开腹射频消融治疗较大肝肿瘤近期疗效分析

目的 探讨开腹Cool-tip冷循环单极射频消融治疗较大肝癌时射频针的排布方法,以提高较大肝癌的完全消融率.方法 2002年8月至2007年8月,64例大肝癌患者采用开腹Cool-tip冷循环单极射频消融.直径3.1～4.0 cm的肿瘤至少使用7个消融点;4.1～5.0 cm的肿瘤至少使用15个消融点;5.1～6.0 cm的肿瘤需要19个消融点;6.1～7.0 cm的肿瘤需要40个消融点,肿瘤可以被完全消融.结果 开腹射频消融治疗大肝癌完全消融率达到93.75％(60/64),并发症发生率低,近期疗效好.结论 开腹射频消融是不可切除大肝癌较好的根治性治疗手段.     

Current status and future perspective of robot‐assisted radical cystectomy for invasive bladder cancer

The current status of robot‐assisted radical cystectomy was reviewed 16 years after the initial robot‐assisted radical cystectomy for the treatment of invasive bladder cancer. Articles associated with robot‐assisted radical cystectomy and written in English were selected from the PubMed database from January 2003 to February 2019. The present review article focused on the distribution of robot‐assisted radical cystectomy, patient selection, preoperative management, surgical technique, lymph node dissection, urinary diversion, recurrence pattern, oncological outcomes, cost, learning curve, complications and educational programs. A total of 400 articles were divided according to the country of the first author's affiliation. The USA was the most dominant at 198 (50%), whereas the number of articles from the countries belonging to the Urological Association of Asia was 15 (3.8%) for China, 17 (4.3%) for South Korea, 10 (2.5%) for Japan, eight (2%) for Taiwan, eight (2%) for Turkey and one (0.2%) for Iran. The percentage of robot‐assisted radical cystectomy carried out is increasing, and intracorporeal urinary diversion and ileal neobladder are also frequently carried out. With a refined technique being performed in high‐volume centers, robot‐assisted radical cystectomy has contributed to the reduction in transfusion rate, length of stay and severe complications; however, it has not yet shown any cancer‐specific survival benefits. Robot‐assisted radical cystectomy is not fully spread throughout the Urological Association of Asia. Further investigation with respect to worldwide results is needed to prove the real benefit of robot‐assisted radical cystectomy regarding low morbidity, reduced total medical cost, and survival benefit. In the era of precision medicine, appropriate drug and surgery will be given based on each genetic profile.