Simultaneous colorectal and parenchymal-sparing liver resection for advanced colorectal carcinoma with synchronous liver metastases:Between conventional and mini-invasive approaches

The optimal timing of surgery in case of synchronous presentation of colorectal cancer and liver metastases is still under debate.Staged approach,with initial colorectal resection followed by liver resection(LR),or even the reverse,liver-first approach in specific situations,is traditionally preferred.Simultaneous resections,however,represent an appealing strategy,because may have perioperative risks comparable to staged resections in appropriately selected patients,while avoiding a second surgical procedure.In patients with larger or multiple synchronous presentation of colorectal cancer and liver metastases,simultaneous major hepatectomies may determine worse perioperative outcomes,so that parenchymal-sparing LR should represent the most appropriate option whenever feasible.Mini-invasive colorectal surgery has experienced rapid spread in the last decades,while laparoscopic LR has progressed much slower,and is usually reserved for limited tumours in favourable locations.Moreover,mini-invasive parenchymal-sparing LR is more complex,especially for larger or multiple tumours in difficult locations.It remains to be established if simultaneous resections are presently feasible with mini-invasive approaches or if we need further technological advances and surgical expertise,at least for more complex procedures.This review aims to critically analyze the current status and future perspectives of simultaneous resections,and the present role of the available miniinvasive techniques.

Can bone mineral density affect intra-operative blood loss of mini-invasive posterior lumbar interbody fusion?

Objective:Many factors affect intraoperative blood loss(BL)in mini-invasive posterior lumbar interbody fusion(PLIF)procedures,but only few has examined.Specifically,the impact of bone mineral density(BMD)levels on intraoperative BL.This study aims to examine the correlation between these two factors.Methods:Retrospective review of 120 patients with low back disorders who were scheduled to undergo mini-invasive PLIF from October 2018 to October 2019 was performed.Patients were divided into two groups based on BMD of the lumbar spine:normal group and abnormal group(osteoporosis and osteopenia).Comparison of age,gender,BMD,BL,BMI,prothrombin time,activated partial thromboplastin time,haemoglobin concentration,intraoperative mean arterial pressure,platelet count,and operative time(OT)between the two groups,and correlation analysis of BMD and BL were conducted.Results:The mean BL of patients in the abnormal group was remarkably higher than that in the normal group:357.22±152.55 ml and 259.37±125.90 ml respectively(p<0.001).The partial correlation coefficient between BL and BMD was0.45(p<0.001).The results of univariate regression analysis demonstrated that only BMD,gender,and OT were related to BL(BMD,r=0.427,p<0.001;gender,r=0.211,p=0.024;OT,r=0.318,p=0.001).While multivariate linear regression analysis demonstrated that patients with lower BMD and longer OT had a higher amount of intraoperative BL(p<0.001).Conclusions:BMD is an important factor influencing intraoperative BL in mini-invasive PLIF.It should be assessed routinely as a part of the preoperative examination to improve preoperative assessment and ensure patient safety.

The role of echocardiography in mini-invasive surgical device closure of ventricular septal defect

Objective To assess the application of echocardiography in mini-invasive surgical device closure of ventricular septal defect (VSD) . Methods 73 VSD patients including 35 with aneurysm formation and among them 21 with multi-defects in the aneurysm were treated by mini-invasive device closure. A closure device was positioned to the defect through parasternal mini-incision in all patients. TEE was used to monitor the whole procedure。

缺血预处理对器官保护作用的文献分析

目的对国内外公开发表的有关缺血预处理(ischemic preconditioning,IPC)对器官保护作用的基础与临床研究文献进行统计与分析,了解IPC的历史沿革、临床和基础研究进展,探索器官移植中IPC的作用和机制。方法计算机检索MEDLINE(1966～2009.8)、EMbase(1974～2009.8)和Cochrane Library(2009年第2期),由两名研究者独立筛选研究IPC的文献,进行分类整理和分析。结果最终纳入1398篇文献,其中75%为基础研究,临床研究仅占25%;研究的靶器官73%是心脏和肝脏。近年有关IPC对心脏、脑、脊髓和肝脏干预效应的研究明显增加,但关于IPC干预在心脏和肝外科及移植手术的临床研究则明显滞后于基础研究;IPC对其他器官如肾脏、肺、胃肠及胰腺效应的临床研究也相对较少。结论IPC对心脏外科及移植相关手术、肝外科手术及活体肝移植、肺普通手术及移植相关手术均有保护效果;IPC可有效减轻中枢神经系统缺血再灌注损伤的程度,但对尸肝移植无保护效果;IPC对肾脏、胃肠道的效应尚不明确。IPC干预对器官的保护效应机制尚无结论。

中晚期舌癌术前辅助化疗的近期疗效观察

目的探讨术前新辅助化疗对中晚期舌癌的近期疗效。方法选择我院初治的经病理确诊的舌癌42例,采用CMF方案化疗2疗程后手术,观察近期效果。结果术前辅助化疗临床有效率达64.3%,且临床有效率于肿瘤临床分期无关(p>0.05),手术切除率达100%。结论术前新辅助化疗可以提高中晚期舌癌的近期疗效,成为治疗该病的一种新手段,具有重要的临床意义。

骨科手术后下肢深静脉血栓的早期诊断与预防性治疗

目的:评价对具有下肢深静脉血栓形成(DVT)的高危因素患者进行恰当的预防性治疗的临床意义。方法:选择我科2000年1月～2004年9月下肢手术病人280例(256位病人)进行回顾性分析。病人随机分为两组,其中围手术期进行综合性预防性治疗组156例,对照组124例只给以右旋糖酐40500mL加复方丹参16mL静脉滴注,每天1次,共7d。两组术后处理相同。记录切口引流量,术后第7天多普勒(Doppler)超声筛查,并对结果进行χ2检验。结果:试验组DVT发生率为5.1%,对照组DVT发生率为39.4%,两组差异有显著性意义(P<0.01)。试验组未发现术后出血增多现象以及由此引发的不良反应。结论:围手术期综合性预防下肢深静脉血栓形成能够有效防止肺栓塞及下肢深静脉血栓形成后综合征,且低分子肝素具有良好安全性。

原发性骶骨肿瘤的外科治疗

目的 探讨原发性骶骨肿瘤的临床表现、诊断及外科治疗方法。方法 回顾1999年12月～2004年5月收治的24例原发性骶骨肿瘤患者，其中脊索瘤12例，骨巨细胞瘤7例，神经纤维瘤2例，动脉瘤样骨囊肿2例，骨肉瘤1例，均行手术切除，配合术后放疗或化疗，术后平均随访2．8年。结果 24例无术中死亡，20例功能恢复满意（83．3％），术后发生尿失禁直肠损伤各1例，术后复发4例（16．7％），术后5年内死亡4例（16．7％）。结论 积极手术切除是原发性骶骨肿瘤的有效治疗手段，充分的术前准备，正确判断术中出血，坚持后继治疗，可以提高患者的生存率。

早期肠内营养在腹部手术中的应用

目的探讨早期肠内营养在腹部手术中的应用价值。方法30例接受腹部手术的患者术后6～24h开始实施肠内营养,观察营养指标和免疫功能的变化及与肠内营养的关系。结果通过肠内营养,患者的体重、血红蛋白、血浆蛋白、前白蛋白、血清白蛋白均有不同程度的提高,期中血浆蛋白和前白蛋白上升最明显(p<0.05),营养前后免疫指标IgA,IgG,IgM淋巴细胞计数差异有显著意义(p<0.01),且无严重并发症的发生。结论早期肠内营养能够显著改善腹部手术患者的营养状况,显著提高患者的免疫功能,有效保障肠粘膜屏障功能的稳定性,防止细菌移位,避免了因此而引起的严重并发症的发生。

食管贲门癌手术后心律失常分析

目的：研究食管责门癌手术后心律的变化。方法：回顾性分析523例食管贲门癌患者外科手术后常规心电图（ECG）。结果：发现心律失常者83例，总发生率为15．87％。发生率居前3位者均为室上性心律失常，依次为：窦性心动过速、心房颤动、房性早搏，有的还同时兼有2种或3种心律失常。结论：提示上述心律失常可能与手术过程中的某些因素有关。

外科手术治疗纵膈肿瘤疗效观察23例

目的:分析纵膈肿瘤的临床特点,观察探讨外科手术治疗纵膈肿瘤的临床疗效。方法:收治纵膈肿瘤患者23例,行外科手术治疗,对临床资料进行回顾性分析。结果:23例患者中,20例良性肿瘤,3例恶性肿瘤,行外科手术切除治疗纵膈肿瘤,手术均顺利完成,手术时间80～200分钟,术后胸管引流时间2～5天,失血量30～80ml,住院时间6～12天。术后1例恶性肿瘤患者死于呼吸衰竭,22例患者保持随访;良性肿瘤患者,术后并发症除发生合并肌无力、术后房颤1例,肺部感染1例,明显切口疼痛1例外,无明显严重并发症。合并肌无力患者在术后6个月内临床症状基本消失,其他并发症患者持续药物治疗11个月后症状得以明显缓解。除1例恶性肿瘤死亡外,1例发生脑转移,1例经2次手术后症状明显好转。即本次外科手术中,17例治愈,4例好转,1例恶化,1例死亡。结论:外科手术治疗纵膈肿瘤的临床疗效比较好,其关键在于及时的诊断,正确的手术切口和方式的选择,适宜的围术期护理。

Experimental Study and Preliminary Clinical Application of Miniinvasive Percutaneous Internal Screw Fixation for Scaphoid Fracture under the Guidance of a 3D-printed Guide Plate

This study explored the feasibility of employing computer-aided design(CAD)and 3 dimensional(3D)-printed personalized guide plate for the mini-invasive percutaneous internal screw fixation of fractured scaphoid.The study consisted of two parts:(1)experimentation on upper limbs from corpses and(2)preliminary clinical application.Corpse experiments involved upper limbs of 6 adult corpses.The specimens of upper limbs were subjected to plain CT scan.Then the CT data were input into computer to conduct 3D reconstruction of wrist region.The direction and depth of the guide wire and screw were designed on the basis of the principle that screw should lie at the center of scaphoid and the long axis of the screw should be aligned with that of the scaphoid.The carpal bone model and the guide plate were designed and 3D-printed.By using the guide plates,the guide wire was placed and the cannulated compression screw was inserted.The wrist region was examined by X-ray and CT to observe the location of the screw in the scaphoid.The scaphoid was longitudinally excised to grossly observe the location and evaluate the result of screw insertion.For clinical application,the guide plate was employed in 4 patients with fresh scaphoid fracture using the aforementioned operative technique.Our results showed that,in the 6 corpse limbs,the guide plate well fitted the skin surface and the guide wire and screw were accurately put in place in one session.X-ray examination and gross observation confirmed that the screw was satisfactorily positioned and the result met the requirements of the preoperative design.For 4 patients,the guide wire and screw were all precisely inserted into place in one session.The operation time and X-ray exposure times were apparently reduced.The imaging examination exhibited satisfactory results and the hand functioned well.It was concluded that the operative guide plate used for the mini­invasive percutaneous internal screw fixation of fractured scaphoid not only can assist in accurate placement of screw but also shorten operation time and reduce insertion and X-ray exposure times,thereby reducing the radiation injury and damage to the substance and the blood circulation of carpal bone.Its use can also improve the learning curve of surgeons.

Surgical approach to right colon cancer:From open technique to robot.State of art

This work is a topic highlight on the surgical treatment of the right colon pathologies,focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures.Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy,laparoscopic assisted right colectomy,laparoscopic facilitated right colectomy,hand-assisted right colectomy,single incision laparoscopic surgery colectomy,robotic right colectomy.Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal(for totally laparoscopic right colectomy,single incision laparoscopic surgery colectomy,laparoscopic assisted right colectomy and robotic technique) or extracorporeal(for laparoscopic assisted right colectomy,laparoscopic facilitated right colectomy,hand-assisted right colectomy and open right colectomy) and the different incision(suprapubic,median or transverse on the right side of abdomen).The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon.The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy,remain a technical challenge due to the complexity of procedures(especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures.Data reported in literature while confirming the advantages of laparoscopic approach,do not allow to solve controversies about which is the best laparoscopic technique(Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer.However,the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages(functional,technical,oncological and cosmetic advantages) even if all studies conclude that further prospective randomized trials are necessary.Robotic technique may be useful to overcome the problems related to inexperience in laparoscopy in some surgical centers.

左胸微创径路冠状动脉搭桥术在高危患者中的应用

１９９６ 年１ 月至７月在１４ 例高危患者中， 采用不使用体外循环的左胸微创径路完成冠状动脉搭桥手术。患者的高危情况包括左室功能不全， 充血性心力衰竭， 年龄７０ 岁以上， 慢性肾功能衰竭， 中风， 糖尿病， 升主动脉严重钙化等， 每位患者平均２．５ 个危险因素。术后无早期死亡和严重并发症， 平均住院时间为４８ ｈ， 插管时间和重症监护病房观察时间均缩短。８例术后１～６月进行了血管造影随访， 所有移植血管都通畅。

宫腔镜电切术治疗宫颈良性病变148例临床分析

目的:研究应用宫腔镜电切术治疗宫颈良性病变的临床效果。方法:应用宫腔镜电切术切除148例宫颈良性病变。结果:手术时间8～27分钟,平均16分钟,出血量5～20ml,平均15·6ml。送检组织病理诊断:慢性宫颈管黏膜炎84例,宫颈管肌瘤4例,宫颈息肉60例。治疗效果2月内随诊148例,治愈率达97·7%。结论:宫腔镜电切术治疗宫颈病变具有操作简便,术野清晰,创面小,恢复快,并发症少,疗效满意。

Solitary bone plasmacytoma of the upper cervical spine: A case report

BACKGROUND Solitary bone plasmacytoma(SBP)of the upper cervical spine is a rare diagnosis.The exact role of surgery for SBP remains unclear.CASE SUMMARY We present the first case of SBP of the C2.A 69-year-old Chinese woman presented with severe neck pain and limitation of rotative activity for 2 mo.She underwent anterior one-stage debridement combined with cement augmentation in the C2 to reconstruct stability of the spine.The patient did not receive postoperative radiotherapy.She now remains disease free with no neck pain or neurological deficit after follow-up of 3 years.CONCLUSION Anterior one-stage debridement combined with cement augmentation of the upper cervical spine may be an alternative treatment for SBP.

Endoscopic Management of Bladder Stones: Initial Experience at a Single Center in Cameroon

Purpose: This study aimed to evaluate the efficacy and safety of endoscopic lithotripsy with the lithoclast (EMS, Switzerland) and laser Holmium YAG in the management of bladder calculi. Materials and methods: This was a retrospective study carried out from January 2013 to December 2019 on 32 patients with bladder calculi. All the patients underwent either Lithoclast or Laser lithotripsy using a 22F Storz cystoscope at the Centre medico-chirugicale d’urologie in Douala, Cameroon. Data on patients’ ages, clinical symptoms, stone sizes, type of lithotripsy, surgery duration, and results of lithotripsy were collected and analyzed using Epi info 7. Results: We recruited 32 participants (24 men and 8 women) with a median age of 41.28 [22 - 68] years into this study. In 9 (28.12%) participants, macroscopic hematuria was the main presenting complaint, followed by lower urinary tract symptoms in 8 (25%) patients. A cystoscopy was performed in 17 (53.12%) patients to confirm the diagnosis of a bladder stone, and ultrasonography of the upper urinary tract was performed in 29 (90.6%) cases to certify the absence of another stone. Lithoclast EMS was used to manage the stones in 23 (71.87%) patients while laser lithotripsy was used in 9 (28.13%). A dormia basket was used to remove stone fragments in 10 (31.25%) patients. The mean surgery duration was 33.59 ± 14.2 minutes, and the bladder stones were successfully managed in all the participants of this study. Minor complications such as pain during micturition were found in 28 (87.37%) patients, with complete resolution occurring two weeks after surgery. Conclusion: Endoscopy with lithotripsy is a safe and effective method of management of bladder stones. This technique is also associated with short surgical procedures and postoperative hospitalization periods. We believe that it is an excellent treatment modality in the management of bladder stones.

Endoscopy-assisted transoral approach for parapharyngeal space tumors:Our experience and a systematic review of the literature

Background:Several approaches have been described for the excision of parapharyngeal space tumors(PPSTs).Advances in endoscopy gave a further stimulus to the use of the transoral route.Aims:We present our experience with the endoscopy-assisted transoral approach(EATA)in this regard and a review of the most recent literature about EATA for PPSTs excision.Materials and Methods:We retrospectively analyzed our experience and systematically reviewed the literature about the outcomes of this technique.Results:Seven PPSTs were completely excised,with three of them requiring a combined transcervical approach.Only one case of postoperative wound dehiscence was registered,and the mean length of stay was 3.9 days.Final histopathological examination confirmed the results obtained with preoperative fine-needle aspiration biopsy in all cases and no recurrences were apparent after a mean follow-up of 28.1 months.Discussion:Magnetic resonance imaging,the modified Mallampati score and the 8 Ts criteria are useful instruments for the choice of the most appropriate surgical approach.Conclusion:In light of our experience and following other published series in the literature,we believe that EATA may represent a safe and effective approach for the treatment of the majority of PPSTs.

当代门静脉高压症治疗方法合理选择

制定合理个体化治疗方案是治疗门静脉高压症的趋势。治疗前应对病人肝功能储备进行充分、客观的评价。门静脉高压症病人监测门静脉压力有重要意义,肝静脉压力梯度与病人食管、胃底曲张静脉破裂出血的存活率和预后密切相关。肝功能失代偿者,肝移植是最佳的治疗手段;但是对于肝功能尚好的病人,仍应采用保守治疗和(或)施行传统手术。控制急性出血及预防再次出血的一线治疗方法。推荐应用血管药物联合内镜治疗,经颈内静脉肝内门体分流术不应考虑作为门静脉高压并发症的首要治疗方法。传统外科手术主要针对肝功能Child-Pugh A、B级者,可有效防止复发出血及降低肝性脑病发生率,并获得较高的长期存活率。

硬膜外血肿手术后脑水肿临床多因素分析

目的探讨急性硬膜外血肿患者术后脑水肿发生的机制及其影响因素和术中去骨瓣减压的指征。方法将150例急性硬膜外血肿患者分为水肿组和无水肿组两组,根据患者GCS评分,瞳孔大小,血肿量,CT或MR检查脑中线移位程度,结合手术时间、中线及周围池改变、血肿部位、年龄及是否有原发昏迷等资料进行统计学分析。结果两组在术前GCS评分,瞳孔进行性散大,血肿量增大,脑中线结构移位程度加重,手术拖延等方面均有显著性差异(P＜0．01)而在血肿部位、年龄、是否有原发昏迷等方面未见显著差异(P＞0．05)。结论急性硬膜外血肿术后脑水肿主要是急性脑受压造成的；脑受压程度越重、时间越长,术后脑水肿越严重；早期手术是避免或减轻术后脑水肿的有效措施,对术后发生较大范围的脑水肿病例应及时去骨瓣减压。

微创治疗肝硬化患者肝内外胆管结石探讨

目的探讨微创疗法在治疗合并有肝硬化的肝内外胆管结石患者的疗效及应用价值。方法总结2008年1月-2012年12月,行腹腔镜胆道镜引导下钬激光碎石治疗的肝内外胆管结石的患者,根据是否合并有肝硬化,分为两组,其中合并有肝硬化的患者为肝硬化组,患者数目为16例;无合并肝硬化的肝内外胆管结石患者为对照组,患者数目为42例。对于合并有肝硬化的患者进行术前Child-Pugh分级,对于C级的患者进行保肝、消除腹水等综合治疗后,尽量纠正肝功能为B级或A级,然后两组患者均进行腹腔镜胆道镜引导下钬激光碎石治疗,然后比较两组患者的手术资料:手术时间、术中出血量、术中中转开腹的手术例数、住院天数、胆道出血例数、胆瘘的例数、结石残留情况、胆汁性腹膜炎例数及胆管狭窄等指标。结果肝硬化组患者的结石残留明显多于对照组(P<0.05),经T管窦道胆道镜取石后均清除干净,此时的残石率无明显区别,两组患者的手术时间、术中出血量、术中中转开腹例数、住院天数、胆道出血、胆瘘、胆汁性腹膜炎及胆管狭窄等指标无显著性意义。结论该微创疗法同样适合于合并有肝硬化的肝内外胆管结石患者。