Intraoperative ultrasonography(IOUS)in hepatobiliary surgery is well known as an essential tool for radical and safe hepatectomies,allowing to perform parenchymal sparing surgery and,as consequence,to expand the surgi...Intraoperative ultrasonography(IOUS)in hepatobiliary surgery is well known as an essential tool for radical and safe hepatectomies,allowing to perform parenchymal sparing surgery and,as consequence,to expand the surgical indications for patients otherwise considered unresectable.Nevertheless,since many years,despite its effectiveness in the study of vascular anatomy of the liver,the gold standard for the assessment of biliary anatomy during surgery is intraoperative cholangiography(IOC),which is used for the validation of preoperative imaging as well as for guiding reconstruction in case of bile duct injury or resection.展开更多
Nested stromal-epithelial tumours(NSETs)of the liver have been reported to be extremely unusual primary hepatic neoplasms.To date,few cases have been described in the literature.NSETs have been defined as non-hepatocy...Nested stromal-epithelial tumours(NSETs)of the liver have been reported to be extremely unusual primary hepatic neoplasms.To date,few cases have been described in the literature.NSETs have been defined as non-hepatocytic and non-biliary tumours of the liver consisting of nests of epithelial and spindled cells,myofibroblastic stroma and variable intralesional calcification and ossification.Here,we report a case of a young female who underwent liver resection for a large hepatic lesion that proved to be a calcifying NSET on pathological examination.Details about the clinical and histopathological features of the tumour are reported.展开更多
The performance of hepatic surgery without a parenchyma-sparing strategy carries significant risks for patient survival because of the not negligible occurrence of postoperative liver failure.The key factor of modern ...The performance of hepatic surgery without a parenchyma-sparing strategy carries significant risks for patient survival because of the not negligible occurrence of postoperative liver failure.The key factor of modern hepatic surgery is the use of the intraoperative ultrasound(IOUS),not only to stage the disease,but more importantly to guide resection with the specific aim to maximize the sparing of the functional parenchyma.Whether in patients with hepatocellular carcinoma and underlying liver cirrhosis,or in patients with colorectal liver metastasis,IOUS allows the performance of the so-called "radical but conservative surgery",which is the pivotal factor to offer a chance of cure to an increasing proportion of patients,who until few years ago were considered only for palliative care.Using some new IOUS-guided surgical maneuvers,which are based on the liver inflow and outflow modulations,more precise anatomically subsegmental-and segmentaloriented resections can be effectively performed.The present work describes the rationale and the surgical technique for a precise tailoring of the area of hepatic resection using the most recent attainments in IOUS.Such important technical achievements should be a fundamental part of the surgical armamentarium of the modern liver surgeon.展开更多
When suitable, surgery still remains the therapeutic option to be preferred for patients carrier of colorectal liver and lung metastases. Since thoracophrenolaparotomy should be helpful during liver resection for some...When suitable, surgery still remains the therapeutic option to be preferred for patients carrier of colorectal liver and lung metastases. Since thoracophrenolaparotomy should be helpful during liver resection for some of these patients, simultaneous removal of right lung metastases can be proposed through this approach. Eleven consecutive patients（median age of 53 years） carrier of colorectal liver and lung metastases, underwent single session surgical resection of both liver and right lung lesions by means of J-shaped thoracophrenolaparotomy. The median number of liver metastases removed was 5（range 2-30） and of lung metastases removed was 2（range 1-3）. Lung metastases were located in the upper lobe in 1 patient, in the middle lobe in 2, in the lower lobe in 6, and in the upper and lower lobe in 2. Mortality and major morbidity were nil. Two patients had a minor morbidity： one had wound infection and bile leakage treated conservatively and the other had transient fever. Mean overall survival was 24.4 months. An aggressive surgical approach should be undertaken for colorectal metastases： in case of multifocal liver disease with complex presentations, J-shaped thoracophrenolaparotomy could be considered as safe approach for combined liver and right lung metastasectomies.展开更多
文摘Intraoperative ultrasonography(IOUS)in hepatobiliary surgery is well known as an essential tool for radical and safe hepatectomies,allowing to perform parenchymal sparing surgery and,as consequence,to expand the surgical indications for patients otherwise considered unresectable.Nevertheless,since many years,despite its effectiveness in the study of vascular anatomy of the liver,the gold standard for the assessment of biliary anatomy during surgery is intraoperative cholangiography(IOC),which is used for the validation of preoperative imaging as well as for guiding reconstruction in case of bile duct injury or resection.
文摘Nested stromal-epithelial tumours(NSETs)of the liver have been reported to be extremely unusual primary hepatic neoplasms.To date,few cases have been described in the literature.NSETs have been defined as non-hepatocytic and non-biliary tumours of the liver consisting of nests of epithelial and spindled cells,myofibroblastic stroma and variable intralesional calcification and ossification.Here,we report a case of a young female who underwent liver resection for a large hepatic lesion that proved to be a calcifying NSET on pathological examination.Details about the clinical and histopathological features of the tumour are reported.
文摘The performance of hepatic surgery without a parenchyma-sparing strategy carries significant risks for patient survival because of the not negligible occurrence of postoperative liver failure.The key factor of modern hepatic surgery is the use of the intraoperative ultrasound(IOUS),not only to stage the disease,but more importantly to guide resection with the specific aim to maximize the sparing of the functional parenchyma.Whether in patients with hepatocellular carcinoma and underlying liver cirrhosis,or in patients with colorectal liver metastasis,IOUS allows the performance of the so-called "radical but conservative surgery",which is the pivotal factor to offer a chance of cure to an increasing proportion of patients,who until few years ago were considered only for palliative care.Using some new IOUS-guided surgical maneuvers,which are based on the liver inflow and outflow modulations,more precise anatomically subsegmental-and segmentaloriented resections can be effectively performed.The present work describes the rationale and the surgical technique for a precise tailoring of the area of hepatic resection using the most recent attainments in IOUS.Such important technical achievements should be a fundamental part of the surgical armamentarium of the modern liver surgeon.
文摘When suitable, surgery still remains the therapeutic option to be preferred for patients carrier of colorectal liver and lung metastases. Since thoracophrenolaparotomy should be helpful during liver resection for some of these patients, simultaneous removal of right lung metastases can be proposed through this approach. Eleven consecutive patients（median age of 53 years） carrier of colorectal liver and lung metastases, underwent single session surgical resection of both liver and right lung lesions by means of J-shaped thoracophrenolaparotomy. The median number of liver metastases removed was 5（range 2-30） and of lung metastases removed was 2（range 1-3）. Lung metastases were located in the upper lobe in 1 patient, in the middle lobe in 2, in the lower lobe in 6, and in the upper and lower lobe in 2. Mortality and major morbidity were nil. Two patients had a minor morbidity： one had wound infection and bile leakage treated conservatively and the other had transient fever. Mean overall survival was 24.4 months. An aggressive surgical approach should be undertaken for colorectal metastases： in case of multifocal liver disease with complex presentations, J-shaped thoracophrenolaparotomy could be considered as safe approach for combined liver and right lung metastasectomies.
