2016年 · 第54卷第06期

enhanced recovery after surgery (ERAS) refers to the adoption of a series of optimized management measures proven effective by evidence-based medical evidence during the perioperative period to reduce the psychological and physiological traumatic stress response of patients, thereby reducing complications, shortening hospital stay, reducing the risk of readmission and death, and reducing medical expenses.

Language functional area tumor surgery should remove the tumor in the greatest extent and preserve the language function as much as possible. In recent years, magnetoencephalography has been gradually used for preoperative functional localization of language functional areas in order to avoid intraoperative damage. From June 2006 to April 2012, our hospital used magnetoencephalographic language functional area localization, and some cases combined with neuronavigation surgery to treat 30 patients with language functional area tumors and achieved good results. The report is as follows.

Male, 42 years old, was admitted to hospital on 8 October 2014 due to "left exophthalmos for more than 3 years". Orbital CT examination showed that the left orbital tip was irregular and low-density shadow, which extended into the cranium through the enlarged supraorbital fissure, and the bone in the lateral wall of the left orbit was obviously thickened and uneven (FIG. 1A)。 Orbital MRI examination showed that irregular abnormal signals were observed at the left orbital apex and the same position in the cranium, with T1WI high signal, T2WI high signal, and enhanced without enhancement; The bone of the left sphenoid greater wing was obviously thickened, with intermediate signal in T1WI and intermediate signal in T2WI. After enhancement, the bone was punctate enhanced. Preliminary diagnosis: orbitocranial communicating tumor (left, lipoma). On October 11, 2014, the patient underwent left orbital-pterional approach orbitocranial communicating tumor resection + cranioplasty under general anesthesia. During the operation, pathological hyperplasia of anterior clinoid process and sphenoid bone was seen, which was soft and brittle. The pathological bone was removed and the supraorbital fissure was enlarged. The pathological sphenoid ridge was cleared with a grinding drill and a small bone-biting forceps. The supraorbital fissure was deformed and bleeding was obvious. The anterior clinoid process was continued to be abraded until the supraorbital fissure was completely opened. Laterally to the inside of the round foramen, carefully separate the skull base bone-dura mater space, continue to grind the root of the sphenoid ridge with an electric grinding drill, expand and grind the local temporal base bone, sphenoid wing, and lateral orbital wall. After satisfaction, the orbital fascia was cut in a "T" shape. Under the microscope, a yellow tumor attached to the eye muscle under the orbital fascia was seen, with unclear boundary and close adhesion to normal tissue, about 2.5 cm ×1.5 cm ×1.0 cm in size, tough in texture and rich in blood supply. Carefully separate the gap between the tumor and normal tissue on the outside of the eye muscle downward, and separate it to the supraorbital fissure. During the operation, it was considered as a lipoma, so most of the tumor was removed. Then the epidural yellow tumor was separated under the microscope, and the tumor was squeezed against the anterior wall of the cavernous sinus. The space between the tumor and the sinus wall was carefully separated from the cavernous sinus wall, and the tumor was removed in blocks. On the second day after surgery, CT of the head revealed that after left orbital cranial mass resection, the left periorbital bone, left sphenoid bone, left frontal bone, and left temporal bone were discontinuous, the left orbital structure was blurred, slightly low density shadow was visible, and the optic nerve was tortuous (FIG. 1B)。 He was successfully discharged from hospital 1 week after surgery, and the incision healed well without complications such as fever. Postoperative pathological report: (left orbit) hyperplasia of fiber and adipose tissue, atrophy of skeletal muscle, irregular trabecular bone (Figure 2)。 Diagnosis: Fibrolipoma. There were no complaints of special discomfort and no protrusion of left eyeball at 3 months postoperative follow up.

Led by the Chairman of the Surgery Branch of Chinese Medical Association, Academician Zhao Yupei of Peking Union Medical College Hospital and Professor Li Zhaoshen of Changhai Hospital affiliated to the Second Military Medical University, and sponsored by Chinese Journal of Surgery, the "Expert Seminar on Multidisciplinary Comprehensive Treatment of Acute Pancreatitis (MDT)" was held in Beijing on April 16th, 2016 with experts from general surgery, gastroenterology, critical care medicine, nephrology, interventional department and emergency department in Beijing and Shanghai.

A 56-year-old female was admitted to hospital mainly for "macroscopic hematuria for more than 1 month". Flexible ureteropyeloscopy: a mass was seen in the left upper renal calyx, single, cauliflower-shaped, with a maximum diameter of about 3 cm (Figure 1), the tumor was more clearly observed under narrow-band imaging technique (Figure 2)； Suspected tumors around the tumor were excluded, and tumors in the renal pelvis and other renal calyces were excluded. Holmium laser vaporization removed the tumor body, base and its periphery within 0.5 cm, and then observed again with narrow band imaging technique, no tumor remained (Figure 3)。

Question 1Can laparoscopic resection be performed for patients with severe cirrhosis of seven segments of liver tumors?

Question 10Laparoscopic intraoperative ultrasound is an essential tool for laparoscopic liver surgery. What is the essential difference between it and open surgery ultrasound? Are there any defects, such as blind spots?