BACKGROUND Several methods,such as finger fracture,Pean crush,cavitron ultrasonic surgical aspirator(CUSA),and water jet(WJ),are used for hepatic parenchymal dissection in liver surgery.CUSA is the conventional method...BACKGROUND Several methods,such as finger fracture,Pean crush,cavitron ultrasonic surgical aspirator(CUSA),and water jet(WJ),are used for hepatic parenchymal dissection in liver surgery.CUSA is the conventional method in Japan.WJ is a relatively novel method for parenchymal dissection.Although it has several advantages,such as lower volume of blood loss and shorter operative time,the effect of the WJ system for hepatic dissection on the remnant liver has not yet been investigated.AIM To investigate and compare the effect of the WJ method vs CUSA on the remnant liver cut surface.METHODS This observational study compared the two types of parenchymal transection methods(WJ vs CUSA)in liver surgery.In total,24 and 40 patients who underwent hepatectomy using the WJ method and CUSA,respectively,were included in the analysis.Accordingly,the clinicopathological characteristics and clinical outcomes of 24 and 40 patients were compared.Furthermore,postoperative contrast-enhanced computed tomography(CT)scan was performed to assess the cut surface length of the remnant liver and the degenerative thickness of the areas with a reduced contrast effect in the dissected plane.Then,the two groups were compared.RESULTS On CT scan,the median areas of denaturation in the liver dissection planes were 522(range:109.5-1242)mm^(2) in the CUSA group and 324(range:93.6-1529)mm^(2) in the WJ group.The area did not significantly differ between the two groups;however,the denaturation thickness of the WJ group was significantly lower than that of the CUSA group[5.8(range:0.7-11.1)mm vs 3.3(range:1.7-10.4)mm,P<0.001].CONCLUSION The WJ group had significantly thinner contrast-enhanced areas in the post hepatectomy detached section than the CUSA group.展开更多
Objective This study aimed to systematically evaluate the application of the Cavitron Ultrasonic Surgical Aspirator(CUSA)system in epilepsy surgery and summarize associated surgical experiences.Methods In this retrosp...Objective This study aimed to systematically evaluate the application of the Cavitron Ultrasonic Surgical Aspirator(CUSA)system in epilepsy surgery and summarize associated surgical experiences.Methods In this retrospective analysis,70 patients with refractory epilepsy underwent CUSA-assisted resection,while 20 controls underwent conventional surgical resection.Patients were categorized according to surgical scenarios for CUSA application,including lesion-related epilepsy resections,mesial temporal lobe procedures,neocortical resections within eloquent areas,and cases requiring preservation of critical vascular structures.Detailed operative metrics were analyzed for each category.Comparative assessments between the CUSA and conventional groups included surgical efficiency,complication rates,and postoperative seizure outcomes on the basis of the modified Engel classification.Results CUSA was used for the following procedures:resection of epileptic lesions(n=26),mesial temporal structures(n=32),the epileptogenic neocortex(n=28),and the rolandic cortex(n=17).Additionally,it was utilized in 6 cases requiring vascular protection during insular resection and in 18 cases involving preservation of cortical dangerous veins.Although the overall surgical efficiency was comparable between the CUSA and conventional groups(68.0±18.2 vs.61.1±14.7 min,P=0.180),the CUSA group demonstrated superior efficiency in resecting low-grade tumors(58.6±14.9 vs.68.1±11.2 min,P=0.034).Furthermore,the CUSA group presented significantly fewer permanent complications(5.7%vs.10%,P<0.0001)and a higher rate of Engel Class I outcomes(82.9%vs.70.0%,P=0.278).Conclusions The CUSA system represents a suitable and promising surgical tool for resective epilepsy surgery,potentially serving as a valuable option for epilepsy surgeons.Further studies are warranted to validate these findings.展开更多
目的：探讨超声外科吸引器（cavitron ultrasonic surgical aspirator,CUSA）在矢状窦、大脑镰旁脑膜瘤切除术中的应用及临床意义。方法：回顾性分析51例矢状窦、大脑镰旁脑膜瘤病历资料,根据是否应用CUSA分成A、B两组,A组27例运用CUSA...目的：探讨超声外科吸引器（cavitron ultrasonic surgical aspirator,CUSA）在矢状窦、大脑镰旁脑膜瘤切除术中的应用及临床意义。方法：回顾性分析51例矢状窦、大脑镰旁脑膜瘤病历资料,根据是否应用CUSA分成A、B两组,A组27例运用CUSA结合双极电凝行矢状窦、大脑镰旁脑膜瘤切除,B组24例组织剪结合双极电凝常规肿瘤切除。比较两组肿瘤切除率、手术时间、术中出血量、术后颅内压（intracranial pressure,ICP）、住院时间、甘露醇剂量、迟发性脑出血例数的统计学差异,并评估分析。结果：Simpson切除标准Ⅰ、Ⅱ、Ⅲ级A组分别为23、3、1例,B组为15、5、4例,两组切除率无统计学差异（P=0.125）;A组平均住院时间（15.11±2.50）d,B组（19.71±4.79）d,组间有统计学意义（P=0.019）;在出血量、手术时间上,A组分别为（631.48±240.65）ml、（4.27±0.27）h,B组为（1050.00±521.70）ml、（4.86±0.54）h,差异均有统计学意义（P=0.006,P=0.029）;ICP方面,6 h内两组差异不明显（P=0.138）;6~72 h及72 h后A组分别为（11.30±3.81 mm Hg、12.59±5.52 mm Hg）,B组为（13.96±9.95 mm Hg、16.83±8.98 mm Hg）,具有统计学差异（P=0.011、P=0.031）。其中A组1例发生急性肾功能衰竭,无迟发性脑出血;B组4例发生急性肾功能衰竭,迟发性脑出血5例,3例行开颅血肿清除术。3个月随访,A组恢复良好24例,恢复较差3例,无病重及死亡病例,组间有统计学差异（P=0.022）。结论：在矢状窦、大脑镰旁脑膜瘤切除术中,虽不能提高肿瘤切除率,但CUSA仍是一种实用而且有效的技术,能缩短手术时间、降低术后并发症,提高手术疗效,预后更佳。展开更多
文摘BACKGROUND Several methods,such as finger fracture,Pean crush,cavitron ultrasonic surgical aspirator(CUSA),and water jet(WJ),are used for hepatic parenchymal dissection in liver surgery.CUSA is the conventional method in Japan.WJ is a relatively novel method for parenchymal dissection.Although it has several advantages,such as lower volume of blood loss and shorter operative time,the effect of the WJ system for hepatic dissection on the remnant liver has not yet been investigated.AIM To investigate and compare the effect of the WJ method vs CUSA on the remnant liver cut surface.METHODS This observational study compared the two types of parenchymal transection methods(WJ vs CUSA)in liver surgery.In total,24 and 40 patients who underwent hepatectomy using the WJ method and CUSA,respectively,were included in the analysis.Accordingly,the clinicopathological characteristics and clinical outcomes of 24 and 40 patients were compared.Furthermore,postoperative contrast-enhanced computed tomography(CT)scan was performed to assess the cut surface length of the remnant liver and the degenerative thickness of the areas with a reduced contrast effect in the dissected plane.Then,the two groups were compared.RESULTS On CT scan,the median areas of denaturation in the liver dissection planes were 522(range:109.5-1242)mm^(2) in the CUSA group and 324(range:93.6-1529)mm^(2) in the WJ group.The area did not significantly differ between the two groups;however,the denaturation thickness of the WJ group was significantly lower than that of the CUSA group[5.8(range:0.7-11.1)mm vs 3.3(range:1.7-10.4)mm,P<0.001].CONCLUSION The WJ group had significantly thinner contrast-enhanced areas in the post hepatectomy detached section than the CUSA group.
基金supported by the Featured Clinical Technique of Guangzhou(2023P-TS09).
文摘Objective This study aimed to systematically evaluate the application of the Cavitron Ultrasonic Surgical Aspirator(CUSA)system in epilepsy surgery and summarize associated surgical experiences.Methods In this retrospective analysis,70 patients with refractory epilepsy underwent CUSA-assisted resection,while 20 controls underwent conventional surgical resection.Patients were categorized according to surgical scenarios for CUSA application,including lesion-related epilepsy resections,mesial temporal lobe procedures,neocortical resections within eloquent areas,and cases requiring preservation of critical vascular structures.Detailed operative metrics were analyzed for each category.Comparative assessments between the CUSA and conventional groups included surgical efficiency,complication rates,and postoperative seizure outcomes on the basis of the modified Engel classification.Results CUSA was used for the following procedures:resection of epileptic lesions(n=26),mesial temporal structures(n=32),the epileptogenic neocortex(n=28),and the rolandic cortex(n=17).Additionally,it was utilized in 6 cases requiring vascular protection during insular resection and in 18 cases involving preservation of cortical dangerous veins.Although the overall surgical efficiency was comparable between the CUSA and conventional groups(68.0±18.2 vs.61.1±14.7 min,P=0.180),the CUSA group demonstrated superior efficiency in resecting low-grade tumors(58.6±14.9 vs.68.1±11.2 min,P=0.034).Furthermore,the CUSA group presented significantly fewer permanent complications(5.7%vs.10%,P<0.0001)and a higher rate of Engel Class I outcomes(82.9%vs.70.0%,P=0.278).Conclusions The CUSA system represents a suitable and promising surgical tool for resective epilepsy surgery,potentially serving as a valuable option for epilepsy surgeons.Further studies are warranted to validate these findings.
文摘目的：探讨超声外科吸引器（cavitron ultrasonic surgical aspirator,CUSA）在矢状窦、大脑镰旁脑膜瘤切除术中的应用及临床意义。方法：回顾性分析51例矢状窦、大脑镰旁脑膜瘤病历资料,根据是否应用CUSA分成A、B两组,A组27例运用CUSA结合双极电凝行矢状窦、大脑镰旁脑膜瘤切除,B组24例组织剪结合双极电凝常规肿瘤切除。比较两组肿瘤切除率、手术时间、术中出血量、术后颅内压（intracranial pressure,ICP）、住院时间、甘露醇剂量、迟发性脑出血例数的统计学差异,并评估分析。结果：Simpson切除标准Ⅰ、Ⅱ、Ⅲ级A组分别为23、3、1例,B组为15、5、4例,两组切除率无统计学差异（P=0.125）;A组平均住院时间（15.11±2.50）d,B组（19.71±4.79）d,组间有统计学意义（P=0.019）;在出血量、手术时间上,A组分别为（631.48±240.65）ml、（4.27±0.27）h,B组为（1050.00±521.70）ml、（4.86±0.54）h,差异均有统计学意义（P=0.006,P=0.029）;ICP方面,6 h内两组差异不明显（P=0.138）;6~72 h及72 h后A组分别为（11.30±3.81 mm Hg、12.59±5.52 mm Hg）,B组为（13.96±9.95 mm Hg、16.83±8.98 mm Hg）,具有统计学差异（P=0.011、P=0.031）。其中A组1例发生急性肾功能衰竭,无迟发性脑出血;B组4例发生急性肾功能衰竭,迟发性脑出血5例,3例行开颅血肿清除术。3个月随访,A组恢复良好24例,恢复较差3例,无病重及死亡病例,组间有统计学差异（P=0.022）。结论：在矢状窦、大脑镰旁脑膜瘤切除术中,虽不能提高肿瘤切除率,但CUSA仍是一种实用而且有效的技术,能缩短手术时间、降低术后并发症,提高手术疗效,预后更佳。
