探讨妇科临床腹腔镜下子宫肌瘤切除术的疗效

从选取最佳手术方式角度入手,努力提升治疗子宫肌瘤患者的效率和质量。方法 本研究以子宫肌瘤病人60例为研究对象,按30例分组,随机分为对照组和实验组。观察组采用传统的手术方法,观察组采用腹腔镜下的子宫肌瘤切除术。最后,将两组患者关于手术的各项指标、术后不良反应发生率、手术治疗效果及其生活质量对比作为验证何种治疗方式效果更好的指标。结果 通过最终整理并记录的数据可以发现,实验组患者的平均手术时长更短,住院时间更短,术中出血量更低,术后排气时间更短;实验组患者手术后出现感染、发热等各种不良反应的人数更少;手术结束后的机体功能和结构恢复情况更接近于正常群体,即临床治疗效率更高;同时,实验组患者术后的生活质量显著强于对照组。结论 相比起常规治疗方式,腹腔镜下子宫肌瘤切除术对于治疗子宫肌瘤患者具有更加明显且积极的临床效果。

腹腔镜胆囊切除术临床路径实施效果分析

目的探讨实施腔镜胆囊切除术(LC)临床路径患者的治疗及经济学效果。方法对2010年3月至2014年2月我院收治的392例慢性胆囊炎伴胆囊结石或胆囊息肉患者实施LC临床路径管理,分析其治疗效果、经济学成本、变异及退出原因。结果 392例患者,完成LC临床路径377例,退出15例,完成率为96.17%。平均住院天数降为(6.50±0.50)d,较实施临床路径前减少2 d;术前平均住院日为2 d,较实施临床路径前减少1 d;平均住院费用为5 100.25元,较实施临床路径前降低28.24%;科室药品费用为1 980.84元,较实施临床路径前降低10.82%;抗菌药物费用为5.8%,检查费用为13.7%。随访292例患者,满意率高达96.3%。结论 LC临床路径规范医疗诊疗行为,降低医疗成本,值得临床进一步推广。

腹腔镜手术与开腹手术治疗异位妊娠的临床疗效与比较分析

目的:探讨异位妊娠采用腹腔镜手术与开腹手术的临床效果对比。方法:本次共选取80例异位妊娠的患者作研究对象,均为我院2010年2月-2013年2月住院患者,随机分组就开腹治疗(对照组)和腹腔镜手术治疗(观察组)的临床效果进行比较。结果:两组手术时间无明显差异(P>0.05),观察组术中出血量明显少于对照组,术后体温恢复至正常时间、离床活动时间明显早于对照组,住院时间明显少于对照组,差异均有统计学意义(P<0.05)。结论:异位妊娠采用腹腔镜手术治疗,具有创伤小、术后恢复快、保留生育功能、患者痛苦小、美观度高的优点,显著提高了患者依从性及远期生存质量,具有非常积极的应用价值。

急性炎症期行腹腔镜胆囊切除术的临床观察

目的探讨急性炎症期胆囊炎患者行腹腔镜胆囊切除术治疗的临床效果。方法选取我院收治的48例急性炎症期胆囊炎患者,随机分成2组,每组24例,将其中实施传统开腹手术治疗者设为对照组,将实施腹腔镜胆囊切除术治疗者设为观察组,比较2组病例的临床治疗情况,总结手术治疗经验。结果观察组手术成功率100%,较对照组的79.2%更为理想,2组比较差异明显(P<0.05);并且其住院时间为(5.27±1.22)d,短于对照组的(12.83±2.61)d,2组比较差异明显(P<0.05)。结论对急性炎症期胆囊炎患者实施腹腔镜胆囊切除术治疗有确切效果。

腹腔镜下治疗卵巢囊肿临床分析

目的:根据临床实践,研究腹腔镜下治疗卵巢囊肿的体会。方法:针对25例卵巢囊肿患者采用腹腔镜手术进行治疗,并且随机选取25例卵巢囊肿患者作为对照组实施开腹手术,对两组患者手术前后治疗效果进行比较。结果:两组患者在手术时间上大体保持一致,腹腔镜组患者在术中出血量、术后发热例数、术后肛门排气恢复、术后住院天数与对照组进行比较,各种数值明显降低,但在伤口愈合不良例数两组数据较为接近。结论:针对卵巢囊肿患者实施腹腔镜手术治疗,具有痛苦轻、创伤小、安全性高、疗效好等特点,可以作为患者治疗卵巢囊肿的首选方法,值得推广。

异位妊娠腹腔镜手术患者临床护理体会

目的:探讨异位妊娠腹腔镜手术患者的有效护理方法、效果及临床应用价值。方法:回顾性分析100例异位妊娠腹腔镜手术患者的一般资料及护理措施,观察并发症的发生情况。结果:经过精心的护理,100例患者腹腔镜手术成功率竟然达到了百分之百,伤口感染和并发症发生率为零,特别是伤口愈合情况达到了令人满意的效果,鉴定为甲级愈合。结论:腹腔镜治疗异位妊娠手术效果显著,手术理论易理解,操作方法也简单便捷,这极大地促进了护士在患者手术期间的精心护理,真正做到让患者身心轻松,安全无忧,促进患者早日康复。

早期低分化型胃癌淋巴结转移的危险因素与腹腔镜局部切除术的探讨

目的:探讨早期低分化型胃癌淋巴结转移的危险因素,从而对早期低分化型胃癌患者,行腹腔镜下局部切除术提供理论依据。方法:回顾性分析80例早期低分化型胃癌的临床病理资料,按照临床病理特征与淋巴结转移的关系进行统计学分析。结果:通过多因素分析,肿瘤大小≥2cn,黏膜下癌和淋巴管癌栓阳性对淋巴结转移有统计学意义(P<0.05)。无危险因素的患者,淋巴结转移率为0;三个危险因素都具有者,淋巴结转移率高达42.9%。结论:肿瘤大小≥2 cm,黏膜下癌和淋巴管癌栓阳性是早期低分化型胃癌淋巴结转移的独立危险因素对于早期低分化型胃癌患者,行腹腔镜下局部切除术,这三项危险因素是判断是否进行附加手术的简单标准。

腹腔镜手术治疗卵巢巧克力囊肿疗效分析

目的:探讨腹腔镜手术治疗卵巢巧克力囊肿的临床疗效。方法:收治卵巢巧克力囊肿患者9例作为观察组,同时选择同期经开腹治疗的卵巢巧克力囊肿患者10例作为对照组。观察组采用腹腔镜手术治疗,对照组采用开腹治疗。结果:观察组手术出血量、手术时间、体温恢复正常时间、排气时间、住院时间等指标与对照组比较差异有显著性(P<0.05)。结论:腹腔镜手术治疗卵巢巧克力囊肿创伤小、出血少、患者恢复快,是治疗卵巢巧克力囊肿的首选方法。

单纯性肝囊肿行经脐单孔腹腔镜肝囊肿去顶减压术的有效性与安全性

目的探究单纯性肝囊肿行经脐单孔腹腔镜肝囊肿去顶减压术的有效性与安全性.方法基于本院自 2013 年 11月-2015 年11 月期间收治的60例单纯性肝囊肿患者的临床资料,按照临床治疗方式的不同,随机的将这60例患者分为对照组（行常规腹腔镜肝囊肿去顶减压术）和观察组（行经脐单孔腹腔镜肝囊肿去顶减压术）,两组各30例,观察比较两组患者的临床治疗效果以及术后并发症发生情况.结果观察组 30例患者的临床治疗总有效率 93.33%（包括11 例患者痊愈、17例患者临床治疗显效）明显的高于对照组30例患者的临床治疗总有效率76.67%（包括8例患者痊愈、15例患者临床治疗显效）（P〈0.05）,具有统计学意义;观察组30例患者的术后并发症发生率20.00%（共6例患者发生并发症,如：复发、切口感染、愈合不良等）明显的低于对照组30例患者的术后并发症发生率46.67%（共14例患者发生并发症）（P〈0.05）,具有统计学意义.结论经脐单孔腹腔镜肝囊肿去顶减压术治疗单纯性肝囊肿其疗效显著,且该治疗手段具有创伤小、康复快、并发症少等应有优势,值得推荐.

阴式子宫肌瘤剔除术临床价值分析

目的：对比分析经阴道子宫肌瘤剔除术与腹腔镜子宫肌瘤剔除术的临床疗效，总结双方优缺点和临床价值。方法：随机选取我院2009年7月至2011年11月107例子宫肌瘤患者的临床案例资料，分为观察组（经阴道行子宫肌瘤剔除术）54例和对照组（经腹腔镜下行子宫肌瘤剔除术）53例，观察对比两组手术情况等方面信息。结果：两组在剔除的肌瘤直径大小、术后排气时间及住院天数方面对比无明显差异（P〉0．05），两组在术中出血量、手术时间及剔除的肌瘤数目方面对比有显著差异（P〈0．05），具有统计学意义。结论：经阴道行子宫肌瘤剔除术在微创、安全性、费用及恢复时间等方面优于腹腔镜下行子宫肌瘤剔除术，更值得在临床上推广应用。

腹腔镜在妇科临床医学治疗上的应用

随着我国医疗卫生事业的发展,各种高新科技在临床领域的应用,解决了大量的医学难题。文章主要讲述腹腔镜检查方法,并探析腹腔镜技术在妇科临床医学上的应用。

Modified laparoscopic Sugarbaker repair of parastomal hernia with a three-point anchoring technique

AIMTo retrospectively evaluate the safety and feasibility of a new modified laparoscopic Sugarbaker repair in patients with parastomal hernias.METHODSA retrospective study was performed to analyze eight patients who underwent parastomal hernia repair between June 2016 and January 2018. All of these patients received modified laparoscopic Sugarbakerhernia repair treatment. This modifed technique included an innovative three-point anchoring and complete su-turing technique to fix the mesh. All procedures were performed by a skilled hernia surgeon. Demographic data and perioperative outcomes were collected to eva-luate the safety and effcacy of this modifed technique.RESULTSOf these eight patients, two had concomitant incisional hernias. All the hernias were repaired by the modifed laparoscopic Sugarbaker technique with no conversion to laparotomy. Three patients had in-situ reconstruc-tion of intestinal stoma. The median mesh size was 300 cm2, and the mean operative time was 205.6 min. The mean postoperative hospitalization time was 10.4 d, with a median pain score of 1 （visual analog scale method） at postoperative day 1. Two patientsdeveloped postoperative complications. One patient had a pocket of effusion surrounding the biologic mesh, and one patient experienced an infection around the reconstructed stoma. Both patients recovered after conservative management. There was no recurrence during the follow-up period （6-22 mo, average 13 mo）.CONCLUSIONThe modifed laparoscopic Sugarbaker repair could fx the mesh reliably with mild postoperative pain and a low recurrence rate. The technique is safe and feasible for parastomal hernias.

Carcinoid tumor of the appendix: A consecutive series from 1237 appendectomies

AIM： To report the experience of the CHU Sart Tilman, University of Liege, Belgium, in the management of appendiceal carinoid tumor. METHODS： A retrospective review of 1237 appendectomies performed in one single centre from January 2000 to May 2004, was undertaken. Analysis of demographic data, clinical presentation, histopathology, operative reports and outcome was presented. RESULTS： Among the 1237 appendectomies, 5 appendiceal carcinoid tumors were identified （0.4%） in 4 male and 1 female patients, with a mean age of 29.2 years （range： 6-82 years）. Acute appendicitis was the clinical presentation for all patients. Four patients underwent open appendectomy and one a laparoscopic procedure. One patient was reoperated to complete the excision of mesoappendix. All tumors were located at the tip of the appendix with a mean diameter of 0.6 cm （range： 0.3-1.0 cm）. No adjuvant therapy was performed. All patients were alive and disease-free during a mean follow-up of 33 mo. CONCLUSION： Appendiceal carcinoid tumor most of-ten presents as appendicitis. In most cases, it is found incidentally during appendectomies and its diagnosis is rarely suspected before histological examination. Appendiceal carcinoid tumor can be managed by simple appendectomy and resection of the mesoappendix, if its size is ≤ 1cm.

D2 dissection in laparoscopic and open gastrectomy for gastric cancer

AIM: To evaluate the radicalness and safety of laparoscopic D2 dissection for gastric cancer. METHODS: Clinicopathological data from 209 patients with gastric cancer, who underwent radical gastrectomy with D2 dissection between January 2007 and February 2011, were analyzed retrospectively. Among these patients, 131 patients underwent laparoscopyassisted gastrectomy (LAG) and 78 underwent open gastrectomy (OG). The parameters analyzed included operative time, blood loss, blood transfusion, morbidity, mortality, the number of harvested lymph nodes (HLNs), and pathological stage.RESULTS: There were no significant differences in sex, age, types of radical resection [radical proximal gastrectomy (PG + D2), radical distal gastrectomy (DG + D2) and radical total gastrectomy (TG + D2)], and stages between the LAG and OG groups (P > 0.05). Among the two groups, 127 cases (96.9%) and 76 cases (97.4%) had 15 or more HLNs, respectively. The average number of HLNs was 26.1 ± 11.4 in the LAG group and 24.2 ± 9.3 in the OG group (P = 0.233). In the same type of radical resection, there were no signifi cant differences in the number of HLNs between the two groups (PG + D2: 21.7 ± 7.5 vs 22.4 ± 9.3; DG + D2: 25.7 ± 11.0 vs 22.3 ± 7.9; TG + D2: 30.9 ± 13.4 vs 29.3 ± 10.4; P > 0.05 for all comparisons). Tumor free margins were obtained in all cases. Compared with OG group, the LAG group had signifi cantly less blood loss, but a longer operation time (P < 0.001). The morbidity of the LAG group was 9.9%, which was not signifi cantly different from the OG group (7.7%) (P = 0.587). The mortality was zero in both groups. CONCLUSION: Laparoscopic D2 dissection is equivalent to OG in the number of HLNs, regardless of tumor location. Thus, this procedure can achieve the same radicalness as OG.

Laparoscopic hemicolectomy in a patient with situs inversustotalis

As among persons with normal anatomy, occasional patients with situs inversus develop malignant tumors. Recently, several laparoscopic operations have been reported in patients with situs inversus. We describe laparoscopic hemicolectomy with radical lymphadenectomy in such a patient. Careful consideration of the mirror-image anatomy permitted safe operation using techniques not otherwise differing from those in ordinary cases. Thus, curative laparoscopic surgery for colon cancer in the presence of situs inversus is feasible and safe.

Risk clinicopathological factors for lymph node metastasis in poorly differentiated early gastric cancer and their impact on laparoscopic wedge resection

AIM:To investigate the predictive factors of lymph node metastasis(LNM) in poorly differentiated early gastric cancer(EGC),and enlarge the possibility of using laparoscopic wedge resection(LWR).METHODS:We retrospectively analyzed 85 patients with poorly differentiated EGC who underwent surgical resection between January 1992 and December 2010.The association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses.Odds ratios(OR) with 95%CI were calculated.We further examined the relationship between the positive number of the three significant predictive factors and the LNM rate.RESULTS:In the univariate analysis,tumor size(P = 0.011),depth of invasion(P = 0.007) and lymphatic vessel involvement(P < 0.001) were significantly associated with a higher rate of LNM.In the multivariate model,tumor size(OR = 7.125,95%CI:1.251-38.218,P = 0.041),depth of invasion(OR = 16.624,95%CI:1.571-82.134,P = 0.036) and lymphatic vessel involvement(OR = 39.112,95%CI:1.745-123.671,P = 0.011) were found to be independently risk clinicopathological factors for LNM.Of the 85 patients diagnosed with poorly differentiated EGC,12(14.1%) had LNM.The LNM rates were 5.7%,42.9% and 57.1%,respectively in cases with one,two and three of the risk factors respectively in poorly differentiated EGC.There was no LNM in 29 patients without the three risk clinicopathological factors.CONCLUSION:LWR alone may be sufficient treatment for intramucosal poorly differentiated EGC if the tumor is less than or equal to 2.0 cm in size,and when lymphatic vessel involvement is absent at postoperative histological examination.

Liver function alterations after laparoscopy-assisted gastrectomy for gastric cancer and its clinical significance

AIM: To evaluate the factors associated with liver function alterations after laparoscopy-assisted gastrectomy (LAG) for gastric cancer. METHODS: We collected the data of gastrectomy patients with gastric cancer and divided them into 2 groups: open gastrectomy (OG) and LAG. We also collected the data of patients with colon cancer to evaluate the effect of liver manipulations during surgery on liver function alterations. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, and alkaline phosphatase were measured on the preoperative day and postoperative day 1 (POD1), POD3, POD5, and POD7. RESULTS: No changes in liver function were observed after the operation in patients with colon cancer (n = 121). However, in gastric cancer patients (n = 215), AST and ALT levels increased until POD5 compared to those in colon cancer patients and these findings were observed both in the LAG and OG without a significant difference except at POD1. The mean hepatic enzyme levels at POD1 in the LAG group were significantly higher than those in the OG group (P = 0.047 for AST and P = 0.039 for ALT). The factors associated with elevated ALT on POD1 in patients with gastric cancer were body mass index (P < 0.001), operation time (P < 0.001), intraoperative hepatic injury (P = 0.048), and ligation of an aberrant left hepatic artery (P = 0.052) but not type of operation (OG vs LAG, P = 0.094). CONCLUSION: We conclude that the liver function alteration after LAG may have been caused by direct liver manipulation or aberrant hepatic artery ligation rather than the CO2 pneumoperitoneum.

Pneumatosis cystoides intestinalis:A single center experience

AIM： To share our experience of the management and outcomes of patients with pneumatosis cystoides in- testinalis （PCI）. METHODS： The charts of seven patients who under- went surgery for PCI between 2001 and 2009 were re- viewed retrospectively. Clinical features, diagnoses and surgical interventions of patients with PCI are discussed. RESULTS： Seven patients with PCI （3 males, 4 fe- males; mean age, 50 ~ 16.1 years; range, 29-74 years） were analyzed. In three of the patients, abdominal pain was the only complaint, whereas additional vomiting and/or constipation occurred in four. Leukocytosis was detected in four patients, whereas it was within normal limits in three. Subdiaphragmatic free air was observed radiologically in four patients but not in three. Six of the patients underwent an applied lapa- rotomy, whereas one underwent an applied explorative laparoscopy. PCI localized to the small intestine only was detected in four patients, whereas it was localized to the small intestine and the colon in three. Three patients underwent a partial small intestine resection and four did not after PCI was diagnosed. Five patients were diagnosed with secondary PCI and two with pri- mary PCI when the surgical findings and medical his- tory were assessed together. Gastric atony developed in one case only, as a complication during a postopera- tive follow-up of 5-14 d. CONCLUSION： Although rare, PCl should be consid- ered in the differential diagnosis of acute abdomen. Diagnostic laparoscopy and preoperative radiological tests, including computed tomography, play an impor- tant role in confirming the diagnosis.

Carcinoembryonic antigen-producing adrenal adenoma resected using combined lateral and anterior transperitoneal laparoscopic surgery

A 74-year-old woman presented with symptoms consistent with hyperadrenocorticism and hyperca- techolaminism. She had a cushingoid appearance and her cortisol level was elevated. Her serum dopamine and noradrenalin levels were also elevated. Computed tomography detected a left adrenal mass measuring 3.5 cm x 3.0 cm in diameter. Metaiodobenzylguanidine scintigraphy was negative. Unexpectedly, the serum Serum carcinoembryonic antigen （CEA） level waselevated. Fluorodeoxyglucose positron emission tomography showed increased uptake in the adrenal tumor only, with a maximum standardized uptake value of 2.8. Selective venography and blood sampling revealed that the concentrations of cortisol, catecholamines and CEA were significantly elevated in the vein draining the tumor. A diagnosis of CEA-producing benign adenoma was made. After preoperative management, we performed a combined lateral and anterior transpedtoneal laparoscopic adrenectomy. Her vital signs remained stable during surgery. Histopathological examination revealed a benign adenoma. Her cortisol, catecholamine and CEA levels normalized immediately after surgery. We present, to the best of our knowledge, the first case of CEA-producing adrenal adenoma, along with a review of the relevant literature, and discuss our laparoscopic surgery techniques.

护理干预对妇科手术患者负面情绪与生活质量的影响

目的：研究临床护理路径干预对妇科腹腔镜手术患者负面情绪与生活质量的影响。方法选择在我院就诊并接受腹腔镜手术的患者，随机分为给予临床护理路径干预的观察组和常规护理的对照组，观察手术相关指标、术后负面情绪及生活质量。结果观察组手术时间、术中出血量、术后引流量、排气时间、下床时间均明显少于对照组；HAMD评分（12．21±1．12）、HAMA评分（10．45±1．03）、NRS评分（2．42±0．38）明显低于对照组，KPS评分（84．37±8．21）和总体生活质量评分（81．84±8．34）明显高于对照组。结论临床护理路径干预能够改善手术相关指标，缓解术后患者的负面情绪，提高生活质量，具有积极的临床意义。