ObjectiveTo investigate the role of 3D visualization technology in the laparoscopic precise hepatectomy. MethodsTo retrieve the literatures about the application of 3D visualization technology in laparoscopic precise hepatectomy, and summarize and analyzed them. ResultsThe application of 3D visualization in laparoscopic precise hepatectomy could effectively reduce the operative time, blood loss, blood transfusion rate, and total complication rate. The application of 3D visualization in preoperative evaluation of the resection surface and residual liver volume had been relatively mature. Although many organizations try to use 3D visualization in laparoscopic hepatectomy, such as laser registration and real-time intraoperative navigation, it had not been widely used in clinic because of technical limitations. ConclusionsExisting research results show that, the application of 3D visualization technology in laparoscopic precise hepatectomy can improve the resectability of lesions, increase perioperative safety, but intraoperative navigation is still need to be further developed before it is expected to be widely used in clinical practice. Existing evidence of increased benefit from laparoscopic precise hepatectomy with 3D reconstruction remains limited, and more rigorous randomized controlled trials of large cases are needed to confirm this.
Objective To analyse the clinical features of Peutz-Jeghers syndrome and its canceration, and to summarize the management and the follow-up strategy for patients with Peutz-Jeghers syndrome. Methods Clinical data of 30 patients with Peutz-Jeghers syndrome dating from October 1985 to September 2005 in West China Hospital of Sichuan University were analyzed retrospectively. Results Fourteen (46.67%) definite family histories of Peutz-Jeghers syndrome were found. Pigmentation of skin and mucosa, abdominalgia and hematochezia were major clinical manifestations of the syndrome. There were 18 patients (60.00%) complicated with intussusception and acute intestinal obstructions, 16 patients (53.33%) with gastrointestinal bleeding, and 6 patients (20.00%) developed malignancy. The frequent types of malignancy were carcinoma of small intestine (3 cases), colon carcinoma (2 cases) and gastric carcinoma (1 case) in order. The mean age of the canceration-diagnosed patients was 32 years old. The type of pathohistology of all the malignancy was poorly differentiated mucus adenocarcinoma. High-frequency endoscopic electroresection, orthdox polypectomy and enterectomy were the major means of treatment. Conclusion Patients with Peutz-Jeghers syndrome are at high risk of canceration at relatively early ages and usually the differentiation of the tumor is poor. Endoscopy should be performed regularly and the high-frequency electroresection is an effective therapy in disposing intestinal polyp. Screening can also improve the efficacy of Peutz-Jeghers syndrome.
【摘要】 目的 探讨经脐单孔腹腔镜胆囊切除术的临床可行性及其优缺点。 方法 回顾分析2010年7-9月行经脐单孔腹腔镜胆囊切除术34例患者临床资料。 结果 患者均顺利完成单孔腹腔镜胆囊切除术，手术平均时间为65 min，术后平均住院时间为3 d，术后未发生出血、感染、胆瘘等并发症。 结论 单孔腹腔镜胆囊切除术是安全可行的，术后腹部无明显瘢痕，美容效果明显。【Abstract】 Objective To evaluate the feasibility and value of the trans-umbilical single-port laparoscopic cholecystectomy. Methods The clinical data of 34 patients who underwent trans-umbilical single-port laparoscopic cholecystectomy from July to September 2010 were retrospectively analyzed. Results The operations of 34 patients were successfully performed. The mean operative duration was 65 minutes, and the mean duration in hospital after the operation was 3 days. No infection, postoperative bleeding, and biliary leakage occurred postoperatively. Conclusion Trans-umbilical single-port laparoscopic cholecystectomy is safe and feasible with good cosmetic effect.
目的 探讨妊娠期并发急性胰腺炎(APIP)的病因、发病机理、临床特点及防治措施. 方法 对四川省宜宾市第二人民医院和四川大学华西医院1995年1月至2006年12月期间收治的72例APIP患者的临床资料进行回顾性分析. 结果 本组72例中,属轻型急性胰腺炎(MAP)者49例(68.06%),重症急性胰腺炎(SAP)者23例(31.94%); 有胆囊炎合并胆囊结石病史者43例(59.72%),伴高脂血症者21例(29.17%).采用非手术治疗56例,手术治疗16例,孕妇治愈66例(91.67%),死亡6例(8.33%),死因为多器官功能障碍综合征、急性呼吸窘迫综合征及严重复腔感染; 终止妊娠16例(均为32～38周妊娠),56例继续妊娠; 72例中双胎2例,胎儿死亡共15例(20.27%); 漏诊、误诊6例.结论 APIP的发生与胆结石和高脂血症有关,并于妊娠中晚期发病率高; 其临床表现复杂,易误诊,对孕妇及胎儿威胁极大; 把握该疾病的特点,提高对APIP的认识和警惕性,及时准确的诊断与"个体化"的治疗原则,适时终止妊娠,可以提高其治愈率,降低母婴死亡率.
Objective To determine the safety and efficacy of surgical biliary bypass on the elderly patients with unresectable pancreatic head cancer. Methods The clinical data of 55 cases with unresectable pancreatic head cancer treated with palliation methods from July 2002 to June 2009 in our hospital were retrospectively analyzed. The patients were divided into three groups according to different age and therapeutic program: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (group A), 19 patients under 65 years of age were treated by surgical biliary bypass (group B) and 17 patients with the age of 65 years or older received percutaneous transhepatic biliary drainage (group C). Then the therapeutic results were compared.Results With respect to the postoperative level of serum bilirubin, the incidence of early complications, postoperative hospitalization and mean survival time, no statistically significant difference was found between group A and B (Pgt;0.05). There was one case of recurrent jaundice and one case of gastric output obstruction in group B, while no one suffered postoperative complication in group A, and the difference was statistically significant (Plt;0.01). Compared with group A, the postoperative level of serum bilirubin, the number of patient readmitted, the rate of recurrent jaundice and gastric output obstruction were higher in group C (Plt;0.05 or Plt;0.01). The mean postoperative hospitalization and overall survival time were significantly shorter in group C than group A (Plt;0.05 or Plt;0.01, respectively). Conclusion Surgical palliation does not increase the morbidity rate, but it does improve the quality of life in elderly patients with unresectable pancreatic head cancer.
Objective To investigate the value of a new double action MR contrast agent——Gd-BOPTA in the diagnosis of focal nodular hyperplasia (FNH) of the liver with correlation of pathology. Methods Dedicated MRI scans were performed for 5 patients suspected to have liver FNH on clinical and imaging basis (six lesions). The MR imaging protocol included axial T1W and T2W plain scan, coronal T2 weighted imaging, 3D MRCP, Gd-BOPTA enhanced LAVA dynamic tri-phasic acquisitions (scanning at 15 s, 55 s and 90 s respectively), enhanced 2D T1W scan, enhanced LAVA in delay phase (at 5 and 10 min) and in the hepatobiliary phase (at 40 and 80 min). The imaging features on each MR sequence were compared with surgical and pathological findings. Results Six lesions in 5 FNH patients were all correctly diagnosed (5 conformed by surgery and 1 by needle biopsy). ①The hemodynamic phase: The parenchyma of 5 lesions were markedly enhanced in the arterial phase, being isointense or slight hypointense in both the portal venous and delay phases, while 1 lesion was isointense in all phases except being slight hyperintense in the arterial phase; The central scar of 5 lesions were not enhanced in the dynamic phase, but showed delayed enhancement. ②The hepatobiliary (excretory) phase: The parenchyma of all 6 lesions were slight hyperintense or isointense, and tree-like bile ducts with hyperintensity were seen within one lesion. The scar showed no enhancement. ③Pathology: The parenchyma was consisted of disarranged normal hepatocytes but with cytoedema, lack of portal tracts and cholestatic change. The central scar showed rich fibrous tissue, a very thick-walled arteriole, proliferative bile ducts, infiltration of inflammatory cells and myxomatous changes. Conclusion As a dual-phase MR contrast agent capable of depicting both the hemodynamic attributes and hepatobiliary excretion, Gd-BOPTA enhanced MRI can reflect the pathological features of FNH and reach a high diagnostic accuracy.