ABSTRACT
Objective To explore the practicability and safety of the application of Percutaneous Vertebroplasty puncture (PVP) needle as a saw guide in the Total En-bloc Spondylectomy (TES) of thoracic and lumbar tumor through single posterior approach.Methods From June 2017 to March 2018,four patients with thoracic and lumbar vertebral neoplasms were analyzed retrospectively.They included 2 males and 2 females,which aged 50-77 years with an average age of 63.75 years.There were 1 case of Tomita 5 grade T7 lymphoma,1 case of Tomita 3 grade T5 metastasis of lung cancer,1 case of Tomita 5 grade T9 metastasis of prostate cancer and 1 case of Tomita 4 grade L2 metastasis of renal cancer.The PVP needle combined with the modified "3-step" method was applied in TES for 4 cases through posterior approach.The operative time and intraoperative blood loss were recorded.The integrity of excised vertebra and postoperative complications were observed.The visual analogue score (VAS) was evaluated to assess the pain improvement.The ASIA classification was evaluated for the assessment of neurological function of thoracic vertebral tumor cases and the muscle strength grades was evaluated for the assessment of neurological function of lumbar vertebral tumor cases.Results In all 4 cases,the vertebra was removed entirely.The average operation time was 4.9 h (4.0-6.5 h)and average blood loss was 3 200 ml (800-9 000 ml).No pachymeninx injury,cerebrospinal fluid leakage,iatrogenic spinal cord injury or vascular injury occurred.During the surgery,the saw-cutting plane is firmly located in the intervertebral disc and no slippage of the cutting plane was observed.Postoperatively,the pain was significantly alleviated.The VAS score decreased to average 1.75 points (1-2 points) after surgery,average reduction of 5.75 points (5-7 points).The neurological deficit was not aggravated in all patients.The neurological improvement of one grade was observed in 3 patients.Two cases of thoracic vertebral tumor had a grade of ASIA classification improved from grade B to grade C.One case of lumbar vertebral tumor had a grade of lower limb muscle strength improved from grade 3 to grade 4.No recurrence of tumor was observed at average 8.1 months (3.5-12 months) followup and 1 case of bone metastasis of lung cancer had intermittent intercostal neuralgia.Conclusion It is feasible and safe to apply PVP puncture needle as a saw guide in TES of thoracic and lumbar tumor through single posterior approach,on the basis of this,the "3-step" intervertebral disc truncation technique is developed,which has good practicability and high safety.
ABSTRACT
With the advancement and development of life science and technology,many problems in liver surgery have been solved,and the surgical procedures of liver surgery have been continuously developed and the indications for surgery have been continuously expanded.Benign and malignant lesions and even donor liver can be performed under laparoscopy.The indications for laparoscopic liver resection are expanding,from superficial liver resection to a wider range of anatomical resection.At the same time of technological advancement,along with the development of the humanistic spirit,liver resection is not only the removal of lesions,but the pursuit of rehabilitation,which is "the best rehabilitation with minimal trauma".Laparoscopic liver resection has been greatly developed due to the spread of the concept of "precise medicine".
ABSTRACT
Objective To determine the safety and feasibility of laparoscopic dissection of hepatic pedicle in liver resections.Methods Laparoscopic dissection of hepatic pedicle was performed to achieve selective hepatic vascular inflow occlusion during anatomical hepatectomies in 43 patients with liver lesions.The average age was (46.1 ± 3.5) years.The hepatic pedicle was dissected precisely with sharp and blunt dissections to expose the portal vein,hepatic artery,and their branches.The hepatic ischemic area was judged after selective hepatic vascular inflow occlusion and the liver lesions were then resected.Results All 43 patients received anatomical hepatectomies successfully using the technique of laparoscopic hepatic pedicle dissection for selective hepatic vascular inflow occlusion.The mean operative time was (63.6 ± 11.2)minutes.The average blood loss was (243.8 ± 35.5)ml,and the mean hospital stay was (7.1 ± 1.6) days.Conclusion Laparoscopic dissection of hepatic pedicle in liver resection was feasible and safe.
ABSTRACT
Objective To explore the feasibility and therapeutic effect of total laparoscopic hepatectomy(LH) for treating hepa‐tolithiasis .Methods 75 consecutive patients with hepatolithiasis operatively treated in our hospital from November 2003 to Novem‐ber 2012 were retrospectively analyzed .Among them ,35 cases underwent laparoscopic hepatectomy(LH group) and 40 cases under‐went open hepatectomies(OH group) .The operative modes in the two groups included the left liver lateral lobe resection ,left hemi‐hepatecomy ,common bile duct incision exploration ,choledochoscopy exploration for calculi extraction ,T tube drainage and cholecys‐tectomy .The clinical indicators including the operation time ,intraoperative blood loss ,analgesic drug use situation ,ambulation time , diet recovery time ,postoperative complication rate ,postoperative hospital stay time ,stone clearance rate and recurrence rate were analyzed and compared between the two groups .Results The operation time of the LH group was longer than that of the OH group[(205 .0 ± 40 .9) min vs .(155 .0 ± 26 .6) min ,P 0 .05) .The use rate of analge‐sic drugs in the LH group was lower than that of the OH group (0 vs .62 .5% ) .The ambulation time and the diet recovery time in the LH group were shorter than those in the OH group[(1 .5 ± 0 .5)d vs .(3 .6 ± 0 .7)d ,P 0 .05) .Conclusion LH combined with choledochoscopy for treating hepatolithiasis is feasible and safe in the patients conforming to the selected standard with an e‐qual therapeutic effect to that of open hepatectomy .LH has the advanteages of minimally invasive surgery such as small incision , less pain ,fast recovery ,less complications ,etc .
ABSTRACT
Objective To compare the feasibility and safety of laparoscopic versus open hepatectomy.Methods The data of 165 patients who underwent laparoscopic hepatectomy were compared with 170 patients who underwent open hepatectomy in our hospital from November 2002 to December 2010.Results Laparoscopic hepatectomy was successfully carried out in 159 patients and 6 patients were converted to open operation because of intra-operative hemorrhage.The 170 patients in the open operative group had open hepatectomy successfully carried out.The hospital stay and cost in the laparoscopic group(7.6±1.3 d,31767.4±220.1(￥))were less than the open operation group(14.6±3.3 d,35127.3±392.2(￥))(t=-12.657,P＜0.001; t=-78.859,P＜0.001).There was no significant difference in Pringle's manoeuvre time,blood loss and postoperative complications(20.6 ±8.5vs.18.6±6.5 min,t=2.108,P=0.068),(420.8±76.5 vs.395.9±96.1 ml,t=2.157,P=0.063),(0 vs.4 cases,t=2.011,P=0.156))between the 2 groups.The operative time in the laparoscopic group was significantly longer than the open group(59.6 ± 12.2 vs.42.7 ± 22.6 min)(t=6.941,P＜0.001).Conclusions Laparoscopic hepatectomy is feasible and safe.It has the advantages of having less trauma and quicker recovery for tumors which were located superficially in the left liver and in the inferior part of the right liver.The operative time was longer than open hepatectomy,but there was no significant difference between the 2 groups in Pringle's manoeuvre time,blood loss and postoperative complications.The hospital stay and total hospital cost in the open operation group were higher than the laparoscopic hepatectomy group.
ABSTRACT
Objective To study the feasibility and safety of laparoscopic anatomical liver lobectomy for liver tumor. Methods The feasibility and therapeutic effect of laparoscopic anatomical liver resection on 67 patients were analyzed in our hospital from January 2005 to February 2010. Results Laparoscopic anatomical liver lobectomy was carried out successfully on all the patients. The operative time was 50.6± 16.2 min and the blood loss was 220. 8±76.5 ml. We did not use Pringle's manoeuvre. There was no postoperative complication. The patients were able to be ambulated out of bed within 24 hours and they started to take in food 1-3 days after surgery. The mean hospital stay was 5-7 days after surgery (mean 6.6±1.1 d). The total hospital cost was 30767.4±150. 1 Yuan. Conclusions Laparoscopic anatomical liver resection is feasible and safe. It has the advantages of minimal trauma and quick recovery for tumors located superficially, in the left liver, and in the inferior part of the right liver. Clinically, it should be used more widely.
ABSTRACT
Objective To evaluate the feasibility and efficacy of laparoscopic treatment of hepatic hemangioma. Methods The clinical data of 27 patients who received laparoscopic treatment of hepatic hemangioma from November 2003 to October 2009 were retrospectively analyzed. The hepatic inflow to the liver or to a hemiliver was temporarily blocked using a Pringle manoeuvre with a self-invented laparoscopic blocker at the porta hepatis or at the pedicle to the relevant hemiliver. The Electriccautery and ultracision were used for liver transaction. Results Laparoscopic treatment of hepatic hemangioma was successfully performed in 25 patients. Conversion to laparotomy was required in two (8%) patients for uncontrollable bleeding. There were no major postoperative complications and no mortality. The mean tumor diameter was (6.34±2. 17) cm. The operating time was ( 105.21 ±72.76)min. The time of hepatic inflow block was (10. 17±12. 21)min. The blood loss was (115. 5±212.14)ml. The volume of blood transfusion was (0. 87 ± 1.45)U. The volume of postoperative drainage was (112.60±201.03)ml. The time taken to return to normal activity was (2. 0±0. 8) days.The length of postoperative hospital stay was (5.5±2.4) days. The length of total hospital stay was (12. 5 ±5.3) days. The total cost was RMB10041.6±8678. 7. Conclusion In selected patients, laparoscopic treatment of hepatic hemangioma was safe and feasible.
ABSTRACT
Objective To investigate the effects of ketamine in relieving postoperative pain after laparoscopic cholecystectomy(LC).Methods Forty patients undergoing selective LC from July to August 2006 were randomly divided into ketamine group and control group,with 20 patients in each group.Incision pain and non-incision pain was assessed at 1,2,4,6,12,24 h and once each day for the first 3 days postoperatively with visual analogue pain scale(VAS)and sedation scale.Adverse effects and analgesic requirements were recorded.Results Patients in ketamine group had significantly lower scores in incision pain and non-incision pain compared with those of control group(F=22.805,P =0.000;F=18.109,P=0.000).Incidence of postoperative nausea and vomiting was not significantly different(P=1.000)between ketamine(55%)and control group(60%).No significant difference was noticed in analgesic requirements between ketamine group(3 cases)and control group(9 cases)(P=0.082).Conclusions Preoperative administration of ketamine significantly improves postoperative analgesia after laparoscopic cholecystectomy,but does not reduce the incidence of postoperative nausea and vomiting.
ABSTRACT
Objective To explore the feasibility and advantages of endoscopic thyroidectomy via breast areola approach.Methods Endoscopic thyroidectomy via breast areola approach was performed in 113 cases between August 2002 and May 2005.Preoperative diagnosis included 46 cases of adenoma,62 cases of nodular goiter,and 5 cases of Graves' disease.Results The operation was successfully completed endoscopically in 112 cases,and was converted to conventional thyroidectomy in 1 case because of bleeding.The tumor was 2.3?1.6 cm in diameter(range,0.8~7.0 cm).The operating time was 136.7?58.0 min(range,50~310 min),the intraoperative blood loss was 42.5?62.7 ml(range,10~200 ml),the postoperative drainage volume was 87.1?78.1 ml(range,15~310 ml),the time to resume normal activities was 2.2?0.9 d(range,1~4 d),and the length of postoperative hospital stay was 5.5?1.9 d(range,2~9 d).Out of the 113 cases,analgesic requirement was necessary in 18 cases (15.9%).Postoperative complications occurred in 6 cases,including 2 cases of recurrent laryngeal nerve injuries,1 case of superior laryngeal nerve injuries,1 case of hemorrhage,1 case of hypocalcemia,and 1 case of recurrence of Graves' disease.Pathological results showed 43 cases of thyroid adenoma,58 cases of nodular goiter,5 cases of Graves' disease,3 cases of thyroid cancer,and 4 cases of Hashimoto's thyroiditis.Conclusions Endoscopic thyroidectomy via breast areola approach is a technically feasible and safe procedure.It can be employed as the first choice for indicated patients.
ABSTRACT
Objective To compare the clinical efficiency of endoscopic thyroidectomy by breast approach with conventional open thyroidectomy in patients with benign thyroid tumor. Methods Ninety-one patients of thyroid adenoma or adenomatous goiter underwent endoscopic thyroidectomy (group endoscopy) , Ninety-nine patients underwent conventional open thyroidectomy (group open). Operative time, blood loss, the volum of drainage, time of hospital stay and postoperative stay, postoperative complications and analgesic requirements, time taken to return to normal activity and total fee were compared. Results There were no significant differences in operative time, time of stay and postoperation stay between the two groups. Blood loss was significantly less in group endoscopy (27. 7?17. 4) ml than in group open [ (96. 8?84. 8) ml, P