目的:探讨机器人辅助腹腔镜下腔静脉癌栓切除术联合肝尾状叶切除术治疗301Ⅱ~Ⅲ级下腔静脉癌栓的可行性和有效性。方法:回顾性分析2021年1月至2022年6月于解放军总医院第一医学中心行机器人辅助腹腔镜下腔静脉癌栓切除术的5例患者的临...目的:探讨机器人辅助腹腔镜下腔静脉癌栓切除术联合肝尾状叶切除术治疗301Ⅱ~Ⅲ级下腔静脉癌栓的可行性和有效性。方法:回顾性分析2021年1月至2022年6月于解放军总医院第一医学中心行机器人辅助腹腔镜下腔静脉癌栓切除术的5例患者的临床资料,所有患者术中均联合部分肝尾状叶切除以显露肝后段下腔静脉。其中男性2例,女性3例,中位年龄61(60~75)岁;中位体质量指数24.8(21.7~25.3)kg/m2。根据301分级,Ⅱ级癌栓患者1例,Ⅲ级癌栓患者4例。下腔静脉癌栓中位高度10.8(10.4~13.1)cm,癌栓中位最大径2.0(1.5~3.9)cm。结果:5例患者手术均顺利完成,无中转开放。中位手术时间510(290~795)m i n,中位失血量1500(900~2000)ml。患者术后中位重症监护室(intensive care unit,ICU)住院时间4(0~7)d,中位总住院时间11(6~13)d。术后出现Ⅰ级并发症2例,Ⅱ级并发症3例,无围术期死亡病例。出院时该5例患者的肝、肾功能均降至基线水平。中位随访时间8.3(2.5~16.1)个月,无肿瘤复发、进展、转移等情况。结论:对于肾肿瘤伴高度毗邻第二肝门的粗大下腔静脉癌栓的患者,术中切除肝尾状叶能够更好地显露肝后段下腔静脉,有利于术中尽早控制癌栓近心端下腔静脉,从而提高手术的安全性。展开更多
Bedding slope is a typical heterogeneous slope consisting of different soil/rock layers and is likely to slide along the weakest interface.Conventional slope protection methods for bedding slopes,such as retaining wal...Bedding slope is a typical heterogeneous slope consisting of different soil/rock layers and is likely to slide along the weakest interface.Conventional slope protection methods for bedding slopes,such as retaining walls,stabilizing piles,and anchors,are time-consuming and labor-and energy-intensive.This study proposes an innovative polymer grout method to improve the bearing capacity and reduce the displacement of bedding slopes.A series of large-scale model tests were carried out to verify the effectiveness of polymer grout in protecting bedding slopes.Specifically,load-displacement relationships and failure patterns were analyzed for different testing slopes with various dosages of polymer.Results show the great potential of polymer grout in improving bearing capacity,reducing settlement,and protecting slopes from being crushed under shearing.The polymer-treated slopes remained structurally intact,while the untreated slope exhibited considerable damage when subjected to loads surpassing the bearing capacity.It is also found that polymer-cemented soils concentrate around the injection pipe,forming a fan-shaped sheet-like structure.This study proves the improvement of polymer grouting for bedding slope treatment and will contribute to the development of a fast method to protect bedding slopes from landslides.展开更多
文摘目的:探讨机器人辅助腹腔镜下腔静脉癌栓切除术联合肝尾状叶切除术治疗301Ⅱ~Ⅲ级下腔静脉癌栓的可行性和有效性。方法:回顾性分析2021年1月至2022年6月于解放军总医院第一医学中心行机器人辅助腹腔镜下腔静脉癌栓切除术的5例患者的临床资料,所有患者术中均联合部分肝尾状叶切除以显露肝后段下腔静脉。其中男性2例,女性3例,中位年龄61(60~75)岁;中位体质量指数24.8(21.7~25.3)kg/m2。根据301分级,Ⅱ级癌栓患者1例,Ⅲ级癌栓患者4例。下腔静脉癌栓中位高度10.8(10.4~13.1)cm,癌栓中位最大径2.0(1.5~3.9)cm。结果:5例患者手术均顺利完成,无中转开放。中位手术时间510(290~795)m i n,中位失血量1500(900~2000)ml。患者术后中位重症监护室(intensive care unit,ICU)住院时间4(0~7)d,中位总住院时间11(6~13)d。术后出现Ⅰ级并发症2例,Ⅱ级并发症3例,无围术期死亡病例。出院时该5例患者的肝、肾功能均降至基线水平。中位随访时间8.3(2.5~16.1)个月,无肿瘤复发、进展、转移等情况。结论:对于肾肿瘤伴高度毗邻第二肝门的粗大下腔静脉癌栓的患者,术中切除肝尾状叶能够更好地显露肝后段下腔静脉,有利于术中尽早控制癌栓近心端下腔静脉,从而提高手术的安全性。
基金supported by the Fujian Science Foundation for Outstanding Youth(Grant No.2023J06039)the National Natural Science Foundation of China(Grant No.41977259 and No.U2005205)Fujian Province natural resources science and technology innovation project(Grant No.KY-090000-04-2022-019)。
文摘Bedding slope is a typical heterogeneous slope consisting of different soil/rock layers and is likely to slide along the weakest interface.Conventional slope protection methods for bedding slopes,such as retaining walls,stabilizing piles,and anchors,are time-consuming and labor-and energy-intensive.This study proposes an innovative polymer grout method to improve the bearing capacity and reduce the displacement of bedding slopes.A series of large-scale model tests were carried out to verify the effectiveness of polymer grout in protecting bedding slopes.Specifically,load-displacement relationships and failure patterns were analyzed for different testing slopes with various dosages of polymer.Results show the great potential of polymer grout in improving bearing capacity,reducing settlement,and protecting slopes from being crushed under shearing.The polymer-treated slopes remained structurally intact,while the untreated slope exhibited considerable damage when subjected to loads surpassing the bearing capacity.It is also found that polymer-cemented soils concentrate around the injection pipe,forming a fan-shaped sheet-like structure.This study proves the improvement of polymer grouting for bedding slope treatment and will contribute to the development of a fast method to protect bedding slopes from landslides.
