腔内镜碎石术后泌尿道感染病原学分析

目的分析腔内镜碎石手术后泌尿道感染病原菌分布及其耐药情况,为术后抗生素使用提供依据。方法分析我院2015年1月~2017年12月泌尿外科腔内镜碎石手术后尿培养阳性患者74例细菌培养和药敏情况。结果在74株阳性菌株当中,59株(79.72%)属于革兰阴性菌、14株(18.92%)属于革兰阳性菌、1株(1.35%)属于真菌,而不同的病原菌对于不同抗菌药物也表现出了不一样的耐药性。结论在泌尿外科腔内镜碎石手术后泌尿系统感染中较为主要的病原菌是大肠埃希菌,在使用抗菌药物进行临床治疗过程中应该结合具体的药敏试验来选择。

Natural orifice transluminal endoscopic surgeryvs laparoscopic ovariectomy:Complications and inflammatory response

AIM:To compare natural orifice transluminal endoscopic surgery (NOTES) vs standard laparoscopic ovariectomy in mini pigs with respect to technical aspects,complications and parameters of systemic inflammatory response.METHODS:This was a randomized,experimental,survival study.Ten female mini pigs underwent NOTES transgastric ovariectomy (NOTES group) and ten female mini pigs underwent laparoscopic ovariectomy (LAP group).A "percutaneous endoscopic gastrostomy" approach with guidewire and sphincterotome was used for gastrotomy creation.The ovary was resected using standard biopsy forceps and a snare.The access site was closed using a "KING" closure with a single endoloop and several clips.In the laparoscopic group,a three-port laparoscopy and an ovariectomy were performed with the use of standard laparoscopic devices.C-reactive protein (CRP),white blood count and interleukin (IL)-6 plasma levels were used as indicators of systemic inflammatory response.All animals were euthanized 28 d after surgery.RESULTS:All animals survived without complications.The mean procedure time was 41.3 min ± 17.6 min (NOTES group) and 25.7 min ± 5.25 min (LAP group,P < 0.02).Postmortem examinations demonstrated that 50% and 70% of animals were free of any complications in the NOTES and LAP groups,respectively.The remaining animals developed minor complications (adhesions) in a comparable frequency between the two groups.In the NOTES group,one animal developed a small intramural gastric abscess close to the gastrotomy site.A minor serous exudate that was present in 50% and 40% of the animals in the NOTES and laparoscopy groups,respectively,was not considered a complication.In both groups CRP levels increased significantly on the 2nd and 7th postoperative days (POD) and returned to normal after 28 d.On POD 2,an increase of CRP level was significantly higher in the NOTES group compared to the LAP group.Values of IL-6 did not differ from baseline values in either of the groups postoperatively.Interestingly,the platelet count decreased significantly on POD 2,but returned close to baseline values on POD 7 and PODs 28-30.CONCLUSION:Both NOTES and laparoscopic ovariectomies had a similar frequency of minor complications.However,the NOTES technique produced an increased systemic inflammatory response on POD 2.

Natural orifice transluminal endoscopy surgery:A review

Minimally invasive surgery started spreading worldwide in 1987,when the first laparoscopic cholecystectomy was performed.Meanwhile,improvement of endoscopic equipment and instruments allowed gastroenterologists to attempt more aggressive endoluminal interventions,even beyond the wall barrier.The first transgastric peri-toneoscopy,in 2004,brought to light the concept of natural orifice transluminal endoscopic surgery(NOTES).The idea of incisionless surgery is attractive and has become a new goal for both surgeons and other people interested in this field of investigation.The authors present a review of all developments concerning NOTES,including animal studies and human experience.

Sigmoid colon endometriosis treated with laparoscopy-assisted sigmoidectomy:Significance of preoperative diagnosis

We present a female patient with sigmoid colon endometriosis who was diagnosed correctly preoperatively and underwent minimally invasive surgery. She was admitted to our hospital with rectal bleeding and constipation. We performed several workups. Colonoscopy and endoscopic ultrasonography showed sigmoid colon stenosis caused by submucosal tumor, and magnetic resonance imaging revealed a sigmoid colon tumor displaying signal hy- pointensity on both T1- and T2-weighted imaging. However, colonoscopic ultrasonography-assisted needle aspiration biopsy could not specify tumor characteristics. From these examinations, the lesion was diagnosed as sigmoid colon endometriosis and laparoscopy-assisted sigmoidectomy was performed. Pathological diagnosis from the resected specimen was identical to preoperative diagnosis, i.e., colonic endometriosis. Since differential diagnosis of intestinal endometriosis seems difficult, a cautious preoperative diagnosis is required to select treatments including minimally invasive surgery.

Laparoscopic surgery in endometrial carcinoma staging operation:analysis of 39 cases

Objective:The purpose of our study was to investigate the feasibility and short-term therapeutic effects of laparoscopic staging operation in women with endometrial carcinoma.Methods:We analyzed 86 patients with endometrial carcinoma in PLA general hospital between 2006 and 2009 retrospectively.Thirty-nine patients were performed laparoscopic modified radical hysterectomy plus systemic retroperitoneal lymphadenectomy.Forty-seven patients received traditional abdominal radical hysterectomy plus systemic retroperitoneal lymphadenectomy.We compared the operation time,blood loss,number of lymph nodes retrieved,time for restoration of gastrointestinal function,postoperative complications and morbidity,the incidence of wound infection,the length of hospital stay,and hospital charges.Results:There was no significant deviation between the two groups in age,clinical stage,and pathology.We found that there was no significant deviation between the two groups in the number of lymph nodes retrieved,postoperative complications,the rate of wound infection or hospital charge(P > 0.05).The laparoscopic group had an advantage in blood loss,time for restoration of gastrointestinal function,time for postoperative hospital stay(P < 0.05).Conclusion:Laparoscopic surgery,as a primary surgical intervention,seems to be a safe and feasible option especially in patients with early endometrial cancer.

Clinical Efficacy and Safety Analysis of Laparoscopic- assisted Vaginal Surgery and Laparoscopic-alone Surgery in Treatment of Endometrial Cancer

Objective： Assess clinical efficacy and safety analysis of laparoscopic-assisted vaginal surgery and laparoscopic-alone surgery in treatment of endometrial cancer. Methods： select 76 cases of endometrial cancer patients, divided into two groups, 40 in laparoscopic-alone group and 36 in laparoscopic-assisted group, and compare operation time, intraoperative blood loss, intraoperative complications, postoperative complications, lymph node number, anal exhaust time, indwelling catheter days and hospitalization days by group. Result： compared with laparoscopic-alone surgery, laparoscopic-assisted vaginal surgery has certain advantages in reducing intraoperative blood loss, intraoperative and postoperative complications, anal exhaust time, indwelling catheter days and hospitalization days. Discussion： laparoscopic-assisted vaginal surgery is a relatively safe, effective and good economic benefit surgical method in treatment of endometrial cancer.

气溶胶防护罩在消毒供应中心职业防护中的应用

目的通过对手工清洗的硬式内镜手术器械(带管腔的)在干燥环节中应用气溶胶防护罩的研究,优化环境空气质量,减少气溶胶对人体的危害,提高消毒供应中心人员职业防护依从性。方法选取消毒供应中心2020年6~9月手工清洗的硬式内镜手术器械(带管腔的)2000件为研究对象,随机分为实验组和对照组,各1000件。对照组在干燥环节时不使用气溶胶防护罩,器械前端放置白纱布检测清洗质量和防止气溶胶喷洒。实验组在气溶胶防护罩内进行干燥,比较两组环境空气质量监测结果。结果实验组干燥环节在使用气溶胶防护罩后,气溶胶明显减少,空气中气溶胶浓度明显低于对照组,环境空气质量明显高于对照组,差异具有统计学意义(P<0.05)。结论硬式内镜手术器械(带管腔的)在干燥环节中使用气溶胶防护罩后,显著减少和避免了气溶胶的产生和吸入危害;优化了消毒供应中心环境空气质量;提高了工作人员的职业防护水平及依从性;降低了消毒供应中心工作人员职业暴露的风险。