RESUMO
The modern laparoscopic surgery trents the minimization of the access, which led to the workout of the novel surgical access for the laparoscopic cholecystectomy using only two ports. The advantages of the access, empowered by the positive authors' experience is cited.
Assuntos
Colecistectomia Laparoscópica/instrumentação , Colecistite/cirurgia , Laparoscópios , Adolescente , Adulto , Idoso , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Liver resections by metastatic colorectal cancer are considered to be seldom applicable on the reason of bilobar lesions and insufficient volume of the left liver lobe. The two-stage operations have been suggested for such situations. Of 276 patients, treated in our centre, 52 cases, unsuitable for the single-stage liver resection according to the preoperative data, had been retrospectively chosen. All these patients had the procedure of the right branch of vena porta occlusion, which aimed the compensatory hypertrophy of the left liver lobe. The efficacy of the occlusion was up to 73%. The median left lobe enlargement was 11%. The increase of the summary diameter of metastases was 60,4% (from 53 mm to 85 mm; p < 0,0001). The follow-up time was from 3 to 96 months. The three-year survival time was significantly higher in patients with the completed two-stage surgical treatment in comparison with those, who were refused the liver resection--77 and 43%, respectively. The multifactorial analysis revealed the only independent factor of the survival time--the extrahepatic intraabdominal lesion (p = 0,014).
Assuntos
Neoplasias Colorretais/patologia , Embolização Terapêutica/métodos , Ligadura/métodos , Neoplasias Hepáticas , Fígado/irrigação sanguínea , Idoso , Progressão da Doença , Feminino , Seguimentos , Hepatectomia/métodos , Humanos , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Veia Porta/cirurgia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
The 3-year experience minimally invasive surgery for the treatment of the acute cholecystitis was summarized. Criteria of the access choice and terms of surgery were substantiated. Treatment tactics of the acute cholecystits with the use of minimally invasive surgery were outlined, which allowed to decrease the rate of unreasonable "open" operations.