背景与目的:鞘外解剖法最早由日本学者Takasaki率先提出并且用于开腹肝切除,随着微创理念深入人心,外科手术逐渐步入微创时代,肝胆外科医生将鞘外解剖法灵活运用于腹腔镜肝切除术。本研究通过回顾性分析,比较腹腔镜下鞘外解剖法和鞘内...背景与目的:鞘外解剖法最早由日本学者Takasaki率先提出并且用于开腹肝切除,随着微创理念深入人心,外科手术逐渐步入微创时代,肝胆外科医生将鞘外解剖法灵活运用于腹腔镜肝切除术。本研究通过回顾性分析,比较腹腔镜下鞘外解剖法和鞘内解剖法处理右肝后叶肝蒂在解剖性右肝后叶切除的手术安全性以及近期疗效。方法:回顾性分析2015年1月—2019年9月湖南省人民医院行腹腔镜右肝后叶切除患者43例患者临床资料,其中,29例采用鞘外法处理右肝后叶肝蒂(鞘外组),14例采用鞘内法处理右肝后叶肝蒂(鞘内组),比较两组手术时间、术中失血量、住院天数、术后并发症、术后第3天肝功能指标(总胆红素,白蛋白,丙氨酸氨基转移酶,天门冬氨酸氨基转移酶)以及凝血酶原时间。结果:两组患者术前资料及疾病构成(均以原发性肝细胞癌为主)差异均无统计学意义(均P>0.05)。鞘外组的平均手术时间明显短于鞘内组(191.72 min vs. 231.54 min,P=0.001),两组患者术中失血量,术后第3天肝功能指标、凝血酶原时间、住院时间、近期并发症发生率差异均无统计学意义(均P>0.05)。两组均无围手术期死亡病例。结论:鞘外法与鞘内法在腹腔镜解剖性右肝后叶切除应用中安全性相当。但术前应该有充分的影像学资料以及对肝内管道解剖结构和变异情况充分了解。在严格掌握手术适应证,腹腔镜手术操作熟练的前提下运用鞘外法能缩短手术时间,提高手术效率。展开更多
Focal nodular hyperplasia of the liver(FNH)is a substantial benign liver lesion with an incidence second only to hepatic hemangioma.FNH is a substantial mass with abundant blood supply.It is uncommon in pregnancy,ther...Focal nodular hyperplasia of the liver(FNH)is a substantial benign liver lesion with an incidence second only to hepatic hemangioma.FNH is a substantial mass with abundant blood supply.It is uncommon in pregnancy,there is no clear evidence of whether FNH is associated with estrogen levels,and more information is needed to determine if FNH increases during pregnancy.A29-year-old pregnant woman who was pregnant for 20+ weeks came to the emergency department of our hospital for a day of abdominal pain and vomiting.For the protection of the fetus,the patient underwent color ultrasound and magnetic resonance imaging.The results showed that the benign tumor of the liver was ruptured and the subcapsular hematoma was formed.Meanwhile,the fetus was very healthy.Therefore,after a multidisciplinary discussion,our department performed surgical treatment for this patient.In the end,both the patient and the fetus recovered very well.We first reported a case of multiple focal nodular hyperplasia and rupture of the liver in pregnant women.Surgery is the main method for treating FNH rupture.展开更多
文摘背景与目的:鞘外解剖法最早由日本学者Takasaki率先提出并且用于开腹肝切除,随着微创理念深入人心,外科手术逐渐步入微创时代,肝胆外科医生将鞘外解剖法灵活运用于腹腔镜肝切除术。本研究通过回顾性分析,比较腹腔镜下鞘外解剖法和鞘内解剖法处理右肝后叶肝蒂在解剖性右肝后叶切除的手术安全性以及近期疗效。方法:回顾性分析2015年1月—2019年9月湖南省人民医院行腹腔镜右肝后叶切除患者43例患者临床资料,其中,29例采用鞘外法处理右肝后叶肝蒂(鞘外组),14例采用鞘内法处理右肝后叶肝蒂(鞘内组),比较两组手术时间、术中失血量、住院天数、术后并发症、术后第3天肝功能指标(总胆红素,白蛋白,丙氨酸氨基转移酶,天门冬氨酸氨基转移酶)以及凝血酶原时间。结果:两组患者术前资料及疾病构成(均以原发性肝细胞癌为主)差异均无统计学意义(均P>0.05)。鞘外组的平均手术时间明显短于鞘内组(191.72 min vs. 231.54 min,P=0.001),两组患者术中失血量,术后第3天肝功能指标、凝血酶原时间、住院时间、近期并发症发生率差异均无统计学意义(均P>0.05)。两组均无围手术期死亡病例。结论:鞘外法与鞘内法在腹腔镜解剖性右肝后叶切除应用中安全性相当。但术前应该有充分的影像学资料以及对肝内管道解剖结构和变异情况充分了解。在严格掌握手术适应证,腹腔镜手术操作熟练的前提下运用鞘外法能缩短手术时间,提高手术效率。
基金Huxiang Youth Talent Support Program(Grant No.2020RC3066)Postdoctoral Innovation Talents Project(Grant No.2020RC2064)The Project of Improving the Diagnosis and Treatment Capacity of Hepatobiliary,Pancreas and Intestine Disease in Hunan Province(Xiangwei[2019]Grant No.118)。
文摘Focal nodular hyperplasia of the liver(FNH)is a substantial benign liver lesion with an incidence second only to hepatic hemangioma.FNH is a substantial mass with abundant blood supply.It is uncommon in pregnancy,there is no clear evidence of whether FNH is associated with estrogen levels,and more information is needed to determine if FNH increases during pregnancy.A29-year-old pregnant woman who was pregnant for 20+ weeks came to the emergency department of our hospital for a day of abdominal pain and vomiting.For the protection of the fetus,the patient underwent color ultrasound and magnetic resonance imaging.The results showed that the benign tumor of the liver was ruptured and the subcapsular hematoma was formed.Meanwhile,the fetus was very healthy.Therefore,after a multidisciplinary discussion,our department performed surgical treatment for this patient.In the end,both the patient and the fetus recovered very well.We first reported a case of multiple focal nodular hyperplasia and rupture of the liver in pregnant women.Surgery is the main method for treating FNH rupture.
