The gas-forming liver abscess may be a disease of wide spectrum of severity and may run a fulminating course. Strong antibiotics with early adequate drainage are mandatory. Surgery should not be delayed if necessary.
Study Type – Therapy (case series)
Level of Evidence 4
OBJECTIVE
To determine the effectiveness of the Resonance ureteral stent and clarify the risk factors that lead to stent failure. In the present study, we review our clinical experiences using Resonance stent in treating malignant and benign ureteral obstruction.
PATIENTS AND METHODS
Nineteen patients with extrinsic malignant ureteral obstruction (n= 15) and benign stricture (n= 4) were retrospectively evaluated.
All patients had received Resonance stent insertion through antegrade or cystoscopic retrograde approaches. The pre‐insertion and follow‐up interventions included image studies and biochemical tests. The insertion success rate, obstruction patency rate and complications were reviewed.
For categorical variables, the chi‐square test and Fisher’s exact test were carried out to determine associations between variables.
RESULTS
The technical success rate of stent insertion was 84.6%. The mean follow‐up was 5 months (range 1–10.5 months).
Five stents failed to alleviate the obstruction, and the patency rate was 77.3% (17/22).
Patients who had had previous radiation therapy had a lower ureter patency rate in comparison with non‐radiation patients (50% vs 92.3% respectively, P= 0.039).
The 6‐ and 9‐month patency rates were 81.0% with 11 stents and 27.0% with 3 stents, respectively.
CONCLUSIONS
The results of the present study demonstrated that malignant or benign ureteral obstruction could be treated safely and sufficiently with the Resonance metallic stent.
Careful patient selection is critical to achieve successful results.
For malignant ureteral obstruction, previous radiation therapy is a risk factor for stent failure.
The anatomic variations of the intrahepatic portal vein and bile duct were analyzed to evaluate the potential risk of left hepatectomy. A total of 210 cholangiograms and hepatic arterioportograms were performed in which the ramifications of the intrahepatic portal vein and bile duct were investigated. The orientation of the intrahepatic duct and portal vein were classified into five types. In 175 patients (83.33%), the intrahepatic portal vein and bile duct had the same anatomic classification. In 24 patients (11.43%), the right anterior or posterior intrahepatic duct drained into the left hepatic duct at the umbilical portion (type IV); there were only 15 patients (7.14%) whose portal veins fell into this category. All patients with type IV portal veins had type IV hepatic ducts, but there were 9/49 patients (18.36%) whose hepatic duct distribution belonged to type IV but their portal veins belonged to type II (6 cases) or III (3 cases). Without complete knowledge of the intrahepatic portal and biliary anatomy, insufficient portal perfusion and bile duct complications may result from the left hepatectomy operation. Preoperative portal vein evaluation or left portal vein clamping can provide significant information, but there are still 18.36% of patients where type IV biliary ducts were not detected in those with type II and III portal veins. Cholangiography is of paramount importance in these two groups of patients, as it can prevent inadvertent injury to the right intrahepatic ducts, which drain into the left intrahepatic duct. On the other hand, intraoperative ultrasonography is recommended to identify or exclude an aberrant portal vein if type VI biliary anatomy is detected during intraoperative cholangiography.
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