Resection of polyps involving the appendiceal orifice by combined endo-laparoscopic surgery: Two case reports

BACKGROUND The management of polyps involving the appendiceal orifice(AO)presents notable challenges.Endoscopic resection is frequently hindered by operational complexities,a heightened risk of incomplete removal,and an elevated risk of procedural complications,including appendicitis.Conversely,surgical resection may entail unnecessary excision of intestinal segments,leading to potential morbidity.CASE SUMMARY Here,we reported two patients who presented with polyps deeply situated within the AO,with indistinct boundaries making it challenging to ensure completeness using traditional endoscopic resection.To overcome these challenges,we em-ployed combined endo-laparoscopic surgery(CELS),achieving curative resection without postoperative complications.CONCLUSION The application of CELS in managing polyps involving the AO is emerging as a safe and effective treatment modality.

Combined resection and radiofrequency ablation for multifocal hepatocellular carcinoma: Prognosis and outcomes

AIM: To analyze the combined treatment of resection and intraoperative radiofrequency ablation (RFA) for multifocal hepatocellular carcinoma in terms of prognosis and surgical outcomes.METHODS: This study was a retrospective case comparison study using prospectively collected data. The study covered the period from April 2001 to December 2006. The data of 200 patients with histologically confirmed hepatocellular carcinoma were reviewed. Nineteen patients (17 men and 2 women) having received resection in combination with RFA were chosen as subjects of the study (the combination group). Fiftyfour patients (43 men and 11 women) having received resection alone were selected for comparison (the resection group). The two groups matched tumor number and tumor size, and all the patients in the two groups displayed no tumor rupture, major vascular involvement and distant metastasis. Their demographics, preoperative assessment, disease recurrence patterns, overall survival and diseasefree survival were compared.RESULTS: In the combination group, the medianage was 65 years (range, 3477 years), the median tumor number was 3 (range, 29), and the median tumor size was 6 cm (range, 1.214 cm). In the resection group, the median age was 51.5 years (range, 2780 years, P = 0.003), the median tumor number was 3 (range, 29, P = 0.574), and the median tumor size was 6 cm (range, 114 cm, P = 0.782). The two groups were similar in characteristics of tumors and comorbidities, and had comparable results in preoperative liver function tests. All patients had ChildPugh class A status. Bilobar involvement occurred in 14 patients (73.6%) in the combination group and 3 patients (5.5%) in the resection group (P = 0.04). Six patients (32%) in the combination group and 35 patients (65%) in the resection group underwent major hepatectomy. Thirteen patients (68%) in the combination group and 19 patients (35%) in the resection group underwent minor hepatectomy (P = 0.012). The combination group had fewer major resections (32% vs 65%, P = 0.012), less blood loss (400 vs 657 mL, P = 0.007), shorter operation time (270 vs 400 min, P = 0.001), and shorter hospital stay (7 vs 8.5 d, P = 0.042). The two groups displayed no major differences in surgical complications (15.8% vs 31.5%, P = 0.24), disease recurrence (63.2% vs 50%, P = 0.673), hospital mortality (5.3% vs 5.6%, P = 1), and overall survival (53 vs 44.5 mo, P = 0.496).CONCLUSION: Safe and effective for selected patients with multifocal hepatocellular carcinoma, the combination of resection and intraoperative RFA widens the applicability of surgical intervention for the disease.

Simultaneous laparoscopic multi-organ resection combined with colorectal cancer:Comparison with non-combined surgery

AIM: To access the short-term outcomes of simultaneous laparoscopic surgery combined with resection for synchronous lesions in patients with colorectal cancer. METHODS: Between March 1996 and April 2010 prospectively collected data were reviewed from 93 consecutive patients who had colorectal cancer and underwent simultaneous multiple organ resection (combined group) and 1090 patients who underwent conventional laparoscopic right hemicolectomy or laparoscopic low/ anterior resection for colorectal cancer (non-combined group). In the combined group, there were nine gastric resections, three nephrectomies, nine adrenalectomies, 56 cholecystectomies, and 21 gynecologic resections. In addition, f ive patients underwent simultaneous laparoscopic resection for three organs. The patient demographics, intra-operative outcomes, surgical morbidity, and short-term outcomes were compared between thetwo groups (the combined and non-combined groups). RESULTS: There were no signifi cant differences in the clinicopathological variables between the two groups. The operating time was signifi cantly longer in the combined group than in the non-combined group, regardless of tumor location (laparoscopic right hemicolectomy and laparoscopic low/anterior resection groups; P = 0.048 and P < 0.001, respectively). The other intraoperative outcomes, such as the complications and open conversion rate, were similar in both groups. The rate of post-operative morbidity in the combined group was similar to the non-combined group (combined vs non-combined, 15.1% vs 13.5%, P = 0.667). Oncological safety for the colon and synchronous lesions were obtained in the combined group. CONCLUSION: Simultaneous laparoscopic multiple organ resection combined with colorectal cancer is a safe and feasible option in selected patients.

Prognostic analysis of patients with combined hepatocellularcholangiocarcinoma after radical resection:A retrospective multicenter cohort study

BACKGROUND Combined hepatocellular-cholangiocarcinoma(cHCC-CCA)is a form of rare primary liver cancer that combines intrahepatic cholangiocarcinoma(ICC)and hepatocellular carcinoma.AIM To investigate overall survival(OS)and recurrence-free survival(RFS)after radical resection in patients with cHCC-CCA,and the clinicopathological factors affecting prognosis in two center hospitals of China.METHODS We reviewed consecutive patients with cHCC-CCA who received radical resection between January 2005 and September 2021 at Peking Union Medical College and the 5th Medical Center of the PLA General Hospital retrospectively.Regular follow-up and clinicopathological characteristics were systematic collected for baseline and prognostic analysis.RESULTS Our study included 95 patients who received radical resection.The majority of these patients were male and 82.7%of these patients were infected with HBV.The mean tumor size was 4.5 cm,and approximately 40%of patients had more than one lesion.The median OS was 26.8(95%CI:18.5-43.0)mo,and the median RFS was 7.27(95%CI:5.83-10.3)mo.Independent predictors of OS were CA19-9≥37 U/mL(HR=8.68,P=0.002),Child-Pugh score>5(HR=5.52,P=0.027),tumor number>1(HR=30.85,P=0.002),tumor size and transarterial chemoembolization(TACE)after surgery(HR=0.2,P=0.005).CONCLUSION The overall postoperative survival of cHCC-CCA patients is poor,and most patients experience relapse within a short period of time after surgery.Preoperative tumor biomarker(CA19-9,alphafetoprotein)levels,tumor size,and Child-Pugh score can significantly affect OS.Adjuvant TACE after surgery prolongs RFS,suggesting that TACE is a possible option for postoperative adjuvant therapy in patients with cHCC-CCA.

Combined right hemicolectomy and pancre-aticoduodenectomy for locally advanced right hemicolon cancer

ABSTRACT： Extracolonic invasion of the duodenum and/or pancreatic head rarely occurs in patients with right hemico- Ion cancer. However, when necessary, combined radical op- eration is a challenge to the surgeon. We reported 7 patients with locally advanced right hemicolon cancer who underwent combined right hemicolectomy （RH） and pancreaticoduo- denectomy （PD） due to direct involvement of the duodenum or pancreatic head.

Choice of approach for hepatectomy for hepatocellular carcinoma located in the caudate lobe:Isolated or combined lobectomy?

AIM:To investigate the significance of the surgical approaches in the prognosis of hepatocellular carcinoma(HCC) located in the caudate lobe with a multivariate regression analysis using a Cox proportional hazard model.METHODS:Thirty-six patients with HCC underwent caudate lobectomy at a single tertiary referral center between January 1995 and June 2010.In this series,left-sided,right-sided and bilateral approaches were used.The outcomes of patients who underwent isolated caudate lobectomy or caudate lobectomy combined with an additional partial hepatectomy were compared.The survival curves of the isolated and combined resection groups were generated by the Kaplan-Meier method and compared by a log-rank test.RESULTS:Sixteen(44.4%) of 36 patients underwent isolated total or partial caudate lobectomy whereas 20(55.6%) received a total or partial caudate lobectomy combined with an additional partial hepatectomy.The median diameter of the tumor was 6.7 cm(range,2.1-15.8 cm).Patients who underwent an isolated caudate lobectomy had significantly longer operative time(240 min vs 170 min),longer length of hospital stay(18 d vs 13 d) and more blood loss(780 mL vs 270 mL) than patients who underwent a combined caudate lobectomy(P < 0.05).There were no perioperative deaths in both groups of patients.The complication rate was higher in the patients who underwent an isolated caudate lobectomy than in those who underwent combined caudate lobectomy(31.3% vs 10.0%,P < 0.05).The 1-,3-and 5-year disease-free survival rates for the isolated caudate lobectomy and the combined caudate lobectomy groups were 54.5%,6.5% and 0% and 85.8%,37.6% and 0%,respectively(P < 0.05).The corresponding overall survival rates were 73.8%,18.5% and 0% and 93.1%,43.6% and 6.7%(P < 0.05).CONCLUSION:The caudate lobectomy combined with an additional partial hepatectomy is preferred because this approach is technically less demanding and offers an adequate surgical margin.

Novel combined endoscopic and laparoscopic surgery for advanced T2 gastric cancer:Two case reports

BACKGROUND The standard treatment for advanced T2 gastric cancer(GC)is laparoscopic or surgical gastrectomy(either partial or total)and D2 lymphadenectomy.A novel combined endoscopic and laparoscopic surgery(NCELS)has recently been proposed as a better option for T2 GC.Here we describe two case studies demonstrating the efficacy and safety of NCELS.CASE SUMMARY Two T2 GC cases were both resected by endoscopic submucosal dissection and full-thickness resection and laparoscopic lymph nodes dissection.This method has the advantage of being more precise and minimally invasive compared to current methods.The treatment of these 2 patients was safe and effective with no complications.These cases were followed up for nearly 4 years without recurrence or metastasis.CONCLUSION This novel method provides a minimally invasive treatment option for T2 GC,and its potential indications,effectiveness and safety needs to be further evaluated in controlled studies.

Early and long-term results of combined cardiac surgery and neoplastic resection in patients with concomitant severe heart disease and neoplasms

Background It is a surgical dilemma when patients present with both severe heart disease and neoplasms. The best surgical treatment remains controversial. This study aimed to analyze the early and long-term results of simultaneous surgical treatment of severe heart disease and neoplasms. Methods We reviewed the clinical records of 15 patients who underwent simultaneous neoplastic resection and cardiac surgery between September 2006 and January 2011. There were 5 male and 10 female patients. The mean age was （59.2±12.5） years and the mean left ventricular ejection fraction was （57.4±11.0）%. All patients were followed up completely for a period of 12 to 51 months （mean, （33.1±11.2） months）. Results Fifteen patients underwent simultaneous cardiac surgery and neoplastic resection. Cardiac procedures consisted of off pump coronary artery bypass grafting （n=7）, aortic valve replacement （n=3）, mitral valve replacement （n=3）, mitral valve replacement with coronary artery bypass grafting （n=1） and left atrial myxoma resection （n=1）. Neoplastic resection consisted of lung cancer resection （n=5）, colonic cancer resection （n=3）, gallbladder resection （n=1）, colonic cancer resection with gallbladder resection （n=1）, hysterectomy （n=2）, hysterectomy with bilateral salpingo-oophorectomy （n=2） and left ovariectomy （n=1）. Pathological examination confirmed malignant disease in 10 patients and benign disease in 5 patients. There were no perioperative myocardial infarctions, stroke, pericardial tamponade, renal failure or hospital deaths. The most frequent complications were atrial fibrillation （33.3%）, pneumonia （26.7%）, low cardiac output syndrome （6.7%） and delayed healing of surgical wounds （6.7%）. There was 1 late death 42 months after surgery for recurrent malignant disease. At 1 and 3 years, survival rates were 100% （Kaplan-Meier method）. Conclusions Simultaneous cardiac surgery and neoplastic resection was not associated with increased early or late morbidity or mortality. Cardiopulmonary bypass does not appear to adversely affect survival in patients with malignant disease. The long-term survival was determined by tumor stage.

Mortality and Morbidity Following Surgery for Primary Malignant Musculoskeletal Tumors in the Pelvis and Limbs: A Retrospective Analysis Using the Japanese Diagnosis Procedure Combination Database

Introduction: Resection of malignant pelvic tumors has long been considered to be associated with higher postoperative mortality and morbidity than resection of malignant limb tumors. We compared the postoperative adverse events of pelvic tumor surgery and limb tumor surgery using a national inpatient database. Methods: We identified patients who underwent surgery for primary musculoskeletal malignant tumors of the pelvis or limbs between July and December in 2007- 2010 using the Japanese Diagnosis Procedure Combination inpatient database. We calculated the risk-adjusted odds ratio for the occurrence of postoperative complications following pelvic tumor surgery with reference to limb tumor surgery using a multivariable logistic regression analysis. Results: Of 3255 eligible patients, 3116 underwent limb tumor surgery and 139 underwent pelvic tumor surgery. In-hospital mortality was 0.6% and 0.7% and postoperative complication rates were 8.2% and 18.7%, respectively. The rate of blood transfusion and duration of anesthesia over 480 min were higher in the pelvic tumor group. Blood transfusion volume and duration of anesthesia were independently associated with worse outcomes, but there was no significant association between tumor location and occurrence of postoperative complications (odds ratio 1.18, 95% confidence interval 0.73 - 1.88, p = 0.502). Conclusions: Blood transfusion volume and duration of anesthesia were significant predictors of outcome. Our data demonstrate that the higher morbidity rate after pelvic tumor resection could result from the larger blood transfusion volume and longer anesthesia duration.

老年前列腺增生患者等离子电切术中右美托咪定复合腰硬联合麻醉的镇静效果及对应激反应的影响

目的 探讨老年前列腺增生患者等离子电切术中右美托咪定复合腰硬联合麻醉的镇静效果及对应激反应的影响。方法 前瞻性选取2022年1月—2023年4月在安徽医科大学附属滁州医院行等离子电切术的102例老年前列腺增生患者,按照随机数字表法分为对照组和研究组,每组51例。对照组给予咪达唑仑复合腰硬联合麻醉,研究组给予右美托咪定复合腰硬联合麻醉。对比两组苏醒时间、围手术期血流动力学、术中寒颤、疼痛、认知功能、炎症反应、应激反应情况及不良反应情况。结果 研究组苏醒时间短于对照组(P <0.05)。两组麻醉诱导前、切皮时、术毕时的平均动脉压、心率比较,结果:(1)不同时间点平均动脉压、心率比较,差异均有统计学意义(F=8.523和7.961,均P=0.000);(2)两组平均动脉压、心率比较,差异均有统计学意义(F=8.036和8.185,均P=0.000);(3)两组平均动脉压、心率变化趋势比较,差异均有统计学意义(F=8.654和8.235,均P=0.000)。研究组寒颤发生率低于对照组(P<0.05)。两组术后4 h、12 h、24 h、48 h的疼痛视觉模拟评分(VAS)比较,结果:(1)不同时间点VAS评分比较,差异有统计学意义(F=8.935,P=0.000);(2)两组VAS评分比较,差异有统计学意义(F=7.419,P=0.000);(3)两组VAS评分变化趋势比较,差异有统计学意义(F=7.128,P=0.000)。两组术前、术后24 h、48 h的简易精神状态检查(MMSE)评分比较,两组术前、术后24 h、48 h的MMSE评分比较,结果:(1)不同时间点MMSE评分比较,差异有统计学意义(F=7.986,P=0.000);(2)两组MMSE评分比较,差异无统计学意义(F=0.171,P=0.841);(3)两组MMSE评分变化趋势比较,差异无统计学意义(F=0.315,P=0.702)。两组开始麻醉时、术后24 h、术后48 h的白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)比较,结果:(1)不同时间点TNF-α、IL-6比较,差异均有统计学意义(F=8.517和8.613,均P=0.000);(2)两组TNF-α、IL-6比较,差异均有统计学意义(F=7.987和7.543,均P=0.000);(3)两组TNF-α、IL-6变化趋势比较,差异均有统计学意义(F=7.968和7.741,均P=0.000)。两组术前、术后24 h、术后48 h的肾上腺素(Adr)、皮质醇(Cor)比较,结果:(1)不同时间点Adr、Cor比较,差异均有统计学意义(F=8.001和8.547,均P=0.000);(2)两组Adr、Cor比较,差异均有统计学意义(F=7.958和7.874,均P=0.000);(3)两组的Adr、Cor变化趋势比较,差异均有统计学意义(F=8.147和7.959,均P=0.000)。两组总不良反应发生率比较,差异无统计学意义(P>0.05)。结论 老年前列腺增生患者等离子电切术中右美托咪定复合腰硬联合麻醉的镇静效果显著,可减轻患者围手术期疼痛、炎症反应及应激反应,维持围手术期血流动力学稳定,且安全可靠。

不同路径下腔镜微创贲门癌根治术的疗效及对术后残余胃肠功能营养状况的影响

目的:探讨不同路径下腔镜微创贲门癌根治术的疗效及对术后残余胃肠功能、营养状况的影响。方法:选取2020年5月至2023年5月我院贲门癌患者126例,随机数字表法分为经腹组与经胸腹组,各63例。经腹组给予腹腔镜微创根治术,经胸腹组给予胸腹联合腔镜微创根治术。对比两组疗效、围术期情况、创伤指标[手术前后C-反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平]、胃肠功能指标[术后拔胃管时间、肛门排气时间、进食时间、手术前后血管活性肠肽(VIP)、生长抑素(SS)、胃动素(MTL)水平]、营养状况[手术前后血清白蛋白(ALB)、预后营养指数(PNI)、主观综合营养评估法(SGA)评分]及术后并发症。结果:两组切缘阳性率、手术根治率对比,差异无统计学意义(P>0.05);经胸腹组手术时间为(131.52±18.77)min,术后肛门排气时间(2.52±0.60)d、术后拔胃管时间(2.88±0.47)d、术后进食时间(4.38±0.85)d、术后下床时间(5.82±1.16)、住院时间(10.72±2.01)d,均短于经腹组的(155.94±21.67)min、(3.40±0.66)d、(3.34±0.53)d、(5.62±0.92)d、(7.10±1.24)d、(12.39±2.33)d,术中出血量、术后引流量分别为(112.46±14.21)mL、(160.89±22.37)mL,均低于经腹组的(124.31±16.08)mL、(186.27±20.15)mL,淋巴结清扫数目为(15.27±1.76)个,高于经腹组的(13.15±1.63)个(t=6.761、7.831、5.154、7.858、5.983、4.308、4.383、6.691、7.015,P均<0.001);术后1d、3d,经胸腹组血清CRP分别为(72.36±16.20)mg/L、(35.28±10.08)mg/L,低于经腹组的(96.58±14.77)mg/L、(51.17±11.62)mg/L,IL-6分别为(212.34±33.16)ng/L、(142.32±23.57)ng/L,低于经腹组的(254.39±37.49)ng/L、(180.67±27.13)ng/L,IL-8分别为(0.28±0.09)μg/L、(0.14±0.04)μg/L,低于经腹组的(0.42±0.11)μg/L、(0.25±0.07)μg/L,VIP分别为(28.76±4.05)pg/mL、(34.69±4.28)pg/mL,高于经腹组的(25.14±3.63)pg/mL、(30.52±3.91)pg/mL,SS分别为(18.23±3.10)pg/mL、(20.21±2.36)pg/mL,高于经腹组的(16.17±2.86)pg/mL、(18.08±2.44)pg/mL,MTL分别为(242.16±21.18)pg/mL、(257.90±23.25)pg/mL,高于经腹组的(227.43±20.64)pg/mL、(238.41±21.76)pg/mL,(t=8.769、8.199、6.668、8.470、7.818、10.829、5.283、5.709、3.877、4.980、3.953、4.858,P均<0.001);术后1个月,经胸腹组血清ALB、差值分别为(75.61±8.03)g/L、(11.95±6.51)g/L,高于经腹组的(70.58±5.95)g/L、(70.58±5.95)g/L,PNI、差值分别为(62.48±6.17)、(14.22±5.13)g,高于经腹组的(57.13±5.82)、(8.60±5.22),SGA评分与差值分别为(9.08±1.42)分、(5.49±1.58)分,高于经腹组的(11.15±1.76)分、(3.06±1.49)分(t=3.944、4.8470、5.007、6.095、7.265、8.881,P均<0.001);经胸腹组并发症发生率为6.35%,低于经腹组的19.05(χ^(2)=4.582,P=0.032)。结论:胸腹联合腔镜微创根治术治疗贲门癌效果确切,能优化手术路径,减轻组织创伤,有助于恢复胃肠功能,改善患者营养状态,减轻并发症发生,加快术后恢复进程。

根治性切除术后复发性肝细胞癌的临床诊疗进展

肝细胞癌(hepatocellular carcinoma,HCC)是世界多发、我国高发的恶性肿瘤,根治性切除术是当前最常见的治疗方式。然而,HCC术后复发率较高,当前临床上对于复发性HCC的管理面临着较多挑战,人们对HCC复发机制的认识相对不足,还没有权威的专门针对复发性HCC的临床管理流程标准,也缺乏早期复发生物标志物的相关研究。明确复发性HCC的定义和制定官方临床管理路径具有特殊的指导价值。文章从HCC的根治性切除标准、复发性HCC的诊断标准、分型、分期和治疗策略等几个方面进行综述,以增加对复发性HCC的认识,提高临床诊断和治疗决策的质量,也为后期复发性HCC临床诊治指南或标准制定提供了借鉴内容。

腰硬联合麻醉在老年患者经尿道前列腺电切术中的应用价值

目的:探究腰硬联合麻醉在老年患者经尿道前列腺电切术中的应用价值。方法:选取2021年1月—2023年12月于肇庆市封开县人民医院行经尿道前列腺电切术治疗的老年患者90例作为研究对象,依据随机数字表法分为两组,各45例。常规组实施连续硬膜外麻醉,研究组实施腰硬联合麻醉。比较两组麻醉效果。结果:相较于常规组,研究组并发症总发生率更低(P<0.05)。研究组最大镇痛节段多于常规组,感觉阻滞起效时间、运动阻滞起效时间、达最大运动阻滞时间短于常规组,感觉阻滞持续时间、运动阻滞持续时间长于对照组(P<0.05)。麻醉前,两组收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO_(2))比较,无统计学差异(P>0.05)。手术开始时、手术结束时,两组SBP、DBP、HR降低,SpO_(2)升高,但研究组SBP、DBP高于常规组(P<0.05);两组HR、SpO_(2)比较,无统计学差异(P>0.05)。研究组麻醉总优良率高于常规组(P<0.05)。结论:腰硬联合麻醉在老年患者经尿道前列腺电切术中的应用价值较高,能够减少并发症,优化麻醉效果,保持血流动力学指标稳定。

新辅助放疗后直肠癌Miles术后会阴部手术切口难愈的影响因素分析

目的探讨影响新辅助放疗后腹会阴联合直肠癌根治术(Miles术)后会阴部手术切口难愈的相关因素。方法回顾性分析125例新辅助放疗后直肠癌Miles术患者的临床资料,统计其术后会阴部手术切口愈合情况,并经单因素及多因素分析影响患者术后会阴部手术切口难愈的相关因素。结果125例新辅助放疗后直肠癌Miles术患者中,有34例患者术后会阴部手术切口难愈,会阴部手术切口难愈率为27.20%(34/125)。单因素分析显示,性别、年龄、有无合并高血压、体质量指数、腹壁切口直径、盆底腹膜修复、术前白蛋白与患者术后会阴部手术切口难愈无关(P>0.05);有无合并糖尿病、放疗后与手术间隔时间、伤口腔内积液是否完全引流与患者术后会阴部手术切口难愈有关(P<0.05);Logistic回归分析显示:合并糖尿病、放疗后间隔1周手术、伤口腔内积液未完全引流是患者术后会阴部手术切口难愈的重要因素(P<0.05)。结论合并糖尿病、放疗后手术间隔时间、伤口腔内积液是否完全引流是影响新辅助放疗后直肠癌Miles术后会阴部手术切口难愈的相关因素,临床需重视并采取相关措施促使术后会阴部手术切口愈合。

瑞马唑仑复合阿芬太尼在宫腔镜子宫内膜病损切除术中的临床应用

目的探讨瑞马唑仑复合阿芬太尼在宫腔镜子宫内膜病损切除术中的临床价值。方法选取80例行宫腔镜子宫内膜病损切除术患者,采取随机数字表法分为两组,各40例。对照组采取丙泊酚+阿芬太尼麻醉,观察组采取瑞马唑仑复合阿芬太尼麻醉。比较两组麻醉效果及术后恢复情况。结果观察组麻醉诱导时间、自主呼吸恢复时间、拔除喉罩时间均比对照组短(P<0.05)。术后6h、术后24h观察组视觉模拟评分法(VAS)评分明显低于对照组(P<0.05)。术后3h、术后6h观察组认知功能简易量表(MMSE)评分比对照组高(P<0.05)。结论瑞马唑仑复合阿芬太尼应用于宫腔镜子宫内膜病损切除术中的镇痛效果显著,且术后麻醉苏醒质量较高,认知功能恢复较快。

三维CT支气管血管成像技术在胸腔镜下单孔肺联合亚段精准切除术中的应用

目的探究三维CT支气管血管成像(three-dimensional computed tomography bronchography and angiography,3D-CTBA)技术在胸腔镜下单孔肺联合亚段精准切除术中的应用。方法选取2022年1月至2023年3月新余市人民医院收治的82例肺小结节患者作为研究对象,按照抽签法分为观察组与对照组,各41例。对照组采用单孔胸腔镜肺叶切除术治疗,观察组采用3D-CTBA技术结合胸腔镜下单孔肺联合亚段精准切除术治疗。比较两组手术时间、术后住院时间、胸管拔除时间、术中出血量、肺叶切除率、中转开胸率。结果观察组手术时间、术后住院时间及胸管拔除时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);观察组肺叶切除率、中转开胸率均低于对照组,差异有统计学意义(P<0.05)。结论3D-CTBA技术应用于胸腔镜下单孔肺联合亚段精准切除术中可有效缩短肺小结节患者手术、术后住院、胸管拔除时间,减少术中出血量,降低肺叶切除率及中转开胸率。

多脏器联合切除治疗中、晚期胃癌的疗效分析

背景与目的:目前,我中心所收治胃癌病例中26.05%的患者探查时发现已有不同程度的周围脏器侵犯。针对该部分中、晚期患者的手术治疗问题,长期以来存有争议。本研究旨在对该类病例手术治疗中联合脏器切除的可行性进行探讨。方法:回顾性分析我中心自1985年～1995年施行多脏器联合切除术治疗的44例中、晚期胃癌患者的临床资料,其中行根治性手术切除34例,姑息性切除10例。对不同性质的手术治疗结果进行分析。结果:联合脏器切除根治性胃癌手术治疗组中位生存期为588天(平均1676天),姑息性切除治疗组中位生存期344天(平均1045天)(P>0.05),无严重术后并发症,无因扩大手术导致死亡的病例。结论:联合脏器切除用于中、晚期胃癌的根治性治疗是可行的,即便是姑息性切除仍可收到较好的疗效。因此,只要情况许可,根治性的手术切除仍应作为其首选的治疗方式。

颅面联合入路切除颅眶鼻沟通瘤

本文报告了颅面联合入路成功切除颅眶鼻沟通瘤5例,包括上颌窦腺鳞癌及胚胎型横纹肌肉瘤各1例,嗅神经母细胞瘤2例,分化好的软骨肉瘤1例。重点讨论了手术方法,眼球保留及颅底修复等问题。

Effect of electroacupuncture on Sevoflurane anesthesia in patients undergoing resection of supratentorial tumor

Objective To observe the supplementary analgesic effect of electroacupuncture and its influence on the maintenance of anesthesia and the speed of recovery of patients undergoing craniotomy. Methods Eighty cases of supratentorial tumor resection were randomly divided into a group A and a group S, 40 cases in each group. All the patients were anesthetized with 2% Sevoflurane. The patients in group A received eleetroacupuneture at Hegu （合谷 LI 4） and Waiguan （外关 TE 5）, Jinmen （金门 BL 63） and Taichong （太冲 LR 3）, Zusanli （足三里 ST 36） and Qiuxtu（丘墟 GB 40） from anesthesia beginning to the end of operation, and in group S without electroacupuncture. tidal Sevoflurane concentration, minimum alveolar concentration （MAC）, bispectral index （BIS） and the information during anesthesia recovery stage were recorded, respectively. Results The end-tidal concentration and MAC of Sevoflurane in group A at all times were significant lower than those in group S （P〈0.05, P〈0.01） with a Sevoflurane saving of 9.62% on average. The BIS in group A during a few phases were higher than that in group S （all P〈0.05）. During anesthesia recovery stage, the time of each phase in group A was significantly shorter than that in group S （all P〈0.01）. No dysphoria and one case with nausea and vomiting were shown in group A, but in group S, 2 patients had dysphoria and 3 patients had nausea and vomiting. Conclusion Electroacupuncture combined with Sevoflurane anesthesia can decrease the dosage of Sevoflurane, shorten the recovery time of anesthesia and improve the quality of anesthesia recovery of the patients undergoing resection of supratentorial tumor.

右美托咪定腰硬联合麻醉用于子宫肌瘤切除术镇静效果评价

目的探讨右美托咪定腰硬联合麻醉用于子宫肌瘤切除术的镇静效果。方法将2015年5月至2016年10月收治的子宫肌瘤切除术患者48例随机分两组,各24例。丙泊酚组在子宫肌瘤切除术治疗过程进行丙泊酚腰硬联合麻醉,右美托咪定组在子宫肌瘤切除术治疗过程进行右美托咪定腰硬联合麻醉。比较两组患者麻醉镇静总有效率,子宫肌瘤切除术中低血压、心动过缓、疼痛呻吟、烦躁不安等不良事件的发生率,麻醉前和手术开展0.5 h患者心率、镇静评分、脑电双频指数的差异。结果右美托咪定组患者麻醉镇静总有效率为95.83%,明显高于丙泊酚组的75.00%(P<0.05);右美托咪定组子宫肌瘤切除术中低血压、心动过缓、疼痛呻吟、烦躁不安等不良事件的发生率低于丙泊酚组(P<0.05);麻醉前,两组患者的心率、镇静评分、脑电双频指数比较无显著差异(P>0.05),手术开展0.5 h右美托咪定组各指标显著优于丙泊酚组(P<0.05)。结论右美托咪定腰硬联合麻醉用于子宫肌瘤切除术的镇静效果确切,可有效维持术中生命体征的平稳,发挥良好的镇静作用,减少不良事件的发生,值得临床推广。