RESUMEN
The paper shows how to create the best ways extracorporeal reconstruction of the renal veins in related transplantation. It is necessary to consider the possibility of autoplasty at nephrectomy from a living donor, expansion of the distal renal vein and allow its implementation through the walls of the gonad donor veins. When there are several veins, the largest is used for anastomosis, others may be tied because of a well-developed network of intrarenal collateral venous outflow. With the right approach to the choice of method of angioplasty and its skillful implementation, taking into account the structural features of the vascular bed of the donor, the presence of several vessels supplying the kidney of a living related donor, not a contraindication to of transplantation and does not reduce the quality of the transplanted organ.
Asunto(s)
Trasplante de Riñón/métodos , Venas Renales/cirugía , Donantes de Tejidos , Procedimientos Quirúrgicos Vasculares/métodos , Adolescente , Adulto , Anciano , Anastomosis Quirúrgica , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The treatment results of 178 patients with liver hemangioms were analyzed. 322 liver hemangioms of the average size of 36,5 (4-350) mm were diagnosed in 178 patients. 50 (28%) patients were operated on. The largest operated lesion was 100mm. Basic indications to the surgical treatment were: symptomatic course of the disease (42%), unclear diagnosis (24%) and fast growth of the lesion (16%). The lethality rate was 2% (1 of 50), postoperative complications were registered in 24% (12 of 50). Tumor enucleation was performed in 12 (24%) cases, the liver resection - in 38 (76%). The long-term follow-up (average of 55 months) was achieved in 50%(89 of 178) patients. The were no symptoms of the disease in 88,5% of the operated patients and they disappeared in 84% of the non-operated patients. The majority of the patients with the nonsympomatic course of the disease showed anuy negative dynamics of the process. Thus, in 85,2% there were no hemangiom growth registered, 11,1% demonstrated the enlargement of the lesion on 13-38 mm, and 3,7% showed the smaller diameter of the tumour. The study highlights the seldom necessity of the operative treatment of liver hemangioms: by severe symptoms, unclear diagnosis and the fast tumour growth. The enucleation of the tumor is preferable to the liver resection. The exact diagnosis permits the long observance with the ultrasound control as often as once a year.
Asunto(s)
Hemangioma Cavernoso/cirugía , Hepatectomía/métodos , Neoplasias Hepáticas/cirugía , Adulto , Anciano , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Hemangioma Cavernoso/diagnóstico , Humanos , Neoplasias Hepáticas/diagnóstico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
Patient with giant rapidly growing liver hemangioma who carried out right hemihepatectomy is reported. The feature if this case is choledocholithiasis after liver resection followed by its rare complication (spontaneous biloma) in 6 years after surgery. Minimally invasive procedures (percutaneous drainage, endoscopic papillotomy and stenting) eliminated each of bile collection and cause of biliary obstruction without surgical intervention.
Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica/métodos , Colestasis Extrahepática , Hepatectomía/efectos adversos , Neoplasias Hepáticas , Presión Negativa de la Región Corporal Inferior/métodos , Complicaciones Posoperatorias , Cavidad Abdominal/patología , Adulto , Coledocolitiasis/diagnóstico por imagen , Coledocolitiasis/etiología , Coledocolitiasis/terapia , Colestasis Extrahepática/diagnóstico por imagen , Colestasis Extrahepática/etiología , Colestasis Extrahepática/terapia , Drenaje/métodos , Femenino , Hemangioma/patología , Hemangioma/cirugía , Hepatectomía/métodos , Humanos , Litotricia/métodos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Imagen por Resonancia Magnética , Tamaño de los Órganos , Resultado del Tratamiento , UltrasonografíaRESUMEN
AIM: To define significance of radiological diagnostics in detection and characterization of hepatic hemangiomas. MATERIALS AND METHODS: Analysis of 176 patients with liver hemangiomas was performed. All patients were investigated or consulted in hepato-pancreato-biliary surgical department. US, CT, MRI, angiography, scintigraphy and liver biopsy were compared. RESULTS: Contemporary noninvasive diagnostics disclose liver hemangiomas with high confidence without need for tumor biopsy. MRI and CT with intravenous enhancement are the most efficient modalities for detection of hepatic hemangiomas.