Management of the middle hepatic vein and its tributaries in right lobe living donor liver transplantation

BACKGROUND: Left liver graft from a small donor will not meet the metabolic demands of a larger adult recipient. To overcome the problem of graft size insufficiency, living donor liver transplantation (LDLT) using the right lobe has become a standard method for adult patients. As the drainage of the median sector (segments V, VIII and IV) is mainly by the middle hepatic vein (MHV), the issue of whether the MHV should or should not be taken with the graft or whether the MHV tributaries (V5, V8) should be reconstructed in the recipient remains to be settled. DATA SOURCES: An English-language literature search was conducted using MEDLINE (1985-2006) on right lobe living donor liver transplantation, middle hepatic vein, vein graft, hepatic venoplasty and other related subjects. RESULTS: Some institutions had proposed their policy for the management of the MHV and its tributaries. Dominancy of the hepatic vein, graft-to-recipient weight ratio, and remnant liver volume as well as the donor-to-recipient body weight ratio, the volume of the donor's right lobe to the recipient's standard liver volume and the size of MHV tributaries are the major elements for the criteria of inclusion of the MHV, while for the policy of MHV tributaries reconstruction, the proportion of congestive area and the diameter of the tributaries are the critical elements. Optimal vein grafts such as recipient's portal vein and hepatic venoplasty technique have been used to obviate hepatic congestion and venous drainage disturbance. CONCLUSIONS: Taking right liver grafts with the MHV trunk (extended right lobe grafts) or performing the MHV tributaries reconstruction in modified right lobe grafts, according to the criteria proposed by the institutions with rich experience, can solve the congestion problem of the right paramedian sector and help to improve the outcomes of the patients. The additional use of optimal vein grafts and hepatic venoplasty also can guarantee excellent venous drainage.

Risks faced by donors of right lobe for living donor liver transplantation

BACKGROUND: Because of the shortage of deceased donors with livers fit for transplantation, living donor liver transplantation (LDLT) is becoming an attractive alternative. Attention should be paid to the donors, especially to those of the right lobe. In this study, we evaluated the risks faced by donors of the right lobe for adult-to-adult LDLT. METHODS: The perioperative data from 105 consecutive living donors of the right lobe performed in West China Hospital from January 2002 to December 2007 were retrospectively studied. Preoperative evaluation included CT, MRCP, and intraoperative cholangiography, showing liver volume, hepatic vasculature and the biliary system. The standard liver volume (SLV) and the ratio of left lobe volume to SLV were calculated. The right lobe grafts were obtained by transecting the liver on the right side of the middle hepatic vein without inflow vascular occlusion, using an ultrasonic dissector. After operation the donors were monitored in the Intensive Care Unit for about three days. Each donor was followed up for at least 6 months. RESULTS: There was no donor mortality. Major complications occurred in 14 donors (13.3%), of whom 3 received conservative treatment, 8 required invasive paracentesis, and 3 required further surgery. All donors were recovered well and resumed their previous occupations. CONCLUSIONS: Donors of the right lobe face low risks. The preoperative evaluation, especially evaluation of the volume of the remnant liver, should be exact. During the operation, the patency of the remnant hepatic vasculature and bile duct must be preserved, and the extent of injury to the remnant liver should be limited as much as possible. The detection and treatment of postoperative complications should be diligently performed.

Outcome of patients undergoing right lobe living donor liver transplantation with small-for-size grafts

AIM: To investigate the outcome of living donor liver transplantation (LDLT) recipients transplanted with small-for-size grafts (SFSGs). METHODS: Between November 2001 and December 2010, 196 patients underwent LDLT with right lobe liver grafts at our center. Recipients were divided into 2 treatment groups: group A with an actuarial graft-to-recipient weight ratio (aGRWR) < 0.8% (n = 45) and group B with an aGRWR = 0.8% (n = 151). We evaluated serum liver function markers within 4 wk after transplantation. We also retrospectively evaluated the outcomes of these patients for potential effects related to the recipients, the donors and the transplantation procedures based upon a review of their medical records. RESULTS: Small-for-size syndrome (SFSS) developed in 7 of 45 patients (15.56%) in group A and 9 of 151 patients (5.96%) in group B (P = 0.080). The levels of alanine aminotransferase and aspartate aminotransferase in group A were higher than those in group B during early period after transplantation, albeit not sig-nificantly. The cumulative 1-, 3-and 5-year liver graft survival rates were 82.22%, 71.11% and 71.11% for group A and 81.46%, 76.82%, and 75.50% for group B patients, respectively (P = 0.623). However, univariate analysis of risk factors associated with graft survival in group A demonstrated that the occurrence of SFSS after LDLT was the only significant risk factor affecting graft survival (P < 0.001). Furthermore, multivariate analysis of our data did not identify any additional significant risk factors accounting for poor graft survival. CONCLUSION: Our study suggests that LDLT recipients with an aGRWR < 0.8% may have liver graft outcomes comparable to those who received larger size grafts. Further studies are required to ascertain the safety of using SFSGs. (c) 2014 Baishideng Publishing Group Co., Limited. All rights reserved.

Experience of donor right lobe hepatectomy in adult-to-adult live donor liver transplantation: clinical analysis of 89 cases

Objective: To review the experience of donor selec- tion and right lobe hepatectomy in adult-to-adult live donor liver transplantation. Methods: From May 1996 to December 2001, 89 live donor liver transplants using right lobe grafts were performed at Queen Mary Hospital, Hong Kong. All donors had received psychological counseling before donor operations. They were screened by laboratory tests including complete blood cell count, liver and renal biochemistry, and viral serology studies. Com- puted tomography (CT), CT volumetry and hepatic arteriography were routinely performed. All donors underwent the operations using the method designed by us. Results: The median duration of the operations was 8.8 hours. The median blood loss recorded 466 ml. The median intensive care unit and hospital stays were 2 and 10 days, respectively. There was no do- nor mortality. Complications of donor operations in- cluded wound infection, urinary tract infection, bili- ary stricture, cholestasis, subphrenic collection, bowel obstruction and incision hernia, etc. All do- nors have recovered and returned to their previous occupations. Conclusions: Live donation of right lobe grafts for a- dult-to-adult liver transplantation is safe, provided that donor selection is strict and utmost care is exer- cised during the operation.

Measures for increasing the safety of donors in living donor liver transplantation using right lobe grafts

BACKGROUND: The safety of donors in living donor liver transplantation (LDLT) should be the primary consideration. The aim of this study was to report our experience in increasing the safety of donors in LDLTs using right lobe grafts. METHODS: We retrospectively studied 37 living donors of right lobe grafts from January 2002 to March 2006. The measures for increasing the safety of donors in LDLT included carefully selected donors, preoperative evaluation by ultrasonography, angiography and computed tomography; and necessary intraoperative cholangiography and ultrasonography. Right lobe grafts were obtained using an ultrasonic dissector without inflow vascular occlusion on the right side of the middle hepatic vein. The standard liver volume and the ratio of left lobe volume to standard liver volume were calculated. RESULTS: There was no donor mortality in our group. Postoperative complications only included bile leakage (I donor), biliary stricture (1) and portal vein thrombosis (1). All donors recovered well and resumed their previous occupations. In recipients, complications included acute rejection (2 patients), hepatic artery thrombosis (1), bile leakage (1), intestinal bleeding (1), left subphrenic abscess (1) and pulmonary infection (1). The mortality rate of recipients was 5.4% (2/37); one recipient with pulmonary infection died from multiple organ failure and another from occurrence of primary disease. CONCLUSIONS: The first consideration in adult-to-adult LDLT is the safety of donors. The donation of a right lobe graft is safe for adults if the remnant hepatic vasculature and bile duct are ensured, and the volume-of the remnant liver exceeds 35% of the total liver volume.

Major complications of adult right lobe living liver donors

BACKGROUND：The right lobe of the liver is generally preferred for living donor liver transplantation in adult patients with end-stage liver disease.It is important to know the preoperative factors relating to the major postoperative complications.We therefore evaluated the possible risk factors for predicting postoperative complications in right lobe liver donors.METHODS：Data from 378 donors who had undergone right lobe hepatectomy at our center were evaluated retrospectively. The factors we evaluated induded donor age, gender, body mass index （BMI）, remnant liver volume, operation time, history of previous abdominal surgery, inclusion of the middle hepatic vein and variations in the portal and bile systems. RESUEI＇S： Of the 378 donors, 219 were male and 159 female. None of the donors died, but 124 （32.8%） donors experienced complications including major complications （Clavien scores III and IV） in 27 （7.1%）. Univariate analysis showed that complica- tions were significantly associated with male gender and higher BMI （P〈0.05）, but not with donor age, remnant liver volume, operation time, graft with middle hepatic vein, variations in the portal and bile systems and previous abdominal surgery （P〉0.05）. Multivariate logistic regression analysis showed that major complications were significantly associated with male gender （P=0.005） and higher BMI （P=0.029）. Moreover, the Chi- square test showed that there were significant relationships between major complications and male gender （P=0.010,Z2=6.614, df=l） and BMI 〉25 kg/m2 （P=-0.031, Z2=8.562, df-1）. Of the 96 male donors with BMI 〉25 kg/m2, 14 （14.6%） with major complications had significantly smaller mean remnant liver volume than those （82, 85.4%） without major complications （32.50%± 4.45% vs 34.63%±3.11%, P=0.029）.CONCLUSION： Male donors with BMI 〉25 kg/m2 and a remnant liver volume 〈32.50% had a significantly increased risk for major complications.

Middle hepatic vein reconstruction in adult right lobe living donor liver transplantation improves recipient survival

Background: The efficacy and necessity of middle hepatic vein(MHV) reconstruction in adult-to-adult right lobe living donor liver transplantation(LDLT) remain controversial. The present study aimed to evaluate the survival beneficiary of MHV reconstructions in LDLT. Methods: We compared the clinical outcomes of liver recipients with MHV reconstruction( n = 101) and without MHV reconstruction( n = 43) who underwent LDLT using right lobe grafts at our institution from January 2006 to May 2017. Results: The overall survival(OS) rate of recipients with MHV reconstruction was significantly higher than that of those without MHV reconstruction in liver transplantation( P = 0.022; 5-yr OS: 76.2% vs 58.1%). The survival of two segments(segments 5 and 8) hepatic vein reconstruction was better than that of the only one segment(segment 5 or segment 8) hepatic vein reconstruction( P = 0.034; 5-yr OS: 83.6% vs 67.4%). The survival of using two straight vascular reconstructions was better than that using Y-shaped vascular reconstruction in liver transplantation with two segments hepatic vein reconstruction( P = 0.020; 5-yr OS: 100% vs 75.0%). The multivariate analysis demonstrated that MHV tributary reconstructions were an independent beneficiary prognostic factor for OS(hazard ratio = 0.519, 95% CI: 0.282–0.954, P = 0.035). Biliary complications were significantly increased in recipients with MHV reconstruction(28.7% vs 11.6%, P = 0.027). Conclusions: MHV reconstruction ensured excellent outflow drainage and favored recipient outcome. The MHV tributaries(segments 5 and 8) should be reconstructed as much as possible to enlarge the hepatic vein anastomosis and reduce congestion.

Hepatic venous outflow reconstruction in adult right lobe living donor liver transplantation without middle hepatic vein

Background It is difficult and challenging to reconstruct hepatic venous outflow in adult right lobe living donor liver transplantation （LDLT） without the middle hepatic vein （MHV）. Excessive perfusion of the portal vein and venous outflow obstruction will lead to acute congestion of the graft, ultimately resulting in primary nonfunction. Although various reconstruction patterns have been explored in many countries, there is currently no clear consensus. In this study we describe a technique to prevent ＂chocking＂ of the graft at the outflow anastomosis with the inferior vena cava （IVC） in LDLT using right lobe graft without the MHV. Methods A retrospective analysis was conducted on clinical data from 55 recipients undergoing LDLT using right lobe grafts without the MHV or reconstruction of hepatic venous outflow. The donor＇s right hepatic vein （RHV） was anastomosed with a triangular opening of the recipient IVC; the inferior right hepatic vein （IRHV）, if large enough, was anastomosed directly to the IVC. The great saphenous vein （GSV） was used for reconstruction of significant MHV tributaries. Results No deaths occurred in any of the donors. Of the 55 recipients, complications occurred in 6, including hepatic vein stricture （1 case）, small-for-size syndrome （1）, hepatic artery thrombosis （1）, intestinal bleeding （1）, bile leakage （1）, left subphrenic abscess and pulmonary infection （1）. A total of three patients died, one from small-for-size syndrome and two from multiple system organ failure. Conclusions The multiple-opening vertical anastomosis was reconstructed with hepatic vein outflow. This technique alleviates surgical risk of living donors, ensures excellent venous drainage, and prevents vascular thromboses and primary nonfunction.

Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts

AIM To analyze the outcomes of living-donor liver transplantation(LDLT) using left-lobe(LL) or right-lobe(RL) small-for-size(SFS) grafts.METHODS Prospectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short-and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight(GW) to recipient standard liver volume(RSLV)(GW/RSLV) of < 50%. The Urata formula was used to estimate RSLV.RESULTS Totally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age(median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, P = 0.997) but had significantly different ratios of men to women(165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, P < 0.0001). The two groups were also significantly different in GW(P < 0.0001), GW/RSLV(P < 0.0001), and graft cold ischemic time(P = 0.007). When it comes to postoperative complication, the groups were comparable(P = 0.105). Five patients died in hospital,4(2%) in the RL-LDLT group and 1(5.3%) in the LLLDLT group(P = 0.918). There were 38 graft losses, 33(16.6%) in the RL-LDLT group and 5(26.3%) in the LL-LDLT group(P = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group(95.2% vs 89.5%, P = 0.049). The two groups had similar 5-year patient survival rates(RL-LDLT: 86.8%, LL-LDLT: 89.5%, P = 0.476).CONCLUSION The use of SFS graft in LDLT requires careful tailormade surgical planning and meticulous operation. LLLDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed in order to validate the use of LL graft.

Reducing biliary complications in adult-to-adult living donor liver transplantation using right lobe graft:experience of 124 cases

The aim of this paper is to summarize our experience of using right lobe liver grafts to reduce biliary complications in adult-to-adult(A-A)living donor liver transplantation(LDLT).From January 2002 to October 2007,124 adult patients underwent living donor liver transplantation using right lobe grafts at the West China Hospital,Sichuan University Medical School,China.There was no death in all donors.Biliary reconstruction for 178 hepatic duct orifices from 124 donor grafts was performed which included 106 reconstructions of duct-to-duct anastomoses and 72 cholangiojejunostomy.Nine recipients had biliary complications including six bile lea-kages(four from the anastomotic site and two from the cut surface of the liver graft)and three biliary strictures.With the improved techniques for biliary reconstruction,we have achieved good results in 124 recipients of A-A LDLT.We ascribe our success to the introduction of microsurgical techniques and the use of fixed operators which help in decreasing the biliary complications of LDLT.

Survival outcomes of right-lobe living donor liver transplantation for patients with high Model for End-stage Liver Disease scores

BACKGROUND: Controversy exists over whether living donor liver transplantation (LDLT) should be offered to patients with high Model for End-stage Liver Disease (MELD) scores. This study tried to determine whether a high MELD score would result in inferior outcomes of right-lobe LDLT. METHODS: Among 411 consecutive patients who received right-lobe LDLT at our center, 143 were included in this study. The patients were divided into two groups according to their MELD scores: a high-score group (MELD score ≥25; n=75) and a low-score group (MELD score 【25; n=68). Their demographic data and perioperative conditions were compared. Univariable and multivariable analyses were performed to identify risk factors affecting patient survival. RESULTS: In the high-score group, more patients required preoperative intensive care unit admission (49.3% vs 2.9%; P【0.001), mechanical ventilation (21.3% vs 0%; P【0.001), or hemodialysis (13.3% vs 0%; P=0.005); the waiting time before LDLT was shorter (4 vs 66 days; P【0.001); more blood was transfused during operation (7 vs 2 units; P【0.001); patients stayed longer in the intensive care unit (6 vs 3 days; P【0.001) and hospital (21 vs 15 days; P=0.015) after transplantation;more patients developed early postoperative complications (69.3% vs 50.0%; P=0.018); and values of postoperative peak blood parameters were higher. However, the two groups had comparable hospital mortality. Graft survival and patient overall survival at one year (94.7% vs 95.6%; 95.9% vs 96.9%), three years (91.9% vs 92.6%; 93.2% vs 95.3%), and five years (90.2% vs 90.2%; 93.2% vs 95.3%) were also similar between the groups. CONCLUSIONS: Although the high-score group had signifi-cantly more early postoperative complications, the two groups had comparable hospital mortality and similar satisfactory rates of graft survival and patient overall survival. Therefore, a high MELD score should not be a contraindication to right-lobe LDLT if donor risk and recipient benefit are taken into full account.

Cortical infarction of the right parietal lobe and neurogenic heart disease A report of three cases

Three male patients were diagnosed with new cortical infarctions of the right parietal lobe on the basis of head magnetic resonance imaging; high-intensity signals indicating lesions in the right parietal lobe were noted on diffusion-weighted images at admission. Two of them presented with left hand weakness, and one exhibited left upper limb weakness. Treatment for improving blood supply to the brain was administered. One patient died suddenly because of ventricular fibrillation 3 days after admission. The other two patients had increased troponin levels and abnormal electrocardiograms, and were diagnosed with acute myocardial infarction half a month after admission. When lesions exist in field 7 of the parietal cortex （resulting in paralysis of the contralateral hand）, the sympathetic center of the posterior lateral nucleus of the hypothalamus demonstrates compensatory excitement, which easily causes tachyarrhythmia and sudden death. Our experimental findings indicate that close electrocardiograph monitoring and cerebral infarction treatment should be standard procedures to predict and help prevent heart disease in patients with cerebral infarction in the right parietal lobe and left upper limb weakness as the main complaint.

Characteristics of Non-Small Cell Lung Cancer Located in the Right Middle Lobe According to a Retrospective Study of Recurrence and Prognosis

Background: Some studies have suggested that among all cases of lung cancer, the outcome of lung cancer located in the right middle lobe (RML) is the worst. However, with the advances in the diagnosis and treatment methods of lung cancer over the last couple of decades, we investigated whether the prognosis of primary lung cancer located in the RML still remains inferior to that of lung cancer arising from other lobes. Methods: Between July 2003 and December 2011, 505 consecutive patients with non-small cell lung cancer (NSCLC) underwent surgical resection at our institution. Of these, 32 patients (6.3%) had tumors arising from the RML. Results: The rate of incomplete resection was higher for cancer located in the RML than that for cancer arising from other lobes. Significant associations were noted between cancer located in the RML and the rate of lymph node metastasis and initial locoregional recurrence. Multivariate analysis identified lymph node metastasis and location in the RML as independent risk factors influencing the recurrence-free survival (p = 0.006), although location in the RML was not extracted as an independent risk factor influenceing the overall survival (p = 0.060). Conclusion: Despite the recent advances in the treatment of lung cancer, evaluation of complete resection revealed that the outcome of cancer located in the RML is still the worst among cancer of all the lobes. Further early diagnosis and adjuvant therapy are needed for improving the prognosis of cancer located in the RML.

非酒精性脂肪性肝病患者C/RL-r、APRI、FIB-4水平与肝纤维化发生的相关性

目的分析非酒精性脂肪性肝病(NAFLD)患者改良肝尾状叶/右叶比值(C/RL-r)、天门冬氨酸氨基转移酶与血小板比值指数(APRI)、基于4因子的纤维化指数(FIB-4)与肝纤维化发生的相关性。方法选择2021年2月至2022年12月在保定市第一中心医院治疗的NAFLD患者153例,根据病理学结果,将患者分为无肝纤维化组81例、肝纤维化组72例。行MRI扫描检测C/RL-r;计算APRI、FIB-4水平;分析NAFLD患者实验室指标、C/RL-r、APRI、FIB-4水平与发生肝纤维化的相关性,发生肝纤维化的独立危险因素及C/RL-r、APRI、FIB-4对NAFLD患者发生肝纤维化的预测价值。结果肝纤维化组ALT、AST、TBil、GGT、TG、C/RL-r、APRI、FIB-4水平显著高于无肝纤维化组,分别为(42.32±10.21)U/L比(36.21±7.78)U/L、(45.36±8.72)U/L比(27.45±5.40)U/L、(13.52±3.65)μmol/L比(12.24±2.16)μmol/L、(60.53±13.41)U/L比(53.69±12.44)U/L、(1.99±0.53)mmol/L比(1.05±0.33)mmol/L、(1.15±0.12)比(0.92±0.09)、(0.52±0.15)比(0.32±0.10)、(1.47±0.47)比(0.94±0.30),高密度脂蛋白胆固醇(HDL-C)水平显著低于无肝纤维化组为(1.03±0.26)mmol/L比(1.32±0.45)mmol/L,(t=4.189、15.453、2.674、3.272、13.322、13.501、4.302、8.405、4.801,均P<0.05);NAFLD患者ALT、AST、TG、C/RL-r、APRI、FIB-4与发生肝纤维化呈正相关(r=0.531、0.435、0.571、0.605、0.771、0.716,均P<0.001);ALT、AST、TG、C/RL-r、APRI、FIB-4水平高是影响NAFLD患者发生肝纤维化的独立危险因素(P<0.05);C/RL-r、APRI、FIB-4、三者联合预测NAFLD患者发生肝纤维化的曲线下面积(AUC)分别为0.767、0.830、0.754、0.936;相较于C/RL-r、APRI、FIB-4单独预测的AUC,三者联合预测的AUC更高(Z=4.495、3.999、4.677,均P<0.001)。结论发生肝纤维化的NAFLD患者C/RL-r、APRI、FIB-4水平较高,三者联合检测对NAFLD患者发生肝纤维化具有较高预测价值。

左侧卧位腹腔镜肝右叶部分切除术临床分析

目的探讨左侧卧位腹腔镜肝右叶各肝段部分切除的可行性及疗效。方法回顾性分析右江民族医学院附属医院百东院区2022年5月至2023年4月期间39例行左侧卧位腹腔镜肝右叶部分切除术的病例资料。结果39例中有腹部手术史者13例;肿瘤1个34例,肿瘤2个3例,肿瘤3个2例,肿瘤最大径37.0(24.0,58.0)mm。其中行非解剖性肝切除20例,解剖性肝切除19例;单一肝段切除术28例,两部位肝部分切除术10例,三部位肝部分切除术1例;联合腹腔镜胆囊切除24例;无血流阻断9例,行Pringle法血流阻断30例。平均手术时间(143.5±56.8)min;中位术中出血量100.0(50.0,300.0)mL,4例术中输血(合计29.50 U),无中转开腹。35例放置引流管,引流管留置时间(6.3±3.7)d;术后平均住院时间(10.1±4.0)d,住院总费用(41121.8±18978.3)元。术后23例患者出现少量胸腔积液;1例患者并发急性呼吸窘迫综合征(ARDS)及肝功能不全,经ICU复苏治愈;1例出现少量气胸;无感染、出血、胆漏等并发症发生;无非计划性再次手术发生。所有患者均通过门诊或电话的方式获得随访,所有病例近期无复发。结论左侧卧位行腹腔镜肝右叶部分切除术操作简单,暴露好,手术时间相对较短,出血少。

右侧顶叶低频重复经颅磁刺激治疗焦虑失眠的随机对照研究

目的探讨右侧顶叶低频重复经颅磁刺激(rTMS)对焦虑失眠患者的治疗效果及其机制。方法随机将60例焦虑失眠患者分为研究组和对照组,研究组采用1 Hz rTMS刺激右侧顶叶皮层,每次2000脉冲,共20次治疗,对照组采用与研究组相同的刺激设备、参数及次数,但将刺激线圈旋转90度,使其垂直于患者头皮,保证磁刺激不能实际作用于大脑的同时又有刺激声音输出。比较治疗前后两组的汉密尔顿焦虑量表(HAMA)评分和匹兹堡睡眠质量指数(PSQI)评分的变化以及事件相关电位失匹配负波(MMN)、P300的潜伏期及波幅的变化,分析治疗前后各项指标及其变化值之间的相关性。结果研究组治疗后HAMA、PSQI评分均较治疗前降低(P<0.05)。研究组治疗后MMN和P300的潜伏期较治疗前缩短,波幅增高(P<0.05)。研究组治疗前后HAMA评分的差值与PSQI评分的差值呈正相关(P<0.01)。研究组治疗前后P300波幅差值与HAMA评分差值呈正相关(P<0.05)。结论右侧顶叶低频rTMS对焦虑失眠患者有确切疗效,可改善患者的焦虑状态、睡眠质量及认知功能,P300的波幅变化可作为焦虑症状改善的生物学指标。

完全左侧卧位急诊腹腔镜手术治疗肝右叶外伤16例的可行性探究

目的 探究完全左侧卧位急诊腹腔镜手术治疗肝右叶外伤16例的可行性。方法 选择我院急诊2022年4月至2022年10月收治的34例肝右叶外伤患者,按照随机数字表法分为一组(n=16)和二组(n=18),一组行完全性左侧卧位腹腔镜手术,二组在倾斜30°-60°左侧卧位腹腔镜下进行手术。比较两组手术相关指标和术后并发症(胆漏、腹腔积液、腹腔感染、术后出血)发生率。结果 一组患者手术时间及术后引流时间均短于二组,术中出血量及术后引流量均低于二组(P<0.05);一组患者并发症总发生率低于二组(P<0.05)。结论 完全左侧卧位腹腔镜手术治疗肝右叶外伤在术中能够更好地开阔视野,便于术者操作,缩短手术时间,减少术中出血量,降低并发症的发生,具有较高的临床可行性。

θ爆发刺激治疗卒中相关失眠的疗效分析

目的观察连续性θ爆发刺激(cTBS)治疗卒中相关失眠的疗效。方法纳入亚急性期脑梗死患者60例,采用匹兹堡睡眠质量指数(PSQI)进行测评,以PSQI量表总分>7分作为判断睡眠障碍的标准。随机分为药物治疗组、联合治疗组,各30例。药物治疗组给予唑吡坦10 mg口服、联合治疗组给予唑吡坦5 mg口服+cTBS模式刺激右侧背外侧前额叶和顶枕区域,分别比较两组患者抗失眠药物停药时间和2周停药率、PSQI减分率、NIHSS评分、HAMD和HAMA评分的变化,以观察cTBS治疗卒中相关失眠的临床疗效。结果联合治疗组平均停药时间短于药物治疗组,2周停药率均高于药物治疗组(P<0.05);两组患者NIHSS评分、HAMD及HAMA评分随治疗时间呈现好转趋势,同一随访时间组间比较无明显差异。由于两组患者HAMD、HAMA评分交互P有统计学意义,说明随着时间的变化,两组间的HAMD、HAMA评分会出现差异。结论cTBS对于卒中相关失眠的治疗具有明显作用,且一定程度上改善了患者的焦虑抑郁状态。

DIAGNOSIS AND TREATMENT OF STAGE-ⅢPERIPHERAL SQUAMOUS CELL CARCINOMAOF RIGHT UPPER LUNG

During a 12-year period, 44 patients were surgically treated for stage- Ⅲ peripheral squamous cell car-cinoma of the right upper lobe. The mean time from the discovery of the shadow in the right upper lobe tothe confirmation of the diagnosis was 2 months. All patients underwent the resection of the right upperlobe with the dissection of the right mediastinal lymph nodes, among them, 4 patients had sleeve lobectomy of the right upper lobe. P-TNM staging: 23 cases were in stage- Ⅲ a, 21 cases in stage- Ⅲ b. The fre-quency of the postoperative complications was 20- 4 % (9/44 cases). The 1-year survival rate of all patientswas 61 % (27/44 cases). None of stage - Ⅲ b patients lived longer than 3 years. The postoperative 3-and 5-year survival rates of stage- Ⅲ a cases were 65. 2 % (15/23cases) and 21. 7 % (5/23 cases) respectively. Inthis article, the patients clinical features, the causes of delayed-diagnosis, the operative and postoperativemanagement were discussed. We suggest that the stage- Ⅲ a patients should be given surgical treatment,whereas, for the patients of stage- Ⅲ b, palliative operation was given just for the purpose of reliving thesymptoms.

支气管优先处理法单操作孔胸腔镜右肺上叶癌根治术的学习曲线

目的 探讨具备单向式单操作孔胸腔镜肺癌根治术经验的治疗组开展支气管优先处理法单操作孔胸腔镜右肺上叶癌根治术的学习曲线特征。方法 回顾性分析该手术团队2018年4月~2020年12月连续完成支气管优先处理法单操作孔胸腔镜右肺上叶癌根治术98例资料,使用累积和法(cumulative sum, CUSUM)分析学习曲线,并对学习曲线不同阶段围手术期指标进行比较。结果 该学习曲线最佳拟合方程为:y=1.512+1.760x-1.775×10-2x2-1.222×10-5x3,拟合优度R2=0.976。根据该方程,连续实施48例本术式后可进入熟练阶段(第49~98例),之前为学习阶段(第1~48例)。熟练阶段淋巴结清扫个数多于学习阶段(P<0.05),而手术时间、术中出血量、切割缝合器钉匣数均少于学习阶段(P<0.05),2个阶段清扫淋巴结组数、中转开胸率、术后住院时间、术后并发症率差异均无显著性(P>0.05)。结论 在具备单向式单操作孔胸腔镜肺癌根治术经验的治疗组,经过48例手术后可熟练掌握支气管优先处理法单操作孔胸腔镜右肺上叶癌根治术。