ABSTRACT
OBJECTIVE@#To propose and evaluate the clinical effect of midpiece facial nerve dissection through transparotid approach in regional parotidectomy.@*METHODS@#A total of 136 patients with benign parotid tumors were categorized into three groups according to the way of facial nerve dissection: anterograde dissection from main trunk (anterograde, n=70), retrograde dissection from distal branches (retrograde, n=34), and midpiece dissection through transparotid approach (middle dissection, n=32). Surgery duration, facial nerve injury, salivary fistula, earlobe sensation, Frey's syndrome, and aesthetic evaluation were compared.@*RESULTS@#The surgery duration in the middle dissection group was significantly shorter than that in the other two groups. The proportion of salivary fistula was higher in the anterograde group (9 cases, 12.9%; P<0.05) compared with that in the other groups. Postoperative facial nerve injury was similar between the middle dissection (1 case, 3.1%) and anterograde groups (3 cases, 4.3%) with lower injury rate compared with the retrograde group (7 cases, 20.6%). The anterograde group had more cases of hypoesthesia of the earlobe (12 cases, 17.1%; P<0.05) than the other two groups. Aesthetic score was higher in the anterograde and middle dissection groups compared with that in the retrograde group (P<0.05).@*CONCLUSIONS@#Midpiece facial nerve dissection is technically feasible and clinically viable in regional parotidectomy.
Subject(s)
Humans , Esthetics, Dental , Facial Nerve , Parotid Gland , Parotid Neoplasms , Postoperative Complications , Retrospective Studies , Sweating, GustatoryABSTRACT
Objective To explore the application value of perihilar surgery technique in the reoperation of biliary dilatation of central large intra-and extra-hepatic bile ducts above the hilar convergence.Methods The retrospective cross-sectional study was conducted.The clinical data of 3 patients with biliary dilatation of central large intra-and extra-hepatic bile ducts above the hilar convergence who underwent the reoperation in the Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from August 2017 to January 2018 were collected.All three patients had been collected a detailed previous surgical history.After preoperative lab and imaging examinations,evaluation of liver function,residual liver volume and general condition were done,then 3 patients underwent left hemihepatectomy + dilated right hepatic duct and extrahepatic bile duct resection,right anterior and posterior hepatic duct reconstructive surgery and Roux-en-Y anastomosis of the jejunum.The surgical procedures followed as:intra-abdominal adhesions separation,extrahepatic antergrade dissection of porta hepatis,transverse cutting the dilated extrahepatic bile duct,split the cantlie line,exposure of the hilar plate,left hemihepatectomy,dilated right hepatic bile duct resection,right anterior and posterior hepatic duct remodeling and biliary-enteric anastomosis.Observation indicators included:(1) surgical and postoperative recovery;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect general condition,complications,liver function and residual choledochal cysts up to May 2018.Results (1) Surgical and postoperative recovery:All the 3 patients underwent choledochal cysts resection + left hemihepatectomy + dilated right hepatic duct + right anterior and posterior hepatic duct reconstructive surgery and Roux-en-Y anastomosis of the jejunum using the perihilar surgery technique and extrahepatic anterograde combined by intrahepatic retrograde dissection method exposing portal hepatis.There was no perioperative death.The operation time and volume of intraoperative blood loss in 3 patients were 435 minutes,490 minutes,395 minutes and 250 mL,300 mL,200 mL,respectively.There was no intraoperative blood transfusion.Three patients had no bleeding and abdominal liver function.One patient with bile leakage and delayed gastric emptying at 1 week postoperatively received puncture drainage,gastrointestinal decompression,gastric lavage with hypertonic saline,acupuncture and total parenteral nutrition,then bile leakage was cured after 3-week therapy,gastric motility was improved after 5-week therapy,and then gastric tube was removed.The abdominal drainage tube was removed at 3 weeks postoperatively in 1 patient and at 1 week postoperatively in 2 patients.The postoperative gross specimen examinations showed intra-and extra-hepatic bile duct dilatation in 3 patients,including 2 combined with choledocholithiasis and 1 with left intrahepatic bile duct cancer.The postoperative pathological findings showed that 3 patients had intrahepatic bile duct cystic dilatation with chronic inflammation,peripheral small bile duct hyperplasia with inflammatory cell infiltration,1 of which had intrahepatic intraductal papilloma with high grade intraepithelial neoplasia.One and 2 patients were discharged from hospital at 7 weeks postoperatively and 2 weeks postoperatively,respectively.(2) Follow-up:All 3 patients were followed up for 4-8 months.During the follow-up,patients had good general condition and no symptoms of cholecystitis such as abdominal pain,chills and fever,liver function was normal,and no residual bile duct cyst was found by enhanced scan of CT.Conclusion The perihilar surgery technique and extrahepatic anterograde combined by intrahepatic retrograde dissection method exposing portal hepatis for the treatment of biliary dilatation of central large intra-and extrahepatic bile ducts above the hilar convergence can increase the radical resection rate and surgical efficacy.
ABSTRACT
Objective To study a safe and effective method for the dissection of the cystic duct under laparoscope.Methods Laparoscopic cholecystectomy was performed in 1 460 cases,by using the retrograde dissection of the cystic duct,from December 2002 to December 2005 in this hospital. Results The laparoscopic cholecystectomy was successfully completed in 1 442 cases,with an operation time of 15~100 min(mean, 42 min).A conversion to open surgery was required in 18 cases(1.23%).Complications included 5 cases of bile duct injury(0.34%),3 cases of intraabdominal hemorrhage(0.21%),and 3 cases of biliary leakage(0.21%).Follow-up for 2~24 months(mean,11.8 months) found 2 cases of residual calculi in the common bile duct.Conclusions The retrograde dissection of the cystic duct during laparoscopic cholecystectomy is a safe method and simple to perform.