2017年 · 第55卷第11期

laparoscopic pancreaticoduodenectomy (LPD) is considered to be a very challenging surgery due to the difficulty of pancreatic surgery, many resected organs, complicated reconstruction of digestive tract, and many postoperative complications. In recent years, with the progress of technology and the improvement of surgical instruments, its minimally invasive effect has been obviously improved^[1,2,3]However, some key techniques such as uncinate process resection and digestive tract reconstruction have not been effectively solved. We have completed 80 cases of LPD since 2012, accumulated some surgical experience, and made improvements to some key technologies, which are reported below.

Currently, radical resection is the best treatment for long-term survival in patients with hilar cholangiocarcinoma. Radical resection of hilar cholangiocarcinoma is one of the most challenging operations in hepatobiliary surgery due to many factors such as narrow hilar space, complex anatomical structure and multipolar tumor invasion. Advanced hilar cholangiocarcinoma refers to the involvement of unilateral or bilateral secondary bile ducts, namely Bismuth type III and IV tumors. Bismuth type III tumors often require combined hemihepatectomy to obtain a negative margin, while Bismuth type IV tumors are often considered a contraindication to radical surgery or require more aggressive surgical methods such as combined trilobar hepatectomy. At present, many scholars also believe that liver transplantation should be performed for Bismuth type IV tumors^[1,2]。 Variability in the structure of vital liver vessels is easily overlooked in imaging evaluation, and the impact of anatomical variation on surgical decisions for advanced hilar cholangiocarcinoma has been rarely reported. From April 2015 to January 2017, a total of 3 patients with advanced hilar cholangiocarcinoma with anatomical variation who underwent radical resection were treated in our department. The clinical data are reported below.

Vocal cord paralysis caused by recurrent laryngeal nerve injury is the main cause of hoarseness or dyspnea after thyroid surgery. The mechanism of recurrent laryngeal nerve injury is complex. Different types of injury lead to different microscopic anatomical changes and different degrees of recovery after injury. intraoperative neuromonitoring (IONM) can identify early recurrent laryngeal nerve injury, especially non-visible injury, quantify the degree of nerve recovery, and better assist in formulating intraoperative and postoperative treatment plans.