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| 1 | Liver surgery in cirrhosis and portal hypertension显示文摘The prevalence of hepatic cirrhosis in Europe and the United States, currently 250 patients per 100000 inhabitants, is steadily increasing. Thus, we observe a significant increase in patients with cirrhosis and portal hypertension needing liver resections for primary ormetastatic lesions. However, extended liver resections in patients with underlying hepatic cirrhosis and portal hypertension still represent a medical challenge in regard to perioperative morbidity, surgical management and postoperative outcome. The Barcelona Clinic Liver Cancer classification recommends to restrict curative liver resections for hepatocellular carcinoma in cirrhotic patients to early tumor stages in patients with Child A cirrhosis not showing portal hypertension. However, during the last two decades, relevant improvements in preoperative diagnostic, perioperative hepatologic and intensive care management as well as in surgical techniques during hepatic resections have rendered even extended liver resections in higher-degree cirrhotic patients with portal hypertension possible. However, there are few standard indications for hepatic resections in cirrhotic patients and risk stratifications have to be performed in an interdisciplinary setting for each individual patient. We here review the indications, the preoperative risk-stratifications, the morbidity and the mortality of extended resections for primary and metastatic lesions in cirrhotic livers. Furthermore, we provide a review of literature on perioperative management in cirrhotic patients needing extrahepatic abdominal surgery and an overview of surgical options in the treatment of hepatic cirrhosis. | Christina Hackl Hans J Schlitt Philipp Renner Sven A Lang | 2016 | World Journal of Gastroenterology2016，22，9： | 21 |
| 2 | Significance of functional hepatic resection rate calculated using 3D CT/^(99m)Tc-galactosyl human serum albumin singlephoton emission computed tomography fusion imaging显示文摘AIM: To evaluate the usefulness of the functional hepatic resection rate(FHRR) calculated using 3D computed tomography(CT)/^(99m)Tc-galactosyl-human serum albumin(GSA) single-photon emission computed tomography(SPECT) fusion imaging for surgical decision making. METHODS: We enrolled 57 patients who underwent bi- or trisectionectomy at our institution between October 2013 and March 2015. Of these, 26 patients presented with hepatocellular carcinoma, 12 with hilar cholangiocarcinoma, six with intrahepatic cholangiocarcinoma, four with liver metastasis, and nine with other diseases. All patients preoperatively underwent three-phase dynamic multidetector CT and ^(99m)Tc-GSA scintigraphy. We compared the parenchymal hepatic resection rate(PHRR) with the FHRR, which was defined as the resection volume counts per total liver volume counts on 3D CT/^(99m)Tc-GSA SPECT fusion images.RESULTS: In total, 50 patients underwent bisectionectomy and seven underwent trisectionectomy.Biliary reconstruction was performed in 15 patients, including hepatopancreatoduodenectomy in two. FHRR and PHRR were 38.6 ± 19.9 and 44.5 ± 16.0, respectively; FHRR was strongly correlated with PHRR. The regression coefficient for FHRR on PHRR was 1.16(P < 0.0001). The ratio of FHRR to PHRR for patients with preoperative therapies(transcatheter arterial chemoembolization, radiation, radiofrequency ablation, etc.), large tumors with a volume of > 1000 m L, and/or macroscopic vascular invasion was significantly smaller than that for patients without these factors(0.73 ± 0.19 vs 0.82 ± 0.18, P < 0.05). Postoperative hyperbilirubinemia was observed in six patients. Major morbidities(Clavien-Dindo grade ≥ 3) occurred in 17 patients(29.8%). There was no case of surgeryrelated death.CONCLUSION: Our results suggest that FHRR is an important deciding factor for major hepatectomy, because FHRR and PHRR may be discrepant owing to insufficient hepatic inflow and congestion in patients with preoperative therapies, macroscopic vascular invasion, and/or a tumor volume of > 1000 m L. | Yosuke Tsuruga Toshiya Kamiyama Hirofumi Kamachi Shingo Shimada Kenji Wakayama Tatsuya Orimo Tatsuhiko Kakisaka Hideki Yokoo Akinobu Taketomi | 2016 | World Journal of Gastroenterology2016，22，17： | 6 |
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