記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Early postoperative edema and ascites after liver resection are common; however, the endocrine drivers of water retention are not fully defined. Arginine vasopressin (AVP) promotes antidiuresis via V2-mediated aquaporin trafficking, whereas the renin-angiotensin-aldosterone system primarily modulates sodium handling. Differences in postoperative trajectories and their relationship to early fluid retention have not been clarified in patients undergoing liver resection. AIM: To examine postoperative changes in plasma AVP and plasma aldosterone concentration (PAC) after liver resection, and association with fluid retention. METHODS: We conducted a prospective cohort study of adults undergoing elective liver resection at a tertiary center. Blood samples were collected preoperatively, immediately post-resection, and on postoperative days (POD) 1, 2, 3, and 5. The primary objective was characterizing postoperative dynamics of AVP and PAC. Secondary objectives evaluated their temporal alignment with early fluid retention (body weight, urine output during POD 1-3) and compared hormonal profiles between major and minor resections. Analyses used trajectory and time-based comparisons by resection extent. RESULTS: AVP increased sharply immediately after resection and remained above the preoperative baseline through POD 3, showing the most pronounced and sustained elevation after major liver resection. In contrast, PAC showed a transient postoperative increase that returned to near-baseline levels by POD 2. The period of elevated AVP closely matched the time frame during which early postoperative fluid retention was most evident, as indicated by greater short-term weight gain and reduced urine output. These patterns were consistent across sensitivity analyses and showed similar directional trends in subgroup comparisons based on resection extent. CONCLUSION: AVP remains elevated longer than aldosterone and coincides with early fluid retention, particularly after major resection. Vasopressin-driven antidiuresis may be important in postoperative water retention.

DOI： 10.3748/wjg.v32.i10.115167

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Hepatocellular carcinoma (HCC) presents as a hepatic mass and may involve vascular invasion or extrahepatic spread. However, intraductal growth within the intrahepatic bile duct is rare and is often associated with obstructive jaundice. HCCs confined to the intrahepatic bile duct without detectable hepatic mass or jaundice are rare, and diagnosis is often difficult due to clinical and radiological resemblance to perihilar cholangiocarcinoma. Moreover, such cases generally carry a poor prognosis. We report a rare case of HCC that developed exclusively within the intrahepatic bile ducts, without forming a detectable mass in the liver or causing jaundice. CASE PRESENTATION: A 70-year-old man presented with right hypochondriac pain. Imaging revealed dilation of the intrahepatic bile ducts in the anterior sector and intraductal filling defects, particularly in the intrahepatic bile duct branch of segment 8, without a detectable hepatic mass. Alpha-fetoprotein and Duke pancreatic monoclonal antigen type 2 levels were elevated, whereas prothrombin induced by vitamin K absence-II, carbohydrate antigen 19-9, and carcinoembryonic antigen levels were within normal limits. Perihilar cholangiocarcinoma was suspected based on imaging. Right hepatectomy with extrahepatic bile duct resection was performed after preoperative portal vein embolization. Intraoperative ultrasonography and gross examination revealed no parenchymal mass. Histopathology showed atypical hepatocyte-like cell clusters with pleomorphic nuclei proliferating within the Glisson's capsule and infiltrating the adjacent liver parenchyma in a trabecular pattern without fibrous capsule formation. Tumor infiltration into the bile duct epithelium was evident. Immunohistochemical staining was positive for HepPar1 and negative for cytokeratin 19, with a 40% Ki-67 labeling index, confirming HCC diagnosis. The patient remains recurrence-free at 2 years and 7 months postoperatively. CONCLUSIONS: This case highlights a rare presentation of HCC without a hepatic mass or jaundice, confined to the intrahepatic bile duct. Most patients present with obstructive jaundice. Only two other English-language cases have no prior history of primary HCC, no hepatic mass, no jaundice, and disease confined to the bile duct. Although bile duct-invading HCC is generally associated with poor prognosis, our case suggests that early surgical intervention may lead to favorable long-term outcomes in select patients.

DOI： 10.70352/scrj.cr.25-0429

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap