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Objective To investigate the application value of transabdominal-tansanal total mesorectal excision combined with liver metastasis resection for synchronous low rectal liver metastasis.Methods The retrospective descriptive study was adopted.The clinical data of a male patient with synchronous low rectal liver metastasis who was admitted to the Peking University Third Hospital in November 2015 was collected.Transabdominal-transanal total mesorectal excision combined with liver metastasis resection was performed after multidisciplinary team conference.The liver metastasis resection,vascular disconnection,lymph node dissection and upper and middle mesorectal disconnection were done by transabdominal approach.Then complete mesorectal excision and specimen removal of rectum and liver were done by transanal approach.The intraoperative status (operation method,operation time,volume of intraoperative blood loss,blood transfusion),occurrence of postoperative complications,results of pathological examination and follow-up were observed.The patient was followed up by outpatient examination till January 2016.Results The operation was performed successfully without severe perioperative complications.The operation time and volume of intraoperative blood loss were 360 minutes and 170 mL,respectively.The patient did not receive intraoperative blood transfusion,without urinary retention and presacral abscesses.The patient was discharged at postoperative day 9.The postoperative pathological results showed high-differentiated rectal protruded adenoma and high-middle differentiated adenocarcinoma metastasis in the liver tissue with the negative resection margins.The tumor sizes of rectum and liver metastasis were 5.0 cm × 5.0 cm× 1.5 cm and 1.5 cm × 1.0 cm × 1.5 cm,respectively.The tumor node metastasis (TNM) stage was stage Ⅳ (pT3N0M1).The patient had a good life quality during the follow-up of 1 month.Conclusion Transabdominal-transanal approach might provide an alternative operative approach and resection method for synchronous low rectal liver metastasis,with a good short-term outcome.
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Objective To explore the clinical application of laparoscopic splenectomy in treatment of spleen disease at our hospital.Methods We reviewed laparoscopic splenectomy carried out at our hospital since 1995,patients were grouped by date.63 laparoscopic splenectomies were divided into six groups.Operation time,intraoperative blood loss,postoperative hospital stay,time to feeding,days of drainage,amount of drainage,postoperative complications and indications for surgery were compared.Results Patient's age averaged at 44.19 years,body mass index averaged at 23.75,3 patients were converted to open surgery.Mean operating time,blood loss,postoperative hospital stay,time to feeding,converting rate in the 53 cases which had the surgery after 2003 were much better than the 10 cases before 2003.Surgical indications for laparoscopic splenectomy were limited to hematopoietic disease related splemegaly before 2003,the indication range significantly expanded after 2003,during which laparoscopic splenectomy were mainly applied to treat spleen tumors.Conclusions There is a marked learning curve in laparoscopic splenectomy after 10 surgeries before 2003 we have achieved the level.With the suitable approach,apparatus and skillful technique,laparoscopic splenectomy is safe and feasible to treat tumors of the spleen.
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Objective To summarize the initial experience in application of mesohepatectomy for the treatment of central liver tumors while focusing on its indication, short-term and long-term prognosis and especially outlining its technical details. Methods The clinical data of 3 patients receiving mesohepatectomy from December 2007 to March 2009 in our hospital were retrospectively analyzed.The imaging characteristics were summarized to convey the indication details. The technique details of the operation were outlined so as to reduce blood loss or other complications during and after the operation. The post-operative course and follow-up data were also collected and analyzed. Results Two patients suffered from primary hepatocellular carcinoma with liver cirrhosis and the other from giant hemangioma. The tumors were located in Couinaud yegment Ⅳ and/or Ⅷ. The average blood loss and operative duration were 800 ml and 7 h, respectively. Blood liver function tests returned to normal within 7 days postoperatively and the patients were discharged after that. No complications occurred. The follow-up for 7-15 months showed that there was no recurrence. Conclusion Mesohepatectomy is the principal choice of treatment for centrally located liver tumors. For the safety and avoidance of complications, the doctor should abide by the concept of segment-oriented hepatectomy and apply the updated techniques such as CUSA (Cavitron ultrasonic surgical aspirator). For patients with compromised liver function, mesohepatectomy might be superior to extended bepatectomy. Thus, the application of mesohepatectomy should be expanded. Meanwhile, further investigation is needed for its full evaluation.
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Objective To summarize the experience in the diagnosis and treatment of elastofibroma dorsi,focusing on the clinical features,the specific radiological characteristics,and the typical pathological alterations.Methods Clinical data of 10 cases of pathologically confirmed elastofibroma dorsi from January 1997 to April 2008 were retrospectively reviewed.Results Most patients were female(8/10)in this series.All the lesions were located within the muscles in the subscapular region.There were 13 lesions in 10 cases(3 cases with bilateral involvement).Seven patients complained of pain and feeling of foreign body,and three were asymptomatic.The size of the masses was between 4 centimeters to 12 centimeters,averaging at(7.46 ±2.70)centimeters.Except for the early 3 cases,accurate diagnosis was made in all the other 7 cases before the histological exams solely based on the physical examination and imaging findings.Marginal excision was done for all the cases under general anesthesia.Fluid accumulation,as the only kind of complication was found in 3 cases which was resolved by repeated paracentesis.No recurrence was found during the follow-up period(4 months to 125 months,median 11 months).Conclusion Elastofibroma dorsi is a rare,pseudotumoral lesion usually found in elderly women.It is a very special type of soft tissue tumors that its diagnosis can usually be made solely on the basis of unique imaging characteristics and physical examination before the histological exam.Surgical marginal excision is the choice of treatment with good short-term and long-term results.
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Objective To study the application of the selective regional anemia hepatectomy. Methods The hepatic veins and hilar plates of 5 liver samples of posthepatitic cirrhosis were measured. Results Out of the 5 samples, the average width and depth of the left branch of hilar plate were 1.78cm and 0.82cm, of the left medial branch were 1.04cm and 1.02cm, of the left lateral superior branch were 0.96cm and 0.74cm, of the left lateral inferior branch were 1.02cm and 0.76cm, of the right branch were 2.02 cm and 1.28cm, of the right posterior branch were 1.20cm and 1.10cm, and of the right anterior branch, 1.22cm and 1.16cm. The average width and depth of the left hepatic vein were 0.82cm and 0.74cm, of the right hepatic vein were 1.16cm and 1.04cm, and of the middle hepatic vein, 0.92cm and 1.18cm. The regional anemia hepatectomy was performed successfully in 2 cases. Conclusions Selective occlusion of the blood flow in and out the hepatic segment or lobe may contribute to a safe and reliable hepatectomy.