Giant hiatal hernia（GHH） comprises 5% of hiatal hernia and is associated with significant complications.The traditional operative procedure,no matter transthoracic or transabdomen repair of giant hiatal hernia,is ch...Giant hiatal hernia（GHH） comprises 5% of hiatal hernia and is associated with significant complications.The traditional operative procedure,no matter transthoracic or transabdomen repair of giant hiatal hernia,is characteristic of more invasion and more complications.Although laparoscopic repair as a minimally invasive surgery is accepted,a part of patients can not tolerate pneumoperitoneum because of combination with cardiopulmonary diseases or severe posterior mediastinal and neck emphesema during operation.The aim of this article was to analyze our experience in gasless laparoscopic repair with abdominal wall lifting to treat the giant hiatal hernia.We performed a retrospective review of patients undergoing gasless laparoscopic repair of GHH with abdominal wall lifting from 2012 to 2015 at our institution.The GHH was defined as greater than one-third of the stomach in the chest.Gasless laparoscopic repair of GHH with abdominal wall lifting was attempted in 27 patients.Mean age was 67 years.The results showed that there were no conversions to open surgery and no intraoperative deaths.The mean duration of operation was 100 min（range：90–130 min）.One-side pleura was injured in 4 cases（14.8%）.The mean postoperative length of stay was 4 days（range：3–7 days）.Median follow-up was 26 months（range：6–38 months）.Transient dysphagia for solid food occurred in three patients（11.1%）,and this symptom disappeared within three months.There was one patient with recurrent hiatal hernia who was reoperated on.Two patients still complained of heartburn three months after surgery.Neither reoperation nor endoscopic treatment due to signs of postoperative esophageal stenosis was required in any patient.Totally,satisfactory outcome was reported in 88.9% patients.It was concluded that the gasless laparoscopic approach with abdominal wall lifting to the repair of GHH is feasible,safe,and effective for the patients who cannot tolerate the pneumoperitoneum.展开更多
Uterine leiomyoma causes considerable morbidity in women. This study systematically reviewed the efficacy and safety of gasless laparoscopic myomectomy（GLM） in the management of uterine leiomyoma by comparing GLM wi...Uterine leiomyoma causes considerable morbidity in women. This study systematically reviewed the efficacy and safety of gasless laparoscopic myomectomy（GLM） in the management of uterine leiomyoma by comparing GLM with other minimally invasive procedures. Cochrane Library, PubMed, EMBASE, Web of Science, WANFANG database and China National Knowledge Infrastructure（CNKI） were searched for studies published in English or Chinese between January 1995 and May 2015, and related references were traced. Study outcomes from randomized controlled trials and retrospective cohort studies were presented as mean difference（MD） or odds ratio（OR） with a 95% confidence interval（CI）. Seventeen studies（including 1862 patients） meeting the inclusion criteria, including 934 treated with GLM and 928 treated with other minimally invasive procedures were reviewed. The results of meta-analysis revealed that GLM resulted in significantly shorter operating time [MD=–10.34, 95% CI（–18.12, –2.56）, P〈0.00001], shorter hospital stay [MD=–0.47, 95% CI（–0.88, –0.06）], less time to flatus [MD=–2.04, 95% CI（–2.59, –1.48）], less postoperative complications [OR=0.20, 95% CI（0.06, 0.62）] and less blood loss [MD =–30.74, 95% CI（–47.50, –13.98）]. On the other hand, there were no significant differences in duration of post-operative fever [MD=–0.52, 95% CI（–1.46, 0.42）] between the two groups. Additionally, GLM was associated with lower febrile morbidity, lower postoperative abdominal pain, and higher postoperative hemoglobin than other minimally invasive procedures for the treatment of uterine leiomyoma. In conclusion, GLM and other minimally invasive procedures are feasible, safe, and reliable for uterine leiomyoma treatment. However, available studies show that GLM is more effective and safer than other minimally invasive approaches.展开更多
目的探讨免气腹腹腔镜子宫肌瘤剔除术的临床应用价值。方法选取2007年5月～2008年5月在我院行免气腹腹腔镜下子宫肌瘤剔除术（免气腹组）的子宫肌壁间肌瘤43例，及同期气腹腹腔镜下子宫肌瘤剔除术（气腹组）40例进行回顾性对照研究，比...目的探讨免气腹腹腔镜子宫肌瘤剔除术的临床应用价值。方法选取2007年5月～2008年5月在我院行免气腹腹腔镜下子宫肌瘤剔除术（免气腹组）的子宫肌壁间肌瘤43例，及同期气腹腹腔镜下子宫肌瘤剔除术（气腹组）40例进行回顾性对照研究，比较2组手术时间、术中出血量、术后腹腔引流量、术后胃肠功能恢复时间及术后半年的复发情况。结果2组手术均在腹腔镜下顺利完成，无术中、术后并发症。与气腹组相比，免气腹组手术时间短[（46．2±17．2）min vs （59．4±20．8）min，t=-3．160，P=0．002]，术中出血量少[（235．3±83．1）ml vs （310．5±99．4）ml，t=-3．749，P=0．000]，术后24h腹腔引流量少[108．4±23．4）ml vs （125．9±35．1）ml，t=-2．690，P=0．010]，术后胃肠功能恢复快[肛门首次排气时间（17．4±7．2）h vs （21．6±9．8）h，t=-2．236，P=0．023；首次排便时间（23．5±8．1）h vs （31．0±9．4）h，t=-3．902，P=0．001]。2组术后2个月阴道B超均未发现肌瘤，术后6个月阴道B超提示气腹组1例子宫后壁肌层内见一直径12mm的小肌瘤，2组复发率差异无显著性（0／43 vs 1／40，P=0．482）。结论与气腹腹腔镜子宫肌瘤剔除比较，免气腹法具有手术时间短、术中出血少、手术操作简便、术后病人恢复快等优点，对于拟施行子宫肌瘤剔除术的患者是一种较好的手术方式。展开更多
基金supported by a grant from the Beijing Municipal Science&Technology Commission(No.Z141107002514121)
文摘Giant hiatal hernia（GHH） comprises 5% of hiatal hernia and is associated with significant complications.The traditional operative procedure,no matter transthoracic or transabdomen repair of giant hiatal hernia,is characteristic of more invasion and more complications.Although laparoscopic repair as a minimally invasive surgery is accepted,a part of patients can not tolerate pneumoperitoneum because of combination with cardiopulmonary diseases or severe posterior mediastinal and neck emphesema during operation.The aim of this article was to analyze our experience in gasless laparoscopic repair with abdominal wall lifting to treat the giant hiatal hernia.We performed a retrospective review of patients undergoing gasless laparoscopic repair of GHH with abdominal wall lifting from 2012 to 2015 at our institution.The GHH was defined as greater than one-third of the stomach in the chest.Gasless laparoscopic repair of GHH with abdominal wall lifting was attempted in 27 patients.Mean age was 67 years.The results showed that there were no conversions to open surgery and no intraoperative deaths.The mean duration of operation was 100 min（range：90–130 min）.One-side pleura was injured in 4 cases（14.8%）.The mean postoperative length of stay was 4 days（range：3–7 days）.Median follow-up was 26 months（range：6–38 months）.Transient dysphagia for solid food occurred in three patients（11.1%）,and this symptom disappeared within three months.There was one patient with recurrent hiatal hernia who was reoperated on.Two patients still complained of heartburn three months after surgery.Neither reoperation nor endoscopic treatment due to signs of postoperative esophageal stenosis was required in any patient.Totally,satisfactory outcome was reported in 88.9% patients.It was concluded that the gasless laparoscopic approach with abdominal wall lifting to the repair of GHH is feasible,safe,and effective for the patients who cannot tolerate the pneumoperitoneum.
文摘Uterine leiomyoma causes considerable morbidity in women. This study systematically reviewed the efficacy and safety of gasless laparoscopic myomectomy（GLM） in the management of uterine leiomyoma by comparing GLM with other minimally invasive procedures. Cochrane Library, PubMed, EMBASE, Web of Science, WANFANG database and China National Knowledge Infrastructure（CNKI） were searched for studies published in English or Chinese between January 1995 and May 2015, and related references were traced. Study outcomes from randomized controlled trials and retrospective cohort studies were presented as mean difference（MD） or odds ratio（OR） with a 95% confidence interval（CI）. Seventeen studies（including 1862 patients） meeting the inclusion criteria, including 934 treated with GLM and 928 treated with other minimally invasive procedures were reviewed. The results of meta-analysis revealed that GLM resulted in significantly shorter operating time [MD=–10.34, 95% CI（–18.12, –2.56）, P〈0.00001], shorter hospital stay [MD=–0.47, 95% CI（–0.88, –0.06）], less time to flatus [MD=–2.04, 95% CI（–2.59, –1.48）], less postoperative complications [OR=0.20, 95% CI（0.06, 0.62）] and less blood loss [MD =–30.74, 95% CI（–47.50, –13.98）]. On the other hand, there were no significant differences in duration of post-operative fever [MD=–0.52, 95% CI（–1.46, 0.42）] between the two groups. Additionally, GLM was associated with lower febrile morbidity, lower postoperative abdominal pain, and higher postoperative hemoglobin than other minimally invasive procedures for the treatment of uterine leiomyoma. In conclusion, GLM and other minimally invasive procedures are feasible, safe, and reliable for uterine leiomyoma treatment. However, available studies show that GLM is more effective and safer than other minimally invasive approaches.
文摘目的探讨免气腹腹腔镜子宫肌瘤剔除术的临床应用价值。方法选取2007年5月～2008年5月在我院行免气腹腹腔镜下子宫肌瘤剔除术（免气腹组）的子宫肌壁间肌瘤43例，及同期气腹腹腔镜下子宫肌瘤剔除术（气腹组）40例进行回顾性对照研究，比较2组手术时间、术中出血量、术后腹腔引流量、术后胃肠功能恢复时间及术后半年的复发情况。结果2组手术均在腹腔镜下顺利完成，无术中、术后并发症。与气腹组相比，免气腹组手术时间短[（46．2±17．2）min vs （59．4±20．8）min，t=-3．160，P=0．002]，术中出血量少[（235．3±83．1）ml vs （310．5±99．4）ml，t=-3．749，P=0．000]，术后24h腹腔引流量少[108．4±23．4）ml vs （125．9±35．1）ml，t=-2．690，P=0．010]，术后胃肠功能恢复快[肛门首次排气时间（17．4±7．2）h vs （21．6±9．8）h，t=-2．236，P=0．023；首次排便时间（23．5±8．1）h vs （31．0±9．4）h，t=-3．902，P=0．001]。2组术后2个月阴道B超均未发现肌瘤，术后6个月阴道B超提示气腹组1例子宫后壁肌层内见一直径12mm的小肌瘤，2组复发率差异无显著性（0／43 vs 1／40，P=0．482）。结论与气腹腹腔镜子宫肌瘤剔除比较，免气腹法具有手术时间短、术中出血少、手术操作简便、术后病人恢复快等优点，对于拟施行子宫肌瘤剔除术的患者是一种较好的手术方式。
