ObjectiveTo explore the effect of laparoscopic partial recto-sigmoid resection with rectopexy for adult complete rectal prolapse. MethodsClinical data of 32 adult patients with complete rectal prolapse who underwent laparoscopic partial recto-sigmoid resection with rectopexy in our hospital from May. 2010 to May. 2013 were analyzed. ResultsAll operations were performed successfully and all patients were cured, no one transferred to open surgery. The mean of operation time was 114.7 min (95-167 min), the mean of operative blood loss was 80 mL (55-150 mL), and the mean of hospital stay was 9.8 d (6-14 d). All patients were followed up for 3-48 months (mean of 25.6 months), and anal function of them recovered well. During the follow-up period, there were no operative complications and recurrent case. ConclusionsLaparoscopic partial recto-sigmoid resection with rectopexy is a safe and effective procedure for the treatment of adult complete rectal prolapse, with minimal invasion, quick recovery, and a low recurrence rate. It provides a novel surgical method with a high value of clinical application.
目的 探讨脾占位性病变的临床诊断特点和治疗对策。方法 回顾性分析68例脾占位性病变患者的临床资料。结果 超声和CT是诊断脾占位性病变的主要方法。68例脾占位性病变中良性48例，恶性20例。手术治疗47例，其中脾切除37例，脾切除加胰尾切除2例，脾部分切除3例，脾切除加脾窝引流4例，单纯脾囊肿去顶减压1例。1例脾脓肿行脾切除术后发生肺部感染，经抗感染治疗后痊愈； 1例脾脓肿行脾切除术后，发生脾窝脓肿，感染严重，被迫再次开腹行脓肿引流术，其余良性病变经手术治疗后效果好； 恶性病变术后效果差。结论 脾占位性病变良性多见，恶性少见； 影像学检查是诊断脾占位性病变的主要手段。脾切除对成年人是一种有效的治疗方法，良性预后好，恶性预后差； 对儿童、青少年脾良性病变，脾部分切除是一种很好的选择。
Objective To investigate the advance in surgical treatment of inferior pole fracture of patella and to explore the existing problems and further research directions. Methods Domestic and foreign l iterature in recent years on patella fracture was extensively reviewed, the surgical treatment of inferior pole fracture of patella was summarized by combining the research findings with cl inical experience. Results The surgical treatment of inferior pole of patella fractures included retaining the integrity of the patella and partial patellectomy of inferior pole of patella and extending knee installationreconstruction. There were kinds of ways to retain the integrity of the patella, such as circular wire fixation, tension bandfixation, NiTi-patella concentrotor fixation, basket plate fixation, reforming McLaughl in way and polydioxanone suture netfixation; the latter category is partial patellectomy and extensor device reconstruction. Every surgical way had its advantages and l imitations. Conclusion Most studies tend to retain the integrity of the patella, but some researches have shown that partial resection of inferior pole of patella had no significant effect on knee function. It is important to obtain the security excisional range and elongation range postoperative by experiment for regulating the treatment of comminuted fractures of inferior pole of patella.
ObjectiveTo investigate the feasibility of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) combined with mixed reality holographic imaging in treating the massive hepatocellular carcinoma.MethodThe clinicopathologic data of 1 patient with massive hepatocellular carcinoma underwent the ALPPS combined with mixed reality holographic imaging in the Guangdong Second Traditional Chinese Medicine Hospital on January 2019 were retrospectively analyzed.ResultsA 58-year-old female patient, the preoperative CT scan and enhanced scan of the abdomen revealed a 12.0 cm×10.5 cm×17.0 cm mass in the right lobe of the liver, with preoperative Child-Pugh grade A liver function. The ALPPS was performed after the preoperative evaluation. The associating liver partition and portal vein ligation was performed and the mixed reality holographic imaging was used during the stage Ⅰ operation. On day 21 after the stage Ⅰ operation, the CT results of the volume of left lateral lobe of liver was approximately 57.64%. On day 24 after the stage Ⅰ operation, the patient underwent the stage Ⅱ operation (radical hepatectomy). The patient received the chemotherapy after the operation. The courses of those operations were successful. And no severe complications occurred after the operation. The postoperative pathological results showed a moderately differentiated hepatocellular carcinoma with multiple foci and a maximum diameter of 13 cm. Six months after the last operation, there was no new intrahepatic metastasis and other metastases were found.ConclusionsALPPS combined with mixed reality holographic imaging is effective in treatment of massive hepatocellular carcinoma. Mixed reality holographic imaging could show anatomical details with three dimensions, it is beneficial for estimating future liver reserve before operation and locating during operation, and there is also a positive significance of postoperative recovery.
To evaluate the biological tolerance of the human liver to prolonged warm ischemia, 20 patients who underwent liver resections with hepatic inflow occlusion are reported. Biopsy of liver were performed during and after consecutive periods of hepatic ischemia, and speciments were observed under light and electron microscope. The results showed that hepatic vascular occlusion for ＜30 min, resulted in atotissular temporary but reversible pathologic and ultrastructural changes in liver, even patients with liver cirrhosis had better recovery from the operation when the hepatic ischemia was lengthen up to 40 min.
Objective To evaluate the effect of the combined method of l iposuction and semicircular periareolar incision glandular organ partial resection in the treatment of gynecomastia. Methods From June 2004 to June 2006, 40 patients, aged 11-41 years old, were treated, with no-nodule (n=10), nodule (n=22) and female-breast-l ike with nodules (n=8). Three patients were unilateral and 37 ones were bilateral. The levels of serum prolactin, luteinizing hormone, foll icle stimulating hormone, estradiol, testosterone and cortisol were normal in 38 patients, while in the other 2 patients, the levels ofserum prolactin, luteinizing hormone, foll icle stimulating hormone and estradiol were higher than normal, and the testosterone level was lower. Li posuction alone was performed in 10 no-nodule patients (lei po-type), and combined l i posuction and semicircular periareolar incision glandular organ partial resection were conducted in the other 30 patients (lei po-glandular type). Results Except for 2 cases in which hematoma and a small amount of effusion were found on the first and second day postoperatively and then obtained heal ing by first intention right after hematoma removal in time, all the other patients’ incisions obtained heal ing by first intention. Ni pple numbness occurred in 3 cases on the first day postoperatively and no special treatment was conducted. There was still nipple hypesthesia in these 3 cases after 6-month follow-up. There were no compl ications such as hematoma, effusion, nipple and mammary areola necrosis, and nipple hypesthesia in other patients. All the 40 patients were followed up for 6-24 months (13 months on average). They were satisfied with their chest figures and no recurrence was observed. Conclusion The combined method of l iposuction and semicircular periareolar incision glandular organ partial resection in the treatment of gynecomastia has many advantages, such as safe, micro-scars, natural and beautiful male breast figures as well as high patients’ satisfaction.
摘要:目的:探讨腹腔镜胆囊大部分切除在复杂胆囊结石手术中应用的可行性及安全性。方法:回顾性分析2003年1月至2008年10月间41例行腹腔镜胆囊部分切除术的复杂胆囊结石病人。行腹腔镜胆囊切除术指征为:胆囊管不能明确辨认时,诸如:胆囊积脓、Mirris综合征、Calot三角致密粘连呈“冰冻样”、萎缩性胆囊等。手术方法为:切除胆囊前壁,取净结石,腹腔置管引流。结果:41例复杂胆囊结石病人中1例中转开腹手术外,其余全部在腹腔镜下完成,手术时间为45～145分钟,平均(57.42±19.41)分钟,1例术后出现胆漏,其余术后住院时间为2～7天。 结论:在胆囊三角不能安全辨认前提下,对于复杂胆囊结石行腹腔镜胆囊部分切除术是一种安全的手术方式,不但能简化手术、降低手术风险,而且能避免行开腹手术治疗。Abstract: Objective: To study the possibility and safty of laparoscopic subtotal cholecystectomy in complicated cholecystectomy. Methods: Laparoscopic subtotal cholecystectomy was performed when the cystic duct cannot be identified safely, such as empyema cholecystitis, Mirris syndrome, frozen Calot’triangle, shrunken gallbladder. The operation consists of resecting the anterior wall of the gallbladder, removing all stones, and placing a large drain. 41 patients who underwent a laparoscopic subtotal cholecystectomy between 1 January 2003 and 31 October 2008 were retrospectively analyzed. Results: Fortyone cases of complex laparoscopic cholecystectomy were performed. 1 cases in which were changed to open cholecystectomy. Operating time was 45145 min, average (57.42±19.41) min. 1 cases were reoperated because of the bile leak. Hospital stays were 27 days. Conclusion: Laparoscopic subtotal cholecystectomy is a viable procedure during cholecystectomy in which Calot’s triangle cannot be safely dissected. It may simplify the operation and decrease the risk in complicated cholecystectomy and averts the need for a laparotomy.
The detection rate of benign and borderline/low-grade malignant tumors of pancreas has increased year by year. Most of the patients are middle-aged and young people, who have thirst for high quality of life in long-term. Pancreatic-duct-preserving partial pancreatectomy can meet the needs of reducing surgical trauma, preserving normal pancreatic function and improving patients’ quality of life. However, pancreatic-duct-preserving partial pancreatectomy often needs to face the problem of pancreatic duct defect. Repair of pancreatic duct needs to be applied according to different types of pancreatic duct defect. At the same time, the prevention and treatment of pancreatic fistula also require more patience, courage and creativity of pancreatic surgeons. Pancreatic-duct-preserving partial pancreatectomy can solve the current clinical problems. It is safe and feasible with carefully evaluate indications, characters of patients and the personal ability of surgeons.
ObjectiveTo summarize the recent development of surgical treatment for portal hypertension with hypersplenism. MethodsThe related literatures on various operation treatment of hypertension with hypersplenism at home and abroad in recent years were collected and reviewed. ResultsThere are many operation treatment methods of hypertension with hypersplenism, includes the pericardial devascularization, subtotal splenectomy, partial splenic embolization, spleen radiofrequency ablation, splenic artery ligation, distal splenorenal shunt, and so on. The different operation methods each has its advantages and disadvantages, but there are a certain percentage of the incidence of complications. At the same time, due to the limited understanding of the function of the spleen in portal hypertension, the treatment of "resecting" or "reserving" spleen has always been the hot spot of the academic dispute. ConclusionFor what kind of operation method is the most suitable for the treatment of hypertension with hypersplenism is no fixed conclusion.
ObjectiveTo analyze the efficacy and safety of complete excision of the external capsule in the treatment of hepatic echinococcosis.MethodsThe clinical data of 90 patients with hepatic cystic echinococcosis admitted to our hospital from January 2016 to March 2018 were retrospectively analyzed. According to the different surgical methods, this patients were divided into two groups: the partial hepatectomy group and complete excision of the external capsule group, 45 cases in each group. The patient's general condition and the situation during hospitalization were analyzed, and the intraoperative conditions, postoperative complications, recurrence and mortality after one year in different surgical methods were compared.ResultsThe operative time and intraoperative blood loss in the partial hepatectomy group was significantly longer or more than that in the complete excision of the external capsule group (P<0.05), respectively. There was no significant difference between the two groups in hospitalization time (P>0.05). The incidence of postoperative complications was 11.11% in the partial hepatectomy group and 8.88% in the complete excision of the external capsule group. There was no significant difference between the two groups (P>0.05). After 1 year of followed-up, the recurrence rate of the partial hepatectomy group was 4.44%, and there was no recurrence in the complete excision of the external capsule group, and there was no significant difference between the two groups (P>0.05). There was no death in both groups.ConclusionsIn the surgical treatment of hepatic cystic echinococcosis, the most appropriate surgical method should be selected according to the specific conditions of the patient, and the complete excision of the external capsule has higher therapeutic effect and safety in the treatment of hepatic echinococcosis. It is worthy of clinical promotion.