肝叶切除治疗肝内胆管结石37例体会

目的总结肝叶切除治疗肝内胆管结石的经验。方法回顾性分析2006年1月～2010年10月黄山首康医院肝叶切除治疗37例肝内胆管结石患者的手术治疗方法及疗效。结果 37例患者中左半肝切除17例,右肝部分切除2例,左半肝切除+右肝后叶下段切除的3例,左外叶切除的14例,左半肝联合尾状叶切除的1例,术中均同时行胆总管切开取石,同时行胆肠吻合的7例,T管引流的30例。术后发生并发症8例,包括切口感染3例,创缘液化坏死3例,胆漏1例,胆道出血1例。术后残石1例,随访6月～4年,结石复发2例。结论肝叶切除是治疗肝内胆管结石安全、有效的方法。     

甲状腺腺叶切除术和甲状腺次全切除术术后并发症对比研究

目的探讨甲状腺腺叶切除术和甲状腺次全切除术术后并发症的情况。方法选取我院2007至2011年间收治的198例甲状腺手术患者．其中行甲状腺腺叶切除者100例,行甲状腺次全切除术者98例,回顾性分析患者临床资料,对比两种手术方法术后并发症情况。结果100例行甲状腺腺叶切除术者手术均获成功,5例出现术后并发症,并发症发生概率为5．0％;98例行甲状腺次全切除术者手术均获成功,8例出现术后井友症为8．2％。结论甲状腺腺叶切除术手术创伤较小,木后并发症少,临床行甲状腺手术时须根据患者病情慎重选择手术方式,尽量减少并发症发生,以改善患者预后,促进患者健康。     

200例肺癌的诊断及手术治疗体会

本文报告我院1981～1986年200例肺癌外科手术治疗的经验。术前误诊为纵隔肿瘤、肺结核瘤、肺脓肿、肺炎住假瘤等40例,误诊率为20%。行肺叶切除123例;其中2例术后复发,余肺再次切除。复合切除50例;袖状肺叶切除17例,术后无瘘和吻合口狭窄。我们认为熟练的吻合技术是手术成败的关键。全肺切除10例。对14例肺门、纵隔有淋巴结转移的中央型肺癌,术前进行了半量放疗(3000rad),术中均能成功的切除。术后29例轻型并发症全部治愈,1.例术中死于心脏骤停。     

不同VATS切除术式对T1期NSCLC患者手术相关临床指标、肺功能及炎症反应水平的影响

目的:探讨VATS肺段和VATS肺叶切除术式对T1期NSCLC患者手术相关临床指标、肺功能及炎症反应水平的影响。方法:研究对象选取我院2015年6月至2017年6月收治T1期NSCLC患者共130例,根据手术方案不同分为肺叶切除组（65例）和肺段切除组（65例）,分别采用VATS肺段和VATS肺叶切除术式治疗;比较两组患者手术相关临床指标水平、手术前后肺功能指标、炎症反应实验室指标水平及术后并发症发生率。结果:肺叶切除组患者手术操作时间和术中失血量均显著优于肺段切除组（P<0.05）;肺段切除组患者术后引流量、术后引流时间及总住院时间均显著优于肺叶切除组（P<0.05）;两组患者淋巴结数量比较差异无统计学意义（P>0.05）;肺段切除组患者术后肺功能指标水平均显著高于肺叶切除组（P<0.05）;肺段切除组患者术后炎症反应实验室指标水平均显著低于肺叶切除组（P<0.05）;两组患者术后并发症发生率比较差异无统计学意义（P>0.05）。结论:相较于VATS肺叶切除术式,VATS肺段切除术式治疗T1期NSCLC可有效加快病情康复进程,保护肺部通气功能,并有助于抑制术后全身炎症反应;而VATS肺叶切除术式则能够缩短手术用时,降低医源性创伤程度。     

Benign hamartoma of the lung presenting as massive hemoptysis

A case is presented of benign pulmonary hamartoma causing episodes of hemoptysis. This is an extremely unusual manner of presentation for such lesions.     

Endobronchial metastasis of renal cell carcinoma

Endobronchial metastasis from nonpulmonary carcinoma is rare. A case of metastatic renal cell carcinoma is presented and the literature reviewed. Severe haemoptysis was the initial symptom leading to the finding of a bronchial polypoid mass.     

Remote Cerebellar Hemorrhage and Iliofemoral Vein Thrombosis After Supratentorial Craniotomy

Introduction  Cerebellar hemorrhage following supratentorial craniotomy is rare. Its clinical symptoms are often mild and transient. Discussion  Here, we report a case of cerebellar hemorrhage associated with iliofemoral vein thrombosis as a complication of anterior temporal lobectomy and amygdalohippocampectomy for refractory medial temporal epilepsy.     

Standard versus tailored left temporal lobe resections: differences in cognitive outcome?

This study explores differences in cognitive outcome after a standard resection (SR) or tailored (TR) in 100 patients with left temporal lobe epilepsy, controlling for extent in the three lateral gyri. Comparing preoperative to 6-month postoperative performance on a battery of intelligence, language and verbal memory tests revealed the following: a differential effect of the procedure was found for digit span, a short-term memory and attention task, the SR group showing a gain and the TR group a loss postoperatively. This could be explained by a rather large improvement of the SR group with below average resection sizes in the superior temporal gyrus (STG) (<2.8 cm), which small resections are nearly absent in TR resections. Effect of larger extent on the STG in the SR group was related to a decrease in verbal intelligence and a tendency in auditory comprehension which poses a risk in 'large' standard resections. Differences in extent of resection on the other gyri did not cause differences in effects on language functioning or verbal memory. CONCLUSIONS: In standard anterior temporal lobe resections only (without intraoperative language mapping) up to a limit of 4.5 cm, large resections on the STG pose a risk for declining on verbal IQ and auditory comprehension. In general, tailored resections (with language mapping) result in decline on a task measuring short-term memory and attention.     

Independent temporal lobe epilepsy in patients with tuberous sclerosis complex

Tuberous sclerosis complex(TSC)is a rare disease that involves multiple organs,including the brain;approximately 80%-90%of TSC patients exhibit TSC-associated epilepsy.Independent temporal lobe epilepsy(TLE),TSC-unrelated epilepsy,is particularly rare in patients with TSC.Here,we describe three patients with TSC with independent TLEs that were confirmed by stereo-electroencephalography(EEG),postoperative pathological findings,and seizure outcome at follow-up.The patients were retrospectively enrolled at two centers;their ictal epileptiform discharge onsets were determined using electrode contacts in the hippocampus during stereo-EEG.The three patients underwent anterior temporal lobectomies and remained seizure-free at 1-5 years after surgery.Postoperative pathological examinations confirmed hippocampal sclerosis in all three patients.Furthermore,postoperative intelligence quotient improvement was evident in one patient,while the quality of life was improved in two patients at 12 months after surgery.     

Epilepsy surgery in France

We report here the results of the first survey on epilepsy surgery activity in France. Data from a questionnaire sent to 17 centers practicing epilepsy surgery were analyzed. All centers responded; however, all items were not completely documented. Over 50 years, more than 5000 patients have been operated on for drug-resistant epilepsy and more than 3000 patients underwent some invasive monitoring, most often SEEG. Currently, nearly 400 patients (including more than 100 children) are operated on yearly for epilepsy in France. Over a study period varying among centers (from two to 20 years; mean, 9.5 years), results from more than 2000 patients including one-third children were analyzed. Important differences between adults and children, respectively, were observed in terms of location (temporal: 72% versus 4.3%; frontal: 12% versus 28%; central: 2% versus 11%), etiology (hippocampal sclerosis: 41% versus 2%; tumors 20% versus 61%); and procedures (cortectomy: 50% versus 23%; lesionectomy: 8% versus 59%), although overall results were identical (seizure-free rates following temporal lobe surgery: 80.6% versus 79%; following extratemporal surgery: 65.9% versus 65%). In adults, the best results were observed following temporomesial (TM) resection associated with hippocampal sclerosis or other lesions (class I: 83% and 79%, respectively), temporal neocortical (TNC) lesional (82%), while resections for cryptogenic temporal resections were followed by 69% (TM) and 63% (TNC) class I outcome. Extratemporal lesional resections were associated with 71% class I outcome and cryptogenic 43%. In children, the best results were obtained in tumor-associated epilepsy regardless of location (class I: 80%). A surgical complication occurred in 8% after resective surgery - with only 2.5% permanent morbidity - and 4.3% after invasive monitoring (mostly hemorrhagic). Overall results obtained by epilepsy surgery centers were in the higher range of those reported in the literature, along with a low rate of major surgical complications. Growing interest for epilepsy surgery is clearly demonstrated in this survey and supports further development to better satisfy the population's needs, particularly children. Activity should be further evaluated, while existing epilepsy surgery centers as well as healthcare networks should be expanded.