端粒酶和妇科肿瘤的研究进展

端粒酶是一种RNA依赖的逆转录酶 ,能够延长染色体末端的端粒长度。它由三个主要部分组成———端粒酶RNA亚单位、端粒酶催化亚单位及连接二者的端粒酶相关蛋白。端粒酶激活是细胞永生化和肿瘤形成的关键步骤 ,其活性受到多种因素的调控。端粒酶催化亚单位hTERTmRNA可能是其激活的关键限速步骤。在妇科肿瘤的癌变过程中 ,端粒酶活性不同程度地升高 ,hTERT不断上调。端粒酶及其催化亚单位有可能成为妇科肿瘤筛查的一种重要的肿瘤标志物     

Laparoscopic radical cystectomy and bilateral ureteric ligation for muscle-invasive bladder cancer in a patient on hemodialysis

Laparoscopic cystectomy and bilateral ureteric ligation were performed on a 52-year-old woman with end-stage renal disease on hemodialysis (HD) for muscle-invasive bladder cancer. Her volume of urine production was approximately 100 mL/day. Excisions of the bladder and uterus with ligation of the bilateral ureter were conducted completely laparoscopically. Total operative time was 280 min and the amount of blood loss was 60 mL. No complications were seen perioperatively and no adverse events regarding ureteric ligation arose. HD was performed on the second postoperative day. At a 12-month follow-up, the patient showed no evidence of disease.     

腹腔镜下子宫切除术

目的：探讨腹腔镜下子宫切除术的临床应用价值；方法：2002年1月--12月我院对腹腔镜下子宫切除术30例患者进行回顾性分析；结果：其中腹腔镜辅助下的阴式子宫全切术(LAVH)2例，鞘膜内子宫切除术(CISH)8例，腹腔镜下子宫次全切除术(LSH)20例，手术均获成功；结论：腹腔镜下子宫次全切除术是目前妇科最常见的术式之一，从保留器官的功能出发，LSH术式更优于CISH。腹腔镜手术因其创伤小、恢复快、住院时间短等优点，深受患者的认同。     

THE EMERGING ROLE FOR LAPAROSCOPIC GASTROSTOMY

A gastrostomy was fashioned laparoscopically in a 15 year old patient with a severe head injury. A preceding attempt at percutaneous endoscopic gastrostomy had failed. The gastrostomy tube was inserted into the stomach under vision and the stomach attached to the anterior abdominal wall by sutures.     

腹腔镜在胃癌根治术的应用进展

近年来有关早期胃癌的微创治疗进展很快，并已取得国内外的共识。对进展期胃癌应用腹腔镜行胃癌根治术尽管已经取得了较好的临床效果，但仍尚待前瞻性多中心临床随机对照研究。从应用前景看，随着术者技术的完善、观念的改变、经验的积累、手术器械的不断改进，腹腔镜胃癌根治术必将在胃癌手术中扮演越来越重要的角色。     

腹腔镜改良性腹膜后淋巴清除术治疗临床Ⅰ期睾丸非精原细胞瘤

目的:探讨腹腔镜改良性腹膜后淋巴清除术初步经验,评估其手术可行性和近期临床疗效。方法:2004年10月~2006年7月,对7例临床诊断为Ⅰ期睾丸非精原细胞瘤患者,施行了经腹腔途径腹腔镜改良性腹膜后淋巴清除术,年龄26~36岁,平均年龄为30岁,睾丸肿瘤大小为3.0 cm×2.5 cm×2.0 cm~6.5 cm×4.5 cm×3.0 cm,左侧3例,右侧4例,均通过B超、腹膜后CT、胸片检查,并施行了根治性睾丸切除和病理证实。术后淋巴结阳性患者施行了3个疗程的化疗。结果:7例均获得成功,无1例改开放手术。手术时间为120~210 min,平均160 min,手术失血量50~200 ml,平均150 ml,均未输血。术后1~3 d肛门排气,于1~2 d拔除引流管;术后平均住院时间5.5 d。病理报告6例均无转移性淋巴结,其中1例为1/18淋巴结转移,术后无明显并发症。随访6~32个月,平均14个月,阴茎勃起功能良好,射精功能正常。定期复查血hCG、AFP均阴性,B超复查均未发现腹膜后淋巴结,胸片表现均正常。其中淋巴结阳性1例患者术后接受3个疗程的辅助化疗,随访6个月,无瘤存活。结论:腹腔镜改良性腹膜后淋巴清除术具有损伤小、并发症少、术后恢复快等特点,可以代替传统开放手术。     

腹腔镜对不明原因腹水诊断价值研究

目的探讨腹腔镜探查对不明原因腹水的诊断价值及总结手术操作经验。方法回顾性分析1999年9月至2006年10月,第二军医大学附属长海医院普外科在全麻下对72例不明原因腹水病人进行腹腔镜探查,并取可疑组织送病理检查的病例资料。结果腹腔镜手术探查阳性68例(阳性率94.5%),其中结核性腹膜炎44例(61.1%),转移性腺癌12例(占16.7%),腹膜间皮瘤5例(占7.0%),卵巢外腹膜浆液性乳头状癌4例(占5.5%),淋巴瘤、血吸虫病、结肠癌各1例,未明确诊断4例(阴性率为5.5%)。行腹腔镜探查术的病人均未出现并发症。结论腹腔镜腹水探查是一种安全有效的诊断方法,通过镜下观察及活检组织的病理检查基本可以确定产生腹水的病因。腹腔镜在不明原因腹水探查的应用,对操作有其特别要求。     

腹腔镜手术治疗子宫恶性肿瘤的应用价值

目的 研究腹腔镜下广泛全子宫切除术、盆腔淋巴结切除术治疗早期子宫恶性肿瘤的应用价值.方法 回顾性分析34例经腹腔镜和30例开腹手术治疗的临床Ⅰ～Ⅱ期子宫恶性肿瘤患者的临床资料,比较两组的手术时间、术中出血量、并发症、术后恢复情况及淋巴结切除数目等.结果 两组的手术时间、并发症发生率无显著性差异.腹腔镜组的术中出血量为247.13±127.62ml,明显少于同期开腹手术者(904.51±428.37ml,P＜0.01).腹腔镜组淋巴结切除数为23.2±5.8个,多于开腹组淋巴结切除数(16.5±3.8,P＜0.01).术后胃肠功能恢复时间,腹腔镜组为26.4±8.3h,开腹组为54.6±13.5h,两组间有显著性差异(P＜0.01).术后随访11个月两组均未见复发病例.结论 腹腔镜下广泛全子宫切除术、盆腔淋巴结切除术获得满意的效果,近期疗效肯定,远期疗效尚需进一步随访分析.     

后腹腔镜手术CO2气腹对脑氧供需平衡的影响

目的探讨后腹腔镜CO2气腹对脑氧供需平衡的影响. 方法选择后腹腔镜下肾及肾上腺肿瘤切除术20例,ASAⅠ～Ⅱ级,分别于气腹前,气腹后10、30、60 min和关气腹后30 min,抽取颈静脉球血和桡动脉血进行血气分析,比较不同时点动脉血PH(aPH )、颈静脉球PH(jvPH)、动脉血二氧化碳分压(PaCO2)、动脉血糖(aGS)、动脉血乳酸(aLac)、颈内静脉血氧分压(PjvO2)、颈内静脉血氧饱和度(SjvO2)、颅内动静脉氧含量差(AjvDO2)、颈内静脉血二氧化碳分压(PjvCO2)、血糖(jvGS)和乳酸(jvLac)的变化. 结果与气腹前比较,气腹后各时间点aPH、jvPH显著降低(P＜0.05);PaCO2、PjvCO2气腹后各时间点与气腹前相比显著升高(P＜0.05);AjvDO2气腹后各时点与气腹前相比显著下降(P＜0.05);jvLac气腹后各时间点与气腹前相比有降低趋势,但无统计学差异(P＞0.05);aGS、 jvGS气腹前后无显著变化(P＞0.05). 结论后腹腔镜手术期间,脑血流量显著增加,未发现脑无氧代谢增加的证据.     

Outcomes of laparoscopic incisional hernia repair: A prospective evaluation

Objective: Although laparoscopic incisional hernioplasty has been gaining in popularity, the best approach for the repair of incisional hernia remains controversial. The present study was undertaken to evaluate the medium‐term outcomes of laparoscopic incisional hernioplasties utilizing onlay GORE‐TEX DualMesh (GORE‐TEX DualMesh Biomaterial; W.L. Gore and Associates, Flagstaff, Arizona, TX, USA). Methodology: Between June 2000 and July 2004, 42 patients underwent laparoscopic incisional hernioplasties at our institution. Perioperative data and postoperative outcomes were collected prospectively and analyzed. Results: Laparoscopic incisional hernioplasty was successfully performed on 39 (93%) patients. Conversion to open repair was required in three patients. The overall mean operative time was 108 min. Sixteen patients (37%) were found to have more than one hernial defect after reduction of the hernial contents. Postoperative morbidity included seroma (n = 8), urinary retention (n = 3), ileus (n = 1), pneumonia (n = 1), fever (n = 1), wound infection (n = 1), and prolonged suture site pain (n = 1) in 13 patients. All these morbidities resolved spontaneously without intervention. Two‐thirds of the patients were discharged within 2 days after surgery. With a median follow up of 2 years, two clinical recurrences (4.8%) were detected. Conclusion: Laparoscopic approach was a safe and efficacious technique for the repair of incisional hernia. Medium‐term outcomes were promising with low postoperative morbidity and recurrence rates. This technique allows clear identification of multiple hernial defects and confers the advantages of minimal access surgery.