A Comparative Study of the Short-Term Efficacy of Laparoscopic Radical Resection of Right-Sided Colon Cancer with Two Different Surgeon Positions and Trocar Placements

Objective: To investigate the short-term efficacy of laparoscopic radical resection of right-sided colon cancer with two different surgeon positions and trocar placements. Methods: The data of 78 patients who underwent laparoscopic radical resection of right-sided colon cancer between January 2018 and August 2019 were retrospectively analysed. The surgical method was selected by the patients. The patients were divided into two groups according to the surgeons’ positioning habits and trocar placements. The group with the lead surgeon standing between the patient’s legs had 35 patients, and the group with the lead surgeon standing at the left side of the patient had 43 patients. The operation time, intraoperative blood loss, postoperative anal gas evacuation time, postoperative urinary catheter indwelling time, postoperative hospital stay, C-reactive protein (CRP) level on the first day after surgery, and postoperative pathological data and complications were compared between the two groups. Results: All patients underwent the laparoscopic radical resection of right-sided colon cancer, none converting to laparotomy. No significant difference (P > 0.05) in intraoperative blood loss (57.6 ± 21.3 ml vs 60.2 ± 35.3 ml), postoperative anal gas evacuation time (3.5 ± 1.1 d vs 3.8 ± 1.3 d), postoperative urinary catheter indwelling time (2.6 ± 1.3 d vs 2.4 ± 1.2 d), postoperative hospital stay (7.1 ± 1.8 d vs 7.5 ± 2.1 d), or CRP level on the first day after surgery (54.7 ± 9.6 mg/L vs 53.9 ± 8.2 mg/L) was detected between the two groups. The operation time was shorter in the group with the lead surgeon standing between the patient’s legs (185.2 ± 25.6 min vs 196.2 ±19.7 min) (P < 0.05). The two groups did not differ significantly in the tumour length (4.2 ± 1.3 cm vs 3.9 ± 1.5 cm), number of dissected lymph nodes (27.5 ± 11.6 vs 25.1 ± 15.4), pathological type, or postoperative pathological tumour-node-metastasis stage (P > 0.05). No patients died or had anastomotic fistula during their postoperative hospital stay, and the incidence of postoperative complications did not differ between the two groups (22.9% (8/35) vs 23.3% (10/42);P > 0.05). Conclusion: Under the principle of radical resection, the surgeon should adopt the most suitable standing position and trocar placement according to the specific situation. If the surgeon stands between the patient’s legs, this might shorten the operation time and promote a smoother surgery.

Effect of laparoscopic radical resection of rectal cancer on gastrointestinal hormones, visceral protein and pain stress in patients

Objective: To investigate the effects of laparoscopic radical resection of rectal cancer on gastrointestinal hormones, visceral protein and pain stress. Methods: A total of 96 patients with rectal cancer radical resection from January 2017 to December 2017 in our hospital, were selected as the research objects, the patients were randomly divided into the observation group (48 cases) and the control group (48 cases). The observation group received laparoscopic radical resection of rectal cancer, while the control group underwent open radical resection of rectal cancer. The levels of gastrin (GAS), motilin (MTL), vasoactive intestinal peptide (VIP), transferrin (TRF), retinol binding protein (RbP), albumin (ALB), prealbumin (PRE), P substance (SP), bradykinin (BK), and prostaglandin-E2 (PGE2) were measured and compared in the two groups. Results: Before operation, there was no significant difference in GAS, MTL and VIP between the two groups. 1, 3, and 5 d after operation, the GAS, MTL and VIP of the two groups were significantly lower than those before operation, and the differences were statistically significant. 1, 3, and 5 d after operation, GAS of the observation group were (66.60±5.79) μmol/L, (71.95±6.16) μmol/L and (77.68±6.38) μmol/L respectively, MTL were (225.68±19.83) pg/mL, (253.76±21.42) pg/mL and (289.98±24.74) pg/mL, VIP were (1.99±0.42) μmol/L, (2.43±0.46) μmol/L, (2.80±0.51) μmol/L, respectively, which were higher than that of the control group at the same time, and the difference was statistically significant. Before operation, there was no significant difference in TRF, RbP, ALB and PRE levels in the two groups. 1, 3 and 5 d after operation, the TRF, RbP, ALB and PRE levels in the two groups were significantly lower than those before operation, and the differences were statistically significant. 1, 3 and 5 d after operation, TRF of the observation group were (1.64±0.33) ng/L, (1.44±0.30) ng/L, (1.46 ±0.32) ng/L, RbP were (19.05±3.85) mg/L, (21.83±4.26) mg/L and (24.54±4.45) mg/L respectively, and ALB were (31.49±2.54) ng/L, (28.21±2.05) ng/L and (28.43±1.99) ng/L, PRE were (0.20±0.06) ng/L, (0.16±0.05) ng/L, (0.15±0.05) ng/L, which were all higher than those in the control group at the same time, and the differences were statistically significant. Before operation, there was no significant difference in SP, BK and PGE2 between the two groups. 1, 3 and 5 d after operation, the SP, BK and PGE2 of the two groups were significantly higher than those before operation and the differences were statistically significant. 1, 3 and 5 d after operation, SP of the observation group was (7.31±0.87) μg/mL, (5.43±0.51) μg/mL and (3.10±0.24) μg/mL, BK was (9.53±0.80) μg/L, (7.81±0.79) μg/L and 6.30±0.53) pg/mL, and PGE2 were (152.42±14.80) pg/mL, (131.22±13.35) pg/mL, (117.86±11.95) pg/mL, which were all lower than those in the control group at the same time, and the differences were statistically significant. Conclusion: Laparoscopic radical resection of rectal cancer can help patients recover gastrointestinal function faster and cause less pain stress.

Outcomes after robot-assisted laparoscopic radical prostatectomy

Robot-assisted laparoscopic radical prostatectomy （RALRP） using the da Vinci surgical system is now in widespread use in many countries where economic conditions allow the installation of this expensive technology. Controversy has surrounded the procedure since it was first performed in 2000, with many critics highlighting the lack of evidence to support its use. However, despite the lack of level I evidence, many large studies of patients have confirmed that the procedure is feasible and safe, with low morbidity. Available longer-term oncological data seem to show that outcomes from the robotic approach at least match those of traditional open radical prostatectomy. Functional outcomes also seem satisfactory, although randomized controlled trials are lacking. This paper reviews the current status of RALRP with respect to perioperative data and complications and oncologic and functional outcomes.

Prognostic value of Controlling Nutritional Status score for postoperative complications and biochemical recurrence in prostate cancer patients undergoing laparoscopic radical prostatectomy

Background:Controlling Nutritional Status(CONUT)score was used for screening the preoperative nutritional status.The correlation between the CONUT score and the prognosis of patients with prostate cancer(PCa)has yet to be elucidated.Herein,we analyzed the prognostic value of CONUT scores in patients with PCa who underwent laparoscopic radical prostatectomy.Materials and methods:Data of 244 patients were retrospectively evaluated.Perioperative variables and follow-up data were analyzed.The patients were categorized into 2 groups according to their preoperative CONUT scores.Postoperative complication and incontinence rates were also compared.The Kaplan-Meier method was used to estimate the median biochemical recurrence-free survival(BCRFS)between the 2 groups.Univariate and multivariate Cox regression analyses were performed to identify the potential prognostic factors for BCRFS.Results:Patients were categorized into the low-CONUT group(CONUT score<3,n=207)and high-CONUT group(CONUT score≥3,n=37).The high-CONUT group had a higher overall complication rate(40.5%vs.19.3%,p=0.004),a higher major complication rate(10.8%vs.3.9%,p=0.013),and longer postoperative length of stay(8 days vs.7 days,p=0.017).More fever,urinary infection,abdominal infection,scrotal edema,rash,and hemorrhagic events(all p values<0.05)were observed in the high-CONUT group.A higher rate of urinary incontinence was observed in the high-CONUT group at 1(34.4%vs.13.2%,p=0.030)and 3 months(24.1%vs.8.2%,p=0.023)postoperatively.The high-CONUT group had shorter medium BCRFS(23.8 months vs.54.6 months,p=0.029),and a CONUT score≥3 was an independent risk factor for a shorter BCRFS(hazards ratio,1.842;p=0.026).Conclusions:The CONUT score is a useful predictive tool for higher postoperative complication rates and shorter BCRFS in patients with PCa who undergo laparoscopic radical prostatectomy.

Transurethral resection of the prostate is an independent risk factor for biochemical recurrence after radical prostatectomy for prostate cancer

Biochemical recurrence(BCR)is important for measuring the oncological outcomes of patients who undergo radical prostatectomy(RP).Whether transurethral resection of the prostate(TURP)has negative postoperative effects on oncological outcomes remains controversial.The primary aim of our retrospective study was to determine whether a history of TURP could affect the postoperative BCR rate.We retrospectively reviewed patients with prostate cancer(PCa)who had undergone RP between January 2009 and October 2017.Clinical data on age,prostate volume,serum prostate-specific antigen levels(PSA),biopsy Gleason score(GS),metastasis stage(TNM),D’Amico classification,and American Society of Anesthesiologists(ASA)classification were collected.Statistical analyses including Cox proportional hazard models and sensitivity analyses which included propensity score matching,were performed,and the inverse-probability-of-treatment-weighted estimator and standardized mortality ratio-weighted estimator were determined.We included 1083 patients,of which 118 had a history of TURP.Before matching,the non-TURP group differed from the TURP group with respect to GS(P=0.047),prostate volume(mean:45.19 vs 36.00 ml,P<0.001),and PSA level(mean:29.41 vs 15.11 ng ml?1,P=0.001).After adjusting for age,PSA level,T stage,N stage,M stage,and GS,the TURP group showed higher risk of BCR(hazard ratio[HR]:2.27,95%confidence interval[CI]:1.13–3.94,P=0.004).After matching(ratio 1:4),patients who underwent TURP were still more likely to develop BCR according to the adjusted propensity score(HR:2.00,95%CI:1.05–3.79,P=0.034).Among patients with PCa,those with a history of TURP were more likely to develop BCR after RP.

Development and validation of a preoperative nomogram for predicting positive surgical margins after laparoscopic radical prostatectomy

Background:Positive surgical margins are independent risk factor for biochemical recurrence,local recurrence,and distant metastasis after radical prostatectomy.However,limited predictive tools are available.This study aimed to develop and validate a preoperative nomogram for predicting positive surgical margins after laparoscopic radical prostatectomy(LRP).Methods:From January 2010 to March 2016,a total of 418 patients who underwent LRP without receiving neoadjuvant therapy at Peking University Third Hospital were retrospectively involved in this study.Clinical and pathological results of each patient were collected for further analysis.Univariable and multivariable logistic regression(backward stepwise method)were used for the nomogram development.The concordance index(CI),calibration curve analysis and decision curve analysis were used to evaluate the performance of our model.Results:Of 418 patients involved in this study,142 patients(34.0%)had a positive surgical margin on final pathology.Based on the backward selection,four variables were included in the final multivariable regression model,including the percentage of positive cores in preoperative biopsy,clinical stage,free prostate specific antigen(fPSA)/total PSA(tPSA),and age.A nomogram was developed using these four variables.The concordance index(C-index)of the nomogram was 0.722 in the development cohort and 0.700 in the bootstrap validations.The bias-corrected calibration plot showed a limited departure from the ideal line with a mean absolute error of 2.0%.In decision curve analyses,the nomogram showed net benefits in the range from 0.2 to 0.7.Conclusion:A nomogram to predict positive surgical margins after LRP was developed and validated,which could help urologists plan surgical procedures.

Comparison of the extraperitoneal and transperitoneal laparoscopic radical prostatectomy

The laparoscopic radical prostatectomy （LRP） is a developing technique for treatment of localizedprostate cancer, while the extraperitoneal approach has been highlighted recently.1 From May 2003 to April 2006, we performed laparoscopic radical prostatectomy by transperitoneal or extraperitoneal approaches in 31 patients with localized prostate cancer. Some parameters of these patients are compared in this article.

Effect of surgical procedures on prostate tumor gene expression profiles

Current surgical treatment of prostate cancer is typically accomplished by either open radical prostatectomy （ORP） or robotic-assisted laparoscopic radical prostatectomy （RALRP）. Intra-operative procedural differences between the two surgical approaches may alter the molecular composition of resected surgical specimens, which are indispensable for molecular analysis and biomarker evaluation. The objective of this study is to investigate the effect of different surgical procedures on RNA quality and genome-wide expression signature. RNA integrity number （RIN） values were compared between total RNA samples extracted from consecutive LRP （n= 11） and ORP （n= 24） prostate specimens. Expression profiling was performed using the Agilent human whole-genome expression microarrays. Expression differences by surgicat type were analyzed by Volcano plot analysis and gene ontology analysis. Quantitative reverse transcription （RT）-PCR was used for expression validation in an independent set of LRP （n=8） and ORP （n=8） samples. The LRP procedure did not compromise RNA integrity. Differential gene expression by surgery types was limited to a small subset of genes, the number of which was smaller than that expected by chance. Unexpectedly, this small subset of differentially expressed genes was enriched for those encoding transcription factors, oxygen transporters and other previously reported surgery-induced stress-response genes, and demonstrated unidirectional reduction in LRP specimens in comparison to ORP specimens. The effect of the LRP procedure on RNA quality and genome-wide transcript levels is negligible, supporting the suitability of LRP surgical specimens for routine molecular analysis. Blunted in vivo stress response in LRP specimens, likely mediated by CO2 insufflation but not by longer ischemia time, is manifested in the reduced expression of stress-response genes in these specimens.

Single plus one port laparoscopic radical prostatectomy： a report of 8 cases in one center

Laparoscopic radical prostatectomy is considered the first treatment of choice for local prostate cancer due to its minimal invasion advantage. To further achieve the goal of minimal invasion, single port laparoscopic radical prostatectomy has been developed to minimize the complications associated with puncture tracks. The aim of this study was to illustrate the technique for single port laparoscopic radical prostatectomy and evaluate its efficacy and safety. We reported 8 cases of radical prostatectomy with excellent early outcome carried out in Shanghai Changzheng Hospital from June 2009 to August 2009 using a home-made multiple instrument access port and adding an additional small incision at McBumey point.

地佐辛静脉麻醉联合罗哌卡因局部浸润麻醉镇痛对腹腔镜结直肠癌根治术患者镇痛效果及围术期免疫和应激反应影响

目的探讨腹腔镜结直肠癌根治术患者使用地佐辛静脉麻醉联合罗哌卡因局部浸润麻醉镇痛效果及对围术期免疫和应激反应影响。方法选取2020年4月—2022年5月择期行腹腔镜结直肠癌根治术患者100例,据麻醉镇痛方式不同均分为观察组和对照组,观察组给予全麻及地佐辛静脉麻醉联合罗哌卡因局部浸润麻醉镇痛,对照组给予全麻及罗哌卡因局部浸润麻醉镇痛。记录2组麻醉诱导前5 min(T0)、术毕(T1)、拔管即刻(T2)、拔管后30 min(T3)、拔管后60 min(T4)时平均动脉压(MAP)、心率(HR)及血清皮质醇(Cor)、丙二醛(MDA)水平;比较术前、术后24 h 2组外周血CD4+、CD8+和CD4+/CD8+水平,术毕12、24、48 h视觉模拟评分法(VAS)评分,术前、术后3 d简易智力状态检查量表(MMSE)评分,以及2组麻醉恢复期间不良反应。结果T3时,2组MAP、HR高于T0时,且观察组低于对照组(P<0.05);T1、T2、T3、T4时,2组Cor、MDA均高于T0时,且观察组低于对照组(P<0.05)。术后24 h,2组CD4+、CD4+/CD8+降低,CD8+升高,且观察组CD4+、CD4+/CD8+较对照组升高,CD8+较对照组降低(P<0.05)。观察组术毕12、24、48 h VAS评分均较对照组降低(P<0.05)。术后3 d,2组MMSE评分均降低,且观察组低于对照组(P<0.05)。观察组麻醉恢复期间躁动发生率为6.00%(3/50)低于对照组的20.00%(10/50)(P<0.05)。结论全麻及地佐辛静脉联合罗哌卡因局部浸润麻醉镇痛对腹腔镜结直肠癌根治术患者免疫功能影响小,可减轻手术应激,镇痛效果好,且安全性高。

基于MRI的三维重建技术在保留盆腔自主神经的腹腔镜直肠癌D3根治术中的应用价值

目的 评估利用MRI图像三维重建直肠癌患者盆腔自主神经以及周围器官在腹腔镜直肠癌D3根治术中的应用价值。方法 将56例直肠癌患者随机分为重建组和对照组,重建组术前依照MRI三维重建结果制定手术方案,对照组按常规方式制定手术方案,比较2组术中及术后功能恢复相关指标。结果 重建的三维模型能个体化呈现患者盆腔自主神经以及周围器官分布关系。与对照组相比,重建组的手术时间缩短[(143.7±13.3)min vs.(151.5±12.1)min,P=0.040)],失血量减少[(31.3±12.1)mLvs.(39.4±11.6) mL,P=0.024)],国际前列腺症状评分(IPSS)更优[(6.0±1.3)分vs.(7.9±2.6)分,P=0.003)]。此外,重建组的术后拔除尿管时间较对照组短[2.0(2.0,2.0)d vs.3.5(3.0,4.0)d,P <0.001]。结论 基于MRI的盆腔自主神经三维重建能准确呈现盆腔自主神经及器官的解剖关系,提高了D3根治术的效率和安全性,可为术者制定精细化、个性化的手术方案提供重要参考。

磁共振联合前列腺特异性抗原评估前列腺癌术后复发的价值

目的分析磁共振(MRI)多参数成像联合血清前列腺特异性抗原(PSA)对前列腺癌根治术后局部复发的诊断价值。方法回顾性收集2018年1月至2022年12月于四川省中西医结合医院行前列腺癌根治术的243例患者临床资料,根据术后1年是否发生局部复发,将其分为局部复发组(n=22)和未复发组(n=221)。记录磁共振弥散成像(DWI)评分、动态对比增强MRI(DCE-MRI)评分及总风险评分,比较两组临床资料、表观扩散系数(ADC)值、DWI评分、DCE-MRI评分、总风险评分及血清PSA水平差异,使用受试者工作特征(ROC)曲线分析ADC值、总风险评分、血清PSA对前列腺癌根治术后局部复发的诊断价值。结果两组年龄、术前前列腺体积、体重指数及吸烟史比较,差异无统计学意义(P>0.05)。复发组临床分期、血清PSA水平及Gleason、DWI、DCE-MRI、总风险评分均高于未复发组(P<0.05),ADC值低于未复发组(P<0.05)。ROC曲线分析显示,ADC值、总风险评分及血清PSA对前列腺癌根治术后局部复发均具有较高的诊断价值(AUC=0.742、0.965、0.940,P<0.05)。结论基于DCE-MRI和DWI的总风险评分与血清PSA水平对前列腺癌根治术后局部复发诊断均有利,二者联合诊断应用价值较高。

前列腺癌根治术联合间断抗雄激素对前列腺癌患者肿瘤标志物及疾病预后的影响

目的:探讨前列腺癌根治术联合间断抗雄激素对前列腺癌患者肿瘤标志物及疾病预后的影响。方法:将福州市第二医院2018年1月—2022年6月收治66例前列腺癌患者按随机数字表法分为对照组(n=33)和观察组(n=33),对照组患者单纯进行三孔法经腹膜外腹腔镜下根治性前列腺切除术,观察组给予三孔法经腹膜外腹腔镜下根治性前列腺切除术联合间断抗雄激素。比较两组手术指标及术后1周血红蛋白下降量,治疗前及治疗后12个月前列腺特异性抗原(PSA)、前列腺酸性磷酸酶、肿瘤患者生活质量评分(QOL)评分、国际勃起功能指数(IIEF-5)评分,统计两组患者术后并发症及术后1年复发率。结果:观察组血红蛋白下降量为(22.68±5.18)g/L,明显低于对照组的(27.53±5.22)g/L;观察组术后尿管留置时间为(5.55±1.40)d,明显短于对照组的(8.60±1.66)d;观察组住院时间为(8.46±2.42)d,明显短于对照组的(10.30±2.10)d,差异均有统计学意义(P<0.05)。治疗后,观察组PSA、前列腺酸性磷酸酶分别为(2.51±0.74)ng/mL、(2.06±0.58)μg/L,均明显低于治疗前[(254.84±60.28)ng/mL、(23.66±6.42)μg/L]及对照组[(17.25±1.88)ng/mL、(9.35±1.86)μg/L],差异均有统计学意义(P<0.05)。治疗后,观察组QOL评分为(44.22±2.56)分,明显高于治疗前(40.12±6.58)分及对照组(42.57±3.76)分,差异均有统计学意义(P<0.05)。治疗后,观察组IIEF-5评分为(17.96±1.46)分,明显高于对照组的(14.96±1.10)分,差异有统计学意义(P<0.05)。观察组和对照组并发症发生率分别为3.03%和18.18%,差异有统计学意义(P<0.05)。观察组和对照组1年复发率分别为0和15.15%,差异有统计学意义(P<0.05)。结论:前列腺癌患者给予前列腺癌根治术联合间断抗雄激素治疗能够有效降低前列腺癌患者PSA水平,促进术后康复,降低并发症发生率,提高生活质量。

腹腔镜前列腺癌根治术对局限性前列腺癌的影响

目的探究腹腔镜前列腺癌根治术对局限性前列腺癌患者尿动力学及血清游离前列腺特异抗原百分率(FPSAR)的影响。方法选择局限性前列腺癌患者87例,随机数表法分为研究组与对照组。研究组患者44例给予腹腔镜前列腺癌根治术治疗;对照组患者43例给予开放性前列腺癌根治术治疗,观察2组术后国际前列腺症状评分(IPSS)、尿控率、尿动力学指标和FPSAR水平差异。结果术后,2组IPSS评分、膀胱顺应性(BC)、逼尿肌不稳定(DI)率、残余尿量(PVR)、前列腺特异抗原(t-PSA)、游离前列腺特异抗原(f-PSA)水平均降低,最大尿流率(Qmax)、最大尿流率时逼尿肌压力(Pdet at Qmax)、FPSAR均升高(P<0.05)。研究组IPSS评分、BC、DI、PVR水平均低于对照组,Qmax、Pdet at Qmax水平均高于对照组(P<0.05),2组t-PSA、f-PSA、FPSAR水平比较,差异无统计学意义(P>0.05)。研究组术后1个月、2个月、3个月、4个月尿控率均显著高于对照组(P<0.05)。结论腹腔镜前列腺癌根治术治疗局限性前列腺癌,可有效改善尿动力学指标,提高FPSAR水平,治疗效果较好。

人工气胸在全腔镜食管癌根治术肺保护性通气策略中的应用研究

目的分析人工气胸在全腔镜食管癌根治术肺保护性通气策略中的应用效果。方法选取2021年1月-2023年3月在该院行人工气胸全腔镜食管癌根治术治疗的88例患者作为研究对象,按随机数表法分为两组,每组各44例,对照组采用常规通气模式,实验组采用肺保护性通气策略模式,比较不同通气模式的临床效果。结果实验组与对照组在气管插管后10 min(T_(1))、单肺通气1 h(T_(2))、手术完毕时(T_(3))和术后24 h(T_(4))的pH和二氧化碳分压(PCO_(2))比较,差异均无统计学意义(P>0.05),两组患者T_(1)、T_(2)、T_(3)和T_(4)时点的氧合指数比较,差异均有统计学意义(P<0.05);实验组与对照组T_(1)、T_(2)和T_(3)时点的静态肺顺应性(Cs)、平台压(Pplat)和气道峰压(Ppeak)比较,差异均有统计学意义(P<0.05);实验组与对照组T1时点的C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)和白细胞介素-6(IL-6)水平比较,差异均无统计意义(P>0.05),两组患者T_(2)、T_(3)和T_(4)时点上述指标比较,差异均有统计学意义(P<0.05);对照组肺部并发症发生率为25.00%,高于实验组的9.09%,差异有统计学意义(P<0.05)。结论潮气量(VT)6 mL/kg+100.00%吸入氧浓度+呼气末正压5 cmH_(2)O+肺复张的肺保护性通气策略,用于人工气胸全腔镜食管癌根治术中,能够明显降低术中气道压力,减轻炎症反应,提高通气安全性。

舒适护理在腹腔镜宫颈癌根治术护理中的应用

目的舒适护理在腹腔镜宫颈癌根治术护理中的应用分析。方法选取入我院进行腹腔镜宫颈癌根治术医治患者100例为研究对象,选取时段2021年7月至2023年1月,依照护理方式不同将患者分为观察组(n=50)与对照组(n=50),对照组实施常规护理,观察组采取舒适护理,对两组患者术后疼痛评分、引流时长、首次排气用时、下床活动用时、并发症发生率、护理满意度以及生活质量总评分进行比对。结果经比对,观察组患者疼痛评分、引流时长、首次排气用时、下床活动用时、并发症发生率均较对照组低,护理满意度和生活质量总评分均高于对照组(均P<0.05)。结论通过在腹腔镜宫颈癌根治术护理中应用舒适护理干预,可降低术后痛感和出现并发症概率,具有较高安全性,优化生活质量,提高患者护理满意度。

经腹与经腹膜外腹腔镜根治术在前列腺癌治疗中的应用比较

目的比较前列腺癌患者应用经腹与经腹膜外腹腔镜根治术的临床效果。方法采用回顾性分析,收集接受腹腔镜根治术的140例前列腺癌患者临床资料,依据手术方式不同分为经腹组(n=70)与经腹膜外组(n=70),所有患者术后均接受6个月随访。由研究者设计基线资料调查表,详细收集患者一般资料、围术期指标(术中出血量、手术时长、肠道功能恢复时间、术后尿管拔除时间),同时统计2组患者术前及术后6个月时控尿率、最大尿流率及术后6个月内并发症发生情况。结果经腹膜外组术中出血量、肠道功能恢复时间、术后尿管拔除时间均低于经腹组,而手术时间长于经腹组,差异具有统计学意义(P<0.05)。2组术前控尿率及最大尿流率对比,差异无统计学意义(P>0.05);术后6个月,经腹膜外组控尿率及最大尿流率均大于经腹组,差异具有统计学意义(P<0.05)。2组术后6个月内并发症发生率对比,经腹膜外组低于经腹组,差异具有统计学意义(P<0.05)。结论与经腹入路相比,经腹膜外行腹腔镜根治术可有效缩短前列腺癌患者肠道功能恢复时间及术后尿管拔除时间,且能够减少术中出血量,增强患者术后控尿能力,且并发症发生率较低,但手术时间较长,临床需依据患者情况选择合适的入路。

腹腔镜下右半结肠癌根治术中头侧-中央混合入路的可行性分析

目的分析腹腔镜下右半结肠癌根治术中应用头侧-中央混合入路的可行性。方法选取新乡市第一人民医院于2019年2月至2023年1月择期接受腹腔镜下右半结肠癌根治术的患者180例,按照入路方式分为中央入路组(CW组)及头侧-中央混合入路组(HCMW组),其中CW组85例,HCMW组95例。对比两组术中情况、术后情况、根治术完成质量、并发症发生情况。结果两组中转开腹率差异无统计学意义(P>0.05),HCMW组手术时间短于CW组,术时出血量少于CW组,输血率低于CW组(P<0.05)。两组术后情况、根治术质量、手术安全性差异无统计学意义(P>0.05)。结论腹腔镜下右半结肠癌根治术中应用头侧-中央混合入路具有可行性,在保证手术效果的基础上不增加并发症风险,并且能缩短手术时间,减少术时出血量。

不同浓度七氟醚吸入对腹腔镜胆囊癌根治术患者血流动力学及应激反应指标的影响

目的探讨不同浓度七氟醚吸入对腹腔镜胆囊癌根治术患者血流动力学及应激反应指标的影响。方法根据麻醉过程中吸入七氟醚浓度的不同将60例腹腔镜胆囊癌根治术患者分为低剂量组[n=21,0.5最小肺泡浓度(MAC)]、中剂量组(n=20,1.0MAC)和高剂量组(n=19,1.5MAC)。比较两组患者的血流动力学指标[脉搏血氧饱和度(SpO_(2))、平均动脉压(MAP)、心率(HR)]、应激反应指标[肾上腺素(E)、去甲肾上腺素(NE)]及不良反应发生情况。结果麻醉诱导后、气管插管1 min、气管插管10 min,3组患者SpO_(2)、MAP、HR均低于本组麻醉前,低剂量组和高剂量组患者SpO_(2)、MAP、HR均低于中剂量组,差异均有统计学意义(P﹤0.05)。麻醉诱导后10 min、气腹建立30 min、术毕30 min,3组患者E、NE水平均低于本组麻醉诱导前10 min,低剂量组和高剂量组患者E、NE水平均高于中剂量组,差异均有统计学意义(P﹤0.05)。3组患者的不良反应总发生率比较,差异无统计学意义(P﹥0.05)。结论1.0MAC七氟醚吸入可维持腹腔镜胆囊癌根治术患者的血流动力学稳定,减轻应激反应,且具有一定的安全性。

下腔静脉变异度联合SVV指导下的目标导向液体治疗在腹腔镜肠癌根治术麻醉管理中的应用

目的 探讨下腔静脉变异度联合每搏量变异度(SVV)指导下的目标导向液体治疗在腹腔镜肠癌根治术患者麻醉管理中的应用效果。方法 选取2021年7月至2022年6月择期行腹腔镜下肠癌根治术患者60例,按照不同目标导向液体治疗分为常规补液组(对照组)和SVV组(观察组)各30例。比较两组术中液体出入量、不同时间点血流动力学和视神经鞘直径(ONSD)、术前及术后实验室指标水平[C反应蛋白(CRP)、下腔静脉变异度、纤维蛋白原(FIB)、血浆血栓素B2(TXB2)],术前及术后1、3 d认知功能。结果 观察组总入量、胶体量低于对照组(P<0.05),两组晶体量比较差异无统计学意义(P>0.05)。两组部分时间点血流动力学和ONSD差异有统计学意义(P<0.05)。术前和术后1 d实验室指标水平差异有统计学意义,且观察组CRP、FIB水平低于对照组,下腔静脉变异度高于对照组(P<0.05)。术前及术后3 d,两组认知功能差异无统计学意义(P>0.05),术后1 d观察组认知功能评分高于对照组(P<0.05)。结论 下腔静脉变异度联合SVV指导下的目标导向液体治疗应用于腹腔镜肠癌根治术患者麻醉管理中,能够优化术中液体管理,减少外科应激,维持患者内环境稳定,降低术后短期认知功能损害程度,于患者术后康复有益。