BACKGROUND In recent years,pure laparoscopic radical surgery for Bismuth-Corlette type Ⅲ and Ⅳ hilar cholangiocarcinoma(HCCA)has been preliminarily explored and applied,but the surgical strategy and safety are still...BACKGROUND In recent years,pure laparoscopic radical surgery for Bismuth-Corlette type Ⅲ and Ⅳ hilar cholangiocarcinoma(HCCA)has been preliminarily explored and applied,but the surgical strategy and safety are still worthy of further improvement and attention.AIM To summarize and share the application experience of the emerging strategy of“hepatic hilum area dissection priority,liver posterior separation first”in pure laparoscopic radical resection for patients with HCCA of Bismuth-Corlette types Ⅲ and IV.METHODS The clinical data and surgical videos of 6 patients with HCCA of Bismuth-Corlette types Ⅲ and Ⅳ who underwent pure laparoscopic radical resection in our department from December 2021 to December 2023 were retrospectively analyzed.RESULTS Among the 6 patients,4 were males and 2 were females.The average age was 62.2±11.0 years,and the median body mass index was 20.7(19.2-24.1)kg/m^(2).The preoperative median total bilirubin was 57.7(16.0-155.7)μmol/L.One patient had Bismuth-Corlette type Ⅲa,4 patients had Bismuth-Corlette type Ⅲb,and 1 patient had Bismuth-Corlette type Ⅳ.All patients successfully underwent pure laparoscopic radical resection following the strategy of“hepatic hilum area dissection priority,liver posterior separation first”.The operation time was 358.3±85.0 minutes,and the intraoperative blood loss volume was 195.0±108.4 mL.None of the patients received blood transfusions during the perioperative period.The median length of stay was 8.3(7.0-10.0)days.Mild bile leakage occurred in 2 patients,and all patients were discharged without serious surgery-related complications.CONCLUSION The emerging strategy of“hepatic hilum area dissection priority,liver posterior separation first”is safe and feasible in pure laparoscopic radical surgery for patients with HCCA of Bismuth-Corlette types Ⅲ and Ⅳ.This strategy is helpful for promoting the modularization and process of pure laparoscopic radical surgery for complicated HCCA,shortens the learning curve,and is worthy of further clinical application.展开更多
目的:分析数字X射线摄影(digital radiography,DR)下不同骨折线方向GartlandⅢ伸直型肱骨髁上骨折患儿的临床特点。方法:回顾性分析无锡市儿童医院2021年1月-2022年12月收治的GartlandⅢ伸直型肱骨髁上骨折患儿80例的临床资料。按照DR...目的:分析数字X射线摄影(digital radiography,DR)下不同骨折线方向GartlandⅢ伸直型肱骨髁上骨折患儿的临床特点。方法:回顾性分析无锡市儿童医院2021年1月-2022年12月收治的GartlandⅢ伸直型肱骨髁上骨折患儿80例的临床资料。按照DR下不同骨折线方向,分为水平型组(n=25)、顺斜型组(n=25)及逆斜型组(n=30)三组。调查记录三组患儿年龄、受伤至复位时间、性别、受伤部位、分型、致伤原因、骨折类型及合并神经损伤情况;对比分析三组患儿手术时间、切开手术比例、肘前瘀斑比例、治疗方式及Flynn肘关节功能恢复优良率。结果:三组患儿的年龄、受伤至复位时间、性别比例、受伤部位、分型、致伤原因及骨折类型相比无显著差异(P>0.05);逆斜型组患儿的手术时间(61.83±9.37)m i n、肘前瘀斑比例36.67%、切开手术比例23.33%及合并神经损伤比例16.67%、6.67%均长于或高于水平型组及顺斜型组患儿,差异有统计学意义(P<0.05);水平型组及顺斜型组患儿的三项指标项目无显著差异(P>0.05);水平型组、顺斜型组、逆斜型组Flynn肘关节功能恢复优良率分别为96.00%、92.00%、90.00%,三组患儿的Flynn肘关节功能恢复优良率比较差异不显著(P>0.05)。结论:逆斜型GartlandⅢ伸直型肱骨髁上骨折患儿的软组织损伤较重,肘前瘀斑明显,手术时间较长,切开手术比例较高。展开更多
目的探讨成人骨型Ⅲ类患者矫治前后上下前牙区牙槽高度和宽度变化以及前牙区牙根位置变化。方法选取2020年5月—2022年11月在中山市小榄人民医院口腔科正畸掩饰治疗的成人骨型Ⅲ类患者50例,比较正畸治疗前后患者上下颌前牙牙槽骨厚度和...目的探讨成人骨型Ⅲ类患者矫治前后上下前牙区牙槽高度和宽度变化以及前牙区牙根位置变化。方法选取2020年5月—2022年11月在中山市小榄人民医院口腔科正畸掩饰治疗的成人骨型Ⅲ类患者50例,比较正畸治疗前后患者上下颌前牙牙槽骨厚度和高度,其中包括上前牙槽骨厚度(upper anterior alveolar bonethickness,UA)、上后牙槽骨厚度(upper posterior alveolar bone thickness,UP)、上牙槽骨总厚度(upper alveolar bone width,UW)、下前牙槽骨厚度(lower anterior alveolar bone thickness,LA)、下后牙槽骨厚度(lower posterior alveolar bone thickness,LP)、下牙槽骨总厚度(lower alveolar bone width,LW)、根中水平上前牙槽骨厚度(upper anterior alveolar bone thickness at the mid-root level,UA-m)、根中水平上后牙槽骨厚度(upper posterior alveolar bone thickness at the mid-root level,UP-m)、根中水平上牙槽骨总厚度(upper alveolar bone thickness at the mid-root level,UW-m)、根中水平下前牙槽骨厚度(lower anterior alveolar bone thickness at the mid-root level,LA-m)、根中水平下后牙槽骨厚度(lower posterior alveolar bone thickness at the mid-root level,LP-m)、根中水平下牙槽骨总厚度(lower alveolar bone thickness at the mid-root level,LW-m)以及上前牙槽骨高度(upper anterior alveolar bone height,UAH)和下前牙槽骨高度(lower anterior alveolarbone height,LAH)。结果正畸治疗前后患者UA、UP-m测量值比较,差异无统计学意义(P>0.05)。与正畸治疗前比较,正畸治疗后患者UP、UW、UA-m、UW-m测量值均显著降低(P<0.05)。正畸治疗后患者LP、LA-m测量值与正畸治疗前比较,差异无统计学意义(P>0.05)。与正畸治疗前比较,正畸治疗后患者LA、LW、LP-m、LW-m测量值均降低(P<0.05)。与正畸治疗前比较,正畸治疗后患者UAH、LAH测量值均显著降低(P<0.05)。正畸治疗后,患者上下颌前牙解剖牙根长度分别为(10.62±0.57)mm、(9.65±0.48)mm,正畸治疗前患者上下颌前牙解剖牙根长度分别为(11.01±0.58)mm、(10.37±0.48)mm,与正畸治疗前比较,患者上下颌前牙解剖牙根长度明显减小(P<0.05)。结论成人骨型Ⅲ类患者进行正畸掩饰治疗后,牙槽形态会发生相应改变,患者上下前牙牙槽骨厚度和高度会一定程度地减少。因此,在矫治过程中应当对患者牙槽形态的变化给予密切关注,尽量避免上下前牙发生代偿性移动,从而降低不良反应情况发生的风险。展开更多
基金Supported by the Health Research Program of Anhui,No.AHWJ2022b032 and No.AHWJ2023A30034.
文摘BACKGROUND In recent years,pure laparoscopic radical surgery for Bismuth-Corlette type Ⅲ and Ⅳ hilar cholangiocarcinoma(HCCA)has been preliminarily explored and applied,but the surgical strategy and safety are still worthy of further improvement and attention.AIM To summarize and share the application experience of the emerging strategy of“hepatic hilum area dissection priority,liver posterior separation first”in pure laparoscopic radical resection for patients with HCCA of Bismuth-Corlette types Ⅲ and IV.METHODS The clinical data and surgical videos of 6 patients with HCCA of Bismuth-Corlette types Ⅲ and Ⅳ who underwent pure laparoscopic radical resection in our department from December 2021 to December 2023 were retrospectively analyzed.RESULTS Among the 6 patients,4 were males and 2 were females.The average age was 62.2±11.0 years,and the median body mass index was 20.7(19.2-24.1)kg/m^(2).The preoperative median total bilirubin was 57.7(16.0-155.7)μmol/L.One patient had Bismuth-Corlette type Ⅲa,4 patients had Bismuth-Corlette type Ⅲb,and 1 patient had Bismuth-Corlette type Ⅳ.All patients successfully underwent pure laparoscopic radical resection following the strategy of“hepatic hilum area dissection priority,liver posterior separation first”.The operation time was 358.3±85.0 minutes,and the intraoperative blood loss volume was 195.0±108.4 mL.None of the patients received blood transfusions during the perioperative period.The median length of stay was 8.3(7.0-10.0)days.Mild bile leakage occurred in 2 patients,and all patients were discharged without serious surgery-related complications.CONCLUSION The emerging strategy of“hepatic hilum area dissection priority,liver posterior separation first”is safe and feasible in pure laparoscopic radical surgery for patients with HCCA of Bismuth-Corlette types Ⅲ and Ⅳ.This strategy is helpful for promoting the modularization and process of pure laparoscopic radical surgery for complicated HCCA,shortens the learning curve,and is worthy of further clinical application.
文摘目的:分析数字X射线摄影(digital radiography,DR)下不同骨折线方向GartlandⅢ伸直型肱骨髁上骨折患儿的临床特点。方法:回顾性分析无锡市儿童医院2021年1月-2022年12月收治的GartlandⅢ伸直型肱骨髁上骨折患儿80例的临床资料。按照DR下不同骨折线方向,分为水平型组(n=25)、顺斜型组(n=25)及逆斜型组(n=30)三组。调查记录三组患儿年龄、受伤至复位时间、性别、受伤部位、分型、致伤原因、骨折类型及合并神经损伤情况;对比分析三组患儿手术时间、切开手术比例、肘前瘀斑比例、治疗方式及Flynn肘关节功能恢复优良率。结果:三组患儿的年龄、受伤至复位时间、性别比例、受伤部位、分型、致伤原因及骨折类型相比无显著差异(P>0.05);逆斜型组患儿的手术时间(61.83±9.37)m i n、肘前瘀斑比例36.67%、切开手术比例23.33%及合并神经损伤比例16.67%、6.67%均长于或高于水平型组及顺斜型组患儿,差异有统计学意义(P<0.05);水平型组及顺斜型组患儿的三项指标项目无显著差异(P>0.05);水平型组、顺斜型组、逆斜型组Flynn肘关节功能恢复优良率分别为96.00%、92.00%、90.00%,三组患儿的Flynn肘关节功能恢复优良率比较差异不显著(P>0.05)。结论:逆斜型GartlandⅢ伸直型肱骨髁上骨折患儿的软组织损伤较重,肘前瘀斑明显,手术时间较长,切开手术比例较高。
文摘目的探讨成人骨型Ⅲ类患者矫治前后上下前牙区牙槽高度和宽度变化以及前牙区牙根位置变化。方法选取2020年5月—2022年11月在中山市小榄人民医院口腔科正畸掩饰治疗的成人骨型Ⅲ类患者50例,比较正畸治疗前后患者上下颌前牙牙槽骨厚度和高度,其中包括上前牙槽骨厚度(upper anterior alveolar bonethickness,UA)、上后牙槽骨厚度(upper posterior alveolar bone thickness,UP)、上牙槽骨总厚度(upper alveolar bone width,UW)、下前牙槽骨厚度(lower anterior alveolar bone thickness,LA)、下后牙槽骨厚度(lower posterior alveolar bone thickness,LP)、下牙槽骨总厚度(lower alveolar bone width,LW)、根中水平上前牙槽骨厚度(upper anterior alveolar bone thickness at the mid-root level,UA-m)、根中水平上后牙槽骨厚度(upper posterior alveolar bone thickness at the mid-root level,UP-m)、根中水平上牙槽骨总厚度(upper alveolar bone thickness at the mid-root level,UW-m)、根中水平下前牙槽骨厚度(lower anterior alveolar bone thickness at the mid-root level,LA-m)、根中水平下后牙槽骨厚度(lower posterior alveolar bone thickness at the mid-root level,LP-m)、根中水平下牙槽骨总厚度(lower alveolar bone thickness at the mid-root level,LW-m)以及上前牙槽骨高度(upper anterior alveolar bone height,UAH)和下前牙槽骨高度(lower anterior alveolarbone height,LAH)。结果正畸治疗前后患者UA、UP-m测量值比较,差异无统计学意义(P>0.05)。与正畸治疗前比较,正畸治疗后患者UP、UW、UA-m、UW-m测量值均显著降低(P<0.05)。正畸治疗后患者LP、LA-m测量值与正畸治疗前比较,差异无统计学意义(P>0.05)。与正畸治疗前比较,正畸治疗后患者LA、LW、LP-m、LW-m测量值均降低(P<0.05)。与正畸治疗前比较,正畸治疗后患者UAH、LAH测量值均显著降低(P<0.05)。正畸治疗后,患者上下颌前牙解剖牙根长度分别为(10.62±0.57)mm、(9.65±0.48)mm,正畸治疗前患者上下颌前牙解剖牙根长度分别为(11.01±0.58)mm、(10.37±0.48)mm,与正畸治疗前比较,患者上下颌前牙解剖牙根长度明显减小(P<0.05)。结论成人骨型Ⅲ类患者进行正畸掩饰治疗后,牙槽形态会发生相应改变,患者上下前牙牙槽骨厚度和高度会一定程度地减少。因此,在矫治过程中应当对患者牙槽形态的变化给予密切关注,尽量避免上下前牙发生代偿性移动,从而降低不良反应情况发生的风险。
