rare type of HCC,exhibits a wide range of clinical signs and ra...BACKGROUND Hepatocellular carcinoma(HCC)is one of the most frequent cancers and the main cause of cancer-related death worldwide.Ectopic HCC,an extremely rare type of HCC,exhibits a wide range of clinical signs and radiographic features,making preoperative identification challenging.CASE SUMMARY A 47-year-old man underwent routine abdominal color ultrasonography,which identified an asymptomatic tumor in the left upper abdomen.The patient had no history of hepatitis,did not drink alcohol,and had no family history of cancer.Abdominal contrast-enhanced computed tomography(CT)revealed a heterogeneously enhanced lesion between the spleen and stomach that had invaded the diaphragm,with blood supplied by the left inferior phrenic artery.The patient underwent laparoscopic surgery,and HCC was identified by postoperative pathology.Additionally,specific immunohistochemical staining was performed to assess the molecular biological characteristics of the HCC.The patient underwent two rounds of hepatic arterial interventional chemotherapy after surgery.Abdominal plain and enhanced magnetic resonance imaging and lung CT 3 mo postoperatively revealed no signs of local recurrence or distant metastasis.CONCLUSION This asymptomatic ectopic HCC case described achieved an excellent result due to early detection,radical resection,and systematic surveillance.展开更多
文摘BACKGROUND: This study was to clarify the high riskfactors for subphrenic infection (SI) after liver resection forpatients with hepatic malignancy.METHODS: Three hundred and sixty-eight patients whohad undergone hepatectomy from January 1985 throughJune 2002 were randomly divided into 2 groups accordingto resection of liver parenchyma, hepatic cirrhosis, primaryliver cancer, intraoperative blood loss, and subphrenicdrainage. The chi-square was used for statistical analysis.RESULTS: Thirteen patients (3.53%) of the 368 patientshad SI. The high-risk factors for SI after hepatectomy wererelated to resection of liver parenchyma and hepatic cirrho-sis ; but the course or stage of primary liver cancer was notrelated to the incidence of SI. Intraoperative blood loss ofover 1500 ml was found to be a significant risk factor forpostoperative SI. Adequate drainage of the subdiaphragmand the raw surface of the liver after operation was essentialto decreasing SI after liver resection.CONCLUSION: Inadequate subphrenic drainage maylargely contribute to SI in patients with hepatic malignancyundergoing hepatectomy apart from other factors. Com-prehensive measures should be taken to prevent the infec-tion after hepatectomy.
文摘In order to identify the high risk factors that determine subphrenic infection after hepatectomy, 187 liver resections performed during January, 1985 to December, 1990 in Department of Surgery of Tongji Hospital were reviewed. Thirteen patients developed subphrenic infection with the incidence of subphrenic infection being 6. 95%. The results of retrospective study on 187 liver resections demonstrated that the high risk factors related to subphrenic infection after hepatectomy were as follows: (1) The extent of liver resection was associated with subphrenic infection.(2) The incidence of subphrenic infection after liver resection of primary liver cancer patients with hepatic cirrhosis was higher than that of non-cirrhotic patients. (3) Intraoperative estimated blood loss greater than 1500 ml was found to be a significant risk factor in the development of postoperative subphrenic infection.(4) Adequate postoperative drainage of subdiaphragm and the raw surface of the liver was one of critical factors of decreasing subphrenic infection after liver resection.
文摘BACKGROUND Subphrenic carcinoma has been identified as a significant risk factor for the thermal ablation of intrahepatic tumors,resulting in a high rate of residual tumor recurrence.Some studies have proposed that combination treatment with transarterial chemoembolization(TACE)followed by radiofrequency ablation is both feasible and safe for tumors in the subphrenic region.However,research specifically examining the therapeutic outcomes of combination therapy using TACE and microwave ablation(TACE-MWA)in subphrenic tumors is lacking.AIM To evaluate the efficacy and safety of TACE-MWA in patients with subphrenic hepatocellular carcinoma(HCC).METHODS Between December 2017 and December 2021,49 patients diagnosed with HCC≤6 cm,who received TACE-MWA,were included in this retrospective cohort study.These patients were classified into subphrenic and non-subphrenic groups based on the distance between the diaphragm and the tumor margin.The rates of local tumor progression(LTP),progression-free survival(PFS),and overall survival(OS)were compared between the two groups.Complications were evaluated by using a grading system developed by the Society of Interventional Radiology.RESULTS After a median follow-up time of 38 mo,there were no significant differences in LTP between the subphrenic and non-subphrenic groups(27.3%and 22.2%at 5 years,respectively;P=0.66),PFS(55.5%at 5 years in both groups;P=0.91),and OS(85.0%and 90.9%in the subphrenic and non-subphrenic groups at 5 years;P=0.57).However,a significantly higher rate of LTP was observed in subphrenic HCC>3 cm compared to those≤3 cm(P=0.085).The dosage of iodized oil[hazard ratio(HR):1.52;95%confidence interval(CI):1.11-2.08;P=0.009]and multiple tumors(HR:13.22;95%CI:1.62-107.51;P=0.016)were independent prognostic factors for LTP.There were no significant differences in complication rates between the two groups(P=0.549).CONCLUSION Combined TACE and MWA was practical and safe for managing subphrenic HCC.The efficacy and safety levels did not vary significantly when tumors outside the subphrenic region were treated.
文摘The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amylase.This pancreatic pleural effusion is also called a pancreatic pleural fistula.It is characterized by profuse pleural fluid and has a tendency to recur.Here we report a case of delayed internal pancreatic fistula with pancreatic pleural effusion emerging after splenectomy.From the treatment of this case,we conclude that the symptoms and signs of a subphrenic effusion are often obscure;abdominal computed tomography may be required to look for occult,intra-abdominal infection;and active conservative treatment should be carried out in the early period of this complication to reduce the need for endoscopy or surgery.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is one of the most frequent cancers and the main cause of cancer-related death worldwide.Ectopic HCC,an extremely rare type of HCC,exhibits a wide range of clinical signs and radiographic features,making preoperative identification challenging.CASE SUMMARY A 47-year-old man underwent routine abdominal color ultrasonography,which identified an asymptomatic tumor in the left upper abdomen.The patient had no history of hepatitis,did not drink alcohol,and had no family history of cancer.Abdominal contrast-enhanced computed tomography(CT)revealed a heterogeneously enhanced lesion between the spleen and stomach that had invaded the diaphragm,with blood supplied by the left inferior phrenic artery.The patient underwent laparoscopic surgery,and HCC was identified by postoperative pathology.Additionally,specific immunohistochemical staining was performed to assess the molecular biological characteristics of the HCC.The patient underwent two rounds of hepatic arterial interventional chemotherapy after surgery.Abdominal plain and enhanced magnetic resonance imaging and lung CT 3 mo postoperatively revealed no signs of local recurrence or distant metastasis.CONCLUSION This asymptomatic ectopic HCC case described achieved an excellent result due to early detection,radical resection,and systematic surveillance.
