腹腔镜联合纤维胆道镜保胆取石治疗青少年胆囊结石临床体会

目的:评价腹腔镜辅助下纤维胆道镜小切口保胆取石治疗青少年胆囊结石的临床疗效。方法:我院2008年7月至2011年7月间共有28例青少年胆囊结石患者采用腹腔镜辅助下纤维胆道镜小切口保胆取石治疗;搜集本组病例的临床资料和随访资料进行回顾性分析。结果:本组病例均手术顺利,术中无中转行胆囊切除术,术后恢复顺利,1例出现伤口感染,无出血、胆瘘等并发症;随访1-2年,1例失防,1例出现复发性胆囊结石,1例出现左肝内胆管结石,但未见胆囊结石,故本组复发率为(1/27)3.7%。结论:严格把握手术适应证,采用腹腔镜辅助下纤维胆道镜小切口保胆取石治疗胆囊结石安全、效果好,术后无明显并发症且复发率低。

宫-腹腔镜联合活血中药灌肠治疗输卵管性不孕及对IL-6作用的临床研究

目的:观察输卵管性不孕宫-腹腔镜手术联合活血中药灌肠治疗的临床疗效。方法:将我院行宫-腹腔镜联合手术治疗的80例输卵管性不孕患者随机分为两组,每组各40例,治疗组患者在宫-腹腔镜术治疗后予以常规抗生素及活血中药灌肠治疗,对照组患者宫-腹腔镜术后只予常规抗生素治疗。观察治疗前、术后半年患者输卵管通畅情况、中医症状总积分、中医证候疗效及炎症介质IL-6的变化情况。结果:治疗组半年后,患者输卵管通畅疗效的总有效率比对照组有一定程度的提高,但两组相比差异无统计学意义(P>0.05),治疗组中医症状总积分比对照组显著降低、中医证候疗效显著(P<0.05);在实验室指标方面,治疗组患者血浆IL-6的含量也显著降低(P<0.05)。结论:宫-腹腔镜手术联合活血中药灌肠法是治疗输卵管性不孕症有效的方法,可有效改善患者中医症状、减少炎症介质的释放,在一定程度上降低输卵管再通后的复粘率。

Laparoscopic splenectomy for treatment of splenic marginal zone lymphoma

AIM: To investigate the short-term and long-term ef-ficacy and safety of laparoscopic splenectomy (LS) for treatment of splenic marginal zone lymphoma (SMZL). METHODS: A total of 18 continuous patients who were diagnosed with SMZL and underwent LS in our department from 2008 to 2012 were reviewed. The perioperative variables and long-term follow-up were evaluated. To evaluate the efficacy and safety of this procedure better, we also included 34 patients with liver cirrhosis who underwent LS, 49 patients with immune thrombocytopenia (ITP) who underwent LS, and 20 patients with SMZL who underwent open splenectomy (OS). The results observed in the different groups were compared.RESULTS: No differences were found in the sex and Child-Pugh class of the patients in SMZL-LS, SMZL-OS, ITP, and liver cirrhosis groups. The splenic length of the patients in the SMZL-LS group was similar to that in the SMZL-OS and liver cirrhosis groups but significantly longer than in the ITP group. The SMZL-LS group had a significantly longer operating time compared with the SMZL-OS, ITP, and liver cirrhosis groups, and the SMZL-LS group exhibited significantly less blood loss compared with the SMZL-OS group. No difference was found in the length of the postoperative hospital stay between the SMZL-LS, SMZL-OS, ITP, and liver cirrhosis-LS groups. After surgery, 6 (33.3%) SMZL-LS patients suffered slight complications. During mean fol-low-up periods of 13.6 and 12.8 mo, one patient from the SMZL-LS group and two from the SMZL-OS group died as a result of metastasis after surgery. None of the ITP and liver cirrhosis patients died. CONCLUSION: LS should be considered a feasible and safe procedure for treatment of SMZL in an effort to improve the treatment options and survival of patients.

Gastrointestinal symptomatic outcomes of laparoscopic and open gastrectomy

AIM:To compare the laparoscopic and the open gastrectomy approaches for short term morbidity,length of hospital stay and also long term gastrointestinal symptoms.METHODS:Patients who have undergone gastrectomy had their medical records reviewed for demographic data,type of gastrectomy,short term morbidity,and length of hospital stay.Patients were contacted and asked to complete the Gastrointestinal Symptom Rating Scale(GSRS).The GSRS measures three domains of GI symptoms:Dyspepsia Syndrome(DS) for the foregut(best score 0,worse score 15),indigestion syndrome(IS) for the midgut(best score 0,worse score 12),and bowel dysfunction syndrome(BDS) for the hindgut(best score 0,worse score 16).Statistical analysis was done using the Mann-Whitney U-test.RESULTS:We had complete data on 32 patients:7 laparoscopic and 25 open.Of these,25 had a gastroenteric anastomosis and 6 did not.The table shows the results as medians with interquartile range.Laparoscopic gastrectomy had a better score than open gastrectomy in the DS domain(0 vs 1,P = 0.02),while gastrectomy without anastomosis had a better score than gastrectomy with anastomosis in the IS domain(0 vs 1,P = 0.05).CONCLUSION:Patients have little adverse gastroin-testinal symptoms and preserve good gastrointestinal function after undergoing any type of gastrectomy.Laparoscopic approach had better dyspepsia and foregut symptoms.Performing an anastomosis led to mild adverse midgut and indigestion

术前短期戒烟对舒芬太尼术后静脉镇痛用量的影响

目的：观察术前短期戒烟对腹腔镜胆囊切除术后舒芬太尼静脉镇痛用量的影响。方法80例行择期腹腔镜胆囊切除术手术男性患者，按戒烟时间分为多于2周（SA 组）、多于1周少于2周（SB 组）、少于1周（SC 组）及无吸烟史（N 组）四组，每组20例，术后行舒芬太尼患者自控静脉镇痛。记录舒芬太尼术后第1、2天的用量。结果SC 组术后第1天舒芬太尼用量高于 SA 组和 N 组，SB 组高于 N 组（P ＜0．05）；四组术后第2天舒芬太尼用量差异无显著意义（P ＞0．05）。结论术前短期戒烟可减少术后第1天舒芬太尼静脉镇痛用量，且戒烟时间越长，用量越少。

吲哚菁绿荧光腹腔镜侧方淋巴结清除术在中低位直肠癌中的临床疗效

目的:探讨吲哚菁绿荧光腹腔镜侧方淋巴结清除术(LLND)在中低位直肠癌治疗中的应用价值。方法:回顾性分析2018年2月—2020年6月行手术治疗的76例中低位直肠癌患者的临床资料,行腹腔镜全直肠系膜切除术(TME)42例(TME组),行腹腔镜TME联合吲哚菁绿荧光LLND 34例(TME+LLND组),比较两组手术相关指标、围手术期恢复情况、肿瘤学指标及临床近期疗效。结果:TME+LLND组手术时间比TME组长(P<0.001)。与TME组比较,TME+LLND组淋巴结清除总数多(P<0.05);TME+LLND组有7例(20.59%)术后病理报告侧方淋巴结转移,髂外髂总血管区1例,闭孔区3例,髂内血管区3例。随访3年后,两组均未观察到肿瘤相关死亡;局部复发率TME+LLND组为2.94%,TME组为19.05%(P<0.05);远处转移率TME+LLND组为14.71%,TME组为9.52%(P>0.05)。结论:吲哚菁绿荧光腹腔镜直肠癌侧方淋巴结清除降低了局部复发率,且不增加术后并发症,在中低位直肠癌治疗中安全、有效、可行。

三维可视引导下经3D腹腔镜胆道硬镜靶向碎石治疗肝胆管结石36例临床分析

目的研究三维可视引导下经3D腹腔镜胆道硬镜靶向碎石在肝胆管结石诊治中的临床应用价值。方法选择2014年5月至2015年5月间36例肝胆管结石病人临床资料，其中男性16例，女性20例，年龄30～73岁，平均53．8岁。采用腹部医学图像三维可视化软件（MI一3DVS）对肝胆管结石进行三维可视化临床分型和术前规划，指导3D腹腔镜联合胆道硬镜靶向碎石、网石、取石。结果三维可视化临床分型：Ⅰ型18例，I＋Ea型2例，Ⅱa型5例，Ⅱa＋Ea型2例，Ⅱb型7例，Ⅱb＋Ea型1例，ⅡO型1例。术中所见均与三维可视化图像模型吻合，实际手术方式与术前规划均一致。经硬镜检查，术中取尽结石。手术时间（128．6±20．3）（100～165）rain，术中出血（27．1±16．6）（10～80）mL，无围手术期死亡，无输血，无大出血。胆道损伤1例，经保守治疗后痊愈。术后随访（12．9±3．6）（7～19）个月，无结石残留和复发病例。结论三维可视引导下经3D腹腔镜胆道硬镜靶向碎石术，是肝胆管结石数字化微创外科治疗的一种安全有效的方式。

腹腔镜辅助下远端胃癌D2根治术治疗进展期胃癌的疗效及安全性

目的探讨腹腔镜辅助下远端胃癌D2根治术治疗进展期胃癌的疗效及安全性。方法选择宜昌市中心人民医院2010年8月至2013年8月间收治的68例进展期胃癌患者,按照临床前瞻性研究原则将患者分为腹腔镜治疗组(观察组)和远端胃癌D2根治术治疗组(对照组),观察两组患者手术相关指标、术后恢复情况以及治疗效果。结果与对照组比较,观察组患者的手术时间、切口长度、术中出血量、术后肛门排气时间、下床活动时间、进流质饮食时间、住院时间以及并发症中的切口感染、吻合口瘘的发生率均明显降低,差异均有统计学意义(均P<0.05)。但清扫淋巴结总数、远切端距肿瘤距离均降低,近切端距肿瘤距离则增加,但差异无统计学意义(P>0.05)。两组患者的存活率比较,差异无统计学意义(P>0.05)。结论腹腔镜辅助下远端胃癌D2根治术治疗进展期胃癌安全、有效,可达到与开腹手术相当的根治效果,近期疗效甚佳,并发症较少。

腹腔镜下腹膜阴道延长术在子宫颈癌根治术中的应用价值和操作技巧

子宫颈癌广泛性宫颈切除术需要切除宫旁、骶主韧带以及阴道组织至少3cm以上,才能达到满意的手术效果。阴道缩短意味着术后患者的性生活质量下降。近年来,行腹腔镜下子宫颈癌的广泛性子宫切除术同时,可以在合适的患者实施阴道延长术。腹膜阴道延长术操作简单、术后并发症少,可以保证术后较满意的生活质量,在年轻患者人群值得推广。