Search

标准化手术护理配合在 ICG 荧光导航腹腔镜肝叶切除术中的应用

目的比较荧光腹腔镜和传统腹腔镜肝叶切除的安全性和有效性，并总结荧光腹腔镜肝叶切除的手术护理配合要点。方法回顾性收集四川大学华西医院 2017 年 9 月至 2019 年 9 月期间行荧光腹腔镜肝切除（38 例）和传统腹腔镜肝切除（65 例）的肝细胞癌患者，对比 2 组患者的临床资料并对标准化手术护理配合要点进行总结。结果荧光腹腔镜组患者顺利完成手术，无中转开腹，无一例患者术中输血。传统腹腔镜组顺利完成手术，无中转开腹，术中有 2 例患者输血。术后荧光腹腔镜组有 3 例患者出现肺部感染，无围手术期死亡病例，随访期间 9 例患者复发；术后传统腹腔镜组有 4 例患者术后出现肺部感染，1 例切口感染，3 例腹水，1 例消化道出血，无围手术期死亡病例，随访期间 13 例患者肿瘤复发。2 组患者的手术时间、术中出血量和术后住院时间比较差异均有统计学意义（P<0.05），荧光腹腔镜组较优；但 2 组患者的围手术期并发症发生率（P=0.36）和肿瘤复发率（P=0.66）比较差异无统计学意义。结论标准化手术护理配合荧光导航腹腔镜肝叶切除手术安全可靠，手术室护士术前、术中标准化配合对荧光导航腹腔镜肝切除的顺利实施具有重要的临床意义。

腔镜超声联合荧光显像在腹腔镜肝切除术中的应用

Combined laparoscopic and interventional therapy for congenital portosystemicshunt with hepatic focal nodular hyperplasia

ObjectiveTo summarize the treatment of a patient with congenital portosystemic shunt (CPS) complicated with hepatic focal nodular hyperplasia (FNH), and to explore the feasibility and safety of combined laparoscopy and interventional radiology therapy at the same time.MethodsThe clinicopathological data of a patient with CPS complicated with hepatic FNH who admitted to West China Hospital of Sichuan University in March 2019 was retrospectively analyzed.ResultsThe patient underwent laparoscopic liver nodule resection and digital subtraction angiography (DSA) guided jugular portal portosystemic shunt fistula embolization. The laparoscopic surgery operation time was 180 min and the intraoperative blood loss was 50 mL, and for interventional procedure was 230 min and 10 mL respectively. There were no complications after operation and the patient was successfully discharged on the 8th day after surgery. The patient was followed up for six months and in good condition.ConclusionsCPS patient should develop individualized treatment under the discussion of multidisciplinary cooperation group. The combination of laparoscopy and interventional technique can be minimally invasive and efficient to solve portal vein-avitary shunt fistula and benign hepatic nodules at the same time.

Whole process management of hepatocellular carcinoma patients with high-risk of recurrence and metastasis based on multidisciplinary team mode

ObjectiveTo summarize the experience of the whole process management of hepatocellular carcinoma (HCC) patients with high-risk of recurrence and metastasis based on the multidisciplinary team (MDT) mode, and to improve the clinicians’ understanding of the concept of whole process management, so as to improve the survival rate of patients with HCC. MethodThe clinicopathologic data of a HCC patient with high-risk of recurrence and metastasis admitted to the Division of Liver Surgery, Department of General Surgery, West China Hospital of Sichuan University were retrospectively analyzed. ResultsA 52-year-old male patient was diagnosed with HCC with intrahepatic metastasis (China liver cancer staging Ⅱ b, Barcelona Clinic Liver Cancer stage B) after admission due to “epigastric discomfort for 1+-month and liver occupying for 1+-week”. Through discussion by the MDT mode, the allogeneic liver transplantation was performed after successful downstaging following two conversion therapies. No serious complications occurred after operation, and the patient was discharged on the 23rd day after operation. Up to now, pulmonary bacterial and fungal infections and pulmonary metastases had been found during the postoperative follow-up. After anti-infective therapy and targeted therapy combined with radiotherapy, the patient was significantly relieved, had survived for 34 months after operation, and was still under regular follow-up. ConclusionsFor HCC patients with high-risk of recurrence and metastasis, MDT mode has a good clinical benefit for the whole process management of patient. Through the MDT model, the diagnosis, treatment, and follow-up of HCC are organically integrated, and the patient’ s diagnosis and treatment plans are dynamically adjusted to realize the whole process management of HCC patient, and to raise the survival rate and improve quality of life of HCC patient.