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Treatment of large bone defects and nonunion induced by various causes requires bone graft, and autologous iliac bone graft has always been considered as the gold standard for the treatment of bone transplantation. However, there exist problems such as postoperative pain and numbness in the donor area or insufficient bone taking. The application of reamer-irrigator-aspirator(RIA)technique can reduce complications in the donor area and collect a maximum of 90 ml of autologous bone to treat large bone defects. In addition, it can also be used to remove the infected lesion and residual bone cement in the medullary cavity. The authors review the instrument structure, operation process, clinical application and complications of RIA technique, so as to provide a reference in the treatment of bone defects and intramedullary canal infection.
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Objective:To explore the relationship between different gestational weeks of transvaginal ultrasound-guided fetal reduction and abortion in patients with multiple pregnancies after embryo transfer, and to seek the best gestational age for fetal reduction.Methods:The datas of 486 pregnant women with multiple pregnancies after embryo transfer in the Second Hospital of Hebei Medical University from January 2012 to December 2020 were retrospectively analyzed. The relationship between gestational weeks of fetal reduction and abortion rate was analyzed by curve fitting, threshold effect and multivariate logistic regression analysis.Results:After adjusting for age, infertility type, infertility years, number of births, abortion times, body mass index(BMI), various infertility and sterility factors, endometrial thickness on the day of transformation, monozygotic twins and reduction methods, when the gestational age was less than 8.43 weeks, the abortion rate increased significantly with the increase of reduction gestational age, and the abortion rate increased by 221% ( OR=3.21, 95% CI=1.47-6.99, P=0.003 3). When the gestational age of reduction ≥8.43 weeks, the abortion rate tended to be stable and did not increase ( OR=0.81, 95% CI=0.54-1.22, P=0.317 7); meanwhile, in stratified analysis, the OR value of the BMI ≥24 kg/m 2 was 12.38, and that of BMI <24kg/m 2 was 1.91, P=0.053 9. Conclusions:There is a non-linear relationship between gestational age and abortion rate of ultrasound-guided multiple pregnancy reduction in patients with embryo transfer. The abortion rate increases significantly with the increase of gestational age before 8.43 weeks of gestation. It is recommended to carry out the operation as early as possible before 8 weeks of pregnancy. The effect of BMI on the abortion rate of patients with fetal reduction needs further study.
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Since its official application in clinical practice in 2000, da Vinci robotic technology has developed rapidly in recent ten years, especially in the last two years, during which this technology has been widely promoted and used in China. However, in hepatopancreatobiliary (HPB) surgery, da Vinci robotic technology has only been applied in a few large medical centers in China, and its application in HPB surgery is significantly limited compared with that in gastrointestinal surgery, urological surgery, and gynecology, which may be associated with the complexity of HPB surgery and the high risk of postoperative complications. Therefore, how to further promote the application of da Vinci robotic technology in HPB surgery and expand its indications has become an important direction for HPB surgeons.
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Objective:To investigate the effect of endometrial thickness(EMT) on the clinical outcome of blastocyst hormone replacement freeze-thawed embryo transfer (HRT-FET) on the first progesterone day, and to analyze the threshold and optimal thickness interval corresponding to ideal clinical pregnancy rate by statistical method.Methods:The endometrial preparation protocols of 2 825 blastocyst HRT-FET cycles from January 2013 to December 2016 in Henan Provincial People′s Hospital and the Second Hospital of Hebei Medical University were studied retrospectively. According to EMT on the first progesterone day, they were divided into 5 subgroups: group Q1(EMT: 3.5-7.9 mm), group Q2(EMT: 8.0-8.9 mm), group Q3(EMT: 9.0-9.5 mm), group Q4(EMT: 9.6-10.7 mm), group Q5(EMT: 10.8-21.0 mm). Univariate analysis, classification multivariate Logistic regression analysis, curve fitting and threshold effect analysis were used to investigate the effect of endometrial thickness on clinical outcome of blastocyst HRT-FET.Results:Group Q1 was set as the control group in classification multivariate Logistic regression analysis, after adjusting for confounding factors, the clinical pregnancy rate and live birth rate in other groups were higher than the control group. The clinical pregnancy rate and live birth rate in group Q3 and Q4 were significantly increased and the differences were statistically significant(all P<0.05). The cut-off value of the endometrial thickness was 9.6 mm. When endometrial thickness was less than 9.6 mm, with 1 mm increase of endometrial thickness, the clinical pregnancy rate increased by 23%( OR=1.23, 95% CI=1.11-1.36) and the live birth rate increased by 21%( OR=1.21, 95% CI=1.10-1.33). When the endometrial thickness was thicker than the threshold, the clinical pregnancy rate did not increase significantly( OR=0.92, 95% CI=0.84-1.02), and the live birth rate showed a downward trend( OR=0.88, 95% CI=0.81-0.96). Conclusions:In the blastocyst HRT-FET cycle, endometrial thickness showes a curvilinear relationship with clinical outcome. The optimal endometrial thickness range for ideal clinical outcome is 9.0-11.0 mm.
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Objective To evaluate the Thompson procedure in the treatment of chronic mallet finger with tendon defect.Methods From July 2014 to October 2016,9 cases of chronic mallet finger with tendon defect were treated by Thompson procedure at Department of Hand Surgery,Wuhan Puai Hospital.They were 4 males and 5 females,aged from 25 to 56 years (average,36 years).Their disorder was on the left side in 3 cases and on the right side in 6 ones,involving 2 index fingers,3 middle fingers,3 ring fingers and one little finger.The ranges of motion (ROM) for distal and proximal interphalangeal joints were measured after operation.Operative complications were observed and recorded.Dargan functional assessment was used to evaluate the outcomes at the final follow-up.Results All the 9 patients were followed up for 5 to 36 months (average,16.5months).The wounds healed primarily without such complications as infection,skin breakage,abnormal fingertip sensation or nail deformity.All cases of mallet finger malformation were corrected.About 10 weeks after operation,one case presented with mild mallet finger malformation which was completely corrected after active fixation for 8 weeks.The Dargan assessment at the final follow-up showed 8 excellent and one good cases.Conclusion Thompson procedure can lead to satisfactory outcomes and limited complications in the treatment of chronic mallet finger with tendon defect.
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BACKGROUND: Robotic distal pancreatectomy exhibits short-term benefits over laparoscopic distal pancreatectomy. The use of minimal invasive techniques to carry out distal pancreatosplenectomy (DPS) for pancreatic ductal adenocarcinoma (PDAC) remains controversial and has not gained popular acceptance. A comparative study was designed to analyze the short- and mid-term outcomes of robotic DPS (RDPS) versus laparoscopic DPS (LDPS) on patients with PDAC. METHODS: The baseline characteristics, perioperative outcomes and survival data among patients who underwent RDPS (nâ¯=â¯35) versus LDPS (nâ¯=â¯35) for PDAC between December 2011 and December 2015 were compared after a 1:1 propensity score matching. RESULTS: There were no significant differences in the operative time, blood loss, blood transfusion rate, and morbidity and pancreatic fistula rates between the RDPS and LDPS groups. RDPS significantly reduced the rate of conversion to laparotomy (5.7% vs. 22.9% when compared with LDPS, pâ¯=â¯0.04). There were no significant differences in R0 resection rates, number of harvested lymph nodes, positive to harvested lymph node ratios, and disease-free survival and overall survival rates between the two groups. A Cox proportional hazards analysis showed N1 stage to be significantly associated with worse survival and suggested that chemotherapy might prolong overall survival in these PDAC patients. CONCLUSIONS: This single-center study demonstrated that RDPS was safe and efficacious in treatment of PDAC. When compared with LDPS, RDPS was associated with a reduced rate of conversion to open surgery. There were no significantly differences in oncological outcomes and mid-term survival rates between the groups of patients who underwent RDPS or LDPS.
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Carcinoma, Pancreatic Ductal/mortality , Laparoscopy/mortality , Pancreatectomy/mortality , Pancreatic Neoplasms/surgery , Robotic Surgical Procedures/mortality , Splenectomy/methods , Adult , Aged , Blood Transfusion/statistics & numerical data , Carcinoma, Pancreatic Ductal/surgery , Conversion to Open Surgery , Female , Humans , Laparoscopy/methods , Laparotomy , Lymph Nodes/pathology , Male , Middle Aged , Operative Time , Pancreatectomy/methods , Pancreatic Fistula/etiology , Pancreatic Neoplasms/mortality , Postoperative Complications/etiology , Propensity Score , Retrospective Studies , Robotic Surgical Procedures/methods , Survival Rate , Treatment OutcomeABSTRACT
Objective To explore the procedure method and treatment outcome for the dual intersecting trapezoid flaps for repairing flexion contractures of fingers.Methods From February 2013 to April 2015,data of 26 fingers in 11 patients with flexion contractures who were treated with dual intersecting trapezoid flaps and followed up for more than 1 year were retrospectively analyzed.There were 7 males (16 fingers) and 4 females (10 fingers) with an average age of 38.2 years old (ranged from 28 to 60 years old).17 cases of right finger,and 9 cases of the left.There were 8 fingers of mild contracture,14 fingers of moderate contracture,and 4 fingers of severe contracture.Take the scar wrinkle tension line as the central axis,the distance was from 0.5cm to 0.Scm,and decompose the medial axis evenly,form several symmetrical trapezoid skin flaps on the radial side and ulnar side of the fingers.The direction of the double arm of the trapezoid flap is relative to the angle of the central axis from 60° to 70°,and the double skin flap is interlaced.Incisions were designed in a dual intersecting trapezoid flap over the contracture.Coverd the wound with excess skin and scar folds on the dorsal side of the lateral and interphalangeal joints,and full thickness skin graft was utilized to repair skin defect.Results All 24 flaps survived without blood circulation disorders and infections.Only 2 cases appeared flap tip necrosis,delayed healing.The mean active extension and flexion of DIP joints in mild contracture patients were-3° (ranged from-8° to 0°) and 45° (range from 30° to 60°),respectively;and PIP joints were-5° (ranged from-10° to 0°)and 90° (ranged from 70° to 110°),respectively.Contracture scars were extended by an average of 150%.The mean active extension and flexion of DIP joints in moderate contracture in patients were-5° (ranged from-9° to 0°) and 35° (ranged from 20° to 50°),respectively;and PIP joints were-5° (ranged from-10° to 0°) and 85° (ranged from 75° to 120°),respectively.Contracture scars were extended by an average of 130%.The mean active extension and flexion of DIP joints in severe contracture patients were-8° (ranged from-15° to-5°) and 17° (ranged from 10° to 25°),respectively;and PIP joints were-8° (ranged from-10° to-5°) and 78° (ranged from 70° to 90°),respectively.Contracture scars were extended by an average of 220%.According to the upper extremity functional evaluation standard by Hand Surgery Branch of Chinese Medical Association,mild contracture:the results were rated as excellent in 6 cases,good in 1 case and fair in 1 case.The overall satisfactory rate was 87.5%;moderate contracture:the results were rated as excellent in 12 cases,good in 1 case and fair in 1 case.The overall satisfactory rate was 92.9%;severe contracture:the results were rated as excellent in 2 cases,good in 1 case and fair in 1 case.The overall satisfactory rate was 75%.Conclusion The dual intersecting trapezoid flap plasty is easy to use,which has rich vascularity and mobility,and it is a good way to correct the cross-joint scar contracture flexion deformity with less complications.
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Objective To evaluate the outcomes of the free bone flap of medial femoral condyle for treatment of old scaphoid fracture with bone necrosis and review the utility of this procedure.Methods Eleven cases of old scaphoid fracture with bone necrosis were treated with the free medical femoral condyle bone grafting between Feburay,2013 and May,2015(9 males and 2 females).The average age was 34 years ranged from 27 to 55 years.Six cases were in left wrist,and other 5 cases were in right.Six cases were in waist area,and the other 5 cases were proximal pole nonunion.All cases were evaluated with 3D-CT scan,while humpback deformity were occurred in 6 cases,and avascular necrosis at the proximal pole were occurred in 3 cases.After refreshing the fracture,the free medical femoral condyle bone was transferred to the scaphoid,reduct the scaphoid and fix with the Kirschner wire.An endto-side anastomosis was performed with the bone flap artery and the radial artery,accompanied by the end to end anastomosis of the flap vein and the vein with the radial artery.The plaster was used for 8 weeks.Bone healing was evaluated with X-ray and 3D CT scan.A functional review was performed after the operation and a Mayo wrist scoring test was taken 6 months after the treatment.Results The average followed-up period was 13.1 months(ranged from 9 to 24 months).Bone union were demonstrated in all cases at 13.4 weeks after the operation (ranged from 11 to 18 weeks).Mayo wrist scoring testing showed excellent in 5 cases,good in 4 cases,and fair in 2 cases.Conclusion Free bone flap of medial femoral condyle is constant in vascular anatomy,and is easy to perform with plenty bone graft and less morbidity at donor site.Medial femoral condyle bone flap transplantation based on the descending gennicular vessels is an effective method for treatment of old scaphoid fracture with bone necrosis.
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Objective@#To evaluate the feasibility and strategy of the lesser omentum approach for laparoscopic pancreatic enucleation.@*Methods@#Between June 2011 and October 2013, 6 laparoscopic pancreatic enucleations were performed by lesser omentum approach.The average age was 42 years, including 1 male and 5 female.The preoperation diagnosis of 6 cases were pancreatic islet cell tumors determined by abdominal CT/MRI, ultrasound and digital subtraction angiography.The tumors of 3 cases located in pancreatic neck, 2 tumors located in neck and body of pancreas, and 1 tumor located in pancreatic body.Their biggest tumor diameter were 0.8-2.5 cm.@*Results@#Among the 6 cases, all laparoscopic pancreatic enucleations were successfully performed.None of the patients were converted to open operation.Eestimated blood loss was (26.7±18.6)ml, operating time was (82.5±19.4)minutes, and postoperative length of stay was (5.17±1.17)days.Additionally, postoperative complication included grade A pancreatic fistula in 1 case.After 36-64 months followed-up, there was no tumor recurrence and clinical symptom disappeared.@*Conclusion@#For the islet cell tumors located in pancreatic neck and body, the lesser omentumapproach may contribute to good surgical view and operative space, which can make pancreatectomy safer and easier for clinical application.
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Objective@#To investigate the effects of vacuum sealing drainage technique in acute and chronic suppurative tenosynovitis of hand.@*Methods@#A total of 9 cases acute and chronic suppurative tenosynovitis patients from January 2013 to April 2015 in Puai Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology were retrospectively reviewed. There were 6 males and 3 females, aging from 27 to 65 years, the average age was 55 years. There were 3 cases of index finger, 3 cases of middle finger, 2 cases of ring finger, 1 case include three fingers. The infection causes included stabbing with fishbone in 3 cases, stabbing with animal bone fragments in 3 cases, wound by sawdust in 3 cases, meat grinder injury in 1 case, multiple fingers crush injury postoperative infection of garbage truck in 1 case. Bacterial infection included 2 cases with Staphylococcus aureus, 2 cases with Staphylococcus epidermidis, 1 case with normal Escherichia coli, 1 case with mixed infection of Enterobacter aerogenes, Klebsiella oxytoca and Staphylococcus, 1 case with Bauman Acinetobacter bacillus, 1 case with Proteus mirabilis and 1 case of no growth of pathogenic bacteria culture. After thorough debridement, vacuum sealing drainage was used to observe the characteristics of irrigation fluid, the formation of cavity inflammation, the prognosis of infection and the recovery of finger function.@*Results@#Seven patients with suppurative tenosynovitis were treated for 7 to 14 days, replaced the vacuum sealing drainage dressing once; 1 patient was an illustration of the finger tip defect flap infected patients after 21 days of treatment, replaced the vacuum sealing drainage dressing twice, 1 patient was an illustration of the central refers to trauma, postoperative infection patients 28 d, replaced three times in the VSD. The follow-up time was 3 to 12 months (mean 8.2 months), 7 patients without tendon necrosis, secondary suture with no infection, 2 cases of traumatic surgery of patients with infection, tendon necrosis was removed, the infection has been effectively controlled, secondary suture with no infection. There were 6 cases were good and 3 cases were poor in the evaluation of postoperative finger function.@*Conclusion@#Thoroughly debridement after vacuum sealing drainage in the treatment of suppurative tenosynovitis of hand has satisfactory curative effect.
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Objective To investigate the expressions of serum cystatin C CysC),retinolbinding protein (RBP),serum and urinary β2-microglobulin (β2-MG) and their effects on predicting renal damage in primary hypertension in elderly patients.Methods A total of 149 patients were divided into 3 groups of hypertension grade 1 (n =50),hypertension grade 2 (n =50) and hypertension grade 3 group (n=49).92 healthy controls who took physical examination were selected as control group.The levels of serum CysC,RBP,serum and uric β2-MG,blood urea nitrogen,creatinine and other biochemical indexes were detected.The complications of hypertension were observed.The differences in renal function indexes between groups and their correlations were analyzed.Results There were 86 cases with hyperlipidemia (57.7%),71 cases with atherosclerosis (47.7%),59 cases with type 2 diabetes mellitus (39.6%),56 cases with coronary heart disease (37.6%),and 49 cases with cerebral vascular disease (32.9%) in 149 hypertensive patients.The levels of serum CysC,RBP,serum and uric β2-microglobulin were increased in hypertensive patients as compared with healthy controls (P<0.05 or 0.01),and the extents of increments in the above indexes were positively correlated with blood pressure level [CysC:(1.2± 0.5) mg/L,(1.7±0.6) mg/L,(2.2±0.9) mg/L;RBP:(53.1±10.2) mg/L,(65.2±16.3)mg/L,(75.8±17.5) mg/L;serum β2-MG:(2.7±1.5) mg/L,(4.0±2.1) mg/L,(4.9±2.0) mg/L;uric β2-MG:(178.3±73.9) ng/L,(237.9±78.6) ng/L,(277.5±87.5) ng/L;respectively,P<0.05or 0.01].Conclusions Elderly hypertensive patients are complicated with a variety of diseases.The levels of serum CysC,retinol-binding protein,serum and uric β2 microglobulin have significant diagnostic values on renal impairment caused by hypertension,and can be considered as sensitive factors for early renal impairment in essential hypertension.
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BACKGROUND: Retroperitoneoscopic pancreatectomy (RP) is a novel surgical procedure that is safe and feasible in animal models and clinical practice. However, the optimal approach for RP has not been established. OBJECTIVE: This study aimed to introduce the posterior and lateral approaches for RP. METHODS: This prospective study included 19 patients with suspected pancreatic lesions who underwent RP. RP was performed using either a posterior or a lateral approach. RESULTS: The posterior, lateral, and jointed approaches were used in 13 (68.4 %), 3 (15.8 %), and 3 (15.8 %) cases, respectively. Patients underwent enucleation (N = 8), distal pancreatectomy (N = 4), and resection of cystic pancreatic lesions (N = 2) and non-pancreatic lesions (N = 5). All retroperitoneoscopic procedures were successfully accomplished with no conversion to open or laparoscopic surgery. Intraoperative complications occurred in two (12.5 %) cases, including one case with injury to the peritoneum and one case with injury to the peritoneum and splenic vein. Postoperative grade A pancreatic fistulas occurred in six cases, and were cured by delayed drainage. No disease recurrence or abnormal symptoms were observed during the mean follow-up period of 14.06 ± 9.60 months. CONCLUSIONS: RP using the posterior or lateral approach is feasible and effective, but has different indications. The posterior approach is useful for distal pancreatectomy, as well as resection of pancreatic lesions in the posterior or superoposterior region of the distal pancreas. The lateral approach is useful for resection of pancreatic lesions in the anterior or inferior region of the body and tail. The two approaches can be used in combination or conversion.
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Laparoscopy/methods , Pancreatectomy/methods , Pancreatic Fistula/etiology , Pancreatic Neoplasms/surgery , Retroperitoneal Space/surgery , Adult , Aged , Animals , Blood Loss, Surgical , Female , Humans , Laparoscopy/adverse effects , Male , Middle Aged , Neoplasm Recurrence, Local/surgery , Operative Time , Pancreatectomy/adverse effects , Pancreatic Fistula/surgery , Peritoneum/injuries , Prospective Studies , Splenic Vein/injuries , Young AdultABSTRACT
Objective:By observing the effects of curcumin on synovial pathology, synovial osteoprotegerin and receptor activator of nuclear factor κB ligand expression factor of adjuvant arthritis rat models, we try to explore the possible mechanism of prevention and treatment of rheumatoid arthritis.Methods: There were three groups, the normal group, the model group and the curcumin group.We made adjuvant arthritis rat models with Freund′s complete adjuvant,and they were divided into the model group and the curcumin group.On d 28 after modeling,all rats were killed.All synovial membranes were sent for routine histological evaluation with HE staining.And synovial RANKL and OPG protein expression were measured by Western blot.Results: Curcumin could influence synovium pathology change of adjuvant arthritis rats,the pathological picture showed that infiltration of joint synovial cell,pro-liferation of synovial fibroblasts in model group rats were significantly increased,compared with normal group( P<0.01).Pathology of rats synovial tissue in rats of curcumin group were significantly improved, compared with that in rats of model group.Expression of RANKL,OPG protein in synovial tissue of curcumin group,based on pairwise comparison between with model group,the results were statistically significant( P<0.01 ).Synovial RANKL/OPG ratio were significantly lower than model group ( P<0.01 ).Conclusion:Curcumin can improve synovial pathology damage of adjuvant arthritis rats,curcumin may exert a protective effect on arthritis rats by regulating OPG/RANKL signaling pathway.
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Objective To analysis the result of tumor screening for health examination participants.Methods Tumor screening was applied for 15 863 health examination participants without malignant tumor disease history.Clinical examination,laboratory tests and imaging studies were comprehensively analysed combining the results of other medical items.The cancer detection rate and asymptomatic rate were compared among groups of different age,gender and existence of relevant clinical symptoms,respectively.χ2 test and Fisher exact test were adopted for statistical analysis.Results Among 475 tumor patients with a definite diagnosis,116 were malignant tumor;The total detection rate of the group who were younger than 35 year-old(0.617%)was higher than other groups,the detection rate of intracranial neoplasms of the two groups who were younger than 45 year-old (0.206% and 0.132%,respectively)was higher than other groups,the total detection rate of 75-85 group (0.248%)was lower than other groups; The detection rate of lung cancer,liver cancer of the male(0.228% and 0.080%,respectively)was higher than the female,The detection rate of breast cancer and intracranial neoplasms of the female(0.366% and 0.100%,respectively)was higher than the male; There are 67 patients without correlated clinical symptoms,the asymptomatic rate was 57.8%.Conclusions Tumor screening was of importance in health management,which should be carried out actively in health examination.
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Objective To evaluate the outcome of living donor liver transplantation(LDLT)for hepatocellular carcinoma(HCC).Methods We retrospectively analyzed the clinical data of 180 patients,who had received LDLT(n=34)or deceased donor liver transplantation(DDLT,n=146)for HCC,compared overall and recurrence-free survival between LDLT and DDLT,and identified the risk factors of tumor recurrence and prognosis by univariate and multivariate analysis.Results The 5-year overall survival and recurrence-free survival rate were 53 % and 58 %,respectively,in DDLT group,and 60 % and 60 %,respectively,in LDLT group.There was no significant difference in overall (P=0.85)and recurrence-free(P=0.89)survival between these two groups.The tumor recurrence rate was 26.5 % in LDLT group,and 17.8 % in DDLT group,respectively(P=0.25).Multivariate COX regression model analysis identified vascular invasion(relative risk 2.118,95 % confidential interval 1.201-4.353,P=0.032)and tumor beyond UCSF criteria(relative risk 3.490,95 % confidential interval 1.862-8.207,P=0.015)as independent risk factors of tumor recurrence,and tumor beyond UCSF criteria(relative risk 8.573,95 % confidential interval 3.016-18.261,P=0.006)as independent predictors of prognosis.Conclusion LDLT is a safe and effective procedure for patients with HCC,but further studies are required for selection criteria of recipients and higher HCC recurrence rate after LDLT.
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OBJECTIVE@#To investigate the role and clinical significance of the expression of BRMS1 gene in development and progression of nasal and paranasal sinus carcinomas.@*METHOD@#The expression of BRMS1 protein was detected by immunohistochemistry method in the 53 nasal and paranasal sinus carcinomas and 24 nasal polyp tissues and 10 normal mucosa. The expression of BRMS1 was analyzed in nasal and paranasal sinus carcinomas with different clinicopathological parameters.@*RESULT@#The expression of BRMS1 in normal tissues (90.0%) and nasal polyp tissues (79.2%) was statistically significantly higher than that in nasal and paranasal sinus carcinomas (39.6%) (P < 0.01). There was a positive correlation between BRMS1 expression and TNM staging and lymph node metastasis; but not associated with pathological grade.@*CONCLUSION@#The loss of BRMS1 expression may be involved in the development and progression of nasal and paranasal sinus carcinomas.
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Adult , Aged , Female , Humans , Male , Middle Aged , Genes, Tumor Suppressor , Lymphatic Metastasis , Neoplasm Proteins , Genetics , Neoplasm Staging , Nose Neoplasms , Genetics , Pathology , Paranasal Sinus Neoplasms , Genetics , Pathology , Repressor ProteinsABSTRACT
Objective To assess the feasibility,safety and advantages of robotic-assisted precise hepatectomy.Methods Between April and July 2009,13 consecutive patients underwent robotic-assisted hepatectomy for hepatic diseases.The clinical data were analyzed retrospectively.Results All 13 Da Vinci surgical systemassisted precise hepatectomies were successfully performed without conversion to laparotomy.Major hepatectomies were performed in 9 patients,left lateral segmentectomies in 4 patients.All the Da Vinci surgical system-assisted hepatectomies were performed anatomically with hilum dissection.Prior to the parenchymal transaction,vascular control of the portal vessels was carried out whenever possible.The mean operative time was 338 minutes(range,150-720 minutes).The mean blood loss was 208 ml(range,50-800 ml).No patient required blood transfusion,and no mortality,transient bile leakage was observed in patients with hilar cholangiocarcinoma.The mean postoperative stay was 7 days(range,2-13 days).Conclusions These preliminary results show that Da Vinci surgical system-assisted precise hepatectomy is safe and feasible with potential benefits of a minimally invasive approach.Da Vinci surgical system may broaden the indications for laparoscopic hepatactomy,and it enables surgeons to perform precise laparoscopic hepatectomy which required hilum dissection,hepatocaval dissection,endoscopic suturing and microanastamosis.
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Objective To evaluate the effect of Da Vinci surgical system for the treatment of hepatopancreatobiliary diseases.Methods The clinical data of 29 patients with hepatopancreatobiliary diseases who had undergone operations with Da Vinci surgical system from March to November 2009 at the General Hospital of PLA were retrospectively analyzed.Results The operations were successfully done on 28 patients,except 1 patient was converted to open pancreaticoenterostomy.The total operation time was(339±149)minutes,and the time for operations done with Da Vinci surgical system was(285±117)minutes.The postoperative bowl movement recovery time was(33±21)hours,and the length of postoperative hospital stay was(8±6)days.No blood transfusion was needed.Three patients had postoperative complications and were cured by conservative treatment.Conclusion Laparoscopic operations for hepatopancreatobiliary diseases can be applied with the help of the threedimensional imaging system and flexible surgical instruments of the Da Vinci surgical system,and its superiority is more obvious when applied for intractable hepatopancreatobiliary diseases.