MRI-guided laparoscopic and robotic surgery for malignancies

Endoscopic surgery has some clear benefits, but it also has some disadvantages in reducing surgeons' normal dexterity and limiting their ability to deal with difficult situations. Computer-aided surgery has been proposed to overcome some of the drawbacks of traditional minimally invasive surgery. The proposed systems make possible a secure, precise procedure with no limitations on the operator's freedom of movement. Image-guided surgery is a new technical tool in surgical oncology. Interventional magnetic resonance imaging (MRI) has entered a new stage in which computer-based techniques play an expanding role in planning, monitoring, and controlling procedures. MRI-guided surgery not only represents a technical challenge but is a transformation from conventional hand–eye coordination to interactive navigational operations. We have recently developed an MRI-guided robot-assisted interventional surgical system as well as an MRI-compatible endoscope. They allow the performance of precise image-guided interventional therapy and endoscopic surgery. MRI-guided laparoscopic surgery is now feasible for malignancies and will play an important part in the development of minimally invasive therapy.     

腹膜后肿瘤术中重大血管的切除及重建

目的提高切除侵及腹部重大血管的腹膜后肿瘤的手术技能。方法总结近年来本院收治的腹膜后肿瘤中２５例侵及重大血管的手术切除及血管重建方面的经验。结果经过术前准备和术前评估,精心设计手术方案,对２５例患者成功实施了腹膜后肿瘤（包括受累血管）完整切除和相应的重大血管重建,无手术死亡病例。结论侵及重大血管的腹膜后肿瘤已不是手术禁忌证,应尽可能将受累血管及肿瘤完整切除,再行必要的血管重建,从而达到减少术后局部复发以及延长存活时间的目的。     

腹腔镜与开腹Miles手术治疗低位直肠癌的临床研究

目的 对比分析腹腔镜与开腹Miles手术治疗低位直肠癌的疗效.方法 选择83例低位直肠癌患者,依据随机数字表法将患者分为腹腔镜组(n=42)和开腹组(n=41),观察记录两组患者的术中指标、术后恢复情况及术后并发症发生率.结果 腹腔镜组与开腹组患者的手术时间和淋巴结清扫数目比较,差异均无统计学意义(P﹥0.05);但腹腔镜组患者的术中出血量少于开腹组(P﹤0.05),胃肠道功能恢复时间、自主排尿时间、术后下床活动时间、术后住院时间、进食恢复时间均明显短于开腹组(P﹤0.01),并发症总发生率低于对照组(P﹤0.05).结论 腹腔镜Miles手术治疗低位直肠癌能达到开腹Miles手术的切除范围,且术中出血量少、创伤小、术后恢复快、住院时间短、术后并发症发生率低,值得临床推广应用.     

胰腺囊性肿瘤15例的外科治疗

回顾分析了 1987年 1月 12日～ 2 0 0 4年 1月 17日外科治疗 15例胰腺囊性肿瘤患者的临床资料。其中术前诊断率 60 0 % ( 9/15 ) ,手术切除率 73 3 % ( 11/15 ) ,术后 7个月～ 16年随访率 80 0 % ( 12 /15 ) ,无复发者 83 3 % ( 10 /12 ) ,2例黏液性囊腺癌术后 6及 8年仍健在。分析结果提示 ,根据临床表现、影像学检查 (B超、CT)、实验室检查、囊内液肿瘤标记物、酶及细胞学检查综合分析 ,可提高诊断率 ;本病手术切除率及治愈率较高 ,应采取积极的外科治疗措施。     

Total Colectomy as a Part of Ultra-Radical Surgery for Ovarian Cancer—Short- and Long-Term Outcomes

(1) Background: The aim of this study was to assess the outcomes for patients who underwent total colectomy (TC) as a part of surgery for ovarian cancer (OC). (2) Methods: We performed a retrospective analysis of 1636 OC patients. Residual disease (RD) was reported using Sugarbaker’s completeness of cytoreduction score. (3) Results: Forty-two patients underwent TC during primary debulking surgery (PDS), and four and ten patients underwent TC during the interval debulking surgery (IDS) and secondary cytoreduction, respectively. The median overall survival (mOS) in OC patients following the PDS was 45.1 months in those with CC-0 (21%) resection, 11.1 months in those with CC-1 (45%) resection and 20.0 months in those with CC-2 (33%) resection (p = 0.28). Severe adverse events were reported in 18 patients (43%). In the IDS group, two patients survived more than 2 years after IDS and one patient died after 28.6 months. In the recurrent OC group, the mOS was 6.9 months. Patient age above 65 years was associated with a shortened overall survival (OS) and the presence of adverse events. (4) Conclusions: TC as a part of ultra-radical surgery for advanced OC results in high rates of optimal debulking. However, survival benefits were observed only in patients with no macroscopic disease.     

Aggressive surgical strategies in advanced ovarian cancer: a monocentric study of 203 stage IIIC and IV patients

AIMS: The standard treatment for advanced ovarian cancer consists of cytoreductive surgery associated with a platinum/paclitaxel-based chemotherapy. Nevertheless, there is still the question as to the extent and timing of the surgical debulking. The aim of this study was to evaluate the place of surgery in the therapeutic sequence. PATIENTS AND METHODS: We reviewed data from all consecutive patients with stage IIIC and IV epithelial ovarian cancer, operated on at our institution between 1990 and 2005. Patients were divided into 2 groups, according to the position of surgery in the therapeutic sequence. Patients in group 1 received initial debulking surgery. Group 2 consisted of patients having received their first debulking after initial chemotherapy. RESULTS: Two hundred and three patients were identified and frequently underwent aggressive surgery, in particular, digestive surgery with bowel resections. Perioperative mortality and morbidity rates were low (2% and 14%, respectively) and there was no difference between the groups. Overall survival in group 1 for patients with complete cytoreduction (residual disease (RD)=0), optimal surgery (RD<1cm) or sub-optimal surgery (RD>1cm) was 50%, 30% and 14%, respectively. In group 2, overall survival following complete surgery was 30%, and no long-term survival was observed when surgery was not complete at the time of interval surgery. Survival was worse for patients who had received more than 4 cycles of neoadjuvant chemotherapy. CONCLUSION: This study confirms the importance of surgery in the prognosis of advanced ovarian cancer. Only the patient subgroup that underwent complete initial or interval surgery was associated with a prolonged remission. Optimal surgery with a controlled morbidity can be achieved in many cases, even if bowel resection is needed, at the time of primary debulking. In the interval cytoreductive surgery subgroup, the response to initial chemotherapy and surgery was found to be essential for prognosis.     

Objective decision making between conventional and oncoplastic breast-conserving surgery or mastectomy: An aesthetic and functional prospective cohort study

Background

Breast-conserving surgery (BCS) is considered the standard treatment for early-stage breast cancer. However, fair to poor cosmetic outcomes following conventional BCS have been observed in as many as one-third of cases. The aim of this study was to determine the critical tumor-to-breast volume ratio for each quadrant of the breast beyond which conventional BCS would no longer offer acceptable cosmetic and functional results or satisfactory quality of life for the patient.

Transoral endocrine surgery: Considerations for adopting a new technique

Transoral endocrine surgery encompasses a group of operations whereby the thyroid or parathyroid gland is removed through the oral vestibule. This operation has the advantage of leaving no cutaneous scar and a risk profile similar to open surgery. Adoption of this technique has increased dramatically over the last several years. It is of paramount importance for surgeons to undergo adequate training before adopting this technique.     

肺癌的微创治疗

肺癌的外科治疗发生了巨大的变化,已经成为肺癌治疗最主要的治疗手段之一,它是早中期肺癌的首选治疗手段。随着科学技术的进步,外科手术技术及麻醉技术有了飞速的发展,选择性单肺通气的运用,使多数肺癌的外科治疗可以安全地通过微创手术完成。现在肺癌的微创手术治疗主要包括两种方法:①胸腔镜治疗肺癌;②微创肌肉非损伤性手术治疗肺癌。这两种方法与传统的胸部后外侧切口开胸手术比较,均具有创伤小,恢复快,出血、输血少,对心肺功能损伤小,开、关胸时间短,术后并发症少等优势。微创肌肉非损伤性开胸术操作简单,能提供较充分的手术视野,不会因术中暴露不足而影响手术的彻底性,几乎可以完成所有肺癌切除手术,可以作为肺癌手术的常规术式;但目前有关胸腔镜手术尚缺乏严格的前瞻性随机对照研究,而且胸腔镜手术纵隔淋巴结的完全廓清还有困难,住院时间、术后并发症和生存期并没有因为应用胸腔镜手术而改变。总之,胸腔镜手术和微创肌肉非损伤性开胸术都是微创治疗肺癌的新技术,这两种方法应用于肺癌手术是安全可行的。胸腔镜手术比较适合于较早期的选择性患者,微创肌肉非损伤性开胸术可满足完成各种肺癌手术的需要。     

加速肺康复外科临床实践及证据

加速康复外科(enhanced recovery after surgery,ERAS)方案临床应用的多样性,取决于病种和团队而不同.肺术后都有哪些证据有利于加速肺康复(enhanced lung recovery after surgery,ELRAS)的临床实践呢?本文主要从围手术期可采用的措施及方法进行回顾性分析:术前强调教育及高危因素的评估及预防,术中微创手术及流程优化,术后关注以疼痛为主的症状管理.     

外科手术在甲状腺淋巴瘤处理中的作用

目的 评价外科手术在甲状腺淋巴瘤处理中的作用。方法 １４例甲状腺淋巴瘤患者中,行细针穿刺１例,切取活检４例,甲状腺腺叶切除８例,全甲状腺切除１例。单纯放疗４例,单纯化疗２例,放疗加化疗７例,术后拒绝放化疗１例。结果 １例穿刺细胞学无分类,１３例均为非霍奇金淋巴瘤。Ｂ细胞来源１１例,Ｔ细胞来源２例。随诊期间７例无瘤生存,３例死于肿瘤,１例死于并发症,２例死于其他疾病,１例失随。     

475例壶腹周围癌的外科治疗

目的比较不同年代壶腹周围癌患者外科治疗的特点和疗效．方法回顾性分析1958年至2003年外科治疗的壶腹周围癌患者475例。结果1958年至1976年的128例壶腹周围癌中,胰头癌、壶腹癌、胆管下端癌和十二指肠癌的手术切除率分别为26．6％(21／79)、86．2％(25／29)、38．5％(5／13)和57．1％(4／7);1977年至1987年的70例壶腹周围癌中,胰头癌、壶腹癌、胆管下端癌及十二指肠癌切除率分别为26．7％(16／60)、66．7％(4／6)、100％(1／1)和66．7％(2／3);1988年至1998年的147例壶腹周围癌中,胰头癌、壶腹癌、胆管下端癌及十二指肠癌切除率分别为20．2％(22／109)、75．0％(12／16)、50．0％(2／4)和66．7％(12／18);1999年至2003年的130例壶腹周围癌中．胰头癌、壶腹癌、胆管下端癌及十二指肠癌切除率分别为20．4％(20／98)、100(4／4)、75．0％(12／16)和83．3％(10／12)。1958年至2003年期间,胆管下端癌的发生率在壶腹周围癌中显著增高,术前总胆红素平均值呈下降趋势,术中输血量较前明显减少;手术切除的肿瘤直径平均值较前缩小。1999年至2003年间所有的胰十二指肠切除患者术前均未行减黄处理,并发症仍然显著降低,结论由于新的围手术期治疗和监护技术的进步,壶腹周围癌的手术死亡率和并发症发生率均有显著下降,但胰头癌的手术切除率和生存率仍然没有显著变化。     

Outcomes of bilateral mammoplasty for early stage breast cancer

Aim

Long-term oncological follow-up of oncoplastic breast surgery.

Methods

Sixthy-one (63 cancers) patients affected by breast cancer suitable for breast conservation, were treated with bilateral breast reductions. Tumours located in the inferior pole of the breast were treated by a superior pedicle technique; lesions in the upper pole or in the infero-lateral or infero-medial quadrants of the breast were removed with an inferior pedicle reduction. Small and medium size breast irrespective of tumour location required a periareolar, or comma-shaped approach.

Results

Fifty-six patients were alive at a mean follow-up of 68 months. One patient recurred locally and she is currently alive free of disease.

Conclusion

Results from this study are in accordance with those reported by other similar papers. Oncoplastic breast surgery maximizes cosmetic results and with wider excisions provides effective local control.     

进展期胃上部癌根治性手术治疗的探讨

目的:探讨进展期胃癌手术路径的合理选择以及手术技巧与并发症的预防。方法:回顾总结我院1985-1995年经根治性手术治疗的183例胃上部癌的临床资料,其中经腹手术20例,经胸或胸腹联合手术163例。结果:经腹手术在缩小手术创伤、减少出血量及手术并发症方面占有一定的优势,安全性较好,但亦有一定的局限性。结论:手术路径的选择主要应依据肿瘤的具体情况而定,合理掌握指征。对于非贲门胃上部癌、食管侵犯在2cm或以下者以及BorrmannⅠ、Ⅱ型的胃上部癌应优先考虑经腹路径的手术。     

分化型甲状腺癌侵犯喉气管的外科治疗

目的：探讨分化型甲状腺癌（WDTC）侵犯喉气管的手术治疗方法。方法：回顾性分析21例WDTC侵犯喉气管患者的临床资料。根据手术方式的不同,将患者分为肿瘤根治组（A组,5例）、肿瘤易除组（B组,11例）和姑息性切除组（C组,5例）。结果：21例患者的3,5,7年生存率分别为81．0％（17／21）、61．9％（13／21）和42．9％（9／21）。A、B两组的生存率均明显高于C组（P＜0．001,P＜0．03）,A组的5,7年生存率虽高于B组,但差异无显著性（P＞0．05）。结论：多数WDTC侵犯喉气管患者宜采取保守性手术,如肿瘤侵及管腔内,患者出现呼吸困难和呼吸道出血等并发症,则需要采取根治性手术。