Với những thành tựu về miễn dịch học, gây mê hồi sức và ứng dụng công nghệ hiện đại trong điều trị và theo dõi bệnh nhân, ghép tạng nói chung và ghép thận nói riêng đạt được nhiều thành tựu trong những năm gần đây. Tại Việt Nam, ghép thận người cho sống đã trở thành phẫu thuật thường quy tại nhiều trung tâm. Bên cạnh các thăm khám đầy đủ trước ghép, việc nắm vững các biến đổi giải phẫu mạch máu và làm chủ kỹ thuật xử lý mạch máu thận ghép đóng vai trò hết sức quan trọng trong tiên lượng gần và xa của thận ghép[1],[2]. Nghiên cứu này nhằm mục đích mô tả những biến đổi giải phẫu mạch máu thận ứng dụng trong ghép thận người cho sống tại Bệnh viện hữu nghị Việt Đức giai đoạn 2012-2015.
Objective This study aimed to evaluate the safety and efficacy of liver venous deprivation (LVD) following transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Methods Between January 2021 and December 2022, HCC patients indicated for hepatectomy with initial insufficient future liver remnant (FLR) underwent LVD after TACE to induce preoperative liver hypertrophy. Results Twenty-seven HCC patients with a median age of 55 years underwent LVD. No TACE or LVD procedure-associated complications occurred, except for 1 case presenting with grade A liver failure after LVD (then recovered after 7 days). The FLR volume was 29.3% (interquartile range [IQR] = 7.5) and 48.9% (IQR = 8.6) of the total liver volume before and after LVD, respectively (p < 0.001). The degree of hypertrophy and FLR hypertrophy rate were 14.8% (IQR = 8.4) and 55.2% (IQR = 36.7), respectively. All 27 patients demonstrated sufficient FLR after LVD (24 patients at three weeks post-LVD, one at six weeks, and two at ten weeks), but only 21 patients accepted surgery. Postoperative histopathology showed 16 patients with cirrhosis and five with mild fibrosis (F1, F2). One patient presented with severe intraoperative bleeding due to damage of left hepatic vein and developed grade C liver failure, then died on day 32 postoperation. Conclusion LVD following TACE seems to be a safe, effective, and feasible method of inducing significant FLR regeneration in HCC, even in well-selected cirrhotic livers. Comparative studies with a large patient population and multicenter data are needed for further evaluation.
Introduction: Primary aorto-enteric fistula (PAEF) is a rare disease in which a direct communication between the aorta and gastrointestinal structure occurs and causes a gastrointestinal bleeding with high mortality - 100% if untreated in emergency. Method: Retrospective descriptive report of a rare clinical case of aorto-duodenal fistula which was successfully treated at Viet Duc University Hospital, and a review of the literature on this pathology. Result: Case report - a 40-year-old male patient was hospitalized with hemorrhagic shock, abdominal pain, continuous melaena, computed tomography without contrast showed images of abdominal aortic aneurysm 7cm of diameter just below the bifurcation of the renal artery, communicating with the gastrointestinal structure. Surgical treatment was oversewing above and below the aneurysm, extra-anatomical bypass with vascular prothesis; resection of D3, D4 duodenum, duodenum-jejunostomy, jejunostomy. He was discharged from hospital after 26 days, re-examinated 3 months after surgery. The literature in the world reports less than 500 cases of this disease, there are many causes with the most common anatomical locations being fistulas in the duodenum and esophagus. Conclusion: PAEF is a serious disease that requires early diagnosis and multi-specialty emergency management, computed tomography has a high value in definitive diagnosis. Treatment by abdominal aortic oversewing, extra-anatomical bypass and intestinal resection have quite high success rates.
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