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Vitreous surgery for severe ocular trauma

Objective To summarize the visual outcome of patients with severe ocular trauma treated with vitreous surgery. Methods Clinical data of 188(191 eyes) with severe ocular trauma treated with vitreous surgery in a period from November 1996 to April 1998 were analysed retrospectively. Results The study included penetrating injury in 56 eyes, foreign bodies in the posterior segment in 70 eyes, blunt injury in 41 eyes , and globe rupture in 24 eyes. Main complications included endophthalmitis in 35 eyes, choroidal bleeding in 20 eyes, retinal detachment in 60 eyes, and vitreous hemorrhage in 97 eyes. Post-opera-tively, out of 188 eyes, except for 3 of patients too young to examine, visual acuity improved in 133(70.7%), including 85(45.2%) with visal acuity 0.02-1.0, 46(24.5%) remained unchanged; and 9(4.8%) had worse vision. Among 34 with no-light-perception, 12 had light-perception or over. Conclusion A majority of severe trauma eyes can be salvaged with considerable visual recovery after adequate and timely vitreous surgery. (Chin J Ocul Fundus Dis,1999,15:4-6)

Extended Pancreatoduodenectomy Combined with Superior Mesenteric Artery Resection and Reconstruction (Report of 1 Case)

目的　 探讨胰头癌侵犯肠系膜上动脉时行根治性切除的可行性。方法　采用联合将受侵犯的肠系膜上动脉一并切除的胰十二指肠切除术，肠系膜上动脉断端与腹主动脉端侧吻合方式重建。 结果　患者术后恢复顺利，已随访14个月，仍存活。 结论　肠系膜上动脉侵犯的胰头癌仍可行扩大的胰十二指肠切除术，并可延长患者的生存时间和提高生活质量。

腹腔镜胆囊切除术中意外胆囊癌的外科治疗

【摘要】 目的 探讨腹腔镜胆囊切除术（LC）中意外胆囊癌（UGC）的外科治疗。 方法 回顾性分析2002年1月-2008年12月行LC中16例意外UGC的临床资料。 结果 16例UGC中，术中诊断10例，术后诊断6例；pT1 期5例，pT2期9例，pT3期2例。患者1、3和5年存活率分别为80.0%、73.3%、60.0%。pT1期患者5年存活率为100.0%，pT2期患者5年存活率为50.0%，pT3期患者5年存活率为0.0%。 结论 UGC患者的存活与肿瘤分期相关。pT1期UGC行LC即可。术中疑诊UGC需及时行冰冻病理检查，对于确诊pT1期以外的UGC应尽早开腹行UGC根治术，并采用必要措施防止肿瘤种植和转移。

Experience and Technique of Laparoscopic Hepatectomy

Perioperative outcomes of uniportal versus three-port video-assisted thoracoscopic lobectomy for 2 112 lung cancer patients: A propensity score matching study

Objective To analyze the perioperative outcomes of uniportal thoracoscopic lobectomy compared with three-port thoracoscopic lobectomy. Methods Data were extracted from the Western China Lung Cancer Database, a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital, Sichuan University. Perioperative outcomes of the patients who underwent uniportal or three-port thoracoscopic lobectomy for lung cancer during January 2014 through April 2021 were analyzed by using propensity score matching. Altogether 5 817 lung cancer patients were enrolled who underwent thoracoscopic lobectomy (uniportal: 530 patients; three-port: 5 287 patients). After matching, 529 patients of uniportal and 1 583 patients of three-port were included. There were 529 patients with 320 males and 209 females at median age of 58 (51, 65) years in the uniportal group and 1 583 patients with 915 males and 668 females at median age of 58 (51, 65) years in the three-port group. Results Uniportal thoracoscopic lobectomy was associated with less intraoperative blood loss (20 mL vs. 30 mL, P<0.001), longer operative time (115 min vs. 105 min, P<0.001) than three-port thoracoscopic lobectomy. No significant difference was found between the two groups regarding the number of lymph node dissected, rate of conversion to thoracotomy, incidence of postoperative complication, postoperative pain score within 3 postoperative days, length of hospital stay, or hospitalization expenses. Conclusion Uniportal video-assisted thoracoscopic lobectomy is safe and effective, and the overall perioperative outcomes are comparable between uniportal and three-port strategies, although the two groups show differences in intraoperative blood loss.

Reason and Treatment of Complications of Hemorrhage after Laparoscopic Cholecystectomy

目的探讨腹腔镜胆囊切除术(LC)后并发出血的原因与正确的防治方法。方法对1992年10月至2005年2月我院进行的LC术后并发出血的37例患者的临床资料进行回顾性分析。结果胆囊动脉出血21例，胆囊床出血4例，网膜出血6例，trocar穿刺孔出血4例，不明出血部位2例。直接开腹手术7例，腹腔镜再次手术止血并获成功21例，腹腔镜止血失败中转开腹手术4例，非手术止血成功5例。36例顺利恢复出院，死亡1例。随访36例（其中失访1人），恢复良好。结论LC术后并发出血的原因多种多样，但多为胆囊动脉出血； 治疗以腹腔镜再次探查止血为主，但不能忽视非手术治疗的重要性。

PARTIAL HEPATECTOMY IN TREATING HEPATOLITHIASIS (REPORT OF 95 CASES)

目的 了解肝部分切除治疗肝内胆管结石的效果。方法回顾性分析1984年3月至1997年8月对95例肝内胆管结石施行肝部分切除，并辅以狭窄胆管切开整形及胆肠吻合等手术的治疗情况。结果 临床疗效优良者达93.7%，术后残留结石10例，残石率为10.5%。结论 肝部分切除治疗肝内胆管结石是目前较理想有效的手术方式。

The difficulties and countermeasures of laparoscopic hepatectomy in the treatment of hepatocellular carcinoma in the difficult sites of liver

Laparoscopic hepatectomy is routinely used in the surgical treatment of hepatocellular carcinoma, and has formed a standardized operating procedure. Tumors located in the segments Ⅶ and Ⅷ of liver as well as the paracaval subsegment of caudate lobe are considered to be difficult sites for laparoscopic hepatectomy due to the deep anatomical location, proximity to important vascular structures, difficulty in exposing the visual field under laparoscopy, and limited operating space. Based on the experience of our team and related research reports, the authors analyzed and summarized countermeasures for the difficulties of laparoscopic hepatectomy in the treatment of hepatocellular carcinoma in difficult sites. Adhering to the tumor-centered and margin-based principles, accurate preoperative assessment, selection of the correct surgical approach, designing liver resection plane guided by hepatic vena while taking into account portal vein territory, and giving preference to ananatomical hepatectomy while preserving functional liver parenchyma as much as possible are the prerequisites for ensuring minimally invasive and oncology benefits for patients with hepatocellular carcinoma in difficult sites.

远指（趾）间关节黏液囊肿深部切除疗效分析

目的 总结保留皮下囊壁、深部切除方法治疗远指（趾）间关节黏液囊肿的疗效。 方法 2005 年4 月－2009 年5 月，采用保留皮下囊壁、深部切除方法治疗27 例36 处远指（趾）间关节黏液囊肿。男12 例16 处，女15 例20 处；年龄40 ～ 82 岁，平均55 岁。病程1 个月～ 3 年。手指21 例28 处，足趾6 例8 处。囊肿位于远指（趾）间关节单侧24 处，双侧7 处，两侧同发并相互连通5 处。囊肿范围0.6 cm × 0.4 cm ～ 2.2 cm × 1.7 cm。 结果 术后1 例2 处切口发生感染导致溃疡，经换药2 周后愈合；其余切口均Ⅰ期愈合。术后患者均获随访2 年。术中1 处肌腱损伤并发槌状趾，行关节融合术后治愈。术前临床症状均获改善。随访期间3 处囊肿复发，均再次手术后治愈。 结论 远指（趾）间关节背侧骨性及关节囊改变是黏液囊肿重要成因，保留皮下囊壁可修复关节囊，避免皮瓣修复切除后的皮肤组织缺损，深部彻底切除囊肿可有效避免复发。

Curative effects of vitreoctomy and scleral buckling on retinal multiple-tear detachment associated with tracted anterior flap

Objective To evaluate the curative effects of vitreoctomy or simple scleral buckling on retinal multiple-tear detachment associated with tracted anterior flap. Methods The clinical data of 89 eyes in 89 patients with retinal multiple-tear detachment associated with tracted anterior flap diagnosed in Jan, 1999-Jan, 2002 were retrospectively analyzed. In the 89 patients, 41 had undergone vitreoctomy and 48 had undergone scleral buckling without vitrectomy. In the duration of 2- to 36-month follow-up with the mean of (11.02±7.90) months, visual acuity, retinal reattached rate and postoperative complication were examined and the results in the 2 groups were compared. Results In 41 eyes underwent vitreocotmy, successful reattachment was found in 38 (92.7% ); visual acuity increased in 33 (80.5%), didn′t change in 6 (14.6%), and decreased in 2 (4.9%); leakage of flocculent membrane in anterior chamber occured was found in 2 (4.9%), complicated cataract in 3 (7.3%),and severe proliferative vitreoretinopathy (PVR) in 3 (7.3%). In 48 eyes underwent scleral buckling, 41 (85.4%) had success reattachment; visual acuity increased in 36 (75.0%), didn′t change in 4 (8.3%), and decreased in 8 (16.7%); leakage of flocculent membrane in anterior chamber was found in 6 (12.5%), complicated cataract in 9 (18.8 %), and severe PVR in 8 (16.7%). Conclusion There isn′t any difference of the success rate of the surgery between vitrectomy and scleral buckling for retinal multiple-tear detachment associated with tracted anterior flap.The better visual acuity and less complications are found in the vitrectomy gro up than those in the scleral buckling group. (Chin J Ocul Fundus Dis，2004，20：209-211)