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- 저자 : ( S. Baijal ) (검색결과 1 건)
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( Rohan Jagat Chaudhary ),( V. Sagar Puppala ),( Thiagarajan S. ),( Prashant Bhangui ),( Amit Rastogi ),( Tarun Piplani ),( S. Baijal ),( V. Vohra ),( Arvinder Singh Soin ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: To study the outcomes of our algorithmic-approach for safe optimisation and surgical planning in patients with Hilar- Block. Methods: Retrospective-analysis of prospectively-maintained database of patients undergoing surgery for hilar-block from Jan2013-May2019 was done.Our approach includes Imaging, Biliary-decompression, Future-liver-remnant-Volume(FLR)augmentation based on CT-Volumetry and FLR-function assessment. Results: 45cases of hilar-blocks underwent resections.32were Hilar-cholangiocarcinoma,5-Intrahepatic-cholangiocarcinoma, 6-Ca-Gall-Bladder with hilar-block,2-IgG4-sclerosing- cholangitis-presenting as malignant-masquerade. The mean age was57±12years and 30(67%) were males. On MRCP, hilar-blocks types 2,3a,3b,4 were 3,15,17,10 respectively. Pre-operative biliary-decompression of FLR were done in 21cases[19 PTBD(Percutaneous-Transhepatic-biliary-drainage)/ 2 EBD(Endoscopic-biliary-drainage)]. Additional PTBD were done in 2 cases for inadequate fall in SB, and 3 for cholangitis. The mean SB(Serum-Total-Bilirubin) at presentation was 9.57±5.58mg/dl. The rate of fall of S.bilirubin was faster in patients < 50yrs of age and type-3 hilar-blocks than in type-4 hilar- blocks. PVE was performed in 14cases and FLR hypertrophy of 11.3± 3.03%was achieved.The quality of FLR was assessed with LAI(n=39),fibroscan(n=17), ICGR15(n=12), HVPG (n=35), and selective-remnant-biopsy(n=14,if HVPG >10 mm Hg,ICGR15> 15%, or in-suspected steatosis or fibrosis).After optimization, surgical procedures done were Right-Hepatectomy(7), Right-TriSectorectomy(7), Extended-Right-Hepatectomy(9), Left-Hepatectomy(6),Extended-Left-Hepatectomy(5), Left-Trisectorectomy( 8) and Bile-duct-excision-alone(3).Eleven patients required concomitant vascular-resections and reconstructions(- 8portal-vein-resections, 2 hepatic-arterial-resection,1both) to obtain R0. R0 and R1 resections were achieved in 42(93%) and 3 patients. Clavien-Dindo-Grade3/4 complications were 22.2%(n=10). 8(18%)patients had Post-Hepatectomy-Liver- Failure.Overall operative-mortality was 5/45(11.1%). Conclusions: Our algorithmic approach for safe optimization by preoperative-biliary-drainage, FLR-augmentation and FLR-functional- assessment have led to a high rate of R0 major liver resection and good outcomes in patients with hilar-blocks.Augmentation of FLR can also increase resectability in borderline resectable cases.
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