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Current Status of Digestive Tract Reconstruction after Laparoscopy Gastrectomy for Gastric Cancer

帕瑞昔布钠超前镇痛在妇科腹腔镜术中的应用

【摘要】　目的　探讨帕瑞昔布钠超前镇痛对妇科腹腔镜术患者的影响。　方法　2009年9-10月随机选择行妇科腹腔镜术患者60例，分为试验组、对照组各30例。试验组手术前15 min静脉注射帕瑞昔布钠40 mg （10 mL），对照组注射生理盐水10 mL，记录术后1、2、4、6、12、24 h视觉模拟评分（VAS）。　结果　试验组VAS明显低于对照组，差异有统计学意义（Plt;0.05）。　结论　帕瑞昔布钠超前镇痛对妇科腹腔镜手术患者有较好的镇痛效果。

Efficacy of myomectomy via transumbilical laparoendompic single-site surgery and traditional multiport laparoscopy

ObjectiveTo evaluate the efficacy of myomectomy via transumbilical laparoendompic single-site surgery (TU-LESS) and traditional multiport laparoscopy.MethodsThe study was conducted at Chengdu Western Hospital from June 2019 to June 2020. Fifty patients underwent TU-LESS myomectomy (TU-LESS group), while another 50 patients underwent traditional multiport laparoscopic myomectmy (multiport laparoscopy group). The conditions of operation, extra analgetic usage, VAS grade, and patients’ satisfaction degree were compared between two groups.ResultsPatients in both groups had similar age, BMI, fibroma volume, operative time, expelling gas day, blood loss, complication rate, and hospitalized costs (P>0.05). Compared with traditional multiport laparoscopy, the TU-LESS group resulted in significantly shorter hospitalization day, lower VAS score of the 1st/3nd/7th days after surgery, less use of analgetic after surgery, and higher satisfaction degree.ConclusionsTU-LESS is safe and feasible for myomectomy, and it is associated with less pain, shorter hospitalization day, and higher satisfaction degree.

Analysis on Transumbilical SingleIncision Laparoscopy Combined with Endoscopy in Treatment for 30 Cases with Small Gastric Stromal Tumors

目的探讨经脐单孔腹腔镜联合胃镜治疗微小胃间质瘤(gastric stromal tumors, GIST)的可行性和临床疗效。 方法回顾性分析我院2010年10月至2011年5月期间行经脐单孔腹腔镜联合胃镜治疗微小GIST 30例患者的临床资料。 结果30例病灶直径（1.0±0.2） cm（0.5～2.0 cm），术后病理检查均证实为极低危险程度GIST。 24例在单孔腹腔镜辅助下成功完成内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）； 3例因ESD术中发生胃壁穿孔而改行内镜全层切除术（endoscopic full-thickness resection, EFR），其中2例继续在单孔下完成穿孔修补术，1例于左上腹壁另加一 Trocar，在双孔下完成穿孔修补术； 另3例因ESD剥离瘤体困难，改行胃局部切除术，其中2例继续在单孔下完成手术，1例在双孔下完成手术。 ESD成功率为80.0%（24／30），经脐部单孔完成率为93.3%（28/30）。手术时间（87.5±10.3） min （45～150 min）。 全组术后（4.3±0.5） d （3～8 d）出院。术后随访期3～7个月（平均4.6个月），均无病变复发。 结论经脐部单孔腹腔镜联合胃镜治疗微小GIST是安全可行的，早期疗效令人满意。

Gastrointestinal Reconstruction after Laparoscopic Total Gastrectomy

The Therapeutic Effect of Laparoscopy Combining with Pelvic Physiotherapy in Patients with Tubal Infertility

【摘要】目的探讨腹腔镜联合盆腔理疗对输卵管性不孕症的治疗效果,旨在提高术后的受孕率。方法将2007年1月2008年12月进行诊治的不孕者86例随机分为干预组与对照组,每组43例。干预组腹腔镜手术治疗,术后进行理疗;对照组不进行理疗。调查并比较两组的治疗效果和患者满意度。结果干预组43例中13例再次宫内妊娠,受孕率为30.23%;对照组再次宫内妊娠,8例(18.60%)两组比较差异具有统计学意义(Plt;0.05)。干预组总有效率86.05%,明显优于对照组67.44%,且差异亦具有统计学意义(Plt;0.05)。患者满意率干预组为90.67%(39/43),对照组为76.74%(33/43)。两组差异具有统计学意义(Plt;0.05)。结论腹腔镜联合盆腔理疗可以有效改善治疗效果,提高再次受孕率,值得在临床实践中推广应用。

Clinical Analysis of 13 840 Cases Undergoing Laparoscopic Operation

【Abstract】Objective To study the clinical application of laparoscopic operation. Methods The clinical findings from 13 840 cases of laparoscopic surgery in this hospital from 1992 to 2005 were reviewed retrospectively.Results Laparoscopic operation were performed successfully in 13 653（98.6%）,187 cases were transferred to open operation. Complications were occurred in 115 cases, including common bile duct injury in 3 cases. Combined treatment with laparoscope and endoscope were performed in 162 cases. Eleven thousand three hundred and fiftytwo patients had been succeeded in followup survey. Over 90.0 percent of patients recovered smoothly. Conclusion Laparoscopic operation may be applied in a more extensive scope. The major complications can be reduced by strict procedures of laparoscopic operation. The combined treatment of laparoscope and endoscope should be further studied and widely used.

胸腹腔镜联合食管癌根治术（颈部吻合术）视频要点

Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a meta-analysis

ObjectiveTo evaluate the efficacy of robotic intersphincteric resection (ISR) for rectal cancer.MethodsA literature search was performed using the China biomedical literature database, Chinese CNKI, Wanfang, PubMed, Embase, and the Cochrane library. The retrieval time was from the establishment of databases to April 1, 2019. Related interest indicators were brought into meta-analysis by Review Manager 5.2 software.ResultsA total of 510 patients were included in 5 studies, including 273 patients in the robot group and 237 patients in the laparoscopic group. As compared to the laparoscopic group, the robot group had significantly longer operative time [MD=43.27, 95%CI (16.48, 70.07), P=0.002], less blood loss [MD=–19.98.27, 95%CI (–33.14, –6.81), P=0.003], lower conversion rate [MD=0.20, 95%CI (0.04, –0.95), P=0.04], less lymph node harvest [MD=–1.71, 95%CI (–3.21, –0.21), P=0.03] and shorter hospital stay [MD=–1.61, 95%CI (–2.26, –0.97), P<0.000 01]. However, there were no statistically significant differences in the first flatus [MD=–0.01, 95%CI (–0.48, 0.46), P=0.96], time to diet [MD=–0.20, 95%CI (–0.67, 0.27), P=0.41], incidence of complications [OR=0.76, 95%CI (0.50, 1.14), P=0.18], distal resection margin [MD=0.00, 95%CI (–0.17, 0.17), P=0.98] and positive rate of circumferential resection margin [OR=0.61, 95%CI (0.27, 1.37), P=0.23].ConclusionsRobotic and laparoscopic ISR for rectal cancer shows comparable perioperative outcomes. Compared with laparoscopic ISR, robotic ISR has the advantages of less blood loss, lower conversion rate, and longer operation times. These findings suggest that robotic ISR is a safe and effective technique for treating low rectal cancer.

妇科腹腔镜术中体位相关并发症分析及护理对策

【摘要】 目的 探讨腹腔镜手术中不同护理方式对非切口疼痛相关并发症发生率的影响。 方法 2007年11月-2009年12月，将112例腹腔镜患者随机分成两组，观察组采取麻醉前安置好体位，术后常规低流量给氧6 h及术后第1天低流量吸氧4 h，并予术后肩背部按摩护理方式；对照组采取术中麻醉后摆体位，术后常规低流量给氧6 h。观察术后两组患者发生下肢疼痛、腰骶部酸痛、肩背部酸痛发生情况。 结果 观察组下肢疼痛、肩背部酸痛发生率均低于对照组（Plt;0.05）。 结论 腹腔镜患者采取麻醉前安置体位，术后6 h及术后第1天低流量吸氧4 h，配以肩背部按摩及体位改变的护理方式可降低手术并发症发生率。