BACKGROUNDLaparoscopic surgery is advantageous for minimal invasiveness and rapid postoperative recovery. Since the use of laparoscopic hepatectomy in liver resection in the 1990s, it has been performed in a few institutions worldwide. Lack of efficient and safe techniques for liver transaction is the major obstacle preventing from its further development. We developed a new technique for laparoscopic hepatectomy by curettage and aspiration in 1998. In this paper we analyze the clinical outcomes of this technique after 7 years of practice.

METHODSAltogether 59 consecutive patients underwent laparoscopic hepatectomy by curettage and aspiration from August 1998 to January 2005 at our institution. These patients included 33 males and 26 females, with a mean age of 47 years. For liver transection laparoscopic Peng's multifunctional operative dissector (LPMOD) was used. Lesions included malignant liver tumors in 19 patients, benign liver tumors in 17, intrahepatic calculus in 18, and other liver lesions in 5. Procedures included local resections in 30 patients, left lateral segmentectomy in 28, and right hemihepatectomy in 1.

RESULTSLaparoscopic operation was completed in 57 patients. Two patients (3.4%) had the operation converted to laparotomy. The mean operating time was 143 minutes and the mean intraoperative blood loss was 456 ml. The mean length of postoperative hospital stay was 7 days. Complications occurred in 2 patients (3.4%), and there was no perioperative death.

CONCLUSIONLaparoscopic hepatectomy by curettage and aspiration is efficient and safe for liver resection.

Adult ; Aged ; Curettage ; methods ; Female ; Hepatectomy ; adverse effects ; instrumentation ; methods ; Humans ; Laparoscopy ; methods ; Length of Stay ; Male ; Middle Aged ; Suction

Objective To explore the effect of continue nursing out of hospital on the rehabilitation patients with first onset schizophrenia and to provide theoretical guidance for the development of hospital extended care.Methods Totals of 120 patients with first onset schizophrenia were randomly divided into study group and control group,each group 60 cases. Study group received continue nursing interventions out of hospital in two stages,control group only received conventional treatment,nursing,discharge instruction,and followed up one year.Medication compliance,disease recurrence and reemployment of patients were recorded.After patients discharged six months and one year,they were investigated with Brief psychotic symptoms scale (BPRS) and comprehensive assessment of quality of life questionnaire (GQOLI-74).Results In study group,there was 39 patients complied doctors' advice,7 patients' disease recurred and 13 patients were reemployment,while 26 patients complied doctors' advice,17 patients' disease recurred and 4 patients were reemployment in control group,and the differences were statistically significant (x2 =5.673,5.208,5.551,respectively;P＜0.05).There was no significant difference on the BPRS scores in two groups before implemented continue nursing outside hospital ( P ＞ 0.05 ) ; while after implemented continue nursing,the total score of BPRS in study group was (54.34 ± 6.608 ) higher than ( 43.63 ± 5.47 ) in control group,and the differences were statistically significant(t =6.749,P ＜ 0.01 ).One year later,the EQOL-74 score in physical function (62.14 ± 7.16),psychological function ( 61.54 ± 7.14) and social function ( 60.42 ± 5.28 ) in study group were higher than that of control group that was (62.14 ± 7.16),( 61.54 ± 7.14 ),( 60.42 ± 5.28 )respectively,and the differences were statistically significant ( t =3.304,3.259,3.959,respectively; P ＜ 0.01 ).Comparison of medication compliance,and ratio between two groups,the differences were statistically significant (P ＜ 0.05).Condusions Continue nursing care can improve the social function of patients with first onset schizophrenia,improve their quality of life,promote their recovery and return to society.

Objective: To establish a survival prediction model based on the independent prognostic factors of long-term prognosis after laparoscopic liver resection(LLR) for intrahepatic cholangiocarcinoma(ICC). Methods: The clinical and pathological data of 351 consecutive patients with ICC who received radical LLR in 13 Chinese medical centers from August 2010 to May 2021 were collected retrospectively. There were 190 males and 161 females,aged(M(IQR)) 61(14)years(range:23 to 93 years). The total cohort was randomly divided into a training dataset(264 cases) and a validation dataset(87 cases). The patients were followed up by outpatient service or telephone,and the deadline for follow-up was October 2021. Based on the training dataset,the multivariate Cox proportional hazards regression model was used to screen the independent influencing factors of long-term prognosis to construct a Nomogram model. The Nomogram model's discrimination,calibration,and clinical benefit were evaluated through internal and external validation,and an assessment of the overall value of two groups was made through the use of a receiver operating characteristic(ROC) curve. Results: There was no significant difference in clinical and pathological characteristics and long-term survival results between the training and validation datasets(all P>0.05). The multivariate Cox analysis showed that CA19-9,CA125,conversion to laparotomy during laparoscopic surgery,and lymph node metastasis were independent prognostic factors for ICC patients after LLR(all P<0.05). The survival Nomogram was established based on the independent prognostic factors obtained from the above screening. The ROC curve showed that the area under the curve of 1, 3 and 5-year overall survival rates of patients in the training dataset were 0.794(95%CI:0.721 to 0.867),0.728(95%CI:0.618 to 0.839) and 0.799(95%CI:0.670 to 0.928),and those in the validation dataset were 0.787(95%CI:0.660 to 0.915),0.831(95%CI:0.678 to 0.983) and 0.810(95%CI:0.639 to 0.982). Internal and external validation proved that the model exhibited a certain discrimination,calibration,and clinical applicability. Conclusion: The survival Nomogram model based on the independent influencing factors of long-term prognosis after LLR for ICC(including CA19-9,CA125,conversion to laparotomy during laparoscopic surgery,and lymph node metastasis) exhibites a certain differentiation,calibration,and clinical practicability.
Bile Duct Neoplasms/surgery* ; Bile Ducts, Intrahepatic/pathology* ; CA-19-9 Antigen ; Cholangiocarcinoma/diagnosis* ; Female ; Humans ; Laparoscopy ; Lymphatic Metastasis ; Male ; Nomograms ; Prognosis ; Retrospective Studies