Background: Pancreatogenic splenic pseudocysts are a relatively rare condition. Intra-splenic localization is of the splenic pseudocysts is dangerous because of the possibility of massive haemorrhage and organ rupture. Aim: To analyse our experience in the diagnosis and treatment of pancreatogenic pseudocysts of the spleen. Materials and Methods: The analysis of the short and long-term results of treatment of the 34 patients with pancreatogenic splenic pseudocysts (extrapancreatic localization) (1985-2019) was performed. In the study, the majority of male patients - 88.2%, the age of patients was 45 ± 7 years. Results: Percutaneous drainage under US-control was performed in 11 (32.4%) patients, distal pancreatic resection with splenectomy was performed in 23 (67.6%) in the cases of pancreatic tail calcific pancreatitis. In all cases of percutaneous treatment, a high level of amylase was found in the fluid from pseudocysts. Bacteriological confirmation of the growth of any bacteria in the content was not obligatory. Suppuration of the fluid of the pseudocyst was observed in 85.3% of the cases. Conclusion: Pancreatogenic pseudocysts of the spleen are one of the complications of destructive pancreatitis. They can remain undiagnosed for a long time, become infected and aggravate the course of the disease. They are often the cause of the development of sepsis and peritonitis due to the rupture of the organ capsule and bleeding into the abdominal cavity. The use of percutaneous minimally invasive methods of treatment for intra-organ pancreatogenic pseudocysts makes it possible to improve the results of treatment in this group of patients, and also, in the optimal case, be the final method of treatment.
Aim. To improve the treatment outcomes, quality and life expectancy, prognosis in patients with hepatocellular carcinoma based on an analysis of treatment outcomes.Materials and methods. The analysis of the long-term results of treatment of 114 patients with hepatocellular carcinoma for 2015–2020 was carried out. Two groups of patients were distinguished: 41 (35.9%) patients were included in group I (a potentially resectable tumor with R0 surgery), and 63 (55.2%) patients were included in group II (advanced tumor does not suggest R0 resection).Results. Actuarial survival for patients with R0 surgery (48) was: 1 year – 85%, 3 years – 65%, 5 years – 55%; in patients with unresectable tumor after transarterial chemoembolization: 1 year – 65%, 3 years – 29%, 5 years – 11%; after local destruction methods – 0.5 years – 75%, 1 year – 36%, 1.5 years – 22%.Conclusions. The results of treatment of patients with hepatocellular carcinoma confirm the feasibility and effectiveness of a rational multidisciplinary approach. It allows you to achieve satisfactory results in multidisciplinary hospitals. The results are consistent with the data of large surgical centers.
Цель. Улучшение результатов лечения, качества и продолжительности жизни, прогноза у пациентов с метастазами колоректального рака в печени. Материал и методы. Анализировали отдаленные результаты лечения 94 пациентов с метастазами колоректального рака в печени (2014-2019). В 87 (92,6%) наблюдениях выполнили различные оперативные вмешательства. Сегментэктомию выполнили 23 больным, сегментэктомию с радиочастотной абляцией (РЧА)-7, сегментэктомию с криоабляцией-3, сегментэктомию с РЧА и криоабляцией-3. Также гемигепатэктомию выполнили 15 больным, расширенную гемигепатэктомию-13, гемигепатэктомию с РЧА-1, расширенную гемигепатэктомию с РЧА-2. РЧА и криоабляцию выполнили в 8 наблюдениях, трансартериальную химиоэмболизацию-в 12. Средний возраст пациентов составил 56,3 ± 3 года. Всем больным в дальнейшем проводили адъювантную химиотерапию; в 9 наблюдениях ее дополнили регионарной химиоэмболизацией. Результаты. В ближайшем послеоперационном периоде отмечено 30 (34,5%) осложнений. Актуариальная однолетняя выживаемость оперированных пациентов составила 63%, трехлетняя-34%, пятилетняя-28%. Заключение. Дифференцированный подход к локальной деструкции колоректальных метастазов в печени позволяет добиться удовлетворительных отдаленных результатов при множественных билобарных поражениях. Залогом успеха является мультидисциплинарный подход к лечению.
Êëèíè÷åñêîå íàáëþäåíèå / Case reportВнутрипеченочный холангиоцеллюлярный рак является первичной аденокарциномой внутрипеченочных желчных протоков и второй по распространенности опухолью печени. Резекция печени остается наиболее эффективным методом лечения. Однако возможности хирургического лечения могут быть ограничены нерезектабельностью опухоли и неоперабельностью больного в связи с сопутствующими заболеваниями. Известно, что радиочастотная абляция эффективна при лечении гепатоцеллюлярной карциномы и метастазов колоректального рака в печени, однако о ее эффективности при внутрипеченочном холангиоцеллюлярном раке сообщается лишь в нескольких клинических наблюдениях. Накопление опыта локальных методов деструкции при внутрипеченочном холангиоцеллюлярном раке, особенно у неоперабельных больных, представляет клиническую ценность. В клиническом наблюдении представлен результат эффективного лечения пациента с внутрипеченочным холангиоцеллюлярным раком на фоне цирроза печени с помощью радиочастотной абляции. Безрецидивная выживаемость составила 44 мес.
normal. Ultrasound abdomen showed multiple gall stones. Patient underwent laparoscopic cholecystectomy and had uneventful recovery. On 10th post-operative day, patient presented with complaints of dull aching pain in the right hypochondrium on inspiration and vomiting. Patient had tenderness in right hypochondrium on abdomen examination. Ultrasound showed a liver abscess. Contrast enhanced computed tomogram abdomen revealed 13 Â 7 cm abscess in the right lobe of liver. Patient underwent ultrasound guided pig-tail drainage. 500 cc pus was drained. Culture showed E.coli. Patient was discharged with oral antibiotics. Pigtail catheter was removed after ultrasound abdomen showed no residual collection. Conclusion: Delayed complications after ERCP can occur in patients with choledocholithiasis with cholangitis. Careful evaluation of symptoms is required on follow-up.
Aims: ERAS program was initialy developped in colorectal surgery. It is a multidisciplinary approach focus on the patient which include surgeons, anesthesists, nurses and physiotherapeutists. In 2013, the ERAS group published recommandations for pancreatic surgery. Metaanalyses reported, in pancreatic surgery, decreased length of hospital stay with less morbidity and less mortality when compared to traditionnal care. The aim of our study was to evaluate the outcomes after ERAS implementation in pancreatic surgery in Edouard Herriot Hospital, Lyon. Methods: In our center, we started implementation of ERAS in pancreatic surgery in january 2014. We decided to perform a comparative study between patients who had received traditionnal care in 2013 and patients who had received ERAS program in 2014. We evaluated the morbidity, the mortality and the length of hospital stay. Results: 38 patients were included in ERAS group in 2014 and 48 patients were included in traditional care group in 2013. The rate of compliance in ERAS group was high (> 70%). Median length of hospital stay was significantly reduced in ERAS group from 21 days to 9 days. Results suggested less morbidity and less mortality but the difference was not statistically significant. There were significantly less severe complications ( grade 3 according to Dindo clavien classification) in ERAS group. Readmission rate in ERAS group was 13%. Conclusions: The implementation of ERAS in pancreatic surgery, in our center, was associated to high compliance, shorter length of hospital stay and less morbidity. Ongoing studies with larger population are necessary to confirm these results.
Background. Biliary cystadenomas and cystadenocarcinomas are rare cystic tumors of the liver. Complicated differential diagnostics for simple cysts often leads to errors in surveillance of patients with these tumors. Cystadenoma and cystadenocarcinoma should be suspected upon detection of single or multilocular cystic neoplasms of the liver with septa and blood flow loci in the cyst wall, especially in middle-aged women. The localization of the tumor is critical. The most common localization is segment IV of the liver. Urgent intraoperative biopsy is required to determine the extent of surgery.Case description. Clinical observations with analysis of the examination and treatment data of two female patients aged 38 and 56 were presented. Both clinical observations illustrate the underestimation of the preoperative examination data that served as a ground for diagnosis of liver cysts with inadequate extent of surgery. In the first case, the resection was incomplete, and, as such, the biliary cystadenoma recurred in the resection area, the capsule of the neoplasm was ruptured and an encysted fluid collection was formed. In the second case, lack of histological examination of the excised neoplasm, due to confidence in its morphological verification as a cyst, resulted in cystadenoma recurrence in the resection zone with metastasis to the contralateral lobe of the liver.Conclusion. Hepatic cystadenomas and cystadenocarcinomas are often misdiagnosed as simple cysts. These tumors should be suspected in central localization of the tumor in the liver, especially in young women. The clinical and instrumental symptomatology and radiological semiotics of the disease require careful evaluation. The recurrence of a cystic lesion in the resection zone in a patient previously operated for a hepatic cyst serves as an additional signal for detecting biliary cystadenoma. Rational strategy for surgical management of cystic liver lesions should include hepatectomy within healthy tissues (both anatomical and atypical) with mandatory intraoperative ultrasound and urgent histological examinations.
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