Laparoscopic liver surgery: An overview of the literature and experiences of a single centre

In the past two decades there has been an enormous increase in laparoscopic liver surgery. There is a trend from limited to laparoscopic major resections and more centres are adopting laparoscopic liver surgery as a standard of care. Although no randomized clinical trials are published, different reports on minor and major hepatectomies and meta-analyses suggest (at least) equal outcomes and cost-effectiveness compared to open procedures.     

快速康复外科护理对胸腔镜肺段切除术患者术后恢复与护理满意度的影响分析

目的 探讨快速康复外科（FTS）护理对胸腔镜肺段切除术患者术后恢复的影响。方法于2016年1月—2017年1月,选取复旦大学附属华山医院胸外科拟行胸腔镜肺段切除手术的患者126例为研究对象。采用随机数表法分为观察组（n=63）和对照组（n=63）。对照组采用传统的胸外科围手术期护理,观察组患者在围手术期给予FTS护理,比较两组患者术后恢复指标、并发症发生率、术后7d的世界卫生组织生存质量测定简表（WHOQOL-BREF）评分以及出院时患者的护理满意度。结果 观察组术后胸腔引流管放置时间、首次排便时间、术后住院天数与并发症的总发生率显著低于对照组,差异具有统计学意义（P＜0.05）。观察组术后7d WHOQOL-BREF量表的生理、心理、社会关系领域评分及总分显著高于对照组,护理满意度显著优于对照组,差异具有统计学意义（P＜0.05）。结论 FTS护理在胸腔镜肺段切除术的围手术期中的应用效果令人满意,能显著促进术后康复,减少术后并发症的发生风险,提高术后生活质量与护理满意度,值得临床推广应用。     

Anatomical segmentectomy versus pulmonary lobectomy for stage I non-small-cell lung cancer: patients selection and outcomes from the European Society of Thoracic Surgeons database analysis

OBJECTIVES The aims of this study were to describe the potential selection criteria for patients scheduled for lobectomy versus segmentectomy for stage I non-small-cell lung cancer and to compare the 2 procedures in terms of intraoperative variables and postoperative outcomes using the European Society of Thoracic Surgeons (ESTS) Registry.Open in a separate windowMETHODSThis observational multicentre retrospective cross-sectional study was based on data collected from the ESTS database. The following were set as inclusion criteria: pulmonary lobectomy or segmentectomy for stage I primary lung cancer (according to 8th TNM edition), no previous lung surgery and no induction chemotherapy or radiotherapy. Statistical significance was examined using Mann–Whitney or 2 proportions Z tests.RESULTSAmong 63 542 patients enrolled in the ESTS database (2007–2018), 17 692 met the inclusion criteria: 15 845 patients received lobectomy and 1847 segmentectomy. Video-assisted thoracic surgery (VATS) lobectomy and VATS segmentectomy were the 27.8% and 31.9% of the procedures, respectively. Lobectomy group was significantly younger and had a lower American Society of Anaesthesiology (ASA) score, lower comorbidities prevalence and better respiratory function. The segmentectomy group had lower complications rate (25.6% vs 33.8%). When considering only the last 5 years, ASA score was similar between the 2 groups, although pulmonary function remained significantly lower in the segmentectomy group.CONCLUSIONSAccording to the ESTS database, segmentectomy was preferably offered to ‘compromised’ patients, with limited respiratory function, higher ASA score and relevant comorbidities. Nevertheless, the procedure showed lower complications rate and similar short-term outcomes compared to lobectomy. During the last 5 years, segmentectomy appeared to be regarded as a valid alternative, even for selected patients who could tolerate both procedures.     

肝切除术后膈下感染的综合预防

本文报告利用综合措施预防肝切除术后膈下感染，术前预防性应用抗生素，提高患者的肝功能储备；施行取量切肝，本组肝段切除１５６例，仅４例发生膈下感染，感染率为２．５６％，与非肝段切除组相比，膈下感染发生率明显降低（Ｐ〈０．０５）。     

荧光染色法与改良膨胀萎陷法判定段间平面在解剖性肺段切除术中的病例对照研究

目的相较于目前常用的改良膨胀萎陷法,探讨荧光染色法判定段间平面在胸腔镜解剖性肺段切除术中的可行性及安全性。 方法回顾性分析解放军总医院第一医学中心胸外科2017年3月至2019年9月行胸腔镜解剖性肺段切除术的157例临床资料,其中荧光染色组60例,女41例、男19例,年龄36～76岁;改良膨胀萎陷组97组,女62例、男35例,年龄27～85岁。荧光染色组采用反向染色法,分离出预切除肺段的肺动脉分支并切断,经外周静脉快速推注吲哚菁绿25 mg行保留肺脏部分的荧光显影从而判定段间平面。改良膨胀萎陷法,在分离出预切除肺段的支气管分支并切断后,双肺通气使肺脏完全膨胀后恢复单肺通气,一段时间后可形成较明显的段间平面。记录两组的临床资料并进行统计学分析。 结果与改良膨胀萎陷组相比,荧光染色组的段间平面形成时间更早、手术时间缩短,两组差异具有统计学意义[20 s(8～25 s)比1 008 s(884～1 200 s),P＝0.031;(103.3±7.3)min比(132.8±10.4)min,P＝0.021];两组的术中出血量、淋巴结清扫数目、术后置管时间、术后住院时间、并发症发生率比较,差异无统计学意义(P均>0.05)。 结论相较于目前常用的改良膨胀萎陷法,荧光染色法术中不需反复膨肺,同样符合肿瘤学要求,是安全、有效的。     

An improved method for distinguishing the intersegmental plane of the lung

An improved technique for distinguishing the intersegmental plane of the lung was developed as follows. After the involved bronchus is identified, the lobe is inflated and the segmental bronchus is then tied to maintain gas inside of the segments that will be removed, and thereafter is severed at a point proximal to the tie. When almost done closing the stump, a line will develop between the deflated and the inflated area, which represents the intersegmental plane to be operated on. This technique is therefore completely different from the technique described in textbooks, in which the preserved segment is kept inflated while the resected one is kept deflated. Once the line develops, one can operate just on the line using either electrocautery under adequate tension or staples between the collapsed and inflated segments. The cutting surface is so close to the real intersegmental plane that the amounts of air leak and bleeding are negligible. Received: January 26, 2000 / Accepted: May 30, 2000