Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: a single-center experience

AIM To evaluate the safety and efficacy of totally laparoscopic total gastrectomy(TLTG) with esophagojejunostomy using a linear stapler compared with laparoscopic-assisted total gastrectomy(LATG) using a circular stapler in gastric cancer patients.METHODS We retrospectively reviewed 687 patients who underwent laparoscopic total gastrectomy for gastric cancer at a single institution from August 2008 to August 2014. The patients were divided into two groups according to the type of operation: 421 patients underwent TLTG and 266 underwent LATG. Clinicopathologic characteristics and surgical outcomes in the two groups were compared and analyzed.RESULTS The TLTG group had higher mean ages at the time of operation(57.78 ± 11.20 years and 55.69 ± 11.96 years,P = 0.020) and more histories of abdominal surgery(20.2% and 12.4%,P = 0.008) compared with the LATG group. Surgical outcomes such as intraoperative and postoperative transfusions,combined operations,pain scores and administration of analgesics,and complications were similar between the two groups. However,compared with the LATG group,the TLTG group required a shorter operation time(149 min vs 170 min,P < 0.001),had lower postoperative hematocrit change(3.49% vs 4.04%,P = 0.002),less intraoperative events(3.1% vs 10.2%,P < 0.001),less intraoperative anastomosis events(2.4% vs 7.1%,P = 0.003),faster postoperative recovery such as median time to first flatus(3.30 d vs 3.60 d,P < 0.001),faster median commencement of soft diet(4.30 d vs 4.60 d,P < 0.001) and shorter length of postoperative hospital stay(6.75 d vs 7.02 d,P = 0.005). CONCLUSION The intracorporeal method for reconstruction of esophagojejunostomy using a linear stapler may be considered a feasible procedure comparing with extracorporeal anastomosis using circular stapler because TLTG is simpler and more straightforward than LATG. Therefore,TLTG can be recommended as an appropriate procedure for gastric cancer.

Efficacy of totally laparoscopic compared with laparoscopic-assisted total gastrectomy for gastric cancer: A meta-analysis

BACKGROUND Laparoscopic radical gastrectomy is currently the most common surgical approach for gastric cancer.The main difference between totally laparoscopic total gastrectomy(TLTG)and laparoscopic-assisted total gastrectomy(LATG)is the route of digestive tract reconstruction.However,TLTG is currently not widespread as the safety and feasibility of intracorporeal esophagojejunostomy is uncertain.AIM To compare the short-term efficacy of TLTG and LATG for radical gastrectomy of gastric cancer,and to determine the safety and feasibility of intracorporeal esophagojejunostomy.METHODS PubMed,EMBASE,and Web of Science databases were searched for all relevant articles regarding TLTG vs LATG for gastric cancer published up to October 1,2019.Inclusion and exclusion criteria were established.All the basic conditions of patients and important clinical data related to surgery were extracted,and a meta-analysis was performed with RevMan 5.3 software.RESULTS Eight studies involving a total of 1883 cases(869 cases in the TLTG group and 1014 cases in the LATG group)were included.Compared with the LATG group,reduced intraoperative blood loss(weighted mean difference=-35.37,95%CI:-61.69--9.06,P=0.008)and a larger number of retrieved lymph nodes(weighted mean difference=3.11,95%CI:-2.60-12.00,P=0.01)were found in the TLTG group.There were no significant differences in operating time,anastomotic time,tumor size,proximal resection margin length,postoperative pain score,time to first flatus,time to first oral intake,postoperative hospital stay,postoperative anastomosis-related complication rate and overall complication rate between the two groups(P>0.05).CONCLUSION Intracorporeal esophagojejunostomy is safe and feasible.TLTG has the advantages of being minimally invasive,reduced intraoperative blood loss and easier access to lymph nodes compared with LATG.Totally laparoscopic gastrectomy is likely to be the surgical trend for gastric cancer in the future.

Observation on the Therapeutic Effect and Complication Rate of Totally Laparoscopic Total Gastrectomy and Laparoscopic-Assisted Total Gastrectomy in the Treatment of Gastric Cancer

Objective:To investigate the effect and complication rate of totally laparoscopic and laparoscopic-assisted total gastrectomy in the treatment of gastric cancer.Methods:From March 2019 to July 2021,60 patients with gastric cancer were selected as the subjects in this study;the patients in group A underwent laparoscopic-assisted total gastrectomy,whereas those in group B underwent totally laparoscopic total gastrectomy;the treatment effect and complication rate were compared between the two groups.Results:The postoperative recovery of group B was significantly better than that of group A,and the postoperative complications(10.00%)of group B were significantly lower than that of group A(33.33%)(P<0.05).Conclusion:For patients with gastric cancer,totally laparoscopic total gastrectomy has better therapeutic effect and lower postoperative complications,which is worthy of popularization.

Total laparoscopic hysterectomy after liver transplantation

BACKGROUND: The number of females who undergo liver transplantation is growing and sometimes gynecologic operations are needed to control gynecologic diseases after liver transplantation. METHOD: Total laparoscopic hysterectomy was performed in 2 patients who had undergone liver transplantation, one for adenomyosis and the other for hysteromyoma. RESULTS: It was safe to create a pneumoperitoneum through the umbilical skinfold even though mild adhesion in the pelvic cavity occurred in one patient. The operative times were 95 and 90 minutes, with blood loss of about 100 and 60 ml, respectively. Oral intake, flatus passage, and ambulation recovered within a day, after the operation. No significant changes in liver function were observed except complication of diarrhea caused by Candida albicans in one patient. CONCLUSIONS: The result of the two patients suggest that total laparoscopic hysterectomy is a safe and effective surgical approach for patients who have undergone liver transplantation.

Induction of total laparoscopic hysterectomy adopted the marionette technique in peri-menopausal and post-menopausal CIN3 patients

Objective:When performing cervical conization in post-menopausal cervical intraepithelial neoplasia 3(CIN3)patients,the positive rate of endocervical cone margin and the incidence of postoperative cervical stenosis increase.This study summarized a 4-year experience of total laparoscopic hysterectomy as a treatment option for peri-menopausal and post-menopausal CIN3 patients at a single institution.Furthermore,it shared the refinement strategies used during the surgery.Methods:This study retrospectively analyzed the medical records of CIN3 patient aged45 years and who underwent open or laparoscopic hysterectomy at our institution from January 1,2017 to December 31,2020.Totally,30 CIN3 patients were enrolled and divided into abdominal hysterectomy group and laparoscopic hysterectomy based on surgery method,with 5 patients and 25 patients respectively.Results:Compared to the abdominal hysterectomy group,the perioperative blood loss(20 mL vs.220 mL,p=0.004)was less and the duration of in-hospital stay(7 d vs.11 d,p<0.001)were significantly shorter in the laparoscopic hysterectomy group.However,no significant differences in age at hysterectomy(53 y vs.77 y,p=0.054)and operative time(154.4±27.8 min vs.161.0±62.4 min,p=0.826)were observed between them.Diagnostic conization was performed in advance for 12 patients,and among them,10(83.3%)patients had positive endocervical cone margin.Postoperative intestinal obstructionwas noted in one abdominal hysterectomy patient,no other complications were observed in the remaining patients.Conclusion:Compared to conization,hysterectomy is more invasive;however,it is an acceptable treatment option for peri-menopausal and post-menopausal CIN3 patients.In such cases,opting for total laparoscopic hysterectomy adopted the marionette technique might be preferable because the procedure is less invasive.

Novel technique of extracorporeal intrauterine morcellation after total laparoscopic hysterectomy: Three emblematic case reports

BACKGROUND In the presence of a large uterus,total laparoscopic hysterectomy(TLH),always requires morcellation to allow removal of the tissues from the abdominal cavity.However,uncontained morcellation has been scrutinized because of the possible spread of occult leiomyosarcoma.Therefore,in-bag extracorporeal morcellation has been developed.However,tissue containment and extraction are extremely challenging,especially when considering the increasing uterine size to be removed through minimally invasive surgery.CASE SUMMARY Herein,we describe a novel technique for extracorporeal intrauterine morcellation using the uterus outermost layer as a bag to achieve tissue extraction of very large uteri with suspected occult leiomyosarcoma after TLH.The study enrolled patients who were planned for TLH for large uteri(weight>500 g).TLH was performed following the procedure reported in our previous studies.The novel technique has been described step-by-step in a video,which representatively describes the preoperative imaging and morcellation procedure of three very large uteri weighing 1500 g,1700 g,and 3700 g,respectively.The procedures were performed without any complications.The patients had an uneventful postoperative course,and in all cases,the pathology was benign leiomyoma.CONCLUSION Extracorporeal intrauterine morcellation using the uterus outmost layer as a bag was found to be a feasible technique that allows a careful diagnosis and safe removal of suspected occult malignancies.The technique herein presented may be adopted in surgical practice,by adding it to the other available techniques of contained morcellation.It may represent a valid and feasible alternative,especially useful in cases of very large uteri exceeding the capacity of specimen retrieval bags.

Effects of Pre-Operative Single Dose Gabapentin on Postoperative Pain Following Total Abdominal Hysterectomy: A Dose Finding Study

Background & Aims: The multimodal analgesia provides superior pain relief and reduces opioid consumption and its side effects. Gabapentin has been used successfully in multi-modal analgesia in different doses. We designed a double-blind randomized control trial to find the minimal effective dose of gabapentin in multimodal analgesia for postoperative pain following total abdominal hysterectomy. Material & Methods: After informed consent, total of 87 patients were randomly assigned to A, B & C groups to receive gabapentin orally 300 mg, 600 mg, and 900 mg respectively one to two hours before surgery. Postoperatively pain was managed by patient-controlled analgesia (PCA) using pethidine. Pain score, opioid consumption, and side effects of gabapentin were monitored. Rescue analgesia was given and monitored. Results: There was no statistically significant difference among the groups with respect to age, weight, height, pethidine consumption, and rescue analgesia. Mean pain scores were statistically insignificant at baseline, 8, 12, and 24 hours postoperatively. Only at 4 hours, the highest pain score (mean) was found in group A, which is statistically significant. The side effects of gabapentin like nausea, vomiting, somnolence, and dizziness were also statistically insignificant. Conclusion: A single preoperative oral gabapentin 300 mg was found to be minimal effective dose in multimodal analgesic regimen for reducing post-operative pain and analgesic requirement following total abdominal hysterectomy.

Total Laparoscopic Hysterectomy for Diagnosis and Treatment of Cervical Cystic Lesions: A Case Series

Objective: Cervical cystic lesions are often observed in gynecological clinical practice. Many are caused by benign diseases such as lobular endocervical glandular hyperplasia (LEGH), and it is important to differentiate these lesions from those due to malignant diseases such as minimal deviation adenocarcinoma (MDA). In cases in which fertility preservation is not a concern, the final pathology is often confirmed by hysterectomy. To investigate the feasibility and safety of laparoscopic surgery for cervical cystic lesions, we retrospectively examined cases in which total laparoscopic hysterectomy (TLH) was performed for diagnosis and treatment. Methods: The subjects were 28 women who underwent TLH from April 2012 to March 2017 at Keio University Hospital. The pre- and post-operative courses of these patients were examined. Results: The average age was 49.4 (range 39 - 65) years and the mean body mass index was 21.7 (16.8 - 30.5) kg/m2. The average operation time was 159 (101 - 314) min and the average bleeding volume was 106.8 (0 - 600) g. There were no severe perioperative complications. The average hospital stay was 8.4 (7 - 14) days. In postoperative pathological diagnosis, 13 cases had benign diseases such as Nabot cysts, there were 14 cases of LEGH, and one patient was diagnosed with MDA. In the MDA case, additional bilateral salpingo-oophorectomy and pelvic lymph node dissection were performed at a later date. No metastasis was observed in these excised specimens. Conclusions: Our results suggest that TLH for cervical cystic lesions can be performed safely. However, it is important to consider the TLH indication before surgery based on the possibility of malignant disease.

Usefulness of Detailed Analysis with Operative Procedure of Total Laparoscopic Hysterectomy (TLH) Done a Single Surgeon, to Master the Surgical Technique of TLH and Gain Higher Proficiency

Objective: To analyze the relationship between the numbers of cases experienced and the operation time for a single surgeon aiming to master the TLH surgical technique. Material and Methods: Retrospective data analysis of women who underwent TLH for benign diseases between April, 2014 and March, 2016 was conducted by a single surgeon in a single hospital (Showa University of Fujigaoka Hospital). We divided the main procedures of the TLH operation into five sections, and measured the time required for each section. These cases were divided into three groups, group 1, 2, and 3. Results: There were 54 cases of TLH over two years for a single surgeon, and 21 cases that included essential operative procedures were divided into three groups of seven cases each. The average duration of the surgery (min.) was 178.3 ± 48.2 in the group 1, 128.3 ± 15.6 in the group 2, and 111.3 ± 15.9 in the group 3. A significant reduction in the required time was observed between group 1, 2, and 3 groups. As the number of cases increased, the operation time became statistically significantly shorter for every section except B and D. The skill growth rate was different at each section. Conclusion: For a single surgeon, as the number of surgical cases increased, we recognized the increased skill with the procedure in every section and the rate of skill growth differed for different sections. The difference of growth rate for each section implied that the number of operative cases required for a surgeon in each section was different.

Application of dezocine patient-controlled epidural analgesia in postoperative analgesia in patients with total myomectomy

BACKGROUND Uterine fibroids are common benign gynecological conditions.Patients who experience excessive menstruation,anemia,and pressure symptoms should be administered medication,and severe cases require a total hysterectomy.This procedure is invasive and causes severe postoperative pain,which can affect the patient’s postoperative sleep quality and,thus,the recovery process.AIM To evaluate use of dezocine in patient-controlled epidural analgesia(PCEA)for postoperative pain management in patients undergoing total myomectomy.METHODS We selected 100 patients undergoing total abdominal hysterectomy for uterine fibroids and randomized them into two groups:A control group receiving 0.2%ropivacaine plus 0.06 mg/mL of morphine and an observation group receiving 0.2%ropivacaine plus 0.3 mg/mL of diazoxide in their PCEA.Outcomes assessed included pain levels,sedation,recovery indices,PCEA usage,stress factors,and sleep quality.RESULTS The observation group showed lower visual analog scale scores,shorter postoperative recovery indices,fewer mean PCEA compressions,lower cortisol and blood glucose levels,and better polysomnographic parameters compared to the control group(P<0.05).The cumulative incidence of adverse reactions was lower in the observation group than in the control group(P<0.05).CONCLUSION Dezocine PCEA can effectively control the pain associated with total myomectomy,reduce the negative impact of stress factors,and have less impact on patients’sleep,consequently resulting in fewer adverse effects.

Perioperative outcomes of transvaginal specimen extraction laparoscopic total gastrectomy and conventional laparoscopicassisted total gastrectomy

BACKGROUND Natural orifice specimen extraction surgery(NOSES)has emerged as a promising alternative compared to conventional laparoscopic-assisted total gastrectomy(LATG)for treating gastric cancer(GC).However,evidence regarding the efficacy and safety of NOSES for GC surgery is limited.This study aimed to compare the safety and feasibility,in addition to postoperative complications of NOSES and LATG.METHODS Dual circular staplers were used in Roux-en-Y digestive tract reconstruction for transvaginal specimen extraction LATG,and its outcomes were compared with LATG in a cohort of 51 GC patients with tumor size≤5 cm.The study was conducted from May 2018 to September 2020,and patients were categorized into the NOSES group(n=22)and LATG group(n=29).Perioperative parameters were compared and analyzed,including patient and tumor characteristics,postoperative outcomes,and anastomosis-related complications,postoperative hospital stay,the length of abdominal incision,difference in tumor type,postoperative complications,and postoperative survival.RESULTS Postoperative exhaust time,operation duration,mean postoperative hospital stay,length of abdominal incision,number of specific staplers used,and Brief Illness Perception Questionnaire score were significant in both groups(P<0.01).In the NOSES group,the postoperative time to first flatus,mean postoperative hospital stay,and length of abdominal incision were significantly shorter than those in the LATG group.Patients in the NOSES group had faster postoperative recovery,and achieved abdominal minimally invasive incision that met aesthetic requirements.There were no significant differences in gender,age,tumor type,postoperative complications,and postoperative survival between the two groups.CONCLUSION The application of dual circular staplers in Roux-en-Y digestive tract reconstruction combined with NOSES gastrectomy is safe and convenient.This approach offers better short-term outcomes compared to LATG,while long-term survival rates are comparable to those of conventional laparoscopic surgery.

Laparoscopic hysterectomy as optimal approach for 5400 grams uterus with associated polycythemia: A case report

BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is rare.Polycythemia is significantly associated with risk of venous thromboembolism(VTE),which is further increased in case of a large pelvic mass and obesity.Here we report the surgical challenges in the case of an obese patient with a giant fibromatous uterus and associated polycythemia.CASE SUMMARY A 42-year-old obese woman was referred to our department for treatment for a huge fibromatous uterus.She suffered of pelvic pressure and abdominal distension and reported severe dyspnea from several months.Laboratory analyses including hemoglobin(Hb)19.2 g/dL and hematocrit(Hct)59.7%were indicative of polycythemia.Arterial blood gas analysis showed arterial oxygen pressure(pO2)of 81.5 mmHg.Abdominal computed tomography confirmed a giant fibromatous uterus measuring 28.2 cm×17 cm×25 cm.To reduce the thromboembolic risk,the patient underwent low molecular weight heparin,phlebotomy twice before surgery,and we opted for a laparoscopic hysterectomy.The uterus weighed 5400 g and the histology confirmed a diagnosis of leiomyoma.We did not find increased erythropoietin levels in the supernatant of the myomatous uterine tissue.There were no complications.On postoperative day 1,the Hb and the Hct levels normalized to 13.3 g/dL and 41.7%,respectively.Arterial blood gas analysis after surgery showed a pO2 of 144.7 mmHg.These results suggested the diagnosis of myomatous erythrocytosis syndrome.The patient was discharged on the second postoperative day in very good condition with no symptoms.CONCLUSION We believe this is the first reported laparoscopic hysterectomy in a patient with a giant uterus,polycythemia and obesity.Multiple VTE risk factors warranted a laparoscopic approach.

Sphincter-preserving R0 total mesorectal excision with resection of internal genitalia combined with pre-or postoperative chemoradiation for T4 rectal cancer in females

AIM: To evaluate the impact of chemoradiation admi- nistered pre- or postoperatively on prognosis in females following R0 extended resection with sphincter- preserving total mesorectal excision (TME) for locally advanced rectal cancer and to assess the association between chemoradiation and intra- and postoperative variables. METHODS: Twenty-one females were treated for locally advanced but preoperatively assessed as primarily resectable rectal cancer involving reproductive organs. Anterior resection with TME and excision of internal genitalia was combined with neo- or adjuvant chemoradiation. Two-year disease-free survival analysis was performed with the Kaplan-Meier method and log- rank test. The association between chemoradiation and other variables was evaluated with the Fisher’s exact test and Mann-Whitney test. RESULTS: Survival rate decreased in anaemic females (51.5% vs 57.4%), in patients older than 60 years (41.8% vs 66.7%) with poorly differentiated cancers (50.0% vs 55.6%) and tumors located ≤ 7 cm from the anal verge (42.9% vs 68.1%) but with the lack of importance. Patients with negative lymph nodes and women chemoradiated preoperatively had significantly favourable prognosis (85.7% vs 35.7%; P= 0.03 and 80.0% vs 27.3%; P = 0.01, respectively). Preoperative chemoradiation compared to adjuvant radiochemotherapy was not significantly associated with the duration of surgery, incidence of intraoperative bowel perforation and blood loss ≥ 1 L, rate of postoperative bladder and anorectal dysfunction, and minimal distal resection margin. It significantly influenced minimal radial margin (mean 4.2 mm vs 1.1 mm; P < 0.01). CONCLUSION: Despite involving internal genitalia, long-term disease-free survival and sphincter preservation may be achieved with combined-modality therapy for females with T4 locally advanced rectal carcinoma. Neoadjuvant chemoradiation does not compromise functional results and may significantly improve oncological outcomes probably due to enhanced radial clearance.

针对性护理干预在腹腔镜下全子宫切除术中的应用效果

目的:分析针对性护理干预应用于腹腔镜下全子宫切除术中的效果。方法:选取2022年3月—2023年3月滨州医学院附属医院收治的80例择期行腹腔镜下全子宫切除术患者作为研究对象。随机分为研究组和对照组,各40例。对照组采用常规护理,研究组在对照组护理基础上进行针对性护理。比较两组术后恢复情况、护理满意度及并发症发生率等。结果:研究组住院时间短于对照组,首次下床时间早于对照组,差异有统计学意义(P<0.05)。干预后,两组抑郁自评量表(SDS)评分、焦虑自评量表(SAS)评分均低于干预前,且研究组低于对照组,差异有统计学意义(P<0.05)。研究组护理总满意度显著高于对照组,差异有统计学意义(P<0.05)。研究组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论:针对性护理干预在腹腔镜下全子宫切除术治疗患者中的应用获得了较为显著的效果,有效促进预后,改善负性情绪,有利于降低并发症发生。

开腹子宫切除术中QLB-LSAL与双侧TAPB阻滞麻醉镇痛效果比较

目的:分析超声引导下外侧弓状韧带上腰方肌前路阻滞(QLB-LSAL)与双侧腹横肌平面阻滞(TAPB)在开腹子宫切除术(TAH)中的麻醉效果。方法:选取2022年1月-2023年1月本院择期行TAH患者95例,根据入院顺序按单双号分为48例QLB-LSAL组(超声引导下行双侧QLB-LSAL)和47例TAPB组(超声引导下行双侧TAPB),比较两组入室(T0)、切皮时(T1)、手术结束时(T2)、拔管时(T3)及离开麻醉恢复室时(T4)的心率(HR)及平均动脉压(MAP),比较术后48h舒芬太尼消耗量、补救镇痛例数及术后48h内镇痛泵按压次数,比较术后4h、8h、12h、24h静息及咳嗽时视觉疼痛模拟评分(VAS),统计两组术后不良反应和神经阻滞并发症发生情况。结果:两组MAP及HR均呈先上升后降低趋势,且QLB-LSAL组在T1和T2时低于TAPB组(P<0.05);QLB-LSAL组术后48h舒芬太尼消耗量(69.45±4.20μg)、补救镇痛(6.3%)及术后48h内镇痛泵按压(10.5±2.3次)均低于TAPB组(73.15±4.35μg、21.3%、12.2±4.4次)(均P<0.05);两组术后静息及咳嗽时VAS评分均呈降低趋势(P<0.05),两组术后4h、8h评分无差异(P>0.05),术后12h、24h静息及咳嗽时评分QLB-LSAL组低于TAPB组(均P<0.05);两组不良反应(6.3%、4.3%)无差异(P>0.05),两组均无神经阻滞情况发生。结论:相比于双侧TAPB阻滞,超声引导下QLB-LSAL阻滞在TAH中镇痛效果更佳,能有效降低镇痛药物使用剂量,减轻受术患者的疼痛应激反应。

常规器械免举宫经脐单孔腹腔镜全子宫切除术

目的探讨常规器械免举宫经脐单孔腹腔镜全子宫切除术治疗宫颈病变的应用价值。方法选择2021年12月~2023年6月因宫颈高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)或宫颈癌ⅠA1期行腹腔镜全子宫切除术60例,按患者意愿行经脐单孔腹腔镜手术及多孔腹腔镜手术各30例,均使用常规器械,不使用举宫器,比较2组手术指标。结果2组均未出现中转开腹及泌尿系、肠道或大血管等损伤。单孔组出血量较少[(54.6±20.5)ml vs.(67.5±27.0)ml,P=0.041],排气较早[(27.6±8.0)h vs.(32.2±9.0)h,P=0.040],总住院时间较短[(4.4±1.5)d vs.(5.1±1.2)d,P=0.044]。2组子宫重量、手术时间以及术后并发症差异无显著性(P>0.05)。2组切口愈合良好,未出现与穿刺器相关的近期并发症(如穿刺孔感染、出血)或远期并发症(如脐疝、切口疝)。结论免举宫经脐单孔腹腔镜全子宫切除术出血少,术后恢复快,瘢痕最小化,并发症与传统腹腔镜手术相似。

互联网+“手术e候厅”对腹腔镜全子宫切除术患者术前访视知晓度及焦虑水平的影响

目的:探讨互联网+“手术e候厅”对全子宫切除术患者术前访视知晓度及焦虑水平的影响。方法:选取2022年1月-2023年10月本院行腹腔镜全子宫切除术患者102例,随机数字表法分为对照组和观察组各51例,分别予以常规围术期护理模式干预或互联网+“手术e候厅”护理模式干预。比较两组术前访视知晓度、不同时间点焦虑程度(包括家属)、心理及血压变化情况、护理满意度。结果:观察组术前访视知晓度及护理满意度(92.2%)均优于对照组(76.5%),手术室等候时的心率(76.48±9.23)、血压(114.39±6.54 mmHg/76.07±7.13 mmHg)均低于对照组(83.51±8.19、123.58±8.42 mmHg/84.54±6.49 mmHg),手术室等候时、术后1 d 7项广泛性焦虑障碍量表(GAD-7)评分(7.19±2.58分、3.15±1.02分)均低于对照组(9.35±3.26分、4.21±1.07分),其家属手术等候时GAD-7评分(6.28±2.26分)也低于对照组(8.39±2.11分)(均P<0.05)。结论:应用互联网+“手术e候厅”干预可提高全子宫切除术患者术前访视知晓度,缓解焦虑情绪,利于保持心率、血压平稳,护理满意度提高。

基于快速康复外科理念的激励式护理在腹腔镜全子宫切除术患者术后康复中的应用效果

目的 探讨基于快速康复外科理念的激励式护理在腹腔镜全子宫切除术患者术后康复中的应用效果。方法 选取2020年7月至2023年7月于肇庆市第二人民医院行腹腔镜全子宫切除术的70例患者作为研究对象,采用随机数字表法分为对照组(n=35)和试验组(n=35)。对照组接受常规护理干预,试验组在对照组基础上接受基于快速康复外科理念的激励式护理干预,比较两组自我效能感、心理状态、术后恢复情况和术后并发症发生情况。结果 干预后,试验组自我效能感量表评分高于对照组,焦虑自评量表、抑郁自评量表评分均低于对照组(P <0.05)。试验组术后肠鸣音恢复、肛门排气、排便、下床活动和住院时间均短于对照组(P <0.05)。试验组术后并发症总发生率为5.71%,低于对照组的22.86%(P <0.05)。结论 基于快速康复外科理念的激励式护理在腹腔镜全子宫切除术患者术后康复中的应用效果较好,可改善患者自我效能感和心理状态,促进患者术后康复,减少术后并发症。

举宫杯指引下腹腔镜全子宫切除术的临床应用

目的:探索举宫杯指引的腹腔镜全子宫切除术方法在妇科临床应用可行性。方法:回顾性分析2020年10月-2021年10月本院65例腹腔镜全子宫切除术患者临床资料,观察组30例为举宫杯指引的腹腔镜全子宫切除术患者,常规组为35例常规腹腔镜全子宫切除术患者,比较分析两组手术时间、术中出血量、手术并发症、肛门排气时间、术后住院时间及术后阴道伤口残端愈合情况。结果:观察组手术时间(65.7±5.4min)、术中出血量(26.8±10.0 ml)、肛门排气时间(11.2±2.2h)、术后住院中位时间[5.0(5.0,5.0)d]均低于常规组(86.0±7.1min、57.0±8.5ml、17.9±2.1h)[5.0(5.0,6.0)d](均P<0.05);观察组未出现膀胱、输尿管损伤及阴道残端感染,常规组分别出现1例输尿管损伤、1例膀胱损伤和2例阴道残端感染。两组术中并发症、术后随访阴道残端感染率无差异(P>0.05)。结论:举宫杯指引的腹腔镜全子宫切除术手术时间短、术后恢复快、安全可靠,初步证实该方法在妇科临床应用的可行性。

多途径围术期低体温预防在腹腔镜全子宫切除术患者中的应用分析

目的研究腹腔镜全子宫切除术中引入多途径式围术期低体温预防护理机制的效果。方法选择2022年1月至2023年6月行腹腔镜全子宫切除术治疗患者80例,随机数字表法分为对照组和试验组,每组40例。对照组给予腹腔镜全子宫切除术常规式护理,试验组在对照组基础上加用多途径围术期低体温预防护理干预,比较2组干预后的应激反应[肾上腺素(NE)、皮质醇(Cor)、去甲肾上腺素(NA)]、血气指标[动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))]、炎性反应指标[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)],体温、低体温发生率。结果试验组NE、COR、NA、PaO_(2)、PaCO_(2)、CRP、TNF-α、IL-6优于对照组,术时30 min、术时1 h、术毕体温高于对照组,围术期低体温发生率低于对照组,差异均有统计学意义(P<0.05)。结论腹腔镜全子宫切除术患者中给予多途径围术期低体温预防护理机制,具有较高应激反应、炎性反应控制效应,可稳定患者血气与体温,规避围术期低体温风险。