BACKGROUND Laparoscopic hepatectomy is a proven safe and technically feasible approach for liver tumor resection,but laparoscopic anatomical SVIII resection(LASVIIIR)remains rarely reported due to poor accessibility,d...BACKGROUND Laparoscopic hepatectomy is a proven safe and technically feasible approach for liver tumor resection,but laparoscopic anatomical SVIII resection(LASVIIIR)remains rarely reported due to poor accessibility,difficult exposure,and the deep-lying Glissonean pedicle.This study examined the safety,feasibility,and perio-perative outcomes of LASVIIIR via a middle hepatic fissure approach at our in-stitution.AIM To investigate the safety,feasibility,and perioperative outcomes of LASVIIIR via a middle hepatic fissure approach at our institution.METHODS From November 2017 to December 2022,all patients with a liver tumor who underwent LASVIIIR were enrolled.The perioperative outcomes and postope-rative complications were evaluated.RESULTS Thirty-four patients underwent LASVIIIR via a middle hepatic fissure approach from the side or cranio side and were included.The mean operation time was 164±54 minutes,and the intra-operative blood loss was 100 mL(range:20-1000 mL).The mean operative times were,respectively,152±50 minutes and 222±29 minutes(P=0.001)for the caudal side and cranial side approaches.In addition,the median blood loss volumes were 100 mL(range:20-300 mL)and 250 mL(range:20-1000 mL),respectively,for the caudal and cranial sides(P=0.064).Three patients treated using the cranial side approach experienced bile leakage,while 1 patient treated using the caudal side approach had subphrenic collection and underwent percutaneous drainage to successfully recover.There were no differences regarding postoperative hospital stays for the caudal and cranial side approaches[9(7-26)days vs 8(8-19)days](P=0.226).CONCLUSION LASVIIIR resection remains a challenging operation,but the middle hepatic fissure approach is a reasonable and easy-to-implement technique.展开更多
目的分析不同入路小骨窗开颅显微手术治疗基底节区高血压脑出血的效果。方法选取2019年1月至2022年3月丰城市人民医院收治的88例基底节区高血压脑出血患者作为研究对象,随机分为观察组与对照组,每组44例。两组均行小骨窗开颅显微手术,...目的分析不同入路小骨窗开颅显微手术治疗基底节区高血压脑出血的效果。方法选取2019年1月至2022年3月丰城市人民医院收治的88例基底节区高血压脑出血患者作为研究对象,随机分为观察组与对照组,每组44例。两组均行小骨窗开颅显微手术,对照组采用经颞叶皮质入路手术治疗,观察组采用经侧裂下Rolandic点-岛叶入路手术治疗,比较两组手术情况、血肿清除率、再出血率、术后并发症、术后1个月格拉斯哥昏迷量表(Glasgow coma score,GOS)分级情况及术后1、3、6个月的美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分及世界卫生组织生存质量测定量表(World Health Organization on quality of life brief scale,WHOQOL-BREF)评分。结果两组手术时间、术中出血量、引流管放置时间、行大骨瓣减压例数、住院时间比较差异均无统计学意义;观察组开始手术至颅内压下降时间长于对照组,差异有统计学意义(P<0.05)。观察组术后24 h血肿清除率明显高于对照组,差异有统计学意义(P<0.05);两组再出血率比较差异无统计学意义。观察组术后1个月预后良好率为81.82%,高于对照组的61.36%,差异有统计学意义(P<0.05)。术后1、3、6个月,观察组NIHSS评分均低于对照组,WHOQOL-BREF评分均高于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率为6.82%,低于对照组的25.00%,差异有统计学意义(P<0.05)。结论经侧裂下Rolandic点-岛叶入路小骨窗开颅显微手术治疗基底节区高血压脑出血的效果显著,有助于提升血肿清除率,减少术后并发症发生率,促进术后神经功能的恢复,提高患者预后生存质量。展开更多
目的探讨经侧裂-岛叶人路显微手术对基底节区高血压脑出血的疗效。方法回顾性分析2010年1月-2013年6月64例基底节高血压脑出血患者临床资料。其中41例行经侧裂-岛叶入路显微手术(A组);另23例行常规骨瓣开颅手术(B组),比较2组治疗效果及...目的探讨经侧裂-岛叶人路显微手术对基底节区高血压脑出血的疗效。方法回顾性分析2010年1月-2013年6月64例基底节高血压脑出血患者临床资料。其中41例行经侧裂-岛叶入路显微手术(A组);另23例行常规骨瓣开颅手术(B组),比较2组治疗效果及近远期预后。结果 A组手术时间(115.35±46.23)min、术后自动睁眼时间(5.22±3.43)h均短于B组(212.43±58.24)min、(8.74±4.51)h(P<0.05)。术后7 d A组GCS评分(11.92±2.73)分高于B组(9.85±2.46)分(P<0.05)。术后48 h行CT复查,A组血肿大部分清除率为80.49%(33/41)优于B组的56.52%(13/23)(P<0.05)。观察组与对照组并发症发生率无明显差异(39.02%vs.47.83%,P>0.05)。术后3个月随访,A组优良率为60.98%(25/41),明显高于B组的34.78%(8/23)(P<0.05)。术后12个月随访,A组优良率为72.50%(29/40),明显高于B组的47.62%(10/21)(P<0.05)。结论经侧裂-岛叶入路显微手术治疗脑出血是一种损伤小、疗效好、并发症少的治疗方法。展开更多
基金Supported by Guangdong Provincial Science and Technology Plan Project,No.2022A0505050065Guangdong Natural Science Foundation,No.2022A1515011632.
文摘BACKGROUND Laparoscopic hepatectomy is a proven safe and technically feasible approach for liver tumor resection,but laparoscopic anatomical SVIII resection(LASVIIIR)remains rarely reported due to poor accessibility,difficult exposure,and the deep-lying Glissonean pedicle.This study examined the safety,feasibility,and perio-perative outcomes of LASVIIIR via a middle hepatic fissure approach at our in-stitution.AIM To investigate the safety,feasibility,and perioperative outcomes of LASVIIIR via a middle hepatic fissure approach at our institution.METHODS From November 2017 to December 2022,all patients with a liver tumor who underwent LASVIIIR were enrolled.The perioperative outcomes and postope-rative complications were evaluated.RESULTS Thirty-four patients underwent LASVIIIR via a middle hepatic fissure approach from the side or cranio side and were included.The mean operation time was 164±54 minutes,and the intra-operative blood loss was 100 mL(range:20-1000 mL).The mean operative times were,respectively,152±50 minutes and 222±29 minutes(P=0.001)for the caudal side and cranial side approaches.In addition,the median blood loss volumes were 100 mL(range:20-300 mL)and 250 mL(range:20-1000 mL),respectively,for the caudal and cranial sides(P=0.064).Three patients treated using the cranial side approach experienced bile leakage,while 1 patient treated using the caudal side approach had subphrenic collection and underwent percutaneous drainage to successfully recover.There were no differences regarding postoperative hospital stays for the caudal and cranial side approaches[9(7-26)days vs 8(8-19)days](P=0.226).CONCLUSION LASVIIIR resection remains a challenging operation,but the middle hepatic fissure approach is a reasonable and easy-to-implement technique.
文摘目的分析不同入路小骨窗开颅显微手术治疗基底节区高血压脑出血的效果。方法选取2019年1月至2022年3月丰城市人民医院收治的88例基底节区高血压脑出血患者作为研究对象,随机分为观察组与对照组,每组44例。两组均行小骨窗开颅显微手术,对照组采用经颞叶皮质入路手术治疗,观察组采用经侧裂下Rolandic点-岛叶入路手术治疗,比较两组手术情况、血肿清除率、再出血率、术后并发症、术后1个月格拉斯哥昏迷量表(Glasgow coma score,GOS)分级情况及术后1、3、6个月的美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分及世界卫生组织生存质量测定量表(World Health Organization on quality of life brief scale,WHOQOL-BREF)评分。结果两组手术时间、术中出血量、引流管放置时间、行大骨瓣减压例数、住院时间比较差异均无统计学意义;观察组开始手术至颅内压下降时间长于对照组,差异有统计学意义(P<0.05)。观察组术后24 h血肿清除率明显高于对照组,差异有统计学意义(P<0.05);两组再出血率比较差异无统计学意义。观察组术后1个月预后良好率为81.82%,高于对照组的61.36%,差异有统计学意义(P<0.05)。术后1、3、6个月,观察组NIHSS评分均低于对照组,WHOQOL-BREF评分均高于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率为6.82%,低于对照组的25.00%,差异有统计学意义(P<0.05)。结论经侧裂下Rolandic点-岛叶入路小骨窗开颅显微手术治疗基底节区高血压脑出血的效果显著,有助于提升血肿清除率,减少术后并发症发生率,促进术后神经功能的恢复,提高患者预后生存质量。
文摘目的探讨经侧裂-岛叶人路显微手术对基底节区高血压脑出血的疗效。方法回顾性分析2010年1月-2013年6月64例基底节高血压脑出血患者临床资料。其中41例行经侧裂-岛叶入路显微手术(A组);另23例行常规骨瓣开颅手术(B组),比较2组治疗效果及近远期预后。结果 A组手术时间(115.35±46.23)min、术后自动睁眼时间(5.22±3.43)h均短于B组(212.43±58.24)min、(8.74±4.51)h(P<0.05)。术后7 d A组GCS评分(11.92±2.73)分高于B组(9.85±2.46)分(P<0.05)。术后48 h行CT复查,A组血肿大部分清除率为80.49%(33/41)优于B组的56.52%(13/23)(P<0.05)。观察组与对照组并发症发生率无明显差异(39.02%vs.47.83%,P>0.05)。术后3个月随访,A组优良率为60.98%(25/41),明显高于B组的34.78%(8/23)(P<0.05)。术后12个月随访,A组优良率为72.50%(29/40),明显高于B组的47.62%(10/21)(P<0.05)。结论经侧裂-岛叶入路显微手术治疗脑出血是一种损伤小、疗效好、并发症少的治疗方法。
