异位妊娠保守治疗146例分析

目的探讨早期异位妊娠保守治疗的几种方案。方法将146例早期异位妊娠患者，根据不同治疗方案分为3组治疗，比较各组治疗效果。结果MTX组52例成功（94．5％），其中7例行第二次注射MTX（12．7％）；MTX＋米非司酮（RU486）组38例成功（97．4％）其中7例行第二次注射MTX（17．9％y；腹腔镜组52例，全部成功，治愈率为100％。MTX组和MTX＋米非司酮（RU486）组疗效比较差异无显著性（P〉0．05）。结论3种保守治疗方案对早期异位妊娠患者均有效。肌内注射MTX治疗未破裂异位妊娠是一种安全而较为有效的治疗措施。     

Laparoscopic nephrectomy in a living donor

Kidney transplantation is the therapeutic option of choice for patients with end-stage renal disease. With the advent of safer harvesting techniques and immunosuppression, both donor and recipient outcomes have markedly improved in recent years. Kidney donation from Living donors remains the single most important factor responsible for improving patient and graft survival. The laparoscopic donor nephrectomy has revolutionized renal transplantation, allowing expansion of the donor pool by diminishing surgical morbidity while maintaining equivalent recipient outcome. This technique is now becoming the gold-standard harvesting procedure in transplant centres worldwide, despite its technical challenge and ongoing procedural maturation, especially early in the learning curve. Previous contraindications to laparoscopic donor nephrectomy are no longer absolute. In the following analysis, the procedural aspects of the laparoscopic donor nephrectomy are detailed including pre-operative assessment, operative technique and a review of the current literature delineating aspects of both donor and recipient morbidity and mortality compared with open harvesting techniques.     

CO2气腹压力、时间对腹腔镜术后肩部疼痛的影响

目的 探讨腹腔镜术后肩部疼痛与CO2气腹压力、时间的关系。方法 经患者知情同意及医院伦理委员会批准,将60例接受腹腔镜手术的患者分为2组,A组（30例）CO2气腹压力设为9 mmHg,B组（30例）CO2气腹压力设为13 mmHg。观察比较2组24 h内肩痛发生率。另选50例分为手术时间在1 h以内的C组及2 h以上的D组,观察比较2组24 h内肩痛发生率。结果 A组24 h内4例患者发生肩痛,占13.3%;B组12例,占40.0%。2组差异有统计学意义（χ^2=5.455,P〈0.05）。C组3例,占14.3%;D组4例,占13.8%。2组差异无统计学意义（χ^2=0.002 54,P〉0.05）。结论 腹腔镜手术后肩部疼痛与CO2气腹产生的张力有关,但与气腹时间长短无明显相关性。     

舒芬太尼复合丙泊酚对腹腔镜下胆囊切除术患者血流动力学及应激反应的影响

目的：探讨舒芬太尼复合丙泊酚对腹腔镜下胆囊切除术患者血流动力学及应激反应的影响。方法：选取本院进行腹腔镜下胆囊切除术治疗的74例患者为研究对象,然后将74例患者随机分为对照组（瑞芬太尼复合丙泊酚组）37例和观察组（舒芬太尼复合丙泊酚组）37例,然后将两组不同时间的无痛率、不良情况发生率及不同时间点的血流动力学、血清应激指标进行比较。结果：观察组不同时间的无痛率高于对照组,不良情况发生率低于对照组,插管即刻、术中5min及术后5rain的HR、SBP、DBP及血清应激指标均低于对照组,差异具有统计学意义（P〈0．05）。结论：舒芬太尼复合丙泊酚在腹腔镜下胆囊切除术患者中的效果更好,且患者的血流动力学及应激反应更为平稳。     

腹腔镜下进展期胃癌D2根治术的临床体会（附丕例报告）

目的：探讨腹腔镜辅助下进展期胃癌D,根治术的安全性和可行性。方法：回顾性分析我院2009年8月～2011年9月行腹腔镜下进展期胃癌D：根治术26名患者的临床资料。结果：26例患者全部手术成功,根治性远端胃：欠部切除术15例,根治性近端胃大部分切除术7例,根治性全胃切除术4例。手术时间平均为178．6（145～231）min、平均出血量155．5（80—350）mL、淋巴结清扫数目平均33．7枚（23～39）枚、术后肛门排气时间平均4．1（2～13）d、下床活动时间平均3．2（3～17）d、术后住院时间11．3（9～18）d、近端切缘与肿瘤平均距离5．57（5．1～7．2）cm、远端切缘与肿瘤平均距离5．43（5．21—6．76）em。术中及术后无并发症发生,所有患者切口均愈合,顺利出院,近期效果良好。结论：腹腔镜辅助下进展期胃癌D：根治术安全可行,能达到胃癌根治术标准（D2）的淋巴结清扫范围和肿瘤切缘,近期效果良好,远期疗效有待进一步随访观察。     

人性化护理在腹腔镜胆囊切除患者中的应用

目的 对人性化护理在腹腔镜胆囊切除患者中的应用进行探讨.方法笔者所在医院外一科2008～2009年腹腔镜胆囊切除患者312例,将其平均分为2组,一组为干预组,一组为对照组.对照组156例根据病情对患者进行常规护理.干预组156例在基础护理的基础上进行人性化护理.结果干预组显效130例（83.33%）,有效25例（16.03%）,无效1例（0.64%）,总有效率99.36%,明显高于对照组.结论人性化护理在腹腔镜胆囊切除患者中的应用效果良好.     

Rates accessoires après splénectomie pour thrombopénie immunologique chez un patient ayant un déficit immunitaire commun variable

Introduction

Blood cells are mainly destroyed in the spleen during autoimmune cytopenia. Amongst the various therapeutic strategies, splenectomy is sometimes necessary during the disease course. However, splenosis or accessory spleens can account for autoimmune cytopenia relapse after initial splenectomy in these patients.

Case report

We report an 18-year-old male with common variable immunodeficiency who presented with immunological thrombocytopenia. Splenectomy allowed remission of cytopenia, but a relapse was attributed to splenosis, because Jolly bodies were absent on blood smear. Laparoscopic splenectomy of accessory spleens induced long term remission. A literature review is performed.

Conclusion

Fifteen to 20% of relapses of autoimmune cytopenia treated by splenectomy are related to accessory spleens. Ablation of accessory spleens can cure again the patients, including patients with accompanying common variable immunodeficiency.