腹腔镜肝海绵状血管瘤切除7例报道

目的：探讨腹腔镜肝海绵状血管瘤（肝血管瘤）切除的可行性及方法。方法：回顾性分析我院采用超声刀为主要切肝器械,并结合pringle法阻断第一肝门,完成腹腔镜肝血管瘤切除7例。包括局部切除4例,左外叶切除3例。结果：全部顺利完成手术,无中转开腹。手术时间75—225min,（156±47．9）min,术中出血200～1200ml,（460．0±302．5）ml,术后住院时间3-10d,（6．6±3．0）d,除一例出现广泛皮下气肿外,其余病例未发生严重并发症。术后病理均证实为肝海绵状血管瘤。结论：腹腔镜下肝海绵状血管瘤切除对于经选择的病例是安全可行的。     

手术切除治疗巨大肝海绵状血管瘤

肝海绵状血管瘤是最常见的良性肿瘤之一。对无论肿瘤大小，诊断不明恶性不除外，症状反复出现者；直径≥５ｃｍ，肿瘤位于肝脏表面，易受外力而致破裂出血者，直径≥１０ｃｍ的巨大肝海绵状血管瘤；应采用肝叶、半肝切除术或血管瘤摘除术。对直径＜５ｃｍ、无症状、偶然体检发现，非肝脏表面者，可以随访观察。自１９８４年８月－１９８７年８月，共完成１４例巨大肝海绵状血管瘤的手术。采用常温下一次性阻断切肝法，左右半肝切除各４例，扩大右半肝切除、，右前叶切除各１例，左外叶切除３例，肝血管瘤摘除１例，效果满意。     

肝海绵状血管瘤86例诊治体会

肝海绵状血管瘤 (ＣＨＬ)是肝脏最常见的良性肿瘤 ,我院自 1989年 12月至 1998年 12月共收治 86例 ,现报告讨论如下。1　临床资料本组男 2 4例 ,女 6 2例 ,年龄 18～ 70岁 ,平均 4 5.2岁。就诊时右上腹不适及胀痛 4 3例 (占 50 % ) ,右上腹包块 9例 (10 .5% ) ,体检时发现 31例 (36 .0 % ) ,疑为肝癌者 4例 ,腹部手术时发现 3例 (3.5% ) ,其中伴有贫血者 5例 ,血小板减少者 2例 ,肝硬化者 4例。本组术前Ｂ超检查 79例 ,ＣＴ检查 4 9例 ,ＭＲＩ检查 7例 ,肝动脉造影 5例 ,ＥＣＴ检查 3例 ,术前明确诊断 72例 (83.7% )。肝右叶单发 4 1例 ,左…     

肝海绵状血管瘤的外科治疗

随着B型超声、CT及血管造影技术在临床上不断推广应用,近年来发现的肝海绵状血管瘤病例数明显增多。对于本病的治疗是否采用外科手术,迄今各家评论不一。本文报告我院近年来外科治疗的肝海绵状血管瘤35例,其结果显示,在经过认真选择的病例采用外科治疗,不仅安全,而且具有良好的治疗效果。临床资料 35例中,男性27例,女性8例;年龄为25～64岁,平均41岁。床临表现,首发症状为肝区或右上腹疼痛者24例,上腹部饱胀不适4例;上腹部包块5例;体检发现者2例。所有病例均作过一项或一项以上影象学检查,均证     

肝海绵状血管瘤（附10例报告）

临床资料 1.性别与年龄:本组男性4例,女性6例。最小年龄27岁,最大者55岁,平均42.5岁,40岁以上7例。 2.主要症状:腹部肿块(肝肿大)8例,3例伴有上腹胀痛,上消化道出血及失血性休克1例,病程6个月～10年,2年以上6例。 3.化验检查:血常规除1例有贫血外(合并上消化道出血)其余均正常。10例肝功检查均正常,9例作了AFP试验均阴性反应。     

放射治疗肝海绵状血管瘤22例报告

海绵状血管瘤是肝脏常见的良性肿瘤,有研究报道尸检发生率为3％～20％[1].随着诊断技术不断进步临床的发生率有所增加[2-3],新的治疗方法也不断推出.报道22例肝海绵状血管瘤放射治疗的临床资料,探讨肝海绵状血管瘤放射治疗的临床价值. 1 临床资料 1.1 病例选择及一般临床资料 病例选择标准:1)患者有明显的症状,如肝区不适,腹胀等;2)肿瘤较大或多发病变不宜手术;3)患者不愿接受手术或伴有其他疾病不能耐受手术和其他有创治疗者.根据上述标准,解放军309医院1993-05-20-2010-08-30治疗肝海绵状血管瘤患者22例,男12例,女10例.年龄32～56岁,中位年龄40岁.肿瘤直径8～15 cm,2例为多发病变,1例为介入治疗后复发患者.6例正常查体时发现,16例因肝区或腹部不适就诊.所有患者均经B超、增强CT或MR检查确诊.     

肝海绵状血管瘤的诊治

目的：探讨肝海绵状血管瘤的诊断及治疗方法，总结其外科治疗的经验。方法：根据肿瘤的不同情况，分别采用不同的方法对肝海绵状血管瘤进行治疗，其中，手术切除60例，其他方法7例（介入栓塞，硬化等）。结果：所有患的临床症状，体征均不同程度消失或改善，随访3－9年，除1例失访外，均未见增大。结论：肝海棉状血管瘤的治疗需根据患的具体情况选择适当的方法，手术治疗在该病的处理中具有重要的作用，治疗效果明显，预后较好。     

基层医院1例肝巨大血管瘤成功切除的经验总结

目的:成人肝血管瘤是最为常见的肝脏良性肿瘤,有伴随症状、血管瘤巨大、血管瘤增长迅速为手术切除指征,现报道肝巨大血管瘤成功施行手术治疗1例。方法:本例肝巨大血管瘤直径达35 cm,重量12.5 kg,应用术前三维可视化技术制定精准手术方案、先行结扎肝右动脉促使血管瘤自体输血、低中心静脉压技术以及先处理流入道后处理流出道的前入路等多项外科技术。结果:按精准肝切除计划手术成功实施,手术时间3 h,患者术后恢复顺利,术后2周出院。术后1个月复查体力及血常规恢复正常。结论:综合应用术前三维可视化技术、低中心静脉压、前入路肝切除及血管瘤自体输血技术切除肝巨大血管瘤是安全可行的。     

Laparoscopic liver resection for cancer

The field of laparoscopic liver resection surgery has rapidly evolved, with more than 1000 cases now reported. Laparoscopic hepatic resection was initially described for small, peripheral, benign lesions. Experienced teams are now performing laparoscopic anatomic resections for cancer. Operative times improved with experience. When compared with open cases, blood loss was less in most laparoscopic series, but was the main indication for conversion to an open procedure. Patients undergoing laparoscopic resection had shorter length of hospital stay and quicker recovery. Perioperative complications were comparable between the two approaches. Importantly, basic oncologic principles were maintained in the laparoscopic liver resections. The purpose of this review is to summarize the data available on outcomes for laparoscopic hepatic resection for cancer. This includes primary hepatocellular carcinoma, as well as metastatic colorectal cancer to the liver. The evidence to date suggests that laparoscopic results are comparable with the open approach in cancer patients.     

袖式切除治疗82例肺癌患者的临床分析

背景与目的:支气管袖式切除和/或肺血管袖式切除在切除肿瘤的同时能最大限度地保留健康肺组织,为肺癌外科治疗提供了一种手术方式。本研究旨在探讨肺癌袖式切除的技术问题、手术结果、术后并发症及患者术后生存情况。方法:选择2001年6月至2006年12月,在浙江省肿瘤医院行袖式切除的82例中央型肺癌患者,其中23例同时行肺动脉血管袖式切除,2例单独行肺血管袖式切除。所有患者术中行系统淋巴结清扫。观察淋巴结清扫情况以及术后并发症的发生情况,用Kaplan-Meier法对患者的生存情况进行分析。结果:82例患者清扫9～57个淋巴结,平均20个,中位数19个。淋巴结N1转移49例,占59.8%;N2转移21例,占25.6%。2例(2.4%)患者在围手术期死亡,无支气管吻合口瘘发生。全组中位生存期26个月。1、2、3、5年生存率分别为78.4%、52.5%、39.1%、23.4%。男性和女性、<60岁与≥60岁患者的1、3、5年生存率均无显著性差异(P>0.05)。而N1(-)N2(-)、N1( )N2(-)、N2( )患者的1、3、5年生存率差异有显著性(P<0.01);Ⅰ期、Ⅱ期、ⅢA期、ⅢB期患者的1、3、5年生存率差异也有显著性(P<0.01)。结论:肺癌袖式切除手术死亡率以及与吻合相关并发症发生率低,可在掌握适应证的情况下代替全肺切除。系统淋巴结清扫不增加手术并发症和死亡率。袖式切除术后患者的生存与淋巴结转移状况以及临床分期有关,而与性别、年龄无关。     

Laparoscopic liver resection: Current role and limitations

Laparoscopic liver resection (LLR) for the treatment of benign and malignant liver lesions is often performed at specialized centers. Technological advances, such as laparoscopic ultrasonography and electrosurgical tools, have afforded surgeons simultaneous improvements in surgical technique. The utilization of minimally invasive techniques for liver resection has been reported to reduce operative time, decrease blood loss, and shorten length of hospital stay with equivalent postoperative mortality and morbidity rates compared to open liver resection (OLR). Non-anatomic liver resection and left lateral sectionectomy are now routinely performed laparoscopically at many institutions. Furthermore, major hepatic resections are performed by pure laparoscopy, hand-assisted technique, and the hybrid method. In addition, robotic surgery and single port surgery are revealing early promising results. The consensus recommendation for the treatment of benign liver disease and malignant lesions remains unchanged when considering a laparoscopic approach, except when comorbidities and anatomic limitations of the liver lesion preclude this technique. Disease free and survival rates after LLR for hepatocellular carcinoma and metastatic colon cancer correspond to OLR. Patient selection is a significant factor for these favorable outcomes. The limitations include LLR of superior and posterior liver lesions; however, adjustments in technique may now consider a laparoscopic approach as a viable option. As growing data continue to reveal the feasibility and efficacy of laparoscopic liver surgery, this skill is increasingly being adopted by hepatobiliary surgeons. Although the full scope of laparoscopic liver surgery remains infrequently used by many general surgeons, this technique will become a standard in the treatment of liver diseases as studies continue to show favorable outcomes.     

腹腔镜下残胃癌的外科治疗(附16例报告)

目的 探讨腹腔镜残胃癌切除术的安全性和可行性.方法 回顾性分析2008年1月至2010年11月期间,16例施行腹腔镜手术切除的残胃癌患者的临床资料.结果 本组16例残胃癌患者,13例行腹腔镜下D2根治性残胃切除术,2例行姑息性残胃切除,1例中转开腹姑息性残胃切除术.腹腔镜手术时间180～265 min,平均(229.1...     

Laparoscopic anatomic liver resection of segment 7 using a caudo-dorsal approach to the right hepatic vein

BackgroundLaparoscopic anatomic liver resection of segment 7 (S7) is technically challenging because of the posterosuperior location and the lack of clear anatomical landmarks [[1], [2], [3], [4]]. Here, we introduce a caudo-dorsal approach, which may offer a benefit for the difficult procedure.MethodsThe patient was a 53-year-old man with hepatocellular carcinoma located in S7 of the liver. After the transection of caudate process, the Glissonean pedicle of S7 (G7) extending from the right posterior Glissonean pedicle was identified on the liver dorsal side. The demarcation line was noted by isolating and clamping G7. The intraoperative ultrasound was then used to assess the extent of the tumor. The right hepatic vein was approached from the dorsal side and continuously exposed in a caudal-cranial direction along the anterior surface of inferior vena cava after isolating and cutting the venous branches draining S7. Following the dissection of G7, the liver parenchymal transection was proceeded along the ischemic line between segment 6 and 7 with the ventral cutting plane extended to join the dorsal one. The liver parenchyma of the ventral side of the exposed right hepatic vein (RHV) was further transected from the dorsal side toward the root side of RHV. The resection of S7 was completed with perihepatic ligaments dissection.ResultsThe intermittent Pringle maneuver (15 min occlusion and 5 min reperfusion) was applied when necessary with a total time of 45 min. The operation time was 200 min, the estimated blood loss was 300 ml, and no transfusion was required. Pathology confirmed moderately differentiated HCC with negative surgical margin. The patient was discharged on postoperative day 8 with no complications and has been followed up for 8 months without recurrence.ConclusionThis caudo-dorsal approach for laparoscopic anatomical S7 segmentectomy is easy and feasible when performed by experienced surgeons at experienced centers in well-selected patients     

Laparoscopic liver resection versus open liver resection for intrahepatic cholangiocarcinoma: 3-year outcomes of a cohort study with propensity score matching

IntroductionLaparoscopic liver resection(LLR) for intrahepatic cholangiocarcinoma is debatable due to technical challenges associated with major hepatectomy and lymph node dissection. This study aims to analyze the long-term outcomes with propensity score matching.MethodsPatients who underwent liver resection for intrahepatic cholangiocarcinoma from August 2004 to October 2015 were enrolled. Those who had combined hepatocellular-cholangiocarcinoma and palliative surgery were excluded. Medical records were reviewed for postoperative outcome, recurrence, and survival. The 3-year disease-free survival(DFS) and 3-year overall survival(OS) were set as the primary endpoint, and 3-year disease-specific survival, 1-year OS, 1-year DFS, operative outcome, and postoperative complications were secondary endpoints.ResultsA total of 91 patients were enrolled with 61 in the open group and 30 in the laparoscopic group. Propensity score matching included 24 patients in both groups. In total, the 3-year OS was 81.2% in the open group and 76.7% in the laparoscopic group(p = 0.621). For 3-year DFS, open was 42.5% and laparoscopic was 65.6%(p = 0.122). Mean operation time for the open group was 343.2 ± 106.0 min and laparoscopic group was 375.2 ± 204.0 min(p = 0.426). Hospital stay was significantly shorter in the laparoscopic group(9.8 ± 5.1 days) than the open group(18.3 ± 14.7, p=<0.001). There was no difference in complication rate and 30-day readmission rate. Tumor size, nodularity, and presence of perineural invasion showed an independent association with the 3-year DFS in multivariate analysis.ConclusionLaparoscopic liver resection for intrahepatic cholangiocarcinoma is technically feasible and safe, providing short-term benefits without increasing complications or affecting long-term survival.     

Diagnosis and treatment of intracranial cavernous hemangioma: a report of 86 cases

OBJECTIVE To summarize and analyze the clinical manifestations features of imaging diagnosis, and therapeutic efficacy of surgical treatment for intracranial cavernous hemangioma (CH).METHODS Data from 86 cases with intracranial CH from the Department of Neurosurgery of Tianjin Huanhu Hospital, Tianjin,China, during a period from 2000 to 2007, were retrospectively analyzed, and pertinent literature cited.RESULTS Epilepsy, headache, dizziness, sensory disability and limb-kinetic apraxia were the most commonly seen clinical manifestations of the intracranial CH cases. MRI was one of the preferred ways to diagnose CH. All 86 patients were treated with microsurgery, among which neuronavigator-guided surgery .was conducted in 16, a second surgical procedure was performed in 3 due to a postoperative intracranial hematoma, and death occurred in 1. All the other 85 patients had a good prognosis.CONCLUSION MRI was the most sensitive diagnostic means for intracranial CH. Microsurgery was the main method to treat intracranial CH.     

小儿血管瘤131例临床分析

目的　探讨小儿血管瘤的治疗方法。方法　治疗小儿血管瘤采用单纯手术切除 ,单纯瘤体内注射硬化剂 ,手术切除部分瘤体 ,残余瘤体内注射硬化剂的方法。结果　 13 1例小儿血管瘤 ,经 1～ 10年随访 ,治愈 117例 (89.3 1% ) ,复发 14例 (10 .69% )。结论　治疗血管瘤目前尚无十分理想的方法 ,我们认为应视病灶的部位、大小、类型等情况 ,选择一种或两种治疗方法 ,并且要重视随访 ,做到长期随访彻底治疗。