RESUMO
AIM: To assess an experience of robot-assisted liver resection using CUSUM-test. MATERIAL AND METHODS: The results of 46 robot-assisted liver resections were retrospectively analyzed by using of CUSUM-test. RESULTS: There were 3 periods in development of the technology. The 1st period - procedures with the lowest index of difficulty (n=16), the 2nd period - expansion of the indications for difficult resections (n=18) and the 3rd period - stabilization of the results (n=12). The dynamics of difficulty index, intraoperative blood loss, duration of procedure and morbidity (Clavien-Dindo Grade II-V) were evaluated. Five liver resections were needed to decrease blood loss and duration of the procedure. Expansion of indications was feasible after 16 procedures. Stable results were obtained after 34 liver resections.
Assuntos
Hepatectomia/métodos , Hepatopatias/cirurgia , Fígado/cirurgia , Procedimentos Cirúrgicos Robóticos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Hepatectomia/estatística & dados numéricos , Humanos , Morbidade , Duração da Cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Resultado do TratamentoRESUMO
Intrahepatic cholangiocarcinoma (ICC) is one of the most aggressive tumors associated with poor prognosis. Radical surgery is still the main method of treatment in resectable cases. Certain difficulties are observed in case of locally advanced tumors followed by inferior vena cava (IVC) and portal vein (PV) invasion. AIM: To analyze safety of advanced liver resections combined with great vessels repair for locally advanced large and multiple cholangiocellular carcinoma. MATERIAL AND METHODS: Since January 2014 till April 2017 eighty ICC patients have undergone advanced liver resection. There were 62 patients with portal cholangiocarcinoma and 18 with ICC. 4 ICC patients required vascular repair: IVC replacement in 2 cases (i.e. under venous bypass in 1 of them), tangential and circular resection of portal vein bifurcation - in 2 cases. RESULTS: Postoperative complications Clavien-Dindo IIIa developed in all cases. There were no vascular complications. The length of hospital-stay was 14 - 35 days. There were no lethal outcomes. Annual survival was 50%, 2-year - 25%. Adjuvant chemotherapy was used in all patients. CONCLUSION: Advanced liver resection followed by IVC and PV repair for locally advanced ICC may be safely performed and subsequently allows chemotherapeutic treatment.
Assuntos
Neoplasias dos Ductos Biliares , Implante de Prótese Vascular/métodos , Hepatectomia/métodos , Veia Porta , Complicações Pós-Operatórias , Idoso , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/fisiopatologia , Neoplasias dos Ductos Biliares/cirurgia , Implante de Prótese Vascular/efeitos adversos , Colangiocarcinoma/patologia , Colangiocarcinoma/fisiopatologia , Colangiocarcinoma/cirurgia , Feminino , Hepatectomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Veia Porta/patologia , Veia Porta/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Federação Russa , Resultado do Tratamento , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgiaAssuntos
Adenocarcinoma , Cistos , Gastrectomia/métodos , Neoplasias Gástricas , Estômago , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Cistos/congênito , Cistos/patologia , Cistos/cirurgia , Feminino , Humanos , Estadiamento de Neoplasias , Robótica , Estômago/anormalidades , Estômago/patologia , Estômago/cirurgia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia , Resultado do TratamentoAssuntos
Carcinoma Papilar/diagnóstico , Laparotomia , Pancreatectomia/métodos , Neoplasias Pancreáticas/diagnóstico , Robótica/métodos , Tomografia Computadorizada por Raios X/métodos , Biópsia por Agulha Fina , Carcinoma Papilar/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Neoplasias Pancreáticas/cirurgia , Ultrassonografia , Adulto JovemRESUMO
A total of 231 patients with urethral strictures were treated. The disease resulted from trauma, adenomectomy, chronic urethritis, prostatic sclerosis in 92, 72, 51 and 16 patients, respectively. Fifty-one patients underwent conservative treatment which involved bougienage, resolving and anti-inflammatory agents. 38 of them responded, 13 nonresponders were operated on. 72 patients were subjected to partial urethral tunneling according to an original technique which brought success in 90% of the cases. Out of 92 traumatic urethral strictures 88 were cured after end-to-end plastic reconstruction. It is believed that urethral strictures should be managed individually basing on the stricture cause, location, length, severity, complications.