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PubMedDate not supplied

Arterio-portal shunt in liver rescued by hepatectomy after arterial embolization.

Arterio-portal shunts are generally treated with transcatheter arterial embolization, as a therapeutic measure for bleeding of esophageal varices. However, transcatheter arterial embolization is frequently associated with reestablishment of arterio-portal shunts. We now report our experience with partial hepatectomy to remove the arterio-portal shunt associated with esophageal varices, which recurred after transcatheter arterial embolization. The patient was a 60-year-old female, who had massive hematemesis caused by rupture of esophageal varices. Doppler sonography and arteriography demonstrated an arterio-portal shunt in the right anterior superior segment of the liver. Temporary hemostasis was achieved with transcatheter arterial embolization, however, hemorrhage recurred one month later. The second transcatheter arterial embolization failed to manage the shunt and varices. The patient developed hepatic coma. After recovery from coma, she was referred to our hospital. We carried out partial hepatectomy, which provided remarkable hemodynamic improvement; the portal vein flow changed from hepatofugal to hepatopetal. Esophageal varices and hepatic coma have totally disappeared. This patient has had no complaint and has remained free of esophageal varices, for 3 years postoperatively. She is having a normal life. The partial hepatectomy to remove the arterio-portal shunt induced complete resolution of the arterio-portal shunt, as well as dramatic improvement in portal flow and hepatic coma. Our experience in the present case suggests that partial hepatectomy should be considered as a radical therapy for arterio-portal shunt, without insistence on transcatheter arterial embolization.

Arteriovenous Fistula↗
PubMed1998

[Hepatectomy for hepatolithiasis treatment of 354 cases].

OBJECTIVE: To evaluate the effect of hepatectomy for hepatolithiasis. METHOD: 354 patients with hepatolithiasis underwent hepatectomy in the past 10 years. The results were analysed retrospectively, including clinical findings, distribution of stones, patterns of operation, postoperative complications, and residual stones. The clinical data of the patients before 1990 were compared with those thereafter. RESULT: Left hepatolithiasis was the most common form (323 patients). Left lateral lobectomy and left hepatectomy were most commonly employed (91.2%). 166 of the patients underwent concurrent cholangiojejunostomy. 13.8% patients had residual stones, and postoperative complications occurred in 60 patients, including 4 deaths. Few patients were reoperated on and the incidence of residual stones was lower after 1990. 88% the patients showed excellent or good result. CONCLUSION: Hepatectomy is a procedure for the management of hepatolithiasis, but still requires combined plasty of stenotic intrahepatic bile ducts and cholangiojejunostomy to reduce the incidence of residual stones and recurrence.

Adolescent↗
PubMed1998

[Retrograde partial hepatectomy: report of 11 patients].

OBJECTIVE: To study a new approach to hepatectomy for liver tumors resected difficulty by typical method. METHOD: The operative order is retrograde as compared with typical hepatectomy, namely, transection of the liver is performed first, isolating adhesions between the tumor and the diaphragm or partial invaded phrenectomy is performed second, and then after cutting corresponding ligaments, liver tumor is removed. If the surrounding organs were invaded or adhered by tumor too tightly to be separated. They were resected with the tumor. RESULT: The approach was used in 11 patients with malignant tumors of liver from June 1994 to January 1996. Operation time was 192 min (150 - 250 min) and estimated blood loss during operation was 1460 ml (800 - 4, 200 ml). No operative mortality was found and all of the patients recovered uneventfully. CONCLUSION: The retrograde partial hepatectomy is a good method for resection of liver tumors resected difficulty by typical hepatectomy.

Adult↗
PubMedDate not supplied

Hepatectomy for liver metastasis from ampullary cancer after pancreatoduodenectomy.

A 51-year-old Japanese woman with a solitary liver metastasis originating from a carcinoma of the ampulla of Vater was successfully treated by partial hepatectomy 19 months after curative pancreatoduodenectomy with lymphadenectomy. Histologic examination revealed a stage III well-differentiated tubular adenocarcinoma (pT2, pN1, and pM0). Postoperative serum concentrations of carcinoembryonic antigen increased exponentially to 133 ng/mL. The carcinoembryonic antigen doubling time was 63 days. Computed tomography and ultrasonography of the abdomen showed a solitary metastasis in segment VI of the liver. Since neither local recurrences nor other distant metastases were detected, the patient underwent partial hepatectomy. Histologic study confirmed the presence of a metastatic liver tumor from the ampullary carcinoma. The carcinoembryonic antigen levels returned to normal immediately after the partial hepatectomy. She was well without signs of recurrence 18 months after partial hepatectomy.

Adenocarcinoma↗
PubMedDate not supplied

Serum interleukin-6 and hepatocyte growth factor levels in patients after hepatectomy.

BACKGROUND/AIMS: To examine whether serum hepatocyte growth factor and interleukin-6 levels are early parameters of postoperative liver dysfunction after hepatectomy. METHODOLOGY: The serum levels of hepatocyte growth factor and interleukin-6 were measured in 16 hepatectomized patients on the day of surgery (before surgery, immediately after hepatectomy, after completion of surgery) and on postoperative days 1, 3, and 5. Serum liver function tests were determined for 14 days after surgery and their results were correlated with serum interleukin-6 and hepatocyte growth factor levels. RESULTS: Serum interleukin-6 and hepatocyte growth factor levels were elevated after surgery and these values were higher in patients who underwent hepatectomy greater than lobectomy in magnitude. The mean maximum value of interleukin-6 appeared on day 0 and was earlier than that of hepatocyte growth factor, which was found on day 1. Serum total bilirubin and alanine aminotransferase levels reached the maximum within 5 days after surgery. Multiple regression analysis showed that serum levels of interleukin-6 and hepatocyte growth factor on day 0 after surgery were significantly correlated with the postoperative maximum total bilirubin level (P < 0.0001). The maximum interleukin-6 level but not hepatocyte growth factor significantly correlated with the postoperative maximum bilirubin level (P < 0.02). CONCLUSIONS: Both the serum interleukin-6 and hepatocyte growth factor levels are likely early indicators of postoperative liver dysfunction in patients after hepatectomy.

Adult↗
PubMed2002

[Prevention and treatment of complications after hepatectomy].

OBJECTIVE: To study the prevention and treatment of complications after hepatectomy. METHODS: From January 1998 to December 1999, 1 762 patients with pathologically proven primary liver cancer underwent hepatectomy. The types of resection included lobectomy, segmental resection and local hepatectomy. RESULTS: The total complication rate was 4.09% and the total mortality was 0.40%. The rates of intraoperative bleeding, postoperative bleeding, hepatic failure, stockpiling fluid of the pleural cavity, residual fluid under the diaphragm, bile leakage and infection of incision were 0.96%, 0.28%, 0.51%, 1.87%, 0.17%, 0.17% and 0.11% respectively. The mortality of the former three complications were 0.06%, 0.06% and 0.28% respectively. CONCLUSIONS: The complications can be prevented effectively and the mortality can be decreased markedly after hepatectomy by strict control of the indications, sufficient preoperative preparation, better surgical skills and close observation of postoperative state and comprehensive postoperative treatment.

Adolescent↗
PubMedDate not supplied

Staged hepatectomy following arterial embolization for ruptured hepatocellular carcinoma.

BACKGROUND/AIMS: While hemostasis by transcatheter arterial embolization is often the first choice in the initial treatment of ruptured hepatocellular carcinoma, post-transcatheter arterial embolization treatment has not fully been established. We studied the prognoses of ruptured hepatocellular carcinoma cases where hepatectomy was possible after transcatheter arterial embolization. METHODOLOGY: We retrospectively reviewed 10 cases of ruptured hepatocellular carcinoma which had been treated in our institution between 1989 and 1998. In all the 10 cases, emergency transcatheter arterial embolization was performed, which successfully achieved hemostasis. RESULTS: Following the achievement of hemostasis by transcatheter arterial embolization, hepatectomy was carried out in 5 cases after evaluation of general condition, functional liver reserve and extent of tumor spread. There was neither operative nor hospital death. One-year and 3-year survival rates were 100% and 40%, respectively, and 50% survival time was 36 months. In the other 5 patients, hepatectomy was decided to be impossible after evaluation of general condition, functional liver reserve and extent of tumor spread; all of them died within 0.5-10 months after transcatheter arterial embolization. CONCLUSIONS: Among the patients with ruptured hepatocellular carcinoma, those in which hepatectomy was decided to be possible after evaluation of general condition, functional liver reserve and extent of tumor spread, following successful hemostasis by transcatheter arterial embolization, had fairly good prognoses.

Adult↗
PubMed1999

[Influence of different total parenteral nutrition support upon hepatic regeneration after partial hepatectomy in rats].

This study was designed to investigate the effects of different TPN on liver regeneration after partial hepatectomy in rats. Forty Wistar rats were randomly divided into four groups. Groups A and B (normal rats) received BCAA-enriched TPN (45% BCAAs) and standard TPN (24% BCAAs) respectively after 34% hepatectomy; Groups C and D (rats with cirrhosis of liver) received the same TPN as Groups A and B received respectively after 34% hepatectomy. On the third day after operation, all rats were killed and specimens of liver and blood were taken for measurement of activity of liver regeneration. The results showed that DNA synthesis rate and mitosis rate in Groups A and B were significantly greater than those in Groups C and D respectively; RLR, DNA synthesis rate and mitosis rate in Groups A and C were significantly higher than those in Groups B and D respectively. These suggest that the effect of the same TPN on liver regeneration in normal rats is better than that in cirrhosis rats and that BCAA-enriched TPN can provide more excellent supplementation than standard TPN can do either in normal liver or cirrhosis liver after partial hepatectomy.

Animals↗
PubMed2002

[Rapid induction of mRNAs for liver regeneration genes by hepatopoietin and partial hepatectomy].

OBJECTIVE: To investigate the effect of recombinant human hepatopoietin (rhHPO) and partial hepatectomy on rapidly induced expression of immediate early gene. METHODS: We investigated the different gene expression within 1 hour after 2/3 partial hepatectomy by representational difference analysis and in primary cultured hepatocytes system. RESULTS: In the expressed sequence tag (EST) library, we identified that most of these genes were immediate early gene, and found one new gene PC3 that might be associated to liver regeneration in the EST library. Moreover, PC3 gene was rapidly induced after 2/3 partial hepatectomy and the expressing peak was within 1~2 hours after operation. HPO can rapidly induce the expression of these genes (c-fos, LRF-1, and PC3, etc.) in primarily cultured rat hepatocyte, which might be one of HPO molecular mechanism on stimulating hepatocyte proliferation. CONCLUSIONS: rhHPO and partial hepatectomy can rapidly induce the expression of immediate early gene. PC3 gene is immediate early gene related to liver regeneration.

Animals↗
PubMed2002

Hepatocyte growth factor levels in liver and blood, and post-operative liver cell proliferation in patients with benign and malignant liver tumors after partial hepatectomy.

BACKGROUND: The purpose of our study was to investigate hepatocyte proliferation and the expression of hepatocyte growth factor (HGF) in liver tissue and blood from patients with benign and malignant liver tumors after partial hepatectomy. MATERIAL/METHODS: We studied 25 consecutive patients undergoing partial hepatectomy for metastatic colorectal adenocarcinoma (15 cases) and benign liver tumors (10 cases). Immunohistochemical examination for the presence of PCNA and HGF, c-MET/HGF-receptor expression was performed on formalin-fixed samples from: a) sections of resected fragments of liver tissue remote from the tumor; b) tumor tissue; c) remnant liver, 30 min after hepatectomy; d) fine needle aspiration liver biopsy, 7 days after liver resection. Circulating HGF and the level of AFP and GGT as biomarkers for liver cell regeneration were measured in the patients' blood at the same time. RESULTS: The proliferation rate of liver cells was higher in patients with malignant than benign liver tumors. This correlated with increased HGF in blood, but not with the expression of HGF and c-MET/HGF-R in liver tissue. The expression of HGF was detected in specimens from colorectal liver metastases. CONCLUSIONS: The mutual interactions between tumor and other cells may influence the proliferation of hepatocytes throughout the regenerative process in patients with colorectal carcinoma metastases after partial hepatectomy.

Adenocarcinoma↗
PubMed1976

Depression of host versus graft immunity and stimulation of tumor growth following partial hepatectomy.

Tumor growth was measured in inbred (C3H and C3Hf) and hybrid (C3H X C57BL/6F1 and BALB/c X C3HF1) mice after partial hepatectomy, sham hepatectomy, and hind limb amputation. Epithelial tumors (mammary carcinoma) and mesenchymal tumors (methylcholanthrene-induced and spontaneous tissue culture) were used in order to determine the tissue specificity of the tumor growth stimulation. Immunological parameters were defined by: (a) utilization of tumors that were either antigenic or nonantigenic, and (b) measurement of the host versus graft response in partially hepatectomized mice. Partial hepatectomy and the control operations were done on the same day as the tumor cell inoculation. All tumors, regardless of their tissue type or antigenicity, grew significantly better in partially hepatectomized mice as compared with the control mice. There was a significant positive correlation between the magnitude of tumor growth stimulation and the degree of antigenicity of the tumor. Last, skin allograft survival was significantly prolonged in the hepatectomized mice. The results suggest that : (a) the stimulation of tumor growth in hepatectomized mice is not tissue specific as previously reported; and (b) the antigenicity of a tumor is not necessary for growth stimulation after partial hepatectomy.

Adenocarcinoma↗
PubMedDate not supplied

Postoperative evaluation of C-tube drainage after hepatectomy.

BACKGROUND/AIMS: In spite of recent advances in liver surgery, biliary complications remain a common cause of major morbidity after hepatectomy. METHODOLOGY: We studied the postoperative evaluation of 28 hepatectomied patients with transcystic duct tube (C-tube) drainage (C-group), compared with 38 hepatectomied patients without C-tubes (NC-group), in terms of preoperative clinical profiles of patients, intraoperative findings and procedures, postoperative management and bile leakage, daily output of bile, liver function and postoperative infections. RESULTS: There were no significant differences in the preoperative clinical profiles of patients and postoperative management between the two groups. In intraoperative findings and procedures, the tumor size, weight of the resected liver, operation time and operative blood loss were higher in the C-group than those in the NC-group. Therefore, the operative procedure was more serious in the C-group than that in the NC-group. However, bile leakage was observed in only one of 28 patients (3.6%) in the C-group and 10 of 38 patients (26.3%) in the NC-group, that is, bile leakage occurred less frequently in the C-group than in the NC-group. The daily output of bile in the C-group was thought to be enough to decompress the biliary tree. In liver function, aspartate aminotransferase and alanine aminotransferase had lower levels in the C-group than those in the NC-group with bile leakage. White blood cell count, C-reactive protein and body temperature were closer to the normal range in the C-group than those in the NC-group with bile leakage. CONCLUSIONS: C-tube drainage after hepatectomy is thought to be useful for decreasing postoperative complications, especially bile leakage.

Aged↗
PubMed2003

The effects of Korean red ginseng (ginseng radix rubra) on liver regeneration after partial hepatectomy in dogs.

We investigated the effects of the oral administration of Korean red ginseng (KRG) on morphologic change and function of liver in dogs. Fifteen adult mongrel dogs (n=15) were divided into three groups: a control group (40% hepatectomy, untreated), a 250 group (40% hepatectomy, 250 mg/kg of KRG, PO), and a 500 group (40% hepatectomy, 500 mg/kg of KRG, PO). The liver regeneration, histologic findings, CBC (WBC, RBC, PCV, and PLT), and liver function tests (AST, ALT, GGT, ALP, LDH, and T-bil) were examined during experiment. The liver regeneration rates were higher in treated groups than in the control group. But, there were no significant differences. All hematological values were within normal ranges except leukocyte counts for 3 days postoperatively. The levels of AST and ALT in the treated groups were significantly decreased compared to that in the control group (p<0.05). The numbers of degenerative cells and area of connective tissue were significantly decreased in the liver of the dog with KRG administration (p<0.01). On the basis of these results, we could conclude that KRG accelerate the liver regeneration and ameliorate the liver injury after hepatectomy in dogs.

Animals↗
PubMedDate not supplied

Lipid peroxidation and extracellular matrix in normal and cirrhotic rat livers following 70% hepatectomy.

BACKGROUND/AIMS: The aim was to measure the deposition of collagens and proteoglycans and the underlying mechanism leading to lipid peroxidation due to oxidative stress in partially hepatectomized normal and cirrhotic rats. METHODOLOGY: Four groups of adult Wistar rats were used comprising normal livers, regenerated normal livers, cirrhotic livers, and regenerated cirrhotic livers. Cirrhosis was induced by intragastric administration of carbon tetrachloride and phenobarbital in the drinking water of the rats. Hydroxyproline, as a constituent of collagens, uronic acid, as a constituent of proteoglycans, and malondealdehyde, an end-product of lipid peroxides, were measured in normal and cirrhotic rats, and following partial hepatectomy. RESULTS: Hydroxyproline, uronic acid and malondealdehyde levels were 234.2 +/- 41.2, 11.82 +/- 1.92, 46.3 +/- 5.8 and 211.8 +/- 43.6, 9.16 +/- 1.41, 48.5 +/- 7.5 for normal and regenerated normal livers respectively. The values after partial hepatectomy in cirrhotic and regenerated cirrhotic livers were 396.9 +/- 48.5, 17.96 +/- 1.62, 144.5 +/- 25.1 and 309.6 +/- 43.2, 13.35 +/- 1.72, 229.9 +/- 24.4, respectively. When the cirrhotic liver group was compared with the normal liver group, the levels of hydroxyproline, uronic acid and malondealdehyde were significantly higher (p < 0.001). Uronic acid levels of regenerated normal and regenerated cirrhotic livers and hydroxyproline level of regenerated cirrhotic liver were significantly less than those of their non-regenerated states (p < 0.01). Although the malondealdehyde levels of normal and regenerated normal livers did not differ significantly (p > 0.05), the malondealdehyde levels of regenerated cirrhotic liver was significantly higher than cirrhotic liver (p < 0.01). The histopathological examination with light microscopy did not reveal any obvious difference between the groups other than between normal and cirrhotic. CONCLUSIONS: Cirrhotic livers revealed a significantly higher amount of extracellular matrix constituents and lipid peroxidation than normal livers. Although partial hepatectomy in cirrhotic livers caused decreases in the tissue levels of collagens and proteoglycans, it did not actually lower the ongoing oxidative stress, known as physiological lipid peroxidation, in normal and cirrhotic livers following partial hepatectomy.

Animals↗
PubMed2003

[Massive hemorrhage in hepatectomy: causes and management].

OBJECTIVE: To analyse the causes and the management of massive hemorrhage in hepatectomy. METHODS: With over 1 000 ml of bleeding, 4 368 patients with hepatectomy between 1955 and 2000 were analysed retrospectively. RESULTS: Among 4 368 patients receiving hepatectomy, 286 (6.5%) had massive hemorrhage because of damage to the major hepatic veins, portal hypertension, hepatic insufficiency, and the extensive adhesion around the tumor. Massive hemorrhage was managed by repair and transfixation of the damaged vessels; transfixation or devascularization of variceal bleeding; complete vessels ligation of the hepatic section with mattress suture; resection of the ruptured tumor after temporary occlusion of the porta hepatis; fibrinogen infusion; hot saline compression of the surface of the wound and/or daub biological glue; argon beam coagulation and packs placement. CONCLUSIONS: Light performance and nonforce dragging of liver can reduce massive hemorrhage caused by major vessel injury or tumor rupture. Normothetic occlusion of porta hepatis can reduce blood loss effectively when liver resection. In situ hepatectomy must be adopted if there is extensive adhesion around the tumor. Packs placement is still an effective measure to stop bleeding caused by defective coagulation and extensive blood oozing of wound surface.

Adolescent↗
PubMed1992

Mitochondrial changes in phospholipid molecular species during the increased oxidative phosphorylation after hepatectomy.

The changes in liver mitochondrial and microsomal phospholipid molecular species were analyzed during the period of remarkably increased oxidative phosphorylation following partial hepatectomy in rabbits. At 24 hours after hepatectomy, phosphorylative activity increased significantly from 69.7 +/- 5.5 to 118.5 +/- 5.7 nmol of ATP synthesized/min/mg protein, compared to the sham operated group. The ratio of phosphatidylethanolamine to phosphatidylcholine (PE/PC) in mitochondria increased significantly in the hepatectomy group compared with the sham operated group. Remarkable changes in molecular species were observed in mitochondrial phosphatidylethanolamine. 1-Stearoyl-2-arachidonoyl species decreased in the hepatectomy group. On the other hand, microsomal phospholipids hardly changed compared with mitochondrial ones. The change in content of 1-stearoyl-2-arachidonyl phosphatidylethanolamine in mitochondria tended to return to normal levels concomitant with the normalization of phosphorylative activity. The changes in content of mitochondrial phospholipids, especially phosphatidylethanolamine, might also be related to enhancement of phosphorylative activity.

Animals↗
PubMed1992

[Induction of hypertrophy of a small left hepatic lobe by preoperative right portal embolization, preceding extended right hepatectomy].

The aim of this study was to evaluate the compensatory hypertrophy of the left lobe of the liver, induced by a preoperative right portal embolization (PORPE), and then the feasibility of a right extended hepatectomy. The small size of the left lobe did not initially permit such a resection. Eight patients (mean age: 62 years) underwent PORPE for cancer between September 1987 and December 1991. They represented 4% of the 187 patients undergoing hepatectomy for liver cancer during the same period. The PORPE was conducted by percutaneous access and puncture of the left portal vein (Rex's recessus). The clinical and laboratory safety were good, with fewer adverse effects than with arterial chemo-embolization. The mean increased volume of the left lobe, four weeks after PORPE, was 54% (range: 32-100%) allowing hepatectomy to be performed. The post-operative course of these right extended hepatectomies was uneventful. In conclusion, we think that PORPE needs a careful technique but that it is well tolerated and effective to induce hypertrophy of the future remnant left lobe. It allows resection of some initially unresectable tumors. This technique warrants further development.

Aged↗
PubMedDate not supplied

[Hepatic suppurations requiring segmented or atypical hepatectomies].

Following studies of cases with hepatic suppurations the authors indicate the necessity for regular or atypic hepatectomies. The extension of the suppurative process in the liver made necessary the ligature of the great sagital vein and the authors show, on the basis of anatomic and topographical data (hepatic segmentation), that it is necessary to extend the hepatectomy to the IV-th para-median segment. The authors also present the indications for bi-segmental right hepatectomy in segments VII-VI as well as of the total left regulated hepatectomy.

Adolescent↗