Cholestatická onemocnění jater se vyznačují progresivní povahou a omezenými možnostmi konzervativní léčby. Jedinou efektivní metodou léčby terminálního stadia je transplantace jater, která signifikantně prodlužuje dobu přežití pacientů. Transplantace jater je v současnosti indikována nejen u pacientů s chronickým jaterním selháním nebo hepatobiliární malignitou, ale také u pacientů se sníženou kvalitou života při symptomech z obstrukce žlučovodů. Péče po transplantaci jater je specifická zejména z důvodu přítomnosti imunitně asociovaných onemocnění, např. idiopatických střevních zánětů u pacientů s primární sklerozující cholangitidou. Rekurence základního onemocnění v jaterním štěpu je častou dlouhodobou komplikací, která může negativně ovlivnit přežití štěpu i celkovou délku života. Navzdory riziku rekurence jsou dlouhodobé výsledky transplantace jater pro cholestatické nemoci výborné, přičemž pacienti s těmito diagnózami dosahují delšího přežití ve srovnání s ostatními transplantovanými pacienty.
Cholestatic liver diseases are characterized by their progressive nature and limited conservative treatment options. Liver transplantation is the only effective method of treatment for the terminal stage. Before the era of liver transplantation, patients with cholestatic disease had a significantly reduced life expectancy. Liver transplantation is now indicated not only for patients with chronic liver failure or hepatobiliary malignancy, but also for those with reduced quality of life from cholestatic symptoms. Post-transplant care is particularly specific because of the presence of immune-associated diseases, such as inflammatory bowel disease in patients with primary sclerosing cholangitis. Recurrence of the underlying disease in the liver graft is a common long-term complication that can negatively affect graft survival and overall life expectancy. Despite the risk of recurrence, the long-term outcomes of liver transplantation for cholestatic disease are excellent, achieving longer survival compared to other transplant recipients.
- Keywords
- indikace k transplantaci,
- MeSH
- Cholangitis * complications pathology therapy MeSH
- Inflammatory Bowel Diseases complications therapy MeSH
- Humans MeSH
- Cholangitis, Sclerosing complications pathology therapy MeSH
- Liver Transplantation * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Prezentujeme případ mladé ženy, jež prodělala v dospělém věku operaci vrozené cysty pravého hepatiku, kterou vzhledem k těsnému kontaktu s velkými cévami nebylo možné kompletně resekovat. Byla provedena parciální resekce a cysto-jejuno-anastomóza (CJA) kdrenáži žluči. Pacientka byla 4 roky bez obtíží. Posléze se dostavily bolesti břicha, subikterus a laboratorní známky cholestázy Kvůli těmto potížím a opakovaným cholangoitidám prodělala řadu vyšetření a intervencí, které měly zajistit ozřejmění příčiny obstrukce a obnovení odtoku žluči. Použité zobrazovací metody neprokázaly jednoznačnou příčinu obtíží, proto bylo přistoupeno k operační revizi, při níž byl peroperační ultrasonografií prokázán tumor v oblasti CJA. Nález byl vzhledem k lokalizaci inoperabilní. Pacientka měla následně zjištěnu diseminaci malignity v játrech i v uzlinách a zemřela 5 měsíců od zjištění maligní diagnózy na hepatorenální selhání. Tento poměrně raritní případ dokládá zvýšené riziko maligního zvratu vrozených malformací žlučových cest především v případě jejich diagnózy a léčby v dospělém věku. V dostupné literatuře existuje jen málo dokumentovaných případů metachronního karcinomu po resekci žlučových cest.
We present a case of a young woman, who underwent surgery for congenital bile duct cyst in adulthood. Due to location of the cysts it was impossible to completely remove it. The cyst was partially resected and it was performed cyst-jejunal anastomosis (CJA) to drain of bile. After operation the patient was 4 years without any problems. After this interval appeared pain in the right upper quadrant and subicterus with laboratory evidence of cholestasis. The patient suffered from recurrent cholangitis due to which a number of diagnostic tests and interventions were performed. Used imaging metods did not demonstrate an unequivocal cause of problems, therefore subsequently surgical revision was performed and the in-traoperative ultrasonography demonstrated tumor in anastomosis. The finding was inoperable due to inappropriate location. In the following period liver and lymphnode metastases appeared and patient died five months after diagnosis of malignancy. This relatively rare case illustrates an increased risk of malignant transformation of congenital malformations of the biliary tract. There are very few documented metachronous cancer after resection of the biliary tract in the literature.
- Keywords
- cystojejunoanastomóza,
- MeSH
- Abdominal Pain MeSH
- Caroli Disease * diagnosis surgery complications MeSH
- Cholangiocarcinoma * diagnosis complications MeSH
- Cholangitis * diagnosis drug therapy complications MeSH
- Cholecystectomy MeSH
- Cholestasis diagnosis prevention & control MeSH
- Cysts * surgery pathology MeSH
- Diagnostic Techniques and Procedures utilization MeSH
- Adult MeSH
- Fatal Outcome MeSH
- Hepatorenal Syndrome * MeSH
- Humans MeSH
- Neoplasm Metastasis * MeSH
- Liver Neoplasms MeSH
- Tomography, X-Ray Computed * trends utilization MeSH
- Positron-Emission Tomography * trends utilization MeSH
- Reoperation MeSH
- Risk Factors MeSH
- Ultrasonography MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
Úvod: Cieľom práce je názorne dokumentovať peroperačné a pooperačné komplikácie po perkutánnej transhepatickej drenáži žlčových ciest a na základe vlastných skúseností poukázať na možnosti riešenia týchto komplikácií v nemocničnej starostlivosti, ako aj na spôsoby prevencie komplikácií v ambulantnej starostlivosti kde sa uplatňuje úloha ošetrujúceho personálu – sestier Agentúr domácej ošetrovateľskej starostlivosti (Agentur domácí péče). Materiál a metodika: Na Oddelení rádiológie Fakultnej nemocnice F. D. Roosevelta v Banskej Bystrici sa vykoná ročne vyše 100 výkonov perkutánnej transhepatickej drenáže žlčových ciest, v roku 2013 sa vykonalo 105 výkonov. Indikáciou boli inoperabilné cholangiokarcinómy (Klatskinove nádory a nádory distálneho choledochu) a benígne ochorenia žlčovodov kde nebolo možné vykonať endoskopickú drenáž (benígna stenóza choledochu, stenóza biliodigestívnej anastomózy, intrahepatálna cholelitiáza). Na II. chirurgickej klinike SZU bolo v období 2009 – 2013 hospitalizovaných 151 pacientov s prekutánnou transhepatickou drenážou žlčových ciest, z toho bolo 98 u malígnych obštrukcií a 53 u benígnych obštrukcií. Výsledky: U 151 pacientov hospitalizovaných na chirurgickej klinike sa vyskytli tieto pooperačné komplikácie: nepriechodnosť katétra v 6,6 %, biliárna peritonitída v 2 %, sepsa s cholangoitídou v 3,3 % a krvácanie v 4,6 % prípadov. Mortalita v priamej súvislosti s PTD výkonom bola 0,66 % (1 pacient). Záver: Perkutánna transhepatická drenáž žlčových ciest vyžaduje skúseného rádiológa, ktorý dokáže zvládnuť všetky peroperačné komplikácie. Súčasne vyžaduje skúsený zdravotnícky personál, ktorý správne drenážne katétre ošetruje a včas rozpozná závažné komplikácie. Komplikácie perkutánnej transhepatickej drenáže sa vyskytujú aj počas ambulantnej starostlivosti, preto je pri ich riešení dôležitá súčinnosť sestier Agentúr domácej ošetrovateľskej starostlivosti s nemocničnými pracoviskami, ktoré túto drenáž vykonávajú. Preplach drenážneho katétra by mal byť v katalógu výkonov domácej ošetrovateľskej starostlivosti.
Introduction: The aim of this work is to demonstrate perioperative and postoperative complications after percutaneous transhepatic drainage of the biliary tract and, on the basis of our own experience, to show the possibilities of solving these complications within hospital care as well as the ways of preventing such complications in outpatient and home care where the role of home care nurses is very important. Material and methods: At the Department of Radiology in F.D. Roosevelt Teaching Hospital Banska Bystrica, more than 100 percutaenous transhepatic biliary tract drainage procedures are performed every year. In 2013, 105 such procedures were performed. Indications included nonresectable cholangiocarcinomas of the biliary confluence (Klatskin tumours) or common bile duct as well as benign bile obstructions in which endoscopic drainage could not be performed (benign stenosis of thecommon bile duct, stenosis of biliodigestive anastomosis, intrahepatic biliary stones). Between 2009 and 2013, 151 patients with percutaneous transhepatic drainage of the biliary tract were hospitalised at the Department of Surgery in F.D. Roosevelt Hospital Banska Bystrica,of whom 98 had malignant obstruction and 53 benign obstruction. Results: In 151 patients hospitalised at the Department of Surgery, the following postoperative complications occurred: catheter obliteration in 6.6%, biliary peritonitis in 2%, sepsis with cholangitis in 3.3% and haemorrhage in 4.6% of all patients. Mortality directly related to the PTD procedure was 0.66% (1 patient). Conclusion: Percutaneous transhepatic biliary tract drainage requires a skilled radiologist who is able to manage all perioperative complications. At the same time, experienced medical staff are needed who are able to treat the drainage catheters correctly and are able to recognize severe complications in time. Complications after PTD occur also during home care of the patients; therefore, cooperation of home care nurses with hospitals where PTD is performed is therefore important. Catheter flushing should be included in the catalogue listing home care procedures.
- MeSH
- Home Care Agencies MeSH
- Bacterial Infections etiology MeSH
- Biliary Tract Surgical Procedures * adverse effects MeSH
- Cholangiocarcinoma complications MeSH
- Cholangitis complications MeSH
- Home Nursing MeSH
- Drainage * nursing adverse effects utilization MeSH
- Liver MeSH
- Catheterization * adverse effects MeSH
- Catheter-Related Infections etiology MeSH
- Hemorrhage complications MeSH
- Humans MeSH
- Neoplasms MeSH
- Bile Duct Diseases * complications MeSH
- Catheter Obstruction MeSH
- Palliative Care MeSH
- Peritonitis * etiology complications MeSH
- Intraoperative Complications MeSH
- Postoperative Complications MeSH
- Radiology MeSH
- Anastomosis, Roux-en-Y MeSH
- Sepsis etiology microbiology MeSH
- Bile microbiology MeSH
- Bile Ducts, Intrahepatic * physiopathology MeSH
- Check Tag
- Humans MeSH
Hepaticojejunoanastomosis is a surgical replacement of the biliary tract. The most frequent indications for this procedure are biliary duct injuries, other benign biliary tract stenoses, biliary tumours, choledochal cysts, and biliary atresia in children. The main complication of this method is stenosis of the anastomosis. We retrospectively reviewed the cases of eight patients with a history of hepaticojejunoanastomosis for benign disorder with a view to the role of ultrasound examination in their follow-up. All eight patients had hepaticojejunoanastomosisrelated complications during the follow-up. Abdominal ultrasound was used as a primary diagnostic modality in the follow-up of all patients. When a complication was suspected, it was followed directly by an invasive therapeutic method (PTD, ERC, drainage); in four patients there were further noninvasive diagnostic tests indicated. Further non-invasive tests did not provide any new information, they only confirmed the ultrasound findings. If the clinical picture, laboratory tests, and ultrasound examination were taken together, we were able to accurately detect complications in all patients. According to our results we can conclude that abdominal ultrasound is an accurate method for the detection of hepaticojejunoanastomosis- related complications and should be preferred in the surveillance of these patients.
- MeSH
- Anastomosis, Surgical methods adverse effects utilization MeSH
- Biliary Tract Surgical Procedures methods adverse effects utilization MeSH
- Cholangiography methods instrumentation utilization MeSH
- Cholangitis diagnosis complications MeSH
- Diagnostic Techniques, Digestive System trends utilization MeSH
- Adult MeSH
- Humans MeSH
- Biliary Tract Diseases diagnosis complications MeSH
- Constriction, Pathologic diagnosis complications therapy MeSH
- Ultrasonography methods instrumentation utilization MeSH
- Outcome and Process Assessment, Health Care MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Case Reports MeSH
Kolektiv autorů, chirurg, gastroenterolog, radiolog a praktický lékař, se snaží zkrácenou formou předložit lékařům prvé linie základní informace o diagnostice a léčbě obstrukčního ikteru s přihlédnutím k některým novým poznatkům v této oblasti, přičemž všichni vychází ze svých dlouhodobých praktických zkušeností v této oblasti medicíny.
Ateam comprising a surgeon, gastroenterologist, radiologist and general practitioner have attempted to present basic information for front-line physicians on the diagnostics and therapy of obstructive jaundice taking into consideration certain novel pieces of knowledge in this area while all of them drew upon their vast practical experience.
- MeSH
- Biliary Tract Surgical Procedures methods MeSH
- Cholangitis surgery complications MeSH
- Choledocholithiasis complications therapy MeSH
- Diagnostic Imaging methods MeSH
- Humans MeSH
- Pancreatic Neoplasms surgery complications MeSH
- Pancreatitis surgery complications MeSH
- Jaundice diagnosis therapy MeSH
- Check Tag
- Humans MeSH
- MeSH
- Acute Kidney Injury etiology prevention & control therapy MeSH
- Budd-Chiari Syndrome etiology prevention & control therapy MeSH
- Digestive System Surgical Procedures methods utilization MeSH
- Cholangitis complications prevention & control therapy MeSH
- Infections drug therapy complications microbiology MeSH
- Hemorrhage complications prevention & control MeSH
- Humans MeSH
- Liver Diseases surgery pathology MeSH
- Delayed Graft Function etiology prevention & control therapy MeSH
- Postoperative Complications diagnosis etiology prevention & control MeSH
- Graft Survival drug effects radiation effects MeSH
- Liver Transplantation methods pathology utilization MeSH
- Outcome and Process Assessment, Health Care utilization MeSH
- Check Tag
- Humans MeSH
- MeSH
- Cholangitis complications MeSH
- Hepatorenal Syndrome MeSH
- Portasystemic Shunt, Surgical MeSH
- Publication type
- Congress MeSH
- MeSH
- Cholangitis complications therapy MeSH
- Cholestasis complications therapy MeSH
- Crohn Disease therapy MeSH
- Endoscopy, Gastrointestinal MeSH
- Inflammatory Bowel Diseases complications therapy MeSH
- Catheterization MeSH
- Humans MeSH
- Intestinal Obstruction therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Anti-Bacterial Agents pharmacology therapeutic use MeSH
- Cholangiopancreatography, Endoscopic Retrograde methods adverse effects MeSH
- Cholangitis drug therapy complications prevention & control MeSH
- Adult MeSH
- Cholestasis, Extrahepatic MeSH
- Humans MeSH
- Pseudomonas aeruginosa MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
