Efficacy of hand-assisted laparoscopic surgery (HALS) in older adult patients (≥80 years) with primary colorectal cancer

BackgroundFrom 2004 to 2014, 821 colorectal cancer primary resections were conducted at our institution. Of these, 102 patients (12.4%) were older adults over 80 years old. underwent either the conventional laparotomy group (72 patients) or the hand-assisted laparoscopic surgery (HALS) group (30 patients).MethodsData were extracted for 102 patients over 80 years old who underwent primary resection for colorectal cancer and were divided into two groups: conventional laparotomy (CL) (n=72) and hand-assisted laparoscopy (n=30). Pre-operative characteristics and outcomes were compared.ResultsBaseline characteristics were similar between groups, except for age: CL group median 83.5 years old (range, 80–92 years old) and hand-assisted laparoscopy (HALS) group median 81.5 years old (range, 80–88 years old) (P=0.027). Pre-operative cardiac and lung function risk, performance status, and pathological classification stage (pStage) were almost similar between groups (P=0.668, P=0.176, P>0.999, P=0.217). No significant differences were found for operation time. The HALS group resulted in less blood loss (median 204 mL in the CL group and median 68 mL in the HALS group, P=0.003), shorter postoperative hospital stay (median was 18 days in the CL group and median was 12 days in the HALS group, P<0.001), and fewer postoperative wound infections (18 cases in the CL group and 2 cases in the HALS group, P=0.034). Five-year relapse-free survival (5Y-RFS) was 48.1% in the CL group and 73.3% in the HALS group (P=0.028). Five-year overall survival (5Y-OS) was 48.2% in the CL group and 73.3% in the HALS group (P=0.027).ConclusionsApproximately 70% of surgical treatment for patients over 80 years old with colorectal carcinoma were performed by CL. However, HALS had significant advantages including less blood loss, fewer wound infections, and shorter hospital stays. Therefore, HALS could proactively be considered to older adult patients with colorectal cancer.     

Hand-assisted laparoscopic versus laparoscopic-assisted radical gastrectomy in the treatment of advanced distal gastric cancer: final results of a single-center randomized study

ObjectiveTo compare the results and 5- and 8-year overall survival (OS) and disease-free survival (DFS) of hand-assisted laparoscopic surgery (HALS) and laparoscopic-assisted surgery (LAS) in radical gastrectomy for advanced distal gastric cancer.MethodsA total of 124 patients admitted to our institution from May 2009 to April 2013 were randomly divided into a HALS group (n = 62) and a LAS group (n = 62). Postoperatively, 110 patients were followed for 5 and 8 years, and 14 patients were lost to follow-up. The 5- and 8-year OS and DFS rates of the groups were compared and analyzed.ResultsThe 5- and 8-year OS rates, respectively, were 38.8% and 19.4% in the HALS group and 38.3% and 15.3% in the LAS group (log-rank test, χ² = 0.250). The 5- and 8-year DFS rates, respectively, were 23.1% and 10.6% in the HALS group and 19.3% and 11.6% in the LAS group (log-rank test, χ² = 0.109). No significant differences were found.ConclusionCompared with LAS, HALS radical gastrectomy for advanced distal gastric cancer had a lower conversion rate to open surgery, shorter surgical duration, and more thorough dissection of lymph nodes; 5- and 8-year OS and DFS rates were similar to those with LAS.     

腹腔镜肝切除联合脾动脉结扎术治疗肝癌合并门脉高压症的疗效分析

目的 探讨腹腔镜肝切除联合脾动脉结扎术治疗肝癌合并门脉高压症患者的安全性及有效性.方法 2018年2月至2020年2月我院共手术治疗的28例原发性肝细胞肝癌合并肝炎后肝硬化、门脉高压症及脾功能亢进患者,在腹腔镜下先行脾动脉主干结扎、然后再行肝癌的切除,其中局部不规则切除19例、左肝外叶切除9例.回顾性分析患者的一般资料...     

情绪释放疗法对腹腔镜子宫肌瘤剔除术病人疼痛程度、不良情绪、术后恢复及满意度的影响

目的:探讨情绪释放疗法对腹腔镜子宫肌瘤剔除术病人疼痛程度、不良情绪及术后恢复的影响。方法:选择2019年11月—2021年6月医院c4病区收治的腹腔镜子宫肌瘤剔除术病人80例,随机分为对照组与观察组,各40例。对照组行常规干预,观察组行情绪释放疗法干预。比较两组病人手术后疼痛程度、不良情绪、术后恢复效果及满意度。结果:干预后观察组病人术后6 h、24 h的视觉模拟评分法(VAS)评分明显低于对照组(P<0.05);观察组病人术后2 d的汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分明显低于对照组(P<0.05);观察组病人术后肛门首次排气时间、腹胀消失时间、术后首次排便时间、肠鸣音恢复时间、首次下床时间、术后住院时间均明显短于对照组(P<0.05);观察组病人术后满意度明显高于对照组(P<0.05)。结论:情绪释放疗法能明显缓解腹腔镜子宫肌瘤剔除术病人疼痛程度,减轻其不良情绪,提升满意度,促进术后早日康复。     

腹腔镜下萎缩性胆囊炎切除方法的探讨

目的：总结腹腔镜下慢性结石性萎缩性胆囊炎胆囊切除的手术方法和经验。方法：总结2003年1月～2007年5月36例慢性结石性萎缩性胆囊炎患者行腹腔镜胆囊切除术中分离胆囊周围粘连、解剖Calot三角、处理胆囊管及胆囊动脉、切除胆囊的方法。结果：腹腔镜下胆囊切除30例,中转开腹6例。4例胆囊三角区广泛致密粘连,无法分离,行开腹胆囊大部切除术。腹腔镜术后胆漏2例,经腹腔引流治愈。结论：萎缩性胆囊炎腹腔镜手术治疗是安全的。仔细分离胆囊周围粘连,辨认壶腹部与胆囊管的交界,准确解剖Calot三角,合理处理胆囊管,正确掌握中转开腹时机是成功完成手术的关键。     

腹腔镜治疗老年萎缩性胆囊炎44例临床分析

目的:探讨老年萎缩性胆囊炎患者的腹腔镜治疗方法,并预防胆管损伤并发症的发生。方法:回顾分析腹腔镜治疗老年萎缩性胆囊炎44例患者的临床资料。结果:41例顺利完成手术,3例中转开腹,12例放置腹腔引流管,术后肝下积液1例,无其他并发症发生及死亡病例。结论:老年人萎缩性胆囊炎的腹腔镜治疗属于复杂手术,与术中操作技巧,把握好中转手术的时机,充分围手术期准备,熟练术中操作技巧,把握中转开腹的时机,合理使用器械等是预防和减少并发症的关键。     

子宫内膜异位症132例手术诊治临床分析

目的：探讨子宫内膜异位症的手术诊治方式。方法：对132例子宫内膜异位症患者分别行电视腹腔镜诊断治疗和经腹手术治疗。结果：要求保留生育功能病例行腹腔镜手术,保留卵巢功能行子宫切除和根治术病例行经腹手术。结论：腹腔镜手术是诊断和治疗子宫内膜异位症保守性手术的最好方式,对腹腔广泛粘连及严重子宫腺肌症者采用传统经腹手术较为安全。     

右美托咪定对腹腔镜全子宫切除术患者氧化应激反应的影响

目的：观察并评价右美托咪定（dexmedetomidine,Dex）对腹腔镜全子宫切除术患者氧化应激反应的影响。方法择期全麻行腹腔镜全子宫切除术患者40例,随机分为两组：D组（Dex组,n＝20）,Dex静脉泵注负荷剂量为1μg·kg－1（15 min内输注完）,然后以0．5μg·kg－1·h－1持续泵注至手术结束前30 min。C组（对照组,n＝20）,同样方式输注生理盐水。于麻醉前（T0）、气腹结束即刻（T1）、气腹结束后30 min（T2）和术后24 h（T3）4个时间点记录平均动脉压（MAP）、心率（HR）并抽取静脉血,测定血清过氧化氢（H2 O2）、丙二醛（MDA）和总抗氧化态（TAS）浓度。结果与T0相比,C组MAP在T1、T2时间点差异有显著性（P＜0．05）。与T0相比,T1、T2时间点C组、D组H2O2、MDA增高,TAS降低（P＜0．05）。T3时D组H2O2、MDA与T0比较差异无显著性（P＞0．05）,而C组仍较高（P＜0．05）;与C组相比,D组T2、T3时间点H2O2、MDA浓度低,TAS浓度高（P＜0．05）。两组在T1时间点H2O2、MDA差异无显著性（P＞0．05）,但D组较C组TAS浓度高（P＜0．05）。结论右美托咪定可减轻腹腔镜全子宫切除术患者氧化应激反应。     

氯诺昔康与布托啡诺用于腹腔镜胆囊切除术后镇痛效果

目的：对比观察氯诺昔康和布托啡诺用于腹腔镜胆囊切除术（LC）后镇痛的临床效果。方法：90例ASAⅠ-Ⅱ级择期在全麻下行腹腔镜胆囊切除术的患者，随机分为氯诺昔康、布托啡诺和生理盐水3组，每组30例。各组患者于术毕伤口疼痛时，分别静注氯诺昔康8mg、布托啡诺1mg和生理盐水2mL，观察并记录各组注药后1、6、12、24h的疼痛视觉模拟评分（VAS值）、镇静评分、舒适评分、生命体征的变化和不良反应的发生情况。结果：氯诺昔康、布托啡诺组术后各时点VAS评分、镇静评分、舒适评分与生理盐水组比较差异有统计学意义（P〈0．01），术后镇痛期间生命体征变化组间比较差异无统计学意义（P〉0．05），氯诺昔康组术后恶心、呕吐发生率低于生理盐水组（P〈0．05），注药后1h布托啡诺组头晕和嗜睡的发生率明显高于氯诺昔康组（P〈0．05）。结论：氯诺昔康和布托啡诺对LC患者均具有良好的术后镇痛效果，术后不良反应发生率低。     

35例腹腔镜下辅助的阴式子宫切除手术的护理

目的:研究腹腔镜下辅助的阴式子宫切除手术(LAVH)的护理及临床价值。方法:分析35例LAVH患者的临床资料。结果:35例患者均取得满意的治疗效果,康复出院。结论:腹腔镜下辅助的阴式子宫切除手术具有手术时间短、创伤小、恢复快等特点,同时对患者进行精心的护理有助于减少并发症。