RESULTS OF SECOND-LOOK LAPAROTOMY WITH EXTENSIVE DISSECTION OF RETROPERITONEAL LYMPH NODE IN OVARIAN CANCER PATIENTS

Objective: To evaluate retrospectively the results of extensive lymphadenectomy during second-look laparotomy on patients with ovarian cancer. Methods: A total of 63 patients with ovarian malignancies received second-look laparotomy (SLL). Retroperitoneal lymph nodes, including pelvic and para-aortic lymph nodes below the level of left renal vein, were extensively dissected. Results: Of the 63 patients, residual tumor was found in 24 (38.0%) on SLL. The frequency of residual tumor was positively correlated with the clinical stage and with the amount of tumor left after initial debulking but not with degree of differentiation of tumor cells. Lymph node metastasis(LNM) was pathologically confirmed in 19 cases (30.2%), of which no residual tumor was found in 8 patients. Tumor recurred in only 4 of the 39 patients (10.3%) with negative SLL. The overall 3- and 5-year survival rate were 75.0% and 68.0%, respectively. Conclusion: Extensive retroperitoneal lymph node dissection was recommended during SLL. It favored a decrease in recurrence rate in ovarian cancer patients negative on SLL.

Delay for Performing Laparotomy for Extra Uterine Pregnancy in N’Djamena Mother and Child University Hospital

Background: Ectopic pregnancy is defined as any pregnancy developed outside the uterine cavity. Objective: to study the relationship between the duration of laparotomy for EP and maternal prognosis. Patients and method. This was a prospective analytical study performed during a period of six (06) months, from May 1st to October 30, 2023, on delay time to perform laparotomy for EP in N’Djamena Mother and child University hospital (NMCUH). We included in this series all patients admitted for EP managed by laparotomy. Data were collected using Word software and analyzed using SPSS 18.0 version 2018. The p value statistical test was used to compare variables (p significant if ≤5%). Results: We recorded 92 cases of EP out of 5751 pregnancies, giving a frequency of 1.6%. Among patients diagnosed with EP, 76/92 (82.6%) had an indication of laparotomy. In 90.8%, the EP was ruptured. On admission, the diagnosis of EP was made within 1 hour in 15.8% of cases. The time to sign the consent allowing doctor to operate was >1 hour in 14.5% of cases. The operating room was unavailable in 34.2% of cases, with an unavailability of >1 hour in 17.1% of cases. Total salpingectomy was performed in 93.4%. Salpingotomy was performed in 6.6%. The lethality rate was 3.9% with significant value when the delay after indication and admission in the operating room is >1 (p value = 0.03). Conclusion: Various factors, such as the search for blood products, the time loss to sign the consent form and the unavailability of the operating room, delay the laparotomy, influence maternal prognosis. Anticipation on these factors is necessary in order to limit the proportion of delays.

Comparison of the clinical effects of dual-modality endoscopy and traditional laparotomy for the treatment of intra-and extrahepatic bile duct stones

BACKGROUND Bile duct stones(BDSs)may cause patients to develop liver cirrhosis or even liver cancer.Currently,the success rate of surgical treatment for intrahepatic and extrahepatic BDSs is not satisfactory,and there is a risk of postoperative complic-ations.AIM To compare the clinical effects of dual-modality endoscopy(duodenoscopy and laparoscopy)with those of traditional laparotomy in the treatment of intra-and extrahepatic BDSs.METHODS Ninety-five patients with intra-and extrahepatic BDSs who sought medical services at Wuhan No.1 Hospital between August 2019 and May 2023 were selected;45 patients in the control group were treated by traditional laparotomy,and 50 patients in the research group were treated by dual-modality endoscopy.The following factors were collected for analysis:curative effects,safety(incision infection,biliary fistula,lung infection,hemobilia),surgical factors[surgery time,intraoperative blood loss(IBL)volume,gastrointestinal function recovery time,and length of hospital stay],serum inflammatory markers[tumor necrosis factor(TNF)-α,interleukin(IL)-6,and IL-8],and oxidative stress[glutathione peroxidase(GSH-Px),superoxide dismutase(SOD),malondialdehyde(MDA),and advanced protein oxidation products(AOPPs)].RESULTS The analysis revealed markedly better efficacy(an obviously higher total effective rate)in the research group than in the control group.In addition,an evidently lower postoperative complication rate,shorter surgical duration,gastrointestinal function recovery time and hospital stay,and lower IBL volume were observed in the research group.Furthermore,the posttreatment serum inflammatory marker(TNF-α,IL-6,and IL-8)levels were significantly lower in the research group than in the control group.Compared with those in the control group,the posttreatment GSH-Px,SOD,MDA and AOPPs in the research group were equivalent to the pretreatment levels;for example,the GSH-Px and SOD levels were significantly higher,while the MDA and AOPP levels were lower.CONCLUSION Dual-modality endoscopy therapy(duodenoscopy and laparoscopy)is more effective than traditional laparotomy in the treatment of intra-and extrahepatic BDSs and has a lower risk of postoperative complications;significantly shortened surgical time;shorter gastrointestinal function recovery time;shorter hospital stay;and lower intraop-erative bleeding volume,while having a significant inhibitory effect on excessive serum inflammation and causing little postoperative oxidative stress.

Should we perform decompressive laparotomy during severe acute pancreatitis with intra-abdominal hypertension below 25 mmHg:Only the gut knows

We suggest that during severe acute pancreatitis(SAP)with intra-abdominal hypertension,practitioners should consider decompressive laparotomy,even with intra-abdominal pressure(IAP)below 25 mmHg.Indeed,in this setting,non-occlusive mesenteric ischemia(NOMI)may occur even with IAP below this cutoff and lead to transmural necrosis if abdominal perfusion pressure is not promptly restored.We report our experience of 18 critically ill patients with SAP having undergone decompressive laparotomy of which one third had NOMI while IAP was mostly below 25 mmHg.

Post-laparotomy heterotopic ossification of the xiphoid process: A case report

BACKGROUND Heterotopic ossification(HO)represents all types of extraskeletal ossification in the body.It occurs in various areas,including the skin,subcutaneous tissue,muscle,and joints.Surgical excision is recommended for symptomatic HO.Postoperative radiotherapy,oral nonsteroidal anti-inflammatory drugs,and topical sealants,such as bone wax,have been recommended as preventive measures.As HO is rare in occurrence,these recommendations are based on personal experiences,and there is a lack of information on individualized treatments depending on its location.CASE SUMMARY A 62-year-old male was admitted for symptomatic HO along a laparotomy scar.Surgical excision was performed for an 11 cm-sized ossification originating from the xiphoid process,and bone wax was applied to the excisional margin.However,the surgical wound failed to heal.After several weeks of saline-soaked gauze dressing,delayed wound closure was performed.The patient was finally discharged eight weeks after the excision.Because HO can occur in various areas of the body,a treatment strategy that may be effective for some may not be for others.Bone wax has been used as a topical sealant over excisional margins in the shoulder,elbow,and temporomandibular joints.However,in our case,its application on an abdominal surgical wound delayed its primary healing intention.The valuable lesson was that,when choosing a treatment method for HO based on available research data,its location must be considered.CONCLUSION Complete excision should be the priority treatment option for symptomatic HO along the laparotomy scar.Bone wax application is not recommended.Core Tip:Heterotopic ossification(HO)represents all types of extraskeletal ossification,and occurs in various areas,including the skin,muscle,and joints.There are some suggested treatment and preventive approaches for symptomatic HO,which include surgical excision and preventive measures such as postoperative radiotherapy,oral nonsteroidal anti-inflam-matory drugs,and topical sealants(bone wax).However,these recommendations are based on personal experiences limited to HO in certain locations.It is important to individualize our treatment approaches depending on its location.For symptomatic HO along the laparotomy scar,complete surgical excision should be the priority treatment option,and bone wax application is not recommended.

Emergency exploratory laparotomy and radical gastrectomy in patients with gastric cancer combined with acute upper gastrointestinal bleeding

BACKGROUND Gastric cancer(GC)is a prevalent malignant tumor worldwide and ranks as the fourth leading cause of cancer-related mortality.Upper gastrointestinal bleeding(UGIB)is a frequent complication of GC.Radical gastrectomy and palliative therapy are widely used surgical procedures in the clinical management of GC.This study intends to probe the clinical efficacy and safety of radical gastrectomy and palliative therapy on the basis of exploratory laparotomy in patients with GC combined with UGIB,hoping to provide valuable information to aid patients in selecting the appropriate surgical intervention.AIM To investigate the clinical efficacy and safety of exploratory laparotomy^(+)radical gastrectomy and palliative therapy in patients with GC and UGIB combined.METHODS A total of 89 GC patients admitted to the First Affiliated Hospital of the University of South China between July 2018 and July 2020 were selected as participants for this study.The 89 patients were divided into two groups:radical resection group(n=46)treated with exploratory laparotomy^(+)radical gastrectomy and Palliative group(n=43)treated with palliative therapy.The study compared several variables between the two groups,including surgical duration,intraoperative blood transfusion volume,postoperative anal exhaust time,off-bed activity time,length of hospitalization,and incidence of complications such as duodenal stump rupture,anastomotic obstruction,and postoperative incision.Additionally,postoperative immune function indicators(including CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),and CD3^(+)/HLADR^(+)),immunoglobulin(IgG and IgM),tumor markers(CEA,CA199,and CA125),and inflammatory factors(IL-6,IL-17,and TNF-α)were assessed.The surgical efficacy and postoperative quality of life recovery were also evaluated.The patients were monitored for survival and tumor recurrence at 6 mo,1 year,and 2 years post-surgery.RESULTS The results indicated that the duration of operation time and postoperative hospitalization did not differ between the two surgical procedures.However,patients in the radical resection group exhibited shorter intraoperative blood loss,anus exhaust time,off-bed activity time,and inpatient activity time than those in the Palliative group.Although there was no substantial difference in the occurrence of postoperative complications,such as duodenal stump rupture and anastomotic obstruction,between the radical resection group and Palliative group(P>0.05),the radical resection group exhibited higher postoperative immune function indicators(including CD3^(+),CD4^(+),CD8^(+),etc.)and immunoglobulin levels(IgG,IgM)than the Palliative group,while tumor markers and inflammatory factors levels were lower than those in the radical resection group.Additionally,surgical efficacy,postoperative quality of life,and postoperative survival rates were higher in patients who underwent radical gastrectomy than in those who underwent palliative therapy.Moreover,the probability of postoperative tumor recurrence was lower in the radical gastrectomy group compared to the palliative therapy group,and these differences were all statistically significant(P<0.05).CONCLUSION Compared to palliative therapy,exploratory laparotomy^(+)radical gastrectomy can improve immune function,reduce the levels of tumor markers and inflammatory factors,improve surgical efficacy,promote postoperative quality of life recovery,enhance survival rates,and attenuate the probability of tumor recurrence.

Preventing surgical site infection using operating room bundle of care in patients undergoing elective exploratory laparotomy cholecystectomy surgery

Objective:Surgical procedures manifest immense risks to patients.One of the adverse events that healthcare professionals see as a threat to the patient’s health is the development of complications known as surgical site infection(SSI).Although several effor ts are being under taken to determine the proper means to reduce such complications,there is still a high incidence of SSI worldwide.Surgery requires knowledge in infection control and high precision in maintaining a clean surgical site.This study tested the effectiveness of an operating room(OR)bundle of care in preventing SSI in patients undergoing elective exploratory laparotomy cholecystectomy surgery.Methods:A quasi-experimental pretest and posttest design was utilized to determine its effectiveness.The study was composed of 60 par ticipants divided into two groups:30 subjects were selected to receive the OR bundle of care,while the other 30 subjects received the usual care.The groupings were determined through a systematic random sampling technique.The OR bundle of care had three interventions,namely:(1)maintaining perioperative normothermia,(2)no pre-operative surgical site hair removal,and(3)changing gloves before abdominal wall closure.These patients were evaluated using the standard instrument,Bates–Jensen Wound Assessment Tool(BWAT)in the post-intervention phases of the wound healing process,which are as follows:hemostasis,inflammatory,and proliferative phases.To describe the difference in the patients’wound status after implementation of the OR bundle of care in each post-intervention phase,Friedman’s test was used.To describe the difference in the patients’wound status in both groups after implementation of the OR bundle of care,the Mann–Whitney U test was used.Results:The patient’s wound status was lower,indicating a more healing process.Differences between the wound status of the control and the experimental group were observed on the third postoperative day.This indicates that the experimental group’s wound status healed much faster and more effectively than the control group based on the BWAT scoring severity scoring.A significant difference in the patient’s wound status from the hemostasis phase compared with the proliferative phase was observed.Conclusions:The OR bundle of care has been shown to be effective in preventing SSI in patients who had undergone exploratory laparotomy cholecystectomy surgery in the selected hospital,if there is uniform and consistent implementation of the said intervention.

Analysis of the Effectiveness of Laparoscopic Appendectomy Compared to Laparotomy in the Treatment of Acute Appendicitis

Objective:To analyze the clinical effects of laparoscopic appendectomy compared to traditional laparotomy in treating acute appendicitis.Methods:90 patients with acute appendicitis were selected as research subjects.They were divided into a control group and an observation group,with 45 cases in each group.The control group underwent traditional laparotomy,while the observation group underwent laparoscopic appendectomy.The intraoperative indicators,postoperative recovery indicators,postoperative stress indicators,and postoperative complications of the two groups were compared.Results:The operative time of the observation group was longer,but the incision length was shorter and the blood loss was lesser(P<0.05);the observation group had shorter postoperative first gas-passing time,recovery of gastrointestinal function,ambulation time,and lower postoperative pain score.The observation group had lower postoperative stress index levels(P<0.05);the observation group had a lower postoperative complication rate(P<0.05).Conclusion:Aside from prolonging the operative time,laparoscopic appendectomy is more ideal than traditional laparotomy in all other indicators and has better therapeutic effects in treating acute appendicitis.

基于倾向性评分匹配的T_(4a)期胃癌腔镜辅助与开腹手术近期疗效的对比分析

目的:探讨T_(4a)期胃癌行腹腔镜辅助D2根治术的近期疗效。方法:采用倾向性评分匹配,分析2014年1月至2020年12月为T_(4a)期胃腺癌患者行D2淋巴结清扫的临床资料。将患者分为开腹组(n=362)与腹腔镜组(n=134),通过倾向性评分匹配对数据进行1∶1匹配,匹配容差设为0.03。最终获得两组病例各134例。比较两组手术情况、术后并发症、术后炎性指标变化及2年总生存率。结果:倾向性匹配后,两组基线资料具有可比性(P>0.05)。两组术后首次进食时间、住院时间、并发症情况差异均无统计学意义(P>0.05);腹腔镜组与开腹组手术时间[240(203.75,256.25)min vs.140(120,190)min,P<0.05]、术中出血量[200(100,300)mL vs.200(200,300)mL,P<0.05]、淋巴结清扫数量[20.5(17,27.25)vs.16(10,23),P<0.05]、切口长度[5(5,6)cm vs.12(10,15)cm,P<0.05]、术后排气时间[4(3,6)d vs.5(3,6)d,P<0.05]、术后下床活动时间[2(2,3)d vs.3(2,3)d,P<0.05]差异均有统计学意义。两组术前中性粒细胞-淋巴细胞比值、血小板-淋巴细胞比值、淋巴细胞-单核细胞比值差异无统计学意义(P>0.05),术后血小板-淋巴细胞比值差异无统计学意义,腹腔镜组中性粒细胞-淋巴细胞比值低于开腹组,淋巴细胞-单核细胞比值高于开腹组,差异有统计学意义。开腹组与腹腔镜组术后2年总生存率为53.3%与48.3%,差异无统计学意义(P=0.211)。结论:对于T_(4a)期胃癌,腹腔镜手术后并发症发生率、2年生存率与开腹手术相当,但腹腔镜手术具有创伤小、美观、术后康复快的优势。

开腹手术与腹腔镜二氧化碳气腹对患者鼻咽温度的影响

目的探讨开腹手术与腹腔镜二氧化碳气腹对患者鼻咽温度的影响。方法选择收治的择期行腹部手术治疗的患者96例为研究对象,根据患者手术方式的不同分为开腹组和腹腔镜组,每组48例。比较2组鼻咽温度、苏醒时间、去甲肾上腺素和肾上腺素水平及躁动、寒颤和低体温发生率。结果手术开始时,2组鼻咽温度比较,差异无统计学意义(P>0.05);手术1、2 h和术毕时,开腹组鼻咽温度高于腹腔镜组(P<0.05)。开腹组苏醒时间短于腹腔镜组(P<0.05)。手术开始时,2组去甲肾上腺素和肾上腺素水平比较,差异无统计学意义(P>0.05);手术2 h和术毕时,开腹组去甲肾上腺素和肾上腺素水平低于腹腔镜组(P<0.05)。开腹组躁动、寒颤和低体温发生率低于腹腔镜组(P<0.05)。结论相比于开腹手术,腹腔镜手术中的二氧化碳气腹更易导致患者出现低温现象。

机器人辅助手术在复杂大子宫中的应用及疗效分析(附手术视频)

目的:通过对比机器人辅助手术、传统腹腔镜手术及开腹手术3种不同术式在复杂大子宫切除术中的临床应用疗效,为临床医生选择术式提供参考。方法:收集2021年1月—2023年10月在青岛大学附属医院因子宫腺肌病或子宫肌瘤、子宫体≥孕12周、行全子宫切除术、术后病理证实为良性肿瘤的143名患者资料。根据手术方式不同,将患者分为机器人组45例、腹腔镜组60例、开腹组38例。比较三组患者一般资料及围手术期相关指标。结果:机器人组与开腹组子宫大小及体积均大于腹腔镜组;机器人组术中操作出血量与腹腔镜组相比差异无统计学意义,但均少于开腹组,总失血量与开腹组相比差异无统计学意义,但均多于腹腔镜组;机器人组相对手术时间长于腹腔镜组及开腹组,但绝对手术时间与腹腔镜组及开腹组相比差异均无统计学意义;机器人组术后排气时间均短于腹腔镜组及开腹组,术后住院时间与腹腔镜组相比差异无统计学意义,但均少于开腹组;机器人组住院总花费均高于腹腔镜组及开腹组。三组间手术并发症相比差异无统计学意义。结论:达芬奇机器人辅助手术兼具腹腔镜及开腹手术的优势,可以完成体积更大的复杂大子宫手术,而绝对手术时间、术中出血量及并发症发生率等并未增加,且术后恢复快,住院时间短,虽花费较高,但在合理选择患者的情况下更有利于患者恢复。

经皮腹膜后胰腺坏死组织视频辅助与开腹清创引流术的疗效对比

目的 对比研究经皮腹膜后胰腺坏死组织视频辅助清创引流术与开腹胰腺坏死组织清创引流术的临床疗效。方法 回顾性选取2020年4月至2022年4月收治的50例急性坏死性胰腺炎患者临床资料,依据治疗方式分为A组(28例)、B组(22例),前者行经皮腹膜后胰腺坏死组织视频辅助清创引流术,后者行开腹胰腺坏死组织清创引流术。比较两组手术指标、手术前后免疫功能[CD3^(+)、白细胞计数(WBC)、CD4^(+)]、生化指标[血钙、血清淀粉酶、血糖]、炎症应激指标[髓样分化蛋白-88(MyD88)、白细胞介素-4(IL-4)、5-羟色胺(5-HT)]、术后并发症。结果 两组清创前ICU停留例数相比,差异无统计学意义(P>0.05);与B组相比,A组住院时间、术后排气时间、手术时间较短,进食时间较早,出血量较少(P<0.05);与B组相比,A组术后7 d CD3^(+)、CD4^(+)指标较高,WBC指标较低(P<0.05);与B组相比,A组术后7 d血清淀粉酶、血糖指标较低,血钙指标较高(P<0.05);与B组相比,A组术后7 d血清MyD88、IL-4、5-HT水平较低(P<0.05);两组并发症发生率相比,差异无统计学意义(P>0.05)。结论 经皮腹膜后胰腺坏死组织视频辅助清创引流术能改善患者免疫功能,降低生化指标,减轻炎症应激反应,安全性较好。

单中心腹腔镜与开腹手术治疗T_(3)~T_(4a)期结肠癌的近远期疗效比较

目的:比较腹腔镜与开腹手术治疗T_(3)~T_(4a)期结肠癌围术期疗效及远期生存情况。方法:选取2018年1月1日至2019年12月31日采用腹腔镜与开腹手术治疗的T_(3)~T_(4a)期结肠癌患者,分为腹腔镜组(n=102)与开腹组(n=43),分析两组围手术期资料、术后并发症、总生存期、无瘤生存期、1年与3年生存率及无瘤生存率、总生存率、总无瘤生存率、肿瘤复发转移情况。结果:两组患者基线资料差异无统计学意义(P>0.05)。腹腔镜组术中出血量少于开腹组[50.00(20.00,50.00)mL vs. 50.00(50.00,100.00)mL,P<0.001],获取淋巴结数量多于开腹组[17.00(14.00,22.00)枚vs. 14.00(11.00,20.00)枚,P=0.018],术后恢复进食时间[3.00(3.00,4.00)d vs. 4.00(3.00,6.00)d,P<0.001]、排气时间[3.00(3.00,3.00)d vs. 4.00(3.00,5.00)d,P<0.001]短于开腹组,术后总体并发症与不完全肠梗阻发生率低于开腹组(32.35%vs. 51.16%,3.92%vs. 16.28%,P<0.05)。两组术后1年、3年生存率及无瘤生存率、总生存率、总无瘤生存率、肿瘤复发转移率差异无统计学意义(P>0.05)。在T_(4a)亚组中,腹腔镜组与开腹组的各项生存指标差异均无统计学意义(P>0.05)。结论:腹腔镜手术治疗T_(3)~T_(4a)期结肠癌是安全、可行的,更利于术后恢复,可取得与开腹手术相当的肿瘤治疗效果。

新辅助化疗后机器人辅助与开腹手术治疗局部晚期子宫颈癌术后生存影响因素的对比分析

目的:探究局部晚期宫颈癌患者在新辅助化疗后应用机器人辅助下腹腔镜手术与开腹手术治疗后术后生存质量的差异,并对其影响因素进行分析。方法:对2016年1月—2016年12月在南昌大学第一附属医院妇科接受治疗的76例宫颈癌患者进行回顾性研究。其中研究组为机器人手术组,38例患者全部于新辅助化疗结束后行机器人辅助腹腔镜下广泛性子宫切除术及盆腔淋巴结清扫术;对照组为开腹手术组,38例患者在新辅助化疗结束后行开腹下广泛性子宫切除术及盆腔淋巴结清扫术;两组均对部分患者行腹主动脉旁淋巴结取样。纳入研究对象的一般临床特征、术后手术质量评价指标并统计和分析其无进展生存期及总生存期。结果:研究组与对照组的一般临床特征无差异,但研究组术后多项手术质量评价指标与对照组均有统计学差异(P<0.05)。两组病理预后因素、无病生存期、总生存期、3年生存率和5年生存率比较,差异无统计学意义(P>0.05);经单因素和多因素Cox比例风险模型分析发现,宫颈浸润程度和术后是否补充放化疗为预后独立危险因素。结论:对于局部晚期宫颈癌患者,机器人辅助腹腔镜手术比传统开腹手术的手术质量评价好,但两者在患者病理预后因素及术后生存期上无明显差异。

腹部战创伤后非治疗性剖腹探查术的危害及规避对策

并非所有腹部战创伤患者需要行紧急手术。主要因为一些外科手术并不能起到治疗作用,即非治疗性或阴性探查。另外,这些非治疗性或阴性探查会增加潜在的并发症风险并延长住院时间。本文旨在总结有关战创伤后非治疗性剖腹探查术的普遍性及其并发症,并讨论规避非治疗性剖腹探查术的对策。

Ectopic Cornual Pregnancy: Case Report

This article showcases a clinical case of ectopic pregnancy lodged in the cornual. A pregnancy implanted in this location is a rarity, making it difficult to diagnose. By describing this case and screening of the literature, we explain the various diagnostic and therapeutic methods, both medical and surgical. Highlighting the importance of conservative treatment flush with the uterine horn, and conclude with some practical recommendations.

Stranched Internal Hernia Revealed by Occlusion of the Large Libra: A Propos of a Case

The left para-duodenal internal hernia, whose origin is generally embryological, is a rare etiology of intestinal obstruction found mainly in young adults. We report here the case of acute intestinal obstruction by left para-duodenal internal hernia in a 36-year-old young man. It was a patient who consulted urgently for occlusive syndrome with cessation of materials and gases. Abdominal percussion noted abdominal tympanism and pre-hepatic dullness was preserved. The flow and icicle signs were negative. Palpation did not objectify hepatosplenomegaly and did not find any organomegaly either. On the other hand, she found an epigastric defense. The abdominal X-ray without preparation showed water levels that were wider than high, hail-like. We performed a median above and below umbilical laparotomy and intraoperatively, it was an internal hernia with incarceration of small loops in a voluminous left paraduodenal sac of 12 cm. They were not necrotic and quickly recolored after extrication. We resected the hernial sac and closed the hernial orifice with separate stitches with absorbable suture 0. The postoperative course was simple. The patient was discharged from the hospital on the 4th postoperative day. After 18 months of hindsight, he is doing well.

加速康复外科下完全腹腔镜、腹腔镜辅助与开腹根治性全胃切除术的疗效及安全性分析

目的:比较加速康复外科下完全腹腔镜、腹腔镜辅助与开腹根治性全胃切除术的安全性及长期有效性。方法:回顾性收集2017年1月至2021年12月为胃癌患者行完全腹腔镜、腹腔镜辅助及开放根治性全胃切除术的临床资料。结果:共纳入1 447例患者,男1 184例(81.82%),女263例(18.18%);平均(60.7±9.7)岁。其中完全腹腔镜组194例,腹腔镜辅助组249例,开腹组1 004例。3组患者性别、年龄、体质指数等基线资料差异无统计学意义(P>0.05)。完全腹腔镜组、腹腔镜辅助组、开腹组出血量差异有统计学意义[(102.4±9.5)mL vs.(136.8±9)mL vs.(171.2±5.4)mL,P<0.001]。腹腔镜辅助组与开腹组住院时间差异无统计学意义[(7.3±0.2)d vs.(7.4±0.1)d],长于完全腹腔镜组[(6.6±0.2)d],差异有统计学意义(P=0.043)。完全腹腔镜组与腹腔镜辅助组手术费用高于开腹组,差异有统计学意义[(84 193.8±951.7)元vs.(84 444.8±1 343.2)元vs.(76 849.6±728.3)元,P<0.001]。完全腹腔镜组清扫淋巴结总数多于腹腔镜辅助组与开腹组[(30.5±0.6)枚vs.(28.2±0.4)枚vs.(25.9±0.3)枚,P=0.011],阳性淋巴结数量多于其他两组(P=0.002)。术后发生并发症78例(5.4%),Clavien-Dindo分级Ⅰ~Ⅱ级11例(0.8%),Ⅲ级32例(2.2%),Ⅳ级4例(0.3%),Ⅴ级(病死)7例(0.5%),完全腹腔镜组、腹腔镜辅助组与开腹组术后并发症总发生率分别为5.2%(10/194)、4.0%(10/249)与5.8%(58/1 004),差异无统计学意义(P=0.200)。生存分析显示,开腹胃癌手术患者总体生存期、无病生存期更短,多因素Logistic回归分析显示年龄大于60周岁、开腹手术、术后并发症、T分期、N分期是影响根治性全胃切除术后患者生存的独立危险因素。结论:完全腹腔镜、腹腔镜辅助与开腹根治性全胃切除术的安全性一致,腹腔镜手术可能利于改善患者总体生存情况。

腹腔镜肝门部胆管癌根治术有效性与安全性的Meta分析

目的:系统评价腹腔镜手术(LS)与开腹手术(OS)治疗肝门部胆管癌的临床效果与安全性。方法:检索中、英文数据库关于LS与OS治疗肝门部胆管癌的临床对照研究,检索时间截至2023年7月。对纳入的研究进行质量评价与数据提取,采用RevMan 5.3软件进行Meta分析。结果:共纳入17项研究、905例患者,其中LS组380例,OS组525例。结果显示,与OS组相比,LS组手术时间长(MD=74.25,95%CI:56.14~92.36,P<0.00001),术中出血量少(MD=-93.31,95%CI=-127.64~-58.97,P<0.00001),输血率低(OR=0.51,95%CI=0.32~0.82,P=0.006),R0切除率高(OR=2.14,95%CI=1.30~3.53,P=0.003),术后总体并发症发生率低(OR=0.64,95%CI=0.44~0.93,P=0.02),术后住院时间短(MD=-3.63,95%CI=-4.67~-2.60,P<0.00001)。两组淋巴结清扫数量、胆漏发生率、腹腔出血率、肝功能衰竭发生率、切口感染率、围手术期死亡率及1年、2年总体生存率差异均无统计学意义(P>0.05)。结论:基于病例选择及术前充分评估,腹腔镜肝门部胆管癌根治术是安全、可行的,并具有一定的微创优势,在有经验的中心可进一步应用。

传统开腹手术与腹腔镜手术在卵巢囊肿治疗中的应用效果及分析

目的 探究传统开腹手术与腹腔镜手术在卵巢囊肿治疗中的应用效果。方法 随机选取2020年5月—2023年5月泗洪分金亭医院妇产科收治的60例卵巢囊肿患者为研究对象,采用随机数表法分为对照组与观察组,各30例。对照组接受传统开腹手术,观察组采用腹腔镜进行手术治疗,比较两组的手术、住院时间,卵巢功能,临床疗效。结果 观察组手术、住院时间明显短于对照组,差异有统计学意义(P均<0.05)。手术前,两组卵巢功能比较,差异无统计学意义(P>0.05)。手术后,观察组黄体生成素高于对照组,雌二醇以及阴道超声基础窦卵泡计数低于对照组,差异有统计学意义(P均<0.05)。观察组疗效(96.67%)显著优于对照组(83.33%),差异有统计学意义(χ^(2)=9.886,P=0.002)。结论 对卵巢囊肿患者采用腹腔镜手术治疗效果优于传统开腹手术,可缩短手术、住院时间,改善卵巢功能,提高治疗有效率。