Gasless Laparoscopic Surgery plus Abdominal Wall Lifting for Giant Hiatal Hernia——Our Single-center Experience

Giant hiatal hernia（GHH） comprises 5% of hiatal hernia and is associated with significant complications.The traditional operative procedure,no matter transthoracic or transabdomen repair of giant hiatal hernia,is characteristic of more invasion and more complications.Although laparoscopic repair as a minimally invasive surgery is accepted,a part of patients can not tolerate pneumoperitoneum because of combination with cardiopulmonary diseases or severe posterior mediastinal and neck emphesema during operation.The aim of this article was to analyze our experience in gasless laparoscopic repair with abdominal wall lifting to treat the giant hiatal hernia.We performed a retrospective review of patients undergoing gasless laparoscopic repair of GHH with abdominal wall lifting from 2012 to 2015 at our institution.The GHH was defined as greater than one-third of the stomach in the chest.Gasless laparoscopic repair of GHH with abdominal wall lifting was attempted in 27 patients.Mean age was 67 years.The results showed that there were no conversions to open surgery and no intraoperative deaths.The mean duration of operation was 100 min（range：90–130 min）.One-side pleura was injured in 4 cases（14.8%）.The mean postoperative length of stay was 4 days（range：3–7 days）.Median follow-up was 26 months（range：6–38 months）.Transient dysphagia for solid food occurred in three patients（11.1%）,and this symptom disappeared within three months.There was one patient with recurrent hiatal hernia who was reoperated on.Two patients still complained of heartburn three months after surgery.Neither reoperation nor endoscopic treatment due to signs of postoperative esophageal stenosis was required in any patient.Totally,satisfactory outcome was reported in 88.9% patients.It was concluded that the gasless laparoscopic approach with abdominal wall lifting to the repair of GHH is feasible,safe,and effective for the patients who cannot tolerate the pneumoperitoneum.

A Systematic Review on Efficacy and Safety of Gasless Laparoscopy in the Management of Uterine Leiomyoma

Uterine leiomyoma causes considerable morbidity in women. This study systematically reviewed the efficacy and safety of gasless laparoscopic myomectomy（GLM） in the management of uterine leiomyoma by comparing GLM with other minimally invasive procedures. Cochrane Library, PubMed, EMBASE, Web of Science, WANFANG database and China National Knowledge Infrastructure（CNKI） were searched for studies published in English or Chinese between January 1995 and May 2015, and related references were traced. Study outcomes from randomized controlled trials and retrospective cohort studies were presented as mean difference（MD） or odds ratio（OR） with a 95% confidence interval（CI）. Seventeen studies（including 1862 patients） meeting the inclusion criteria, including 934 treated with GLM and 928 treated with other minimally invasive procedures were reviewed. The results of meta-analysis revealed that GLM resulted in significantly shorter operating time [MD=–10.34, 95% CI（–18.12, –2.56）, P〈0.00001], shorter hospital stay [MD=–0.47, 95% CI（–0.88, –0.06）], less time to flatus [MD=–2.04, 95% CI（–2.59, –1.48）], less postoperative complications [OR=0.20, 95% CI（0.06, 0.62）] and less blood loss [MD =–30.74, 95% CI（–47.50, –13.98）]. On the other hand, there were no significant differences in duration of post-operative fever [MD=–0.52, 95% CI（–1.46, 0.42）] between the two groups. Additionally, GLM was associated with lower febrile morbidity, lower postoperative abdominal pain, and higher postoperative hemoglobin than other minimally invasive procedures for the treatment of uterine leiomyoma. In conclusion, GLM and other minimally invasive procedures are feasible, safe, and reliable for uterine leiomyoma treatment. However, available studies show that GLM is more effective and safer than other minimally invasive approaches.

Transvaginal natural orifice transluminal endoscopic surgery:A novel gasless technique to hysterectomy

Transvaginal natural orifice transluminal endoscopic surgery(vNOTES),as a minimally invasive surgery technique,applies CO_(2) for creating pneumoperitoneum,and uses a closed system to through smoke evacuation from a dedicated outlet or port.It has the potential to generate aerosol in the operation room,which can lead to an increased risk of transmission of SARS-CoV-2.This technical note introduces a new technique of gasless pure vNOTES to hysterectomy using silicone face mask as a modified vNOTES port.

Gynecological procedures under gasless laparoscopy

Objective To evaluate gasless laparoscopy in treating gynecological conditions.Methods With Kirschner wire lifting, transversely or longitudinally introduced into abdominal wall subcutaneously, we exposed the operative field and pelvic organs with routine operative instruments under epidural anesthesia. When a dense pelvic adhesion was confronted, we used the temporarily low-pressured pneumolaparoscopy to dissect it.Results All procedures were carried out without organ injury, hematorna, or other complications. The operative field can be clearly seen with this method. The mean time for appendagectorny was one hour and for laparoscopic assisted vaginal hysterectomy 80 minutes.Conclusion Gasless laparoscopy avoids the complications which occur in the routine laparoscopy such as subcutaneous or mediastinal pneurnatoma, hypercarbonernia, air embolism, cardiopulmonary dysfunction.Our lifting method is simple, convenient, time and money saving, as well as more flexible for treating gynecological conditions.

Laparoscopic and gasless laparoscopic sigmoid colon vaginoplasty in women with vaginal agenesis

Background In the past several decades we have seen multiple advances in the reconstruction for girls born with vaginal agenesis.This study aimed to evaluate the technical feasibility,anatomical and functional outcomes of one-stage laparoscopic and gasless laparoscopic vaginoplasty with sigmoid colon for the patients of vaginal agenesis （Mayer-Rokitansky-Kuster-Hauser syndrome）.Methods We did a retrospective review of a total of 150 women with Mayer-Rokitansky-Kuster-Hauser syndrome treated at Beijing Anzhen Hospital,Capital Medical University from March 2006 to August 2010.The patients were divided into the CO2 pneumoperitoneum laparoscopic group and the abdominal wall lift of gasless laparoscopic group.Sigmoid colon vaginoplasty approaches were performed in all of the patients.The surgical techniques,perioperative results,complications,anatomical and functional outcomes of vaginoplasty were recorded.Results All procedures were performed successfully.Significant differences in the operative time and intraoperative blood loss existed in the laparoscopic vaginoplasty group compared with the gasless laparoscopic vaginoplasty group.The patients who underwent sigmoid colon vaginoplasty had good cosmetic results without the problem of excessive mucus production.The postoperative complications were minimal.During a mean follow-up of 15.6 months,no stenosis or shrinkage was encountered.The subjective sexual satisfaction rate with the surgical outcomes in all patients was 83.3%.Conclusions Laparoscopic or gasless laparoscopic vaginoplasty with sigmoid colon are effective and feasible approaches for women with congenital vaginal agenesis.The procedures have satisfactory anatomical and functional results.

Gasless laparoscopy for benign gynecological diseases using an abdominal wall-lifting system

Objectives: The use of gasless laparoscopy with an abdominal wall-lifting device for benign gynecological diseases was compared to conventional laparoscopy with CO2 pneumoperitoneum. Methods: From February 2007 to July 2007,76 women with uterine and/or adnexal benign diseases and candidates for laparoscopic surgery were recruited in this study. Thirty-two women underwent gasless laparoscopic surgery and 44 women underwent pneumoperitoneum laparoscopic surgery. Results: Diverse pathologies,including adnexal cyst,uterine myoma and ectopic pregnancy,were treated successfully with gasless laparoscopic surgery. Compared with the patients in the pneumoperitoneum group,the similar hospital stay (P=0.353) and intraoperative blood loss (P=0.157) were observed. However,the mean operative time in the gasless group was significantly longer than that in the pneumoperitoneum group (P=0.003). No severe intraoperative or postoperative complications were found in either group,except for one case of laparotomic conversion in the pneumoperitoneum group due to dense pelvic adhesions. The total hospital charges were significantly less in the gasless group than in the pneumoperitoneum group (P=0.001). In 38 cases of ovarian cyst resection,the mean operative time in the gasless group remained longer than that in the pneumoperitoneum group (P=0.017). The total hospital charges were also significantly less in the gasless group than in the pneumoperitoneum group (P<0.001). Conclusion: Our preliminary results demonstrated that the laparoscopic procedure using the gasless technique was a safe,effective method to treat benign gynecological diseases. Moreover,it was easy to master. As a minimally invasive treatment,gasless laparoscopic surgery provides a good choice to patients in the undeveloped regions in China without increasing the patients’ and the government’s burden significantly.

Gasless endoscopic surgery through the upper chest in treatment of thyroid tumor

Background Recently, there has been a surge of interest in minimally invasive techniques with endoscope in thyroid surgery. The aim of this study was to investigate the possibility of a scarless neck surgery under endoscopy for the treatment of thyroid tumor and to observe the results of this procedure.Methods A total of 68 patients （64 women and 4 men） underwent the surgery. Their ages ranged from 18 to 65 years,with a mean age of （34±3） years. There were 64 cases of thyroid adenoma, and 4 cases of nodular goiter. An incision was made on the surface of the chest bone. The operation cavity was made by dragging the skin. Sixty-four patients underwent partial thyroid lobectomy, four patients underwent thyroid lobectomy.Results All 68 cases showed healing in one stage. None of the cases showed paralysis of the recurrent laryngeal nerve or tumor recurrence within the next 2 to 60 months of follow-up. The patients experienced slight pain after the operation.The patients were satisfied with the cosmetic results of the surgery.Conclusion The gasless endoscopic surgery through the upper chest, which was performed to treat thyroid tumor, did not leave any scar, and was easy to handle, and gave good cosmetic results.

无充气腋窝入路腔镜手术治疗甲状腺乳头状癌的临床效果

目的比较无充气腋窝入路腔镜手术(GUA)与开放甲状腺手术(OT)治疗甲状腺乳头状癌的效果。方法回顾性分析2022年6—12月于郑州大学第一附属医院收治的接受甲状腺乳头状癌手术的患者。根据手术方式分为开放甲状腺手术组(OT组,82例)、无充气腋窝腔镜甲状腺手术组(GUA组,57例)。比较两组术中术后疗效指标、并发症等情况以及术后疼痛评分、美容满意度评分。结果所有患者均顺利完成手术。两组手术时间、术中出血量、阳性淋巴结数量、总淋巴结数量、术后引流量、拔管时间差异无统计学意义(P>0.05),而术后GUA组住院时间比OT组短(P<0.05)。两组并发症发生率差异无统计学意义(P>0.05)。GUA组较OT组疼痛评分低、美容满意度评分高、瘢痕自我关注度评分低(P<0.05)。结论GUA治疗甲状腺乳头状癌具有一定优势,能够在保证手术治疗效果的同时有效地缩短术后恢复时间,并满足患者对美容的需求,减轻术后疼痛程度,促进患者的快速康复。

免充气锁骨下入路腔镜甲状腺全切除术治疗甲状腺乳头状癌的单中心回顾性研究

目的:探讨免充气锁骨下入路腔镜甲状腺全切除术治疗甲状腺乳头状癌的早期疗效。方法:回顾分析2022年12月至2023年12月行免充气锁骨下入路腔镜甲状腺全切除术联合中央区淋巴结清扫术及传统开放入路甲状腺全切除术联合中央区淋巴结清扫术患者的临床资料。结果:共纳入137例,其中腔镜组37例,开放组100例。腔镜组年龄小于开放组[(44.24±8.44)岁vs.(49.08±10.82)岁],手术时间长于开放组[(106.89±21.90)min vs.(79.88±21.76)min],术后引流量多于开放组[(107.62±31.16)mL vs.(82.04±31.68)mL],术后美容满意度高于开放组[3(2,3)分vs. 2(1,3)分],颈部不适感发生率低于开放组[7(18.9%) vs. 43(43.0%)],差异均有统计学意义(P<0.05)。两组患者性别、BMI、肿瘤直径、桥本甲状腺炎、T分期、术中出血量、中央区淋巴结清扫数量、中央区淋巴结阳性数量、术后引流管留置时间、术后甲状腺球蛋白水平差异无统计学意义(P>0.05);两组暂时性及永久性甲状旁腺功能减退、暂时性及永久性喉返神经损伤、血肿、发生率差异亦无统计学意义(P>0.05),两组均未发生淋巴漏、切口感染、气管损伤、食管损伤。结论:免充气锁骨下入路腔镜甲状腺全切除术联合中央区淋巴结清扫术治疗甲状腺乳头状癌安全、有效,美容效果及术后颈部舒适度优于传统开放甲状腺全切除术。

无充气腋窝入路和颈前开放入路甲状腺癌根治术对甲状旁腺功能及中央区淋巴结清扫水平的影响

目的:比较无充气腋窝入路和颈前开放入路甲状腺癌根治术对甲状旁腺功能及中央区淋巴结清扫水平的影响。方法:回顾性分析2021年1月至2022年6月我院收治的80例甲状腺乳头状癌患者的临床资料,其中40例行颈前开放入路甲状腺癌根治术(开放组),40例行无充气腋窝入路甲状腺癌根治术(腋窝组),对比两组术前和术后血清全段甲状旁腺激素(siPTH)水平、血清钙水平及中央区淋巴结清扫个数。结果:两组术前siPTH和血清钙水平比较差异无统计学意义(P>0.05),两组术后siPTH水平虽有降低,但均在正常范围,两组术后血清钙均值也在正常范围,两组术后siPTH及血清钙水平比较差异无统计学意义(P>0.05)。开放组中央区淋巴结清扫数量多于腋窝组(P<0.05)。结论:两种入路甲状腺癌根治术对甲状旁腺功能的影响无明显差异,但传统颈前开放入路术式较无充气腋窝入路术式对清扫中央区淋巴结更有利。

经锁骨下单孔免充气腔镜手术与传统开放手术治疗甲状腺乳头状癌的临床对比研究

目的:对比经锁骨下单孔免充气腔镜手术与传统开放甲状腺手术治疗甲状腺乳头状癌的临床疗效。方法:回顾分析2021年1月1日至2024年5月1日为308例甲状腺乳头状癌患者行手术治疗的临床资料。其中151例经锁骨下行单孔免充气腔镜甲状腺手术(腔镜组),157例行传统开放手术(开放组)。结果:两组患者性别、年龄、术前血清钙离子及甲状旁腺激素浓度、肿瘤最大径、中央区淋巴结清扫数量、喉返神经信号改变率差异无统计学意义(P>0.05)。腔镜组术后第1天甲状旁腺激素及血清钙离子浓度、术后60 d的美容满意度评分高于开放组,术后甲状旁腺功能减退及颈前区不适发生率低于开放组,手术时间、引流时间、术后住院时间长于开放组,术后引流量多于开放组,差异有统计学意义(P<0.05)。术后两组均未出现出血、切口感染、皮下血肿、颈部乳糜漏及皮瓣坏死等并发症。结论:与传统开放手术相比,经锁骨下单孔免充气腔镜甲状腺手术治疗甲状腺乳头状癌是可行的,可降低术后甲状旁腺功能减退发生率,术后手术疤痕隐蔽,美容及颈前区功能保护效果好,值得推广。

经锁骨下侧入路无充气腔镜甲状腺手术“四标法”

本文介绍经锁骨下侧入路无充气腔镜甲状腺手术的方法及其优势。总结出的“四标法”简化了手术操作,能够快速找到重要的解剖结构,顺利完成手术。该方法具有广泛的适用性和可行性。

单孔免充气腹腔镜在巨大卵巢囊肿手术中的应用

目的:探讨单孔免充气腹腔镜行巨大卵巢囊肿手术的可行性及应用价值。方法:回顾性分析2020年1月至2023年12月在温州医科大学附属黄岩医院因巨大卵巢囊肿行手术治疗的51例患者相关临床资料,其中26例行单孔免充气腹腔镜卵巢囊肿手术(研究组),25例行传统腹腔镜卵巢囊肿手术(对照组)。比较两组患者的围手术期情况、术后疼痛评分及并发症等。结果:两组患者间住院费用、术后住院时间、围术期并发症差异无统计学意义(P>0.05);研究组围术期疗效明显优于对照组,手术时间、术后首次肛门排气时间及术后首次下床活动时间均明显短于对照组,术中出血量明显少于对照组,卵巢囊肿内液外溢率明显低于对照组,切口美容满意度高于对照组(均P<0.05)。结论:对于巨大卵巢囊肿,单孔免充气腹腔镜手术具有手术时间短、出血量少、囊内液外溢率低、快速康复、经济、美容等优点,是一种安全、有效的手术方式。

腋窝入路无充气腔镜手术与开放性甲状腺癌根治术对甲状腺癌患者颈部功能的影响分析

目的分析对甲状腺癌患者采用腋窝入路无充气腔镜手术与开放性甲状腺癌根治术的临床疗效及对其颈部功能的影响。方法70例甲状腺癌患者,采用随机数字表法分为观察组和对照组,每组35例。观察组行腋窝入路无充气腔镜手术,对照组行开放性甲状腺癌根治术。对比两组围术期指标、颈部功能及免疫功能。结果观察组手术时间(125.17±8.55)min及住院时间(6.58±0.88)d长于对照组的(75.59±7.18)min、(5.39±0.58)d,术中出血量(19.41±2.55)ml少于对照组的(33.18±3.59)ml,引流液总量(90.39±5.66)ml多于对照组的(53.29±6.87)ml(P<0.05);两组中央组淋巴结清扫数对比差异无统计学意义(P>0.05)。两组术后3 d及术后半年颈部疼痛评分、颈部损伤指数对比差异无统计学意义(P>0.05)。两组术后3 d吞咽障碍指数对比差异无统计学意义(P>0.05);观察组术后半年吞咽障碍指数(1.29±0.17)分低于对照组的(1.79±0.33)分(P<0.05)。观察组术后CD3+(67.79±5.18)%、CD4+(40.11±5.12)%高于对照组的(59.49±5.09)%、(36.34±5.11)%,CD8+(27.67±4.69)%低于对照组的(32.21±5.22)%(P<0.05)。结论对甲状腺癌患者采用腋窝入路无充气腔镜手术能减轻其免疫抑制,与开放性甲状腺癌根治术相比具有缓解患者吞咽障碍的优势。

人工智能辅助悬吊式无气腹单孔腹腔镜在妇科手术中的应用价值

目的:探讨人工智能辅助下悬吊式无气腹单孔腹腔镜在妇科手术中的临床应用价值。方法:回顾性分析海军军医大学第二附属医院2021年10月—2022年10月诊治的60例妇科良性肿瘤患者的临床资料,按手术方式不同分为人工智能辅助悬吊式无气腹单孔腹腔镜组(A组)与人工智能辅助气腹单孔腹腔镜组(B组),每组30例。对比两组麻醉前、手术开始不同时间点的血压、心率、呼吸峰压(PIP)、呼气末CO_(2)分压(P_(et)CO_(2))的变化及两组患者的手术总时间、估计出血量、手术并发症、复苏时间、肠功能恢复时间、术后住院时间、切口满意度及切口疼痛评分等指标。结果:A组患者手术开始后不同时间点的血压、心率、PIP、P_(et)CO_(2)与麻醉前相比,差异无统计学意义(P>0.05);而B组患者的上述指标与麻醉前相比显著升高,差异具有统计学意义(P<0.05)。A组患者的术中动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))均明显优于B组,差异具有统计学意义(P<0.05)。两组患者的手术总时间、术中出血量、手术并发症及切口满意度方面相比,差异无统计学意义(P>0.05)。A组患者的术后复苏时间、肠功能恢复时间、术后住院时间及切口疼痛评分均优于B组患者,差异具有统计学意义(P<0.05)。结论:人工智能辅助下悬吊式无气腹单孔腹腔镜技术是一种可行且安全的手术技术,但其临床应用价值仍需进一步的前瞻性对照研究来验证。

经腋窝入路无充气腔镜甲状腺切除82例诊治体会

目的评估腋窝入路无充气腔镜甲状腺切除手术的临床疗效。方法回顾性分析2019年2月至2022年10月间浙江省中医院甲状腺外科组收治的甲状腺结节或经穿刺明确为甲状腺恶性肿瘤并行经腋窝入路无充气腔镜甲状腺切除术患者的临床资料。为探索该术式的临床掌握度,选择由同一医师最初完成的47例手术相关资料,按手术时间对病例排序后,以手术时间为参数分析并绘制学习曲线,比较学习曲线两个阶段的手术时间、术中出血量、住院时间等临床资料的差异。结果82例手术均顺利完成。平均手术时间(127.5±36.0)min;平均术中出血量(15.5±6.3)mL;住院时间4~14 d,平均7 d;平均术后引流量(238±87)mL。学习曲线以第17例为界划分为学习阶段和掌握阶段,掌握阶段手术时间及住院时间短于学习阶段(P<0.05),术中出血量等差异无统计学意义(P>0.05)。结论经腋窝入路腔镜甲状腺手术在有效治疗甲状腺疾病的同时,避免了颈部疤痕,保护该解剖区域的感觉运动功能。经过17例无充气腋窝入路腔镜手术的学习后,术者的操作趋于稳定。

无充气腋窝入路腔镜甲状腺癌根治术治疗甲状腺乳头状癌的效果分析

目的:探讨无充气腋窝入路腔镜甲状腺癌根治术(GUA)治疗甲状腺乳头状癌的效果。方法:选取2022年1月—2023年12月湖南省人民医院收治的72例甲状腺乳头状癌患者作为研究对象,随机分为常规组(n=36)与无充气组(n=36)。常规组实施颈前开放入路甲状腺癌根治术,无充气组实施GUA。比较两组治疗效果。结果:两组中央区淋巴结清扫数目比较,差异无统计学意义(P>0.05);无充气组手术时间长于常规组,术后引流量多于常规组,术后住院时间短于常规组(P<0.001)。无充气组并发症发生率低于常规组(P=0.041)。术后1个月,两组甲游离三碘甲腺原氨酸、游离甲状腺素、甲状旁腺激素水平低于术前1 d,但无充气组高于常规组(P<0.05);两组促甲状腺激素水平高于术前1 d,但无充气组低于常规组(P<0.05)。结论:GUA治疗甲状腺乳头状癌的效果显著,可促进患者康复,降低并发症发生率,且对甲状腺功能影响较小。

腔镜经腋窝入路免充气单侧甲状腺癌根治术的疗效研究

目的:探讨经腋窝入路免充气腔镜单侧甲状腺癌根治术的围术期指标及对颈部功能的影响。方法:选择2020年1月至2022年5月收治的120例单侧甲状腺癌患者,根据手术方式分为对照组(n=60,行传统开放手术)与研究组(n=60,行腋窝入路免充气腔镜甲状腺癌根治术),收集两组患者临床资料,对比分析两组手术指标、炎症指标、颈部功能及术后并发症发生率。结果:研究组术中出血量、术后引流量、颈部疼痛视觉模拟评分、颈部损伤指数评分、吞咽障碍指数评分均低于对照组,术后住院时间短于对照组,手术时间长于对照组,差异有统计学意义(P<0.05)。术前2 h,两组白细胞介素-6、肿瘤坏死因子-α水平差异无统计学意义(P>0.05);术后24 h,两组白细胞介素-6及肿瘤坏死因子-α水平均明显降低,研究组低于对照组,差异有统计学意义(P<0.05)。研究组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。术后3个月,研究组美容总满意度高于对照组,差异有统计学意义(P<0.05)。结论:经腋窝入路免充气腔镜甲状腺癌根治术可改善患者手术相关指标及颈部功能,降低炎症因子水平及术后并发症发生率,提高美容满意度。

无充气经腋窝入路传统腔镜与机器人甲状腺切除术疗效的Meta分析

目的:通过Meta分析比较无充气经腋窝入路传统腔镜甲状腺切除术(ET)与相同入路机器人甲状腺切除术(RT)的疗效。方法:制定检索策略,检索万方、CNKI、Embase、Cochrane Library、PubMed数据库中关于两种术式的相关文献,结合纳入与排除标准筛选ET与RT的回顾性临床对照研究,采用Meta分析的方法对所获得的研究进行比较。纳入比较的指标包括手术时间、淋巴结清扫数量、住院时间、甲状旁腺功能减退、暂时性喉返神经损伤、术后引流量。使用RevMan 5.4软件进行分析。结果:共纳入5篇文献、1 752例患者。RT组术中淋巴结清扫数量多于ET组(WMD=-0.55,95%CI=-0.89~-0.20,P=0.002,I2=54%),术后暂时性甲状旁腺功能减退发生率高于ET组(OR=0.25,95%CI=0.14~0.43,P<0.00001,I2=41%)。RT组无永久性甲状腺功能减退发生,ET组发生1例。两组均无永久性喉返神经损伤。两组手术时间(WMD=-20.81,95%CI=-41.89~0.27,P=0.05,I2=95%)、住院时间(WMD=-0.06,95%CI=-0.22~0.11,P=0.50,I2=54%)差异无统计学意义。结论:RT的优势在于清扫中央组淋巴结,在喉返神经损伤、住院时间方面两种术式相近。

腹壁提升免气腹腹腔镜手术

目的 :探索一种免除CO2 气腹的腹腔镜手术方式。方法 :设计一种器械———腹壁提升器 ,采用机械升降牵拉的方法提升腹壁形成腹腔手术空间 ,完成腹腔镜胆囊或阑尾切除。手术在连续硬膜外麻醉下进行。结果 :使用腹壁提升器免气腹的方法成功完成 2 0例胆囊切除 ,8例阑尾切除。胆囊切除平均手术时间 6 2min ,阑尾切除平均手术时间 45min。术后恢复顺利。结论 :腹壁提升器免气腹腹腔镜手术是一种全新、实用、可行、安全的微创手术方法 ,避免了气腹腹腔高压和全麻的诸多并发症 ,扩展了腹腔镜手术的应用范围 。