ObjectiveTo explore the risk factors for failure of enhanced recovery after surgery (ERAS) in partial hepatectomy. MethodsA retrospective analysis was performed on 344 patients who underwent partial hepatectomy at the Division of Liver Surgery, Department of General Surgery in West China Hospital of Sichuan University from January 2019 to December 2019. All patients were treated with ERAS after partial hepatectomy. Univariate and multivariate logistic regression analysis were used to evaluate the risk factors associated with failure of the ERAS after partial hepatectomy. ResultsA total of 344 patients were included in the study, including 44 patients in the ERAS failure group and 300 patients in the ERAS success group. Multivariate logistic regression showed that combined with chronic diseases [OR=2.32, 95%CI (1.07, 4.93), P=0.03] and intraoperative fluid replacement volume ≤2 475 mL [OR=2.16, 95%CI (1.06, 4.42), P=0.03] were risk factors for failure of ERAS. ConclusionChronic diseases and intraoperative fluid volume ≤2 475 mL are risk factors for the failure of ERAS after partial hepatectomy and can affect prognosis.
Thirty-six partial hepatectomies for patients with symptomatic intrahepatic stones is reported.Partial liver resection should be done when the liver containing strictrue(s),dilated ducts and stones.Meanwhile,additional procedures should be performed togather with partial hepatectomy,i,e,common duct exploration and drainage,cholangiotomy and cholangioplanty,and cholangeoenterostomy,according to the location of stones and ductal strictures.Postoperative long-term follow-up in this series showed that the results of 86.2% of patients were satiffactory.Partial hepatectomy can be considered as a better treatment of choice for the stones confined to one segment or lobe of liver or combined with multiple strictures of ducts.
目的 总结应用脾动脉结扎加脾部分切除术治疗外伤性脾破裂的临床经验。方法 对本院近8年间收治的64例接受脾动脉结扎加脾部分切除治疗的脾外伤患者的临床资料进行回顾性分析，重点分析脾部分切除术的手术方法、临床疗效和适应证。结果 术中双重结扎脾动脉，然后根据脾脏损伤的情况决定保留脾脏的部位，保证残脾不少于原脾体积的30%。全组无手术死亡病例，术后出现早期并发症者16例（25.0%），其中发热8例，脾窝积液1例，肠梗阻2例，左侧胸腔积液3例，切口感染2例，均经对症处理后治愈。结论 对部分外伤性脾破裂患者的治疗选择脾动脉结扎加脾部分切除术是安全可行的。
Objective To evaluate the effect of the combined method of l iposuction and semicircular periareolar incision glandular organ partial resection in the treatment of gynecomastia. Methods From June 2004 to June 2006, 40 patients, aged 11-41 years old, were treated, with no-nodule (n=10), nodule (n=22) and female-breast-l ike with nodules (n=8). Three patients were unilateral and 37 ones were bilateral. The levels of serum prolactin, luteinizing hormone, foll icle stimulating hormone, estradiol, testosterone and cortisol were normal in 38 patients, while in the other 2 patients, the levels ofserum prolactin, luteinizing hormone, foll icle stimulating hormone and estradiol were higher than normal, and the testosterone level was lower. Li posuction alone was performed in 10 no-nodule patients (lei po-type), and combined l i posuction and semicircular periareolar incision glandular organ partial resection were conducted in the other 30 patients (lei po-glandular type). Results Except for 2 cases in which hematoma and a small amount of effusion were found on the first and second day postoperatively and then obtained heal ing by first intention right after hematoma removal in time, all the other patients’ incisions obtained heal ing by first intention. Ni pple numbness occurred in 3 cases on the first day postoperatively and no special treatment was conducted. There was still nipple hypesthesia in these 3 cases after 6-month follow-up. There were no compl ications such as hematoma, effusion, nipple and mammary areola necrosis, and nipple hypesthesia in other patients. All the 40 patients were followed up for 6-24 months (13 months on average). They were satisfied with their chest figures and no recurrence was observed. Conclusion The combined method of l iposuction and semicircular periareolar incision glandular organ partial resection in the treatment of gynecomastia has many advantages, such as safe, micro-scars, natural and beautiful male breast figures as well as high patients’ satisfaction.
摘要:目的:探讨腹腔镜胆囊大部分切除在复杂胆囊结石手术中应用的可行性及安全性。方法:回顾性分析2003年1月至2008年10月间41例行腹腔镜胆囊部分切除术的复杂胆囊结石病人。行腹腔镜胆囊切除术指征为:胆囊管不能明确辨认时,诸如:胆囊积脓、Mirris综合征、Calot三角致密粘连呈“冰冻样”、萎缩性胆囊等。手术方法为:切除胆囊前壁,取净结石,腹腔置管引流。结果:41例复杂胆囊结石病人中1例中转开腹手术外,其余全部在腹腔镜下完成,手术时间为45～145分钟,平均(57.42±19.41)分钟,1例术后出现胆漏,其余术后住院时间为2～7天。 结论:在胆囊三角不能安全辨认前提下,对于复杂胆囊结石行腹腔镜胆囊部分切除术是一种安全的手术方式,不但能简化手术、降低手术风险,而且能避免行开腹手术治疗。Abstract: Objective: To study the possibility and safty of laparoscopic subtotal cholecystectomy in complicated cholecystectomy. Methods: Laparoscopic subtotal cholecystectomy was performed when the cystic duct cannot be identified safely, such as empyema cholecystitis, Mirris syndrome, frozen Calot’triangle, shrunken gallbladder. The operation consists of resecting the anterior wall of the gallbladder, removing all stones, and placing a large drain. 41 patients who underwent a laparoscopic subtotal cholecystectomy between 1 January 2003 and 31 October 2008 were retrospectively analyzed. Results: Fortyone cases of complex laparoscopic cholecystectomy were performed. 1 cases in which were changed to open cholecystectomy. Operating time was 45145 min, average (57.42±19.41) min. 1 cases were reoperated because of the bile leak. Hospital stays were 27 days. Conclusion: Laparoscopic subtotal cholecystectomy is a viable procedure during cholecystectomy in which Calot’s triangle cannot be safely dissected. It may simplify the operation and decrease the risk in complicated cholecystectomy and averts the need for a laparotomy.
Objective To verify the feasibility and effectiveness of the modified fast-track surgery (FTS) in the perioperative period of open liver resection. Methods A prospective randomized controlled trial was carried out in 188 consecutive patients undergoing open liver resection between March and December 2014 in the Department of Liver Surgery of West China Hospital. The modified fast recovery procedure and standard rehabilitation procedure were compared in terms of length of hospital stay after operation, hospitalization cost, complications and readmission rate. Results A total of 188 consecutive patients were enrolled in the trial. The analysis included 87 patients in the modified fast recovery group and 89 in the standard rehabilitation group. Compared with the standard rehabilitation group, the modified fast recovery group had a shorter length of hospital stay [(5.70±1.47)vs. (7.26±1.96) days] and a lower cost [(42.7±6.7)vs. (47.3±12.5) thousand yuan], and the differences were statistically significant (P<0.05). There were 20 complication cases in the modified group and 39 in the standard group with significant difference (P=0.003). There was no significant difference in the rate of readmission between the two groups (P=1.000). Compared with the standard group, patients in the modified group had less pain 8 hours, the 1st and 2nd days after surgery, better postoperative activities of daily living, more initiative cough times and off-bed activity times, longer duration of movement, and earlier bowel recovery and exhausting, and all the above differences were significantly different (P<0.05). Stepwise regression analysis showed that postoperative complications and bowel recovery and exhausting time were independent related factors for postoperative hospital stay (P<0.001). Conclusions Multimodal analgesia-based fast recovery procedure is feasible and effective in the perioperative period of partial hepatectomy. It can shorten the time of hospitalization and reduce the cost of hospitalization.
ObjectiveTo analyze the efficacy and safety of complete excision of the external capsule in the treatment of hepatic echinococcosis.MethodsThe clinical data of 90 patients with hepatic cystic echinococcosis admitted to our hospital from January 2016 to March 2018 were retrospectively analyzed. According to the different surgical methods, this patients were divided into two groups: the partial hepatectomy group and complete excision of the external capsule group, 45 cases in each group. The patient's general condition and the situation during hospitalization were analyzed, and the intraoperative conditions, postoperative complications, recurrence and mortality after one year in different surgical methods were compared.ResultsThe operative time and intraoperative blood loss in the partial hepatectomy group was significantly longer or more than that in the complete excision of the external capsule group (P<0.05), respectively. There was no significant difference between the two groups in hospitalization time (P>0.05). The incidence of postoperative complications was 11.11% in the partial hepatectomy group and 8.88% in the complete excision of the external capsule group. There was no significant difference between the two groups (P>0.05). After 1 year of followed-up, the recurrence rate of the partial hepatectomy group was 4.44%, and there was no recurrence in the complete excision of the external capsule group, and there was no significant difference between the two groups (P>0.05). There was no death in both groups.ConclusionsIn the surgical treatment of hepatic cystic echinococcosis, the most appropriate surgical method should be selected according to the specific conditions of the patient, and the complete excision of the external capsule has higher therapeutic effect and safety in the treatment of hepatic echinococcosis. It is worthy of clinical promotion.