AIM:To study our novel caudal approach laparoscopic posterior-sectionectomy with parenchymal transection prior to mobilization under laparoscopy-specific view.METHODS:Points of the procedure are:(1) Patients are put i...AIM:To study our novel caudal approach laparoscopic posterior-sectionectomy with parenchymal transection prior to mobilization under laparoscopy-specific view.METHODS:Points of the procedure are:(1) Patients are put in left lateral position and posterior sector is not mobilized;(2) Glissonian pedicle of the sector is encircled and clamped extra-hepatically and divided afterward during the transection;(3) Dissection of inferior vena cava(IVC) anterior wall behind the liver is started from caudal.Simultaneously,liver transection is performed to search right hepatic vein(RHV) from caudal;(4) Liver transection proceeds to the bifurcation of the vessels from caudal to cranial,exposing the surfaces of IVC and RHV.Since the remnant liver sinks down,the cutting surface is well-opend;and(5) After the completion of transection,dissection of the resected liver from retroperitoneum is easily performed using the gravity.This approach was performed for a 63 years old woman with liver metastasis close to RHV.RESULTS:RHV exposure is required for R0 resection of the lesion.Although the cutting plane is horizontal in supine position and the gravity obstructs the exposure in the small subphrenic space,the use of specific characteristics of laparoscopic hepatectomy,such as the good vision for the dorsal part of the liver and IVC and facilitated dissection using the gravity with the patient positioning,made the complete RHV exposure during the liver transection easy to perform.The operation time was 341 min and operative blood loss was 1356 mL.Her postoperative hospital stay was uneventfull and she is well without any signs of recurrences 14 mo after surgery.CONCLUSION:The new procedure is feasible and useful for the patients with tumors close to RHV and the need of the exposure of RHV.展开更多
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 conf...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.展开更多
目的探讨两种手术入路,在电视胸腔镜右上肺叶切除术中的可行性以及对术后康复的影响。方法收集2017年1月1日至2019年10月31日86例行右肺上叶切除患者的临床资料。按两种手术入路,将患者分为AVB(动脉-静脉-支气管)组46例和aBVA(后升支动...目的探讨两种手术入路,在电视胸腔镜右上肺叶切除术中的可行性以及对术后康复的影响。方法收集2017年1月1日至2019年10月31日86例行右肺上叶切除患者的临床资料。按两种手术入路,将患者分为AVB(动脉-静脉-支气管)组46例和aBVA(后升支动脉-支气管-动静脉)组40例,分析比较两组患者的一般临床特征、病理结果、术中情况及术后康复情况。结果与AVB组相比,aBVA组在手术时间(138.4 vs 181.6 min,P<0.001)、术中失血(113.0 vs 196.5 mL,P<0.001)、切割闭合器钉仓数量(4.0 vs 5.4,P<0.001)、胸腔引流时间(3.6 vs 4.8 d,P<0.001)、住院时间(6.2 vs 7.8 d,P=0.001)、住院总费用(61000 vs 69000元,P=0.001)等方面具有显著优势。在术后并发症方面,两组发生率无统计学差异(15.2%vs 12.5%,P=0.717)。结论电视胸腔镜下右肺上叶切除,采用aBVA解剖入路安全可行,在一定程度上可以降低手术风险,简化手术流程,利于患者术后快速康复。展开更多
文摘AIM:To study our novel caudal approach laparoscopic posterior-sectionectomy with parenchymal transection prior to mobilization under laparoscopy-specific view.METHODS:Points of the procedure are:(1) Patients are put in left lateral position and posterior sector is not mobilized;(2) Glissonian pedicle of the sector is encircled and clamped extra-hepatically and divided afterward during the transection;(3) Dissection of inferior vena cava(IVC) anterior wall behind the liver is started from caudal.Simultaneously,liver transection is performed to search right hepatic vein(RHV) from caudal;(4) Liver transection proceeds to the bifurcation of the vessels from caudal to cranial,exposing the surfaces of IVC and RHV.Since the remnant liver sinks down,the cutting surface is well-opend;and(5) After the completion of transection,dissection of the resected liver from retroperitoneum is easily performed using the gravity.This approach was performed for a 63 years old woman with liver metastasis close to RHV.RESULTS:RHV exposure is required for R0 resection of the lesion.Although the cutting plane is horizontal in supine position and the gravity obstructs the exposure in the small subphrenic space,the use of specific characteristics of laparoscopic hepatectomy,such as the good vision for the dorsal part of the liver and IVC and facilitated dissection using the gravity with the patient positioning,made the complete RHV exposure during the liver transection easy to perform.The operation time was 341 min and operative blood loss was 1356 mL.Her postoperative hospital stay was uneventfull and she is well without any signs of recurrences 14 mo after surgery.CONCLUSION:The new procedure is feasible and useful for the patients with tumors close to RHV and the need of the exposure of RHV.
文摘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.
文摘目的探讨两种手术入路,在电视胸腔镜右上肺叶切除术中的可行性以及对术后康复的影响。方法收集2017年1月1日至2019年10月31日86例行右肺上叶切除患者的临床资料。按两种手术入路,将患者分为AVB(动脉-静脉-支气管)组46例和aBVA(后升支动脉-支气管-动静脉)组40例,分析比较两组患者的一般临床特征、病理结果、术中情况及术后康复情况。结果与AVB组相比,aBVA组在手术时间(138.4 vs 181.6 min,P<0.001)、术中失血(113.0 vs 196.5 mL,P<0.001)、切割闭合器钉仓数量(4.0 vs 5.4,P<0.001)、胸腔引流时间(3.6 vs 4.8 d,P<0.001)、住院时间(6.2 vs 7.8 d,P=0.001)、住院总费用(61000 vs 69000元,P=0.001)等方面具有显著优势。在术后并发症方面,两组发生率无统计学差异(15.2%vs 12.5%,P=0.717)。结论电视胸腔镜下右肺上叶切除,采用aBVA解剖入路安全可行,在一定程度上可以降低手术风险,简化手术流程,利于患者术后快速康复。
