Shou-wang C.,Institute and Hospital of Hepatobiliary Surgery |
Shi-zhong Y.,401 Hospital of PLA |
Wen-ping L.,Institute and Hospital of Hepatobiliary Surgery |
Geng C.,Chongqing Medical University |
And 5 more authors.
Surgery (United States) | Year: 2015
Background: The boundary of the target hepatic segment within the liver parenchyma cannot be marked by the use of a conventional anatomic hepatectomy approach. This study describes a novel methylene blue staining technique for guiding the anatomic resection of hepatocellular carcinoma (HCC). Methods: Between February 2009 and February 2012, anatomic hepatectomy was performed in 106 patients with HCC via a novel, sustained methylene blue staining technique. Sustained staining was achieved by injecting methylene blue into the distal aspect of the portal vein after exposing Glisson's sheath. The hepatic pedicle was immediately ligated, and the hepatic parenchymal transection was performed along the interface between methylene blue stained tissue and unstained tissue. Results: Anatomic hepatectomies included subsegmentectomy (n=16), monosegmentectomy (n=57), multisegmentectomy (n=27), and hemihepatectomy (n=6). The portal vein was injected successfully with methylene blue in 100% of cases, and complete staining of the target hepatic segment was achieved in 98 of 106 (92.5%) cases. Mean intraoperative bleeding was 360±90mL, and the postoperative complication rate was 24.5% (26/106). No perioperative mortality occurred. Operative margins were all negative on pathologic examination. Mean duration of postoperative follow-up was 40months (range, 24-60). No local recurrence (around the operative margin) occurred. Conclusion: This novel technique of achieving sustained staining by injecting methylene blue then immediately ligating the hepatic pedicle is simple and feasible. It can guide the selection of the operative margin during hepatic parenchyma transection to improve the accuracy of anatomic hepatectomy for the treatment of HCC. © 2015 Elsevier Inc.
Duan B.-W.,Capital Medical University |
Lu S.-C.,Institute and Hospital of Hepatobiliary Surgery |
Wu J.-S.,Capital Medical University |
Guo Q.-L.,Capital Medical University |
And 4 more authors.
Transplantation Proceedings | Year: 2014
Background. Acute-on-chronic liver failure (ACLF) is a severe clinical entity and liver transplantation is the only definitive therapy to salvage these patients. However, the timing of liver transplant for these patients remains unclear. Methods. Seventy-eight patients undergoing liver transplantation because of hepatitis B ACLF were retrospectively analyzed from June 2004 to December 2010. The areas under the receiver operating characteristic curve (AUC) of Model for End-Stage Liver Disease (MELD) score and Child-Turcotte-Pugh (CTP) score for the post-transplantation outcomes were calculated. Results. The median age was 44 years (range, 25e64 years), serum bilirubin 418.53 μmol/L (range, 112.90e971.40 μmol/L), INR 3.177 (range, 1.470e9.850), and creatinine 70.84 μmol/L (range, 12.39e844.1 μmol/L); the median MELD score was 32 (range, 21e53) and CTP score 12 (8e15). The AUCs of MELD and CTP scores for 3-month mortality were 0.581 (95% confidence interval [CI], 0.421e0.742; sensitivity, 87.5%; specificity, 32.8%) and 0.547 (95% CI, 0.401e0.693; sensitivity, 75%; specificity, 41%), respectively. Meanwhile, there were no significant differences in hospital mortality (P = .252) or morbidity (P = .338) between the patients with MELD score ≥30 and those <30. Conclusions. MELD score had no predictive ability for the outcomes of patients with hepatitis B ACLF after orthotopic liver transplantation.