经乙状窦后道上结节入路切除岩斜区脑膜瘤

目的 探讨经乙状窦后道上结节入路切除岩斜区脑膜瘤的手术技巧、疗效及适应证。方法 回顾性分析2016年5月—2019年3月采用该入路切除的15例岩斜区脑膜瘤患者的临床特征、手术方法及术后并发症。结果 15例术前均表现头痛、5例面部感觉减退、2例面部疼痛、1例听力下降。SimpsonⅡ级切除11例，Ⅲ级切除3例，Ⅳ级切除1例。平均随访15个月，无死亡，术后远期生活质量评估（KPS）评分80~90分。术后头痛15例均缓解，面部感觉减退3例缓解、2例加重、新增2例，面部疼痛2例缓解，听力下降1例未缓解，新增复视2例、6个月后均缓解。结论 掌握好适应证，经乙状窦后道上结节入路是切除岩斜脑膜瘤的较好途径。     

Outcomes of vascular resection associated with curative intent hepatectomy for intrahepatic cholangiocarcinoma

Background and aimsWe aimed to investigate the impact of vascular resection (VR) on postoperative outcomes and survival of patients undergoing hepatectomy for intrahepatic cholangiocarcinoma (ICC).MethodsA retrospective analysis of a multi-institutional series of 270 patients with resected ICC was carried out. Patients were divided into three groups: portal vein VR (PVR), inferior vena cava VR (CVR) and no VR (NVR). Univariate and multivariate analysis were applied to define the impact of VR on postoperative outcomes and survival.ResultsThirty-one patients (11.5%) underwent VR: 15 (5.6%) to PVR and 16 (5.9%) to CVR. R0 resection rates were 73.6% in NVR, 73.3% of PVR and 68.8% in CVR. The postoperative mortality rate was increased in VR groups: 2.5% in NVR, 6.7% in PVR and 12.5% in CVR. The 5-years overall survival (OS) rates progressively decreased from 38.4% in NVR, to 30.1% in CVR and to 22.2% in PVR, p = 0.030. However, multivariable analysis did not confirm an association between VR and prognosis. The following prognostic factors were identified: size ≥50 mm, patterns of distribution of hepatic nodules (single, satellites or multifocal), lymph-node metastases (N1) and R1 resections. In the VR group the 5-years OS rate in patients without lymph-node metastases undergoing R0 resection (VRR0N0) was 44.4%, while in N1 patients undergoing R1 resection was 20% (p < 0.001).ConclusionVascular resection (PVR and CVR) is associated with higher operative risk, but seems to be justified by the good survival results, especially in patients without other negative prognostic factors (R0N0 resections).     

机器人辅助经尿道前列腺水消融术的临床应用进展

随着前列腺增生微创治疗的不断发展,机器人系统也被广泛引入其治疗当中,相比于机器人腹腔镜手术来说,本文着重介绍近年新出现的辅助水消融的自动化机器人系统。该系统经尿道的入路方式比传统腹腔镜机器人手术损伤更小,而且其处理系统相对简单,便于新手操作,从而降低了学习曲线,减少了手术时间和相关并发症。本文通过综述国外研究经验,为国内引入此技术提供参考借鉴。