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오늘 본 자료
Matthew Fasullo,Priyanush Kandakatla,Reza Amerinasab,Divyanshoo Rai Kohli,Tilak Shah,Samarth Patel,Chandra Bhati,Doumit Bouhaidar,Mohammad S. Siddiqui,Ravi Vachhani 한국간담췌외과학회 2022 Annals of hepato-biliary-pancreatic surgery Vol.26 No.1
Backgrounds/Aims: The aim of this study was to evaluate longitudinal changes of post-liver transplantation (LT) biliary anatomy and to assess the association of increased laboratory values after LT with the development of post-LT anastomotic biliary stricture (ABS). Methods: Adult deceased donor LT recipients from 2008 and 2019 were evaluated. ABS was defined after blinded review of endoscopic cholangiograms. Controls were patients who underwent LT for hepatocellular carcinoma who did not have any clinical or biochemical concerns for ABS. Results: Of 534 patients who underwent LT, 57 patients had ABS and 57 patients served as controls. On MRI, ABS patients had a narrower anastomosis (2.47 ± 1.32 mm vs. 3.38 ± 1.05 mm; p < 0.01) and wider bile duct at 1-cm proximal to the anastomosis (6.73 ± 2.45 mm vs. 5.66 ± 1.95 mm; p = 0.01) than controls. Association between labs at day 7 and ABS formation was as follows: aspartate aminotransferase hazard ratio (HR): 1.014; 95% confidence interval (CI): 1.008–1.020, p = 0.001; total bilirubin HR: 1.292, 95% CI: 1.100–1.517, p = 0.002; and conjugated bilirubin HR: 1.467, 95% CI: 1.216–1.768, p = 0.001. Corresponding analysis results for day 28 were alanine aminotransferase HR: 1.004, 95% CI: 1.002–1.006, p = 0.001; alkaline phosphatase HR: 1.005, 95% CI: 1.003–1.007, p = 0.001; total bilirubin HR: 1.233, 95% CI: 1.110–1.369, p = 0.001; and conjugated bilirubin HR: 1.272, 95% CI: 1.126–1.437, p = 0.001. Conclusions: Elevation of laboratory values early after LT is associated with ABS formation.
Management of hepatic artery aneurysm: A case series
Ashley Rosenberg,Katarzyna Trebska-McGowan,Trevor Reichman,Amit Sharma,Adrian Cotterell,Brian Strife,Aamir A. Khan,Vinay Kumaran,David A. Bruno,Marlon F. Levy,Chandra Shekhar Bhati 한국간담췌외과학회 2020 Annals of hepato-biliary-pancreatic surgery Vol.24 No.3
Hepatic artery aneurysms are rare, but their diagnosis is important because of high mortality and complications. Common risk factors for developing these aneurysms include hypertension, vascular disease, pancreatitis, diabetes, tobacco use, autoimmune diseases, and previous transplantation. Frequent imaging for trauma and tumor surveillance has increased the incidence of naive hepatic aneurysms. These aneurysms can be difficult to manage, and it can be challenging to decide the correct treatment modality for the patient. Hereby, we present four cases of hepatic artery aneurysm and discuss various treatment options. Patient 1 suffered from a proper and right hepatic artery aneurysm discovered incidentally; repaired with an endovascular intervention later complicated by an endoleak which was further managed by another stenting. Patient 2 had a common hepatic artery aneurysm followed with serial imaging without any intervention. Patient 3 had a hepatic artery aneurysm and liver mass diagnosed concurrently. The patient underwent an open surgical repair of his aneurysm with graft and liver resection which was complicated later with rupture of aneurysm followed by surgical bypass repair. Patient 4 suffered from a large hepatic artery aneurysm causing bile duct compression. Her aneurysm was repaired open with splenic artery grafting. Patients were managed from careful observation to surgery with different outcomes.