Intravascular papillary endothelial hyperplasia (Masson's hemangioma) is a disease characterized by exuberant endothelial proliferation within the lumen of medium-sized veins. In 1923, Masson regarded this disease as a neoplasm inducing endothelial proliferation, however, now it is considered to be a reactive vascular proliferation following traumatic vascular stasis. The lesion has a propensity to occur in the head, neck, fingers, and trunk. Occurrence within the abdominal cavity is known to be very rare, and especially in the liver, there has been no reported case up to date. The authors have experienced intravascular papillary endothelial hyperplasia of the liver in a 69-yr-old woman, and report the case with a review of the literature.
Aged ; Angiography ; Endothelium, Vascular/pathology ; Female ; Hemangioendothelioma/*pathology/surgery ; Human ; Liver/*blood supply/*pathology ; Necrosis ; Vascular Neoplasms/*pathology/surgery

BACKGROUNDHepatoblastoma (HB) is a rare childhood tumor. We investigated the effect of intraoperative management of the intrahepatic major vessels in children with HB.

METHODSBetween April 2005 and August 2012, surgical resection was performed on 50 children with hepatoblastoma. These children were divided into a vessel-ligation group (n = 20) and a vessel-repair group (n = 30). In the vessel-ligation group, the intrahepatic major vessels were ligated and removed together with the tumor and the affected liver lobe/liver parenchyma. In the vessel-repair group, the affected intrahepatic major vessels were dissected and preserved as much as possible and the normal liver lobe/liver parenchyma and blood supply from these vessels were also preserved. The outcomes were analyzed by postoperative follow-up.

RESULTSIn the vessel-ligation group, two patients gave up surgery, six patients underwent palliative resection, and 12 patients underwent en bloc resection; four patients died of liver failure and eight patients fully recovered and were discharged. In the vessel-repair group, all 30 patients underwent en bloc resection and were discharged after satisfactory healing. After a follow-up time of 5 - 36 months (median: 20 months), two patient in the vessel-ligation group survived and 22 patients in the vessel-repair group survived.

CONCLUSIONSPatients with HB can be successfully treated by tumor resection with vascular repair. This method prevents postoperative liver failure, ensures patient safety during the perioperative period, and allows for early chemotherapy.

Child ; Child, Preschool ; Female ; Follow-Up Studies ; Hepatoblastoma ; blood supply ; pathology ; surgery ; Humans ; Infant ; Liver Neoplasms ; blood supply ; pathology ; surgery ; Male ; Neoplasm Staging

BACKGROUNDRecently, much attention has been paid to hepatic artery reconstruction in rat liver transplantation, which can prevent bile duct ischemia and preserve better liver structure. In this study, three methods of graft arterialization, including sleeve, cuff, and stent anastomosis, were conducted and the results were compared.

METHODSOrthotopic liver transplantation (OLT) with rearterialization was conducted in 90 rats, which were divided into sleeve, cuff, and stent groups (n = 30 in each). Ninety-six rats received OLTs with standardized two-cuff technique without rearterialization as a control. The sleeve technique included an end-to-end anastomosis between the donor common hepatic artery and recipient proper hepatic artery, or between the donor celiac artery and recipient common hepatic artery. Cuff technique involved an anastomosis between the donor common hepatic artery and recipient common hepatic artery. In the stent technique, the recipient hepatic artery and donor hepatic artery were connected using an intraluminal polyethylene stent. The arterial anastomosis time and arterial patency rate in each group were recorded. The liver graft survival and bile duct complication rates were measured.

RESULTSThe total surgical time of OLT with rearterialization was (118.3 +/- 12.9) minutes in the sleeve group, (106.2 +/- 11.6) minutes in the cuff, (93.8 +/- 10.2) minutes in the stent, and (88.2 +/- 9.6) minutes in the control. The corresponding anhepatic phase was (19.6 +/- 2.8), (19.2 +/- 2.2), (18.6 +/- 1.8), and (20.0 +/- 2.5) minutes respectively in the sleeve, cuff, stent, and control groups. One-week survival rate was 86.5% in the control, and 86.7% in the groups with rearterialization. No significant difference was detected in the survival rate between them (P > 0.05). The incidence of biliary complications in non-rearterialized group (17.7%) was significantly higher than that in the rearterialized group (6.7%, P < 0.05). No significant difference was found in the incidence of biliary complications among the three rearterialized groups (P > 0.05).

CONCLUSIONSThe OLT with rearterialization is more physiological than that without rearterialization, and leads to a lower rate of bile duct complications. Among the three methods of rearterialization, sleeve anastomosis is associated with a higher survival rate, allowing less dissection and less injury to the surrounding tissues.

Animals ; Hepatic Artery ; surgery ; Liver ; blood supply ; pathology ; surgery ; Liver Transplantation ; methods ; Male ; Rats ; Rats, Sprague-Dawley

Liver transplantation is the only solution for end-stage liver diseases. The common hepatic artery (CHA) arises from the coeliac trunk (CT), and the right (RHA) and left hepatic (LHA) arteries are its terminal branches. An abnormal arterial pattern would influence the surgical outcome. The anterior layer of the lesser omentum of a female cadaver was cleaned to identify the CHA, which was traced backwards for its origin and toward the porta hepatis for its terminal branches. In this case, the replaced RHA originated from the CT and ran posterior to the portal vein and the common bile duct. The replaced LHA arose from the left gastric artery. The CHA originated from the CT and branched out as the middle hepatic and gastroduodenal arteries. The replaced RHA and LHA with alteration in relation to the neighbouring structures is a complex and rare variant. Knowledge of this uncommon arterial anomaly is beneficial for hepatobiliary surgeons.
Cadaver ; Education, Medical ; Female ; Hepatic Artery ; anatomy & histology ; pathology ; Humans ; Liver ; blood supply ; surgery ; Models, Anatomic

OBJECTIVETo assess the feasibility and the significance of surgical resection of small intrahepatic lesions adjacent to the major vasculature.

METHODSThe results of treatment were retrospectively reviewed in 40 patients who received operation for intrahepatic lesions less than 3 cm in diameter between Jan. 2003 and Dec. 2005. The lesions were all adjacent to the major vasculature in the liver.

RESULTSIn the 40 patients, a total of 44 small intrahepatic lesions were successfully resected with minimal morbidity and blood loss (mean 163 ml). A second lesion was found in 4 patients (10%) during intraoperative exploration. Histologically the lesion was malignant in 29 cases (including 4 cases with two lesions) and benign in 11 cases, with correct preoperative diagnosis in 62.5% of all cases. For 26 patients with hepatocellular carcinoma, the 1-, 2-, and 3-year postoperative survival rates were 90.1%, 83.2% and 64.7%, respectively, while the patients with benign lesions were cured with the operation.

CONCLUSIONSSurgical resection of small intrahepatic lesions adjacent to the major vasculature is demanding but feasible and with satisfying effect. The significance of surgical management of these small lesions is not only excising the lesions but also making definite diagnosis and finding new lesions in some patients.

Adult ; Aged ; Blood Vessels ; pathology ; Feasibility Studies ; Female ; Follow-Up Studies ; Hepatectomy ; Humans ; Liver ; blood supply ; pathology ; surgery ; Liver Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVE: We wished to evaluate the effect of the Pringle maneuver (occlusion of both the hepatic artery and portal vein) on the pathologic changes in the hepatic vessels, bile ducts and liver parenchyma surrounding the ablation zone in rabbit livers. MATERIALS AND METHODS: Radiofrequency (RF) ablation zones were created in the livers of 24 rabbits in vivo by using a 50-W, 480-kHz monopolar RF generator and a 15-gauge expandable electrode with four sharp prongs for 7 mins. The tips of the electrodes were placed in the liver parenchyma near the porta hepatis with the distal 1 cm of their prongs deployed. Radiofrequency ablation was performed in the groups with (n=12 rabbits) and without (n=12 rabbits) the Pringle maneuver. Three animals of each group were sacrificed immediately, three days (the acute phase), seven days (the early subacute phase) and two weeks (the late subacute phase) after RF ablation. The ablation zones were excised and serial pathologic changes in the hepatic vessels, bile ducts and liver parenchyma surrounding the ablation zone were evaluated. RESULTS: With the Pringle maneuver, portal vein thrombosis was found in three cases (in the immediate [n=2] and acute phase [n=1]), bile duct dilatation adjacent to the ablation zone was found in one case (in the late subacute phase [n=1]), infarction adjacent to the ablation zone was found in three cases (in the early subacute [n=2] and late subacute [n=1] phases). None of the above changes was found in the livers ablated without the Pringle maneuver. On the microscopic findings, centrilobular congestion, sinusoidal congestion, sinusoidal platelet and neutrophilic adhesion, and hepatocyte vacuolar and ballooning changes in liver ablated with Pringle maneuver showed more significant changes than in those livers ablated without the Pringle maneuver (p < 0.05) CONCLUSION: Radiofrequency ablation with the Pringle maneuver created more severe pathologic changes in the portal vein, bile ducts and liver parenchyma surrounding the ablation zone compared with RF ablation without the Pringle maneuver. Therefore, we suggest that RF ablation with the Pringle maneuver should be performed with great caution in order to avoid unwanted thermal injury.
Animals ; Bile Ducts/*pathology/surgery ; *Catheter Ablation ; Disease Models, Animal ; Hepatic Artery/*pathology/surgery ; Liver/*blood supply/pathology/*surgery ; Male ; Necrosis ; Portal Vein/pathology ; Rabbits

OBJECTIVE: To evaluate the highly-selective regional vascular exclusion in the risk hepatectomy for liver tumor. METHODS: Short hepatic veins were ligated and divided followed by the dissection, and isolation of the inflow and outflow vessels of the tumor-bearing lobe, which were completely devascularized after the occlusion of these vessels. The blood loss volume, postoperative recovering situation of the liver function and the incidence of complication were observed in 68 cases. RESULTS: Main hepatic veins were dissected and isolated exo-hepatically in 65 cases. In the other 3 cases, the main hepatic veins were blocked by Satin skin clamp applied longitudely along the inferior vena cava. Hepatic pedicle was routinely excluded.The amount of blood loss was from 400 to 1200 (600+/-200) mL and 26 (65%) cases didn't receive transfusion.There was no operative mortality and liver function failure. Surgical complications included subphrenic abscess in 2 cases and bile leakage in 2 cases, which were cured conservatively. CONCLUSION Highly-selective regional exclusion of hepatic blood flow during the risk hepatectomy is safe and effective to prevent massive bleeding and to reduce the incidence of liver failure.
Adult ; Aged ; Female ; Hepatectomy ; methods ; Hepatic Veins ; surgery ; Humans ; Liver ; blood supply ; surgery ; Liver Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Vena Cava, Inferior ; surgery

OBJECTIVETo present one cases of the use of balloon catheter in surgical treatment of renal angiomyolipoma involving the renal vein and vena cava as a tumor thrombus and review literatures.

METHODSAbdominal ultrasound and CT and MRI demonstrated a large right renal mass with tumor thrombus in the inferior vena cava. Right nephrectomy and en-bloc removal of the intra caval tumor thrombus were performed. A balloon catheter was used to block vena cava under the level of liver vena during the operation.

RESULTSThe pathological diagnosis was angiomyolipoma. The length of the tumor thrombus was 6.5 cm. The patient recovered well 1 year after surgery.

CONCLUSIONRenal angiomyolipoma with a tumor thrombus should be paid more attention.

Adult ; Angiomyolipoma ; complications ; surgery ; Balloon Occlusion ; Embolectomy ; methods ; Embolism ; etiology ; surgery ; Female ; Humans ; Kidney Neoplasms ; complications ; surgery ; Liver ; blood supply ; pathology ; surgery ; Nephrectomy ; Vena Cava, Inferior

OBJECTIVETo explore the role of extrahepatic control on blood flow of hepatic vein and inferior vena cava in hepatectomy, and observe its effect on minimizing hemorrhage.

METHODSFrom 2001 to April 2003, 33 patients who had liver tumors involving segment IV, VII, VIII or half liver underwent major hepatectomies that required exposure of the inferior vena cava and main trunks of hepatic veins, during which the major hepatic veins and inferior vena cava were isolated and taped to control blood flow when necessary.

RESULTSIn 33 attempts, 32 were successful and all tumors were resected successfully. The placement of occlusion tape was unsuccessful in 1 case. 7 cases did not need blood transfusion during operation. The amount of blood transfusion for other cases were form 0 to 1 600 ml. there was no operative mortality.

CONCLUSIONSAppropriate control of main truck of hepatic vein and inferior vena cava is effective in reducing blood loss during hepatectomies. It is also very helpful for performing difficult hepatectomies.

Adult ; Aged ; Carcinoma, Hepatocellular ; surgery ; Female ; Hepatectomy ; adverse effects ; methods ; Hepatic Duct, Common ; surgery ; Hepatic Veins ; surgery ; Humans ; Liver ; blood supply ; pathology ; Liver Cirrhosis ; etiology ; Liver Neoplasms ; surgery ; Male ; Middle Aged ; Treatment Outcome ; Vena Cava, Inferior ; surgery

OBJECTIVETo study the clinical effect of segmental resection of the liver using Glissonean pedicle transection for primary liver cancer.

METHODSThe clinical data of 55 primary liver cancer patients admitted from January 2006 to October 2008 were analyzed retrospectively. Twenty-five of the patients underwent segmental resection of the liver by Glissonean pedicle transection (group A), and 30 underwent routine hepatectomy (group B). The positivity rate of the resection margin, micrometastasis in the hepatic parenchyma surrounding the lesions and postoperative recurrence rates were investigated.

RESULTSThe positivity rate of the resection margin was 4.0% in group A, significantly lower than that of group B. The number of histological micrometastasis was significantly higher in group A than in group B (16 vs 8). The median distance of histological micrometastasis was 6.8 mm (2.7-25.6 mm) in group A and 4.2 mm (2.4-9.0 mm) in group B. The one-year recurrence rate was significantly lower in group A than in group B (16% vs 26.7%).

CONCLUSIONGlissonean pedicle transection for segmental liver resection is a simpler procedure than routine hepatectomy for primary liver cancer and can reduce the number of histological micrometastasis and recurrence rate.

Carcinoma, Hepatocellular ; blood supply ; pathology ; surgery ; Female ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; blood supply ; pathology ; surgery ; Male ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; prevention & control ; Retrospective Studies ; Survival Rate ; Treatment Outcome