腹腔镜肝癌切除术与开放式肝癌切除术的疗效比较研究

目的：探讨腹腔镜肝癌切除手术治疗原发性肝癌的可行性及安全性。方法：选取2008年6月至2011年1月在我院行腹腔镜肝癌切除术的30例患者作为研究对象,另外选择同期在我院行开放式肝癌切除术的30例患者作为对照。结果：30例均在腹腔镜下成功地完成手术,其中22例行腹腔镜局部切除术,8例行肝左外叶切除术。手术时间103—142min,出血量60-480mL,术后均未发生严重并发症,术后平均住院8．6d。术后随访18～36个月,局部复发或种植性转移率与对照组无显著差异。结论：腹腔镜肝癌切除术是安全可行治疗原发性肝癌的手术方式.     

原发性肝癌腹腔镜肝叶切除术的护理配合

目的探讨腹腔镜肝叶切除术治疗原发性肝癌的护理配合要点。方法对52例行腹腔镜肝叶切除术治疗的原发性肝癌患者的手术配合情况进行总结,包括术前访视、器械物品准备、术中配合及术后处理等护理配合措施。结果 52例患者均成功完成全腹腔镜下肝切除术,无1例中转开腹。术后并发肝下脓肿1例,余无感染、胆漏、胸腔或膈下积液等并发症发生,随访复发3例(5.77%)。结论积极有效的护理配合措施对减小术中创伤、提高手术成功率、降低中转开腹手术率、促进患者康复具有重要意义。     

精准肝切除术治疗原发性肝癌的临床效果分析

目的:探讨腹腔镜精准肝切除术的特点及效果,为普外科手术提供参考。方法:选取2011年10月-2013年7月我院收治的92例原发性肝癌患者的临床资料进行回顾分析。根据手术方式不同,将病例分为常规肝切除组和精准肝切除组,每组46例。观察并比较两组患者的评均术中出血量、手术时间、住院时间、手术前后的肝功能指标变化、并发症的发生率、肿瘤局部复发率及远期转移率等。结果:与常规肝切除组相比较,精准肝切除组患者的平均术中出血量少、住院时间短、术后并发症的发生率及肿瘤复发转移率低,但手术时间较长,组间比较差异显著,具有统计学意义(P0.05)。与手术前比较,两组患者手术后的血清TBIL、ALT及AST含量降低,ALB升高,精准肝切除组患者各项指标的变化程度更显著,肝功能优于常规肝切除组,组内及组间比较差异具有统计学意义(P0.05)。结论:精准肝切除术对于原发性肝癌的治疗具有良好临床的效果,不仅能够彻底清除病灶,而且降低了术后肝衰竭等并发症的发生率,值得推广应用。     

阴式全子宫切除术和腹腔镜下全子宫切除术的临床对比分析

目的:比较阴式全子宫切除术与腹腔镜下全子宫切除术的临床治疗效果。方法:回顾性分析2014年6月-2015年6月我院收治的137例子宫良性病变患者的临床病历资料,按照手术方式将其分为阴式组(行阴式全子宫切除术)和腹腔镜组(行腹腔镜下全子宫切除术),比较两组患者的术中、术后临床指标及术后并发症情况。结果:阴式组手术时间及术中出血量均少于腹腔镜组,差异有统计学意义(P0.05)。阴式组肛门排气时间、下床活动时间以及住院时间均短于腹腔镜组,住院总费用低于腹腔镜组,差异有统计学意义(P0.05)。两组患者并发症发生情况差异无统计学意义(P0.05)。结论:阴式全子宫切除术较腹腔镜下全子宫切除术而言,具有手术创伤小、术后恢复快的特点,值得临床推广。     

经皮穿刺微波消融术与腹腔镜切除肝癌预后的比较研究

目的:探讨在肝癌治疗中分别应用腹腔镜切除术与经皮穿刺微波消融术对患者预后影响。方法:从我院2010年3月至2012年3月收治的肝癌患者中选取90例为研究对象,经随机数字表法分为A组45例,B组45例,A组行经皮穿刺微波消融术治疗,B组行腹腔镜切除术治疗,观察两组患者手术时间、术中出血量及预后效果。结果:A组患者手术时间及术中出血量情况明显优于B组(P0.05);A组并发症发生为6.67%,同B组比较,明显较低(P0.05);A组局部复发率为20.00%,同B组8.89%比较,明显较高(P0.05),总复发率无明显差异(P0.05);两组患者术后1、2、3年存活率均无明显差异(P0.05)。结论:在肝癌治疗中,经皮穿刺微波消融术与腹腔镜切除远期疗效均较好,经皮穿刺微波消融术创伤小,并发症发生率低,对预后改善具有重要作用。     

高龄肝癌患者肝癌切除术后并发症及预后分析

目的:探讨高龄原发性肝癌患者肝癌根治性切除术的疗效及安全性。方法:回顾性分析63例(高龄组≥70岁)与98例(对照组70岁)行肝部分切除术的原发性肝癌患者的一般资料及其围手术期情况,对其术后并发症及预后进行探讨。结果:高龄组术后并发症发生率为36.5%,对照组31.6%(P0.05),高龄组7(11.1%)例肝衰竭,2(3.17%)例术后有出血现象,3(4.8%)例切口感染,3(4.8%)例胸腔积液,1(1.5%)例伴有隔下感染,1(1.5%)例有严重肺部感染,由于下肢深静脉血栓脱落,死于急性肺动脉栓塞。组织病理类型高龄组以结节型多见,Edmondson Ⅰ-Ⅱ级33例,Ⅲ-Ⅳ级18例,胆管细胞癌8例,混合细胞型4例。BCLC-0、A、B、C期分别占2、9、35、17例。高龄组与对照组1、2、3年生存率分别为82.5%VS85.7%、34.9%VS46.3%、15.9%VS36.8%。结论:高龄对肝部分切除术后并发症的发生并无明显影响,并不是原发性肝癌根治性手术切除术的禁忌症,高龄患者2、3年生存率较对照组低。     

急诊胃癌穿孔腹腔镜手术方式选择的研究

目的:对急诊胃癌穿孔腹腔镜手术方式的选择进行探讨,为进一步优化治疗方案提供依据。方法:选取笔者所在医院2008年6月-2013年6月经治的21例胃癌穿孔临床资料作为研究对象,所有患者的病历资料完整,术式选择、并发症发生情况和术后存活时间进行分析。结果:21例均成功行腹腔镜手术。3例行单纯腹腔镜修补术,12例行经腹腔镜胃癌根治术(Ⅰ期7例+Ⅱ期5例),6例行姑息性远侧胃大部切除术(Ⅰ期5例+Ⅱ期1例)。结论:胃癌穿孔患者,全身情况较好可耐受全麻及腹腔镜根治性切除者,可积极行Ⅰ期腹腔镜根治行切除术。无条件者行穿孔修补术后2-3周再施行Ⅱ期经腹腔镜胃癌根治术。     

腹腔镜辅助下阴式子宫切除术与阴式子宫全切除术治疗子宫良性病变的临床比较

目的:探究阴式子宫全切除术与腹腔镜辅助下阴式子宫切除术治疗子宫良性病变的临床效果。方法:选择2011年10月~2013年9月我院收治的子宫良性病变的患者120例,其中行腹腔镜辅助下阴式子宫切除术80例(研究组)和行阴式子全宫切除术40例(对照组),观察并分析两组的临床指标及手术并发症。结果:研究组住院费用明显高于对照组(P0.05),手术时间、术中出血量及住院时间均低于对照组(P0.05);研究组无邻近脏器损伤,对照组输尿管损伤2例(5.00%),研究组患者出现手术损伤率明显低于对照组,差异存在统计学差异(x2=3.968,P=0.046);对两组患者术后随访1年,两组患者均无出现再手术情况;两组患者术后阴道残端均愈合较好,未出现阴道残端漏,患者无大小便困难及其他不适。结论:腹腔镜辅助下阴式子宫切除术治疗子宫良性病变疗效优于阴式子宫全切术,其手术时间、术中出血量及住院时间均较低,创伤小,更有利于患者恢复健康,在临床上值得应用推广。     

腹腔镜子宫肌瘤切除术临床效果观察

目的:探讨腹腔镜子宫肌瘤切除术的临床效果。方法:选取2013年7月~2014年9月期间我院收治的100例子宫肌瘤患者,将其随机均分为对照组和观察组。前者采取开腹子宫肌瘤切除术治疗,后者采取腹腔镜子宫肌瘤切除术治疗,对比两组的术中及术后情况。结果:对照组患者的术中出血量、手术时间、术后肠胃功能恢复时间、术后住院时间均大于观察组,术后并发症发生率小于观察组,P0.05,差异显著,具有统计学意义。结论:治疗子宫肌瘤时采用腹腔镜下子宫肌瘤切除术,不仅创伤小、出血量少、恢复快、术后并发症少,而且疗效显著,值得推广。     

脾动脉结扎联合肝癌切除术治疗肝癌并门静脉高压症临床研究

目的:探讨脾动脉结扎联合肝癌切除术对肝癌并门静脉高压症的治疗效果和临床应用的价值。方法:对2008年10月至2013年10月期间我院收治的84例肝癌并门静脉高压症患者的资料进行回顾性分析,其中脾动脉结扎联合肝癌切除手术的患者50例为研究组,患者34例行肝癌切除及脾切断流术为对照组。比较两组治疗效果及患者术前、术后情况。结果:研究组术前白细胞计数、血小板计数、红细胞计数为(3.1±0.9)×109/L、(58.6±12.7)×109/L、(3.4±0.4)×109/L,术后2周白细胞计数、血小板计数、红细胞计数分别为(5.9±1.5)×109/L、(140.3±50.1)×109/L、(3.6±0.7)×109/L;对照组为术前白细胞计数、血小板计数、红细胞计数为(2.8±1.2)×109/L、(45.8±20.5)×109/L、(3.4±0.4)×109/L,术后2周白细胞计数、血小板计数、红细胞计数为(6.2±0.7)×109/L、(172.5±32.7)×109/L、(3.6±0.3)×109/L。研究组与对照组相比,术后2周白细胞计数、红细胞计数相比差异无统计学意义(P0.05),但术后2周血小板计数研究组低于对照组,差异有统计学意义(P0.05)。研究组术前与术后的白细胞计数、血小板计数、红细胞计数相比,差异均有统计学意义(P0.05)。研究组有17例患者出现术后并发症,占16.0%;对照组有20例患者出现术后并发症,占38.2%;两组对比差异有统计学意义(P0.05)。结论:根据病情合理选择使用脾动脉结扎联合肝癌切除术治疗肝癌并门静脉高压症,可以有效治疗肝癌和脾功能亢进,促进肝功能恢复,对延长原发性肝癌合并肝硬化脾功能亢进患者的生存时间,提高生活质量,具有重要意义。     

Safety of simultaneous resections of colorectal cancer and liver metastases

Liver resection is the only potentially curative method for patients with colorectal cancer metastases and 5-year survival rates are 20%-40%. Simultaneous resection of colorectal cancer and synchronous liver metastases has been recommended if minor hepatectomy is indicated. The purpose of this paper is to analyze the treatment of hepatic colorectal secondaries and to assess the safety of simultaneous and delayed liver resections and relations of morbidity to the extensiveness of hepatectomy and perioperative factors. Analyzed were 21 patients with liver metastases from colorectal cancer operated between 1997 and 1999 in the Clinical Hospital "Sestre milosrdnice". Operating time for simultaneous colorectal and liver resections was not significantly longer compared to liver resections alone. No significant difference in complication rate was found after simultaneous procedures and liver resection alone (38% vs. 31%). Complication rate after major liver resections was not significantly greater than after minor resections (38% vs. 31%). No statistically significant differences were found in operation time and blood replacement between patients who developed postoperative complications and those who did not. In conclusion, simultaneous resections of primary colorectal cancer and liver metastases may be considered safe. Morbidity rates are not significantly different from those after liver resections alone, nor depend significantly upon the extensiveness of liver resection, providing that the operation time and blood loss are within the range observed in this study.     

Classifying the Stage IV Colorectal Cancer: Prognostic Impact of Radical Resection for Colorectal liver Metastases and Proposal for a New Staging System

Currently, there is no universally accepted system to classify the stage IV colorectal cancer. Here, we analyze the prognostic impact of radical resection for colorectal liver metastases and propose a new staging system for stage IV colorectal cancer. A retrospective review was undertaken of 126 consecutive patients who underwent surgical treatment for colorectal liver metastases from January 1997 to January 2004. Based on the overall survival rates (Kaplan–Meier method) and surgical outcomes, we propose a new staging system for stage IV colorectal cancer. Patients were divided into two groups: patients who underwent initial hepatic resections (R0 resection) for liver metastases (group 1, n = 22), and patients who underwent palliative resection for unresectable liver metastases (group 2, n = 104). The overall survival rates in group 1 at 1, 3, and 5 years were 68.2 % (15/22), 40.9 % (9/22), and 18.2 % (4/22), respectively. The overall survival rates in group 2 at 1, 3, and 5 years were 54.8 % (57/104), 16.3 % (17/104), and 0 % (0/104), respectively. There was a significant difference in overall survival rates between both groups (p < 0.05). Based on the study results, we propose a new staging system where all distant metastases are grouped within stage IV and subclassified into resectable (R0 resection) and unresectable stages. Curative surgical treatment is a critical prognostic factor in colorectal liver metastases. The proposed new staging system for stage IV colorectal cancer is simple and is clinically useful to estimate the prognosis.     

Can Microwave Ablation be an Alternative to Resection for the Treatment of Neuroendocrine Liver Metastases?

Objective: Surgical resection of neuroendocrine tumor liver metastases has been proven to improve survival, but the benefit of microwave ablation as an alternative or adjunct to surgery has yet to be assessed. Our hypothesis is that ablation is equal to surgery in terms of local recurrence and survival.Methods: We conducted a retrospective analysis including all patients treated with microwave ablation and/or surgical resection for neuroendocrine liver metastases in our institution between 2008 and 2017.Results: A total of 47 patients and 68 treatments were analyzed, including 34 liver resections, 20 ablations, and 14 combined procedures. A total of 130 individual metastases were treated with ablation, representing a median of 4 per session (range 1–30). While no major complications occurred after ablation, we observed 11 minor and 3 major complications after open surgical resection (P = .0135). Length of stay was significantly shorter after ablation (P = .0008). The majority of patients (33/47, 70.2%) underwent curative procedures, 14 patients underwent (29.8%) debulking procedures. There was no difference in local recurrence rate between tumors treated with ablation or resection. Liver-only disease progression was detected in 29% of the patients and overall progression was detected in 66% of the patients. The mean survival was not significantly different between patients treated with ablation only versus resection with or without ablation (P = .1570). Overall survival was mean 75.3 months (6 to 374 months).Conclusion: Depending on the extent of the liver metastases, microwave ablation might be a safe alternative or addition to resection for neuroendocrine tumor liver metastases with low morbidity and high local efficiency.Abbreviations: CT = computed tomography; MWA = microwave ablation; NET = neuroendocrine tumor; PET = positron emission tomography; RFA = radiofrequency ablation; RFS = recurrence-free survival; SMWA = stereotactic microwave ablation     

Association between Duration of Carbon Dioxide Pneumoperitoneum during Laparoscopic Abdominal Surgery and Hepatic Injury: A Meta-Analysis

Background

The aim of this study is to accurately assess whether the duration of intraoperative carbon dioxide pneumoperitoneum (CDP) is associated with the induction of hepatic injury.

Methods

We conducted a systematic review of PubMed, Embase, and Cochrane Library databases (through February 2014) to identify case-match studies that compared high-pressure CDP with low-pressure CDP or varied the duration of CDP in patients who underwent abdominal surgery. The outcome of interest was postoperative liver function (ALT, AST, TB).

Results

Eleven comparative studies involving 2,235 participants were included. Overall, levels of ALT, AST, and TB (on postoperative days 1, 3, and 7) were significantly elevated in the study groups. However, the results of the subanalyses of those who underwent laparoscopic colorectal cancer resection (LCR) versus open colorectal cancer resection (OCR) and those who underwent laparoscopic gastric bypass (LGBP) versus open gastric bypass (OGBP) were inconsistent.

Conclusions

The current evidence suggests that the duration of CDP during laparoscopic abdominal surgery may be associated with hepatic injury. Additional large-scale, randomized, controlled trials are urgently needed to further confirm this.     

Follow-up computed tomography in patients operated on for liver malignancies

The aim of the investigation was to study a role of computed tomography (CT) in choosing treatment policy for patients after hepatectomy. In 186 patients with liver malignancies, 558 follow-up studies were performed 3 months to 8 years after surgery and adjuvant treatment. RESULTS: the permanent change of the liver, which is detectable at postoperative CT, is its outline deformity. Inverted (87%), irregular (56%), and, less frequently, convex (13%) outlines were identified. Among 41 patients who had postoperatively undergone adjuvant chemoembolization, 7 (17%) patients were seen to have a local compact lipidiol concentration adjacent to the resection plane. CT carried out in 19 patients with suspected postoperative complications could recognize the cause of complications (liver abscesses, abdominal fluid, bilomas) in 15 (78.9%) cases. In 20 patients, compact lipidiol accumulation in the vicinity of the resection plane was the most common, but not pathognomonic sign of tumor resection in the resection plane. Thus, CT plays an important role in the follow-up of patients after liver resections for malignancies in both the early and late postoperative periods.     

颅底脊索瘤的影像学诊断及治疗研究(附26例报告)(英文)

目的:探讨颅底脊索瘤的CT、MRI表现及治疗措施。方法:回顾性分析经病理证实的26例脊索瘤患者的临床资料。肿瘤位于鞍区及鼻咽部者9例,位于中颅窝者5例,位于后颅窝者8例,混合型4例。手术入路:额颞入路-翼点开颅9例,鼻内镜下经蝶入路5例,颞下、颞枕及扩大中颅窝入路8例,4例未手术行放射治疗。结果:肿瘤全切8例,大部及次全切14例,围手术期未见死亡病例。25例患者获得随访;3例于术后1年内复发,其中2例死亡,余者颅神经损伤及肢体症状均有改善。结论:脊索瘤无典型临床表现,现多可通过术前影像学检查得以诊断,少数位于特殊位置者需与垂体瘤,颅咽管瘤,三叉神经鞘瘤等鉴别;肿瘤全切较为困难,根据需要选择相应的手术入路可明显提高手术效果;放疗可作为术后辅助治疗。     

Deficiency in Thrombopoietin Induction after Liver Surgery Is Associated with Postoperative Liver Dysfunction

Background and Aims

Thrombopoietin (TPO) has been implicated in the process of liver regeneration and was found to correlate with hepatic function in patients with liver disease. With this investigation we aimed to determine if perioperative TPO levels were associated with postoperative outcome in patients undergoing liver resection.

Methods

Perioperative TPO was analyzed prior to liver resection as well as on the first and fifth postoperative day in 46 colorectal cancer patients with liver metastasis (mCRC) as well as 23 hepatocellular carcinoma patients (HCC). Serum markers of liver function within the first postoperative week were used to define liver dysfunction.

Results

While circulating TPO levels significantly increased one day after liver resection in patients without liver cirrhosis (mCRC) (P < 0.001), patients with underlying liver disease (HCC) failed to significantly induce TPO postoperatively. Accordingly, HCC patients had significantly lower TPO levels on POD1 and 5. Similarly, patients with major resections failed to increase circulating TPO levels. Perioperative dynamics of TPO were found to specifically predict liver dysfunction (AUC: 0.893, P < 0.001) after hepatectomy and remained an independent predictor upon multivariate analysis.

Conclusions

We here demonstrate that perioperative TPO dynamics are associated with postoperative LD. Postoperative TPO levels were found to be lowest in high-risk patients (HCC patients undergoing major resection) but showed an independent predictive value. Thus, a dampened TPO increase after liver resection reflects a poor capacity for hepatic recovery and may help to identify patients who require close monitoring or intervention for potential complications.     

改良腹腔镜下子宫悬吊术加圆韧带缩短术治疗子宫脱垂的临床观察

目的:研究改良腹腔镜下子宫悬吊术加圆韧带缩短术治疗子宫脱垂的临床效果。方法:将从2014年1月至2015年8月在我院妇科接受手术治疗的子宫脱垂患者60例作为研究对象,其中接受改良腹腔镜辅助下实施子宫悬吊术联合圆韧带缩短术者30例纳入观察组,接受阴式子宫切除术者30例纳入对照组,观察并对比两组治疗前后的盆腔器官脱垂定量(POP-Q)分度情况、手术相关指标及手术并发症。结果:与治疗前比,治疗后两组的POP-Q分度均显著改善(P0.05)。观察组的手术时间、术中出血量以及术后留院时长分别显著少于对照组(P0.05)。观察组的手术并发症总发生率是10.00%,显著低于对照组的33.33%(P0.05)。结论:在改良腹腔镜辅助下实施子宫悬吊术联合圆韧带缩短术对子宫脱垂患者的疗效显著,且有利于患者尽快康复,安全性高,值得临床推广应用。     

吲哚菁绿荧光显像技术在腹腔镜结直肠癌根治术中的临床应用价值分析

摘要 目的：探讨吲哚菁绿荧光显像技术在腹腔镜结直肠癌根治术中的临床应用价值。方法：选取2020 年6月到2021年6月于我院行腹腔镜结直肠癌根治术的患者112例,按照随机数字表法分为研究组和对照组,每组各56例。两组均采用腹腔镜结直肠癌根治术治疗,研究组术中应用吲哚菁绿荧光显像技术观察吻合口肠段血运情况。比较两组患者手术相关指标、术后并发症发生率、吻合口漏、吻合口出血发生率及围手术期死亡率。结果：两组患者术中均无死亡,两组患者术中出血量、手术时间、首次肛门排气时间、下床活动时间及术中死亡率比较无统计学差异（P>0.05）。研究组腹腔出血、腹腔感染、吻合口漏、吻合口出血发生率显著低于对照组（P<0.05）,两组肠梗阻、切口感染、围手术期死亡率比较无统计学差异（P>0.05）。结论：应用吲哚菁绿荧光显像技术可以显著降低腹腔镜结直肠癌根治术患者腹腔出血、腹腔感染、吻合口漏、吻合口出血发生率,在腹腔镜结直肠癌根治术中具有较好的应用价值。