AIM To compare the clinical outcomes of right hepatectomy for large hepatocellular carcinoma via the anterior and conventional approach.METHODS We comprehensively performed an electronic search of Pub Med, EMBASE, and...AIM To compare the clinical outcomes of right hepatectomy for large hepatocellular carcinoma via the anterior and conventional approach.METHODS We comprehensively performed an electronic search of Pub Med, EMBASE, and the Cochrane Library for randomized controlled trials(RCTs) or controlled clinical trials(CCTs) published between January 2000 and May 2017 concerning the anterior approach(AA) and the conventional approach(CA) to right hepatectomy. Studies that met the inclusion criteria were included, and their outcome analyses were further assessed using a fixed or random effects model.RESULTS This analysis included 2297 patients enrolled in 16 studies(3 RCTs and 13 CTTs). Intraoperative blood loss [weighted mean difference =-255.21; 95% confidence interval(95%CI):-371.3 to-139.12; P < 0.0001], intraoperative blood transfusion [odds ratio(OR) = 0.42; 95%CI: 0.29-0.61; P < 0.0001], mortality(OR = 0.59; 95%CI: 0.38-0.92; P = 0.02), morbidity(OR = 0.77; 95%CI: 0.62-0.95; P = 0.01), and recurrencerate(OR = 0.62; 95%CI: 0.47-0.83; P = 0.001) were significantly reduced in the AA group. Patients in the AA group had better overall survival(hazard ratio [HR] = 0.71; 95%CI: 0.50-1.00; P = 0.05) and disease-free survival(HR = 0.67; 95%CI: 0.58-0.79; P < 0.0001) than those in the CA group.CONCLUSION The AA is safe and effective for right hepatectomy for large hepatocellular carcinoma and could accelerate postoperative recovery and achieve better survival outcomes than the CA.展开更多
Background:Although the utility of laser fiber in microscopic stapes surgery has been documented in the past,their role can be highly emphasized in endoscopic stapes surgery,especially in difficult anatomical situatio...Background:Although the utility of laser fiber in microscopic stapes surgery has been documented in the past,their role can be highly emphasized in endoscopic stapes surgery,especially in difficult anatomical situations.Methods:This is a retrospective analysis of cases where a total of 46 patients(22 in conventional stapedotomy and 24 in CO_(2) laser‐assisted stapedotomy)were included in the study.The clinical parameters were assessed both in the preoperative and postoperative periods in the respective groups and later compared 12 weeks after stapedotomy.Results:A total of 90.90%(20/22)of the patients in the conventional stapedotomy and 95.83%(23/24)of patients in laser‐assisted stapedotomy had<20 dB of AB gap in the postoperative period(P=0.71).Canaloplasty was required in six patients in the conventional stapedotomy and none of the patients in the laser group needed the same(P=0.01).Chorda tympani nerve was manipulated in 59.09%(13/22)and 25.00%(6/24)of cases in the conventional group and in the CO_(2) laser group,respectively(P=0.01).Conclusion:Although the audiological outcomes with fiber‐enabled CO_(2) laser in endoscopic stapedotomy are comparable to conventional surgery,it is a better tool in a narrow auditory canal,requiring minimal manipulation of the chorda tympani nerve.展开更多
基金Supported by the National Natural Science Foundation of China,No.81572368the Guangdong Natural Science Foundation,No.2016A030313278the Science and Technology Planning Project of Guangdong Province,China,No.2014A020212084
文摘AIM To compare the clinical outcomes of right hepatectomy for large hepatocellular carcinoma via the anterior and conventional approach.METHODS We comprehensively performed an electronic search of Pub Med, EMBASE, and the Cochrane Library for randomized controlled trials(RCTs) or controlled clinical trials(CCTs) published between January 2000 and May 2017 concerning the anterior approach(AA) and the conventional approach(CA) to right hepatectomy. Studies that met the inclusion criteria were included, and their outcome analyses were further assessed using a fixed or random effects model.RESULTS This analysis included 2297 patients enrolled in 16 studies(3 RCTs and 13 CTTs). Intraoperative blood loss [weighted mean difference =-255.21; 95% confidence interval(95%CI):-371.3 to-139.12; P < 0.0001], intraoperative blood transfusion [odds ratio(OR) = 0.42; 95%CI: 0.29-0.61; P < 0.0001], mortality(OR = 0.59; 95%CI: 0.38-0.92; P = 0.02), morbidity(OR = 0.77; 95%CI: 0.62-0.95; P = 0.01), and recurrencerate(OR = 0.62; 95%CI: 0.47-0.83; P = 0.001) were significantly reduced in the AA group. Patients in the AA group had better overall survival(hazard ratio [HR] = 0.71; 95%CI: 0.50-1.00; P = 0.05) and disease-free survival(HR = 0.67; 95%CI: 0.58-0.79; P < 0.0001) than those in the CA group.CONCLUSION The AA is safe and effective for right hepatectomy for large hepatocellular carcinoma and could accelerate postoperative recovery and achieve better survival outcomes than the CA.
文摘Background:Although the utility of laser fiber in microscopic stapes surgery has been documented in the past,their role can be highly emphasized in endoscopic stapes surgery,especially in difficult anatomical situations.Methods:This is a retrospective analysis of cases where a total of 46 patients(22 in conventional stapedotomy and 24 in CO_(2) laser‐assisted stapedotomy)were included in the study.The clinical parameters were assessed both in the preoperative and postoperative periods in the respective groups and later compared 12 weeks after stapedotomy.Results:A total of 90.90%(20/22)of the patients in the conventional stapedotomy and 95.83%(23/24)of patients in laser‐assisted stapedotomy had<20 dB of AB gap in the postoperative period(P=0.71).Canaloplasty was required in six patients in the conventional stapedotomy and none of the patients in the laser group needed the same(P=0.01).Chorda tympani nerve was manipulated in 59.09%(13/22)and 25.00%(6/24)of cases in the conventional group and in the CO_(2) laser group,respectively(P=0.01).Conclusion:Although the audiological outcomes with fiber‐enabled CO_(2) laser in endoscopic stapedotomy are comparable to conventional surgery,it is a better tool in a narrow auditory canal,requiring minimal manipulation of the chorda tympani nerve.