Foreign country home care, minimally invasive technology to relieve chronic disease – the first expe-jkforum

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The prevalence of minimally invasive technology to lift the exotic home medical ills — I completed the first provincial expert laparoscopic ALPPS surgery (Liu Yu) recently, professor and director of senior hospital doctors tumor surgical department of hepatobiliary surgery Xu Lishan team, the success of a massive hepatic tumors underwent radical surgery for advanced hepatocellular carcinoma — ALPPS (stages of liver segmentation and portal vein ligation combined with liver excision surgery). Ms. Cui, 35, worked for a long time in Korea. She had paroxysmal abdominal pain three months ago, which seriously affected her work and life. She was admitted to the local hospital and underwent liver CT, which showed multiple irregular masses and nodules in the liver parenchyma. Subsequently, the patients were treated in Korea and many hospitals in the country. They were told that the tumor volume was huge and the residual liver volume was too small to be treated. It was estimated that the survival time was less than 2 months. For families of patients presented to four Hayi Da Hospital tumor surgery department of hepatobiliary surgery director Xu Lishan is good at the treatment of liver tumor. After detailed examination of patients by Xu director, combined with laboratory and imaging examination results, diagnosed as giant bile duct cell type of liver cancer. Professor Xu Lishan team through the liver 3D reconstruction for patients were assessed accurately before operation, the decision for the "combined liver interruption and portal vein ligation two hepatectomy (associatingliver partition and portal vein ligation for staged hepatectomy, ALPPS)". Previous surgery requires patients to undergo two laparotomy within one week, resulting in a greater burden on the patient’s psychology and physiology. Adhering to the concept of minimally invasive and trauma control, Xu Ding decided to play the advantages of team minimally invasive surgery, the application of laparoscopy to complete a phase of surgery, through five 0.5-1.0cm puncture hole can be completed open surgery, need a large incision to carry out the operation. This is the first attempt by our province to perform endoscopic ALPPS surgery, which is difficult and requires skilled liver minimally invasive surgical techniques and precise anatomical basis of the liver. According to the plan, Ms. Cui completed the ligation of the right branch of the portal vein and the complete disconnection of the left outer lobe and right hepatic lobe under the microscope. The operation lasted for 4 hours and the bleeding was less than 100ml. The patient recovered very well and was able to move away from bed on the third day. Six days later, the volume of residual liver in the left lateral lobe of the liver was increased by nearly 70%, which met the requirements of the two phase surgery. The two stage operation was performed on a week after operation. The right liver cancer (more than 10 lesions, the largest lesion was about 20× 20cm) was resected completely, and the remaining two lesions on the left outer lobe of the liver were completely removed. The operation lasted for 6.5 hours and the operation was successful. The bleeding was about 200ML. After careful treatment and meticulous nursing, no complications occurred, and discharged smoothly tenth days after operation. The patients and their family members spoke highly of Xu Lishan director and senior hospital doctors quality service team. According to director Xu Lishan, ALPPS surgery is used to treat patients with advanced liver cancer who are small in size and unable to tolerate massive hepatectomy.

异国患病家乡求医 微创技术解除顽疾――我省专家首次完成腔镜下ALPPS手术   (刘宇)近日哈医大四院肿瘤外科肝胆外科主任徐力善教授团队成功为一名肝脏巨大肿瘤患者施行了晚期肝癌的根治性手术――ALPPS(联合肝脏分割和门静脉结扎的分阶段肝切除术)手术。   35岁的崔女士,长期在韩国务工,三个月前出现阵发性的腹部胀痛,严重影响了工作生活,遂于当地医院就诊,行肝脏CT提示肝实质内见多发不规则形肿块影及结节影。随后患者在韩国及国内多家医院求医,均被告知瘤体体积巨大,残余肝脏体积过小,无法行手术治疗,预计生存期不超过2个月。患者家属慕名求诊于擅长肝脏肿瘤治疗的哈医大四院肿瘤外科肝胆外科徐力善主任。经徐主任详细查看患者,结合实验室及影像学检查结果确诊为巨大胆管细胞型肝癌。   徐力善教授团队通过肝脏三维重建技术对患者进行了精准的术前评估,决定为其行“联合肝脏离断和门静脉结扎的二步肝切除术(associatingliver partition and portal vein ligation for staged hepatectomy,ALPPS)”。既往该手术需要患者在一周内接受两次开腹手术,对患者心理和生理都造成较大负担。秉承微创观念和创伤控制理念,徐主任决定发挥团队微创手术的优势,应用腹腔镜完成一期手术,通过五个0.5-1.0cm的穿刺孔即可完成开放手术需要大切口才能进行的操作。这也是我省专家首次尝试腔镜下ALPPS手术,该手术难度较大,需要娴熟的肝脏微创手术技巧和精准的肝脏解剖基础。崔女士一期手术按计划开展,在镜下完成了门脉右支的结扎及左外叶与右三叶肝组织的完全离断,手术历时4小时,出血不到100ml。术后患者恢复非常顺利,第三天既可离床活动。六天后,经肝脏三维重建技术测量,肝脏左外叶残肝体积增长近70%,满足了二期手术要求。二期手术于一周后如期开展,手术完整切除了右三叶患癌肝脏(肿瘤病灶多达10余处,最大灶约20×20cm),并完整切除了保留的肝左外叶上两处病灶。手术历时6.5小时,术中顺利,出血约为200ml。术后患者经过精心的治疗及精细的护理,无并发症发生,术后第十天顺利出院。患者及家属对徐力善主任团队及医大四院优质的服务给予了高度的评价。   据徐力善主任介绍ALPPS手术用于治疗剩余肝脏体积较小而不能耐受大体积肝脏切除的较晚期肝癌病人,为不能手术的巨大肝脏肿瘤患者带来了新的希望。该技术由徐力善主任的团队率先于东三省开展,并有多例成功经验。徐力善教授救治的第一位接受该手术的巨大肝癌患者现术后2年余仍健康存活。腹腔镜下ALPPS的成功开展也标志着我省微创技术达到国内一流水平。相关的主题文章:

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