腹腔镜手术治疗妇产科疾病临床观察

目的 通过分析腹腔镜手术在治疗妇产科疾病中的临床应用,探讨手术治疗效果.方法 对本院行腹腔镜手术治疗疾病的121例妇科患者临床资料进行回顾性分析.结果 腹腔镜手术在妇产科中疾病的治疗中应用广泛,患者术后恢复比较快,同时疼痛创伤比较小,操作过程简单易行.结论 行腹腔镜手术治疗妇产科疾病效果显著,能够减轻病人的痛苦,有出血少、恢复快、简便易行等优点,是妇产科手术的首选.     

3D打印Dry Lab模型在腹腔镜胃底折叠手术教学中的应用

3D打印模型的腹腔镜下手术培训寻是一种新颖、教学成本低、效果好的教学方法，一定程度上弥补传统教育和实践操作教育之间的不足。利用3D抗反流手术模型在腹腔镜下完成胃底折叠手术学习曲线，对于外科医师手术技术的提高将有极大的帮助，同时也可以弥补由于手术量不足及患者个体解剖变异所带来的手术难度及风险的提升，有利于规避患者术中和术后并发症的发生，为手术规范化标准化提供保证。     

手术室护士实施综合性护理干预对腹腔镜胆总管切开探查取石术患者心理状况及并发症的影响

目的探讨手术室护士实施综合性护理干预对腹腔镜胆总管切开探查取石术患者的心理状况及并发症的影响。方法全部入选病例均为本院2013年1月~2014年3月期间择期行腹腔镜胆总管切开探查取石术患者,根据护理方法不同分为干预组和对照组各40例,两组患者均由手术室护士进行围术期护理,其中对照组实施常规护理及随机对症护理,干预组手术室护士着重实施包括心理干预、T形管的护理、并发症的护理等综合性护理干预措施,比较两组患者术前和术后的焦虑心理状况SAS评分、两组患者的术中出血量、手术时间、术后排气时间、住院时间及两组患者的并发症情况。结果干预组和对照组的SAS评分术后与术前比较差异有统计学意义(P<0.05),且干预组患者术后的SAS评分显著低于对照组(P<0.05)。干预组患者的术中出血量、术后排气时间与对照组比较,差异有统计学意义(P<0.05),干预组患者的手术时间、住院时间略短于对照组,组间比较差异无统计学意义(P>0.05)。两组均未发生胆道狭窄,干预组患者术后发生胆石残留1例,术后出血1例,其并发症发生率达5.0%,显著低于对照组患者术后的并发症发生率27.5%(P<0.05)。其中干预组患者术后出血的发生率达2.5%,显著低于对照组的12.5%(P<0.05)。结论手术室护士对腹腔镜胆总管切开探查取石术患者通过实施综合性护理干预,有利于减轻患者的焦虑心理,减少并发症的发生率,从而明显提高手术治疗效果。     

经脐单一切口腹腔镜阑尾切除术131例分析

目的 探讨经脐单一切口腹腔镜阑尾切除术（transumbilical single-incision laparoscopic appendectomy,TUSILA）的可行性和应用价值.方法 我院2008年2月～2011年6月行131例TUSILA,在脐环下缘沿脐缘做弧形切口,长1.5~1.8 cm,于弧形切口置入1个10 mm trocar和2个3 mm trocar,trocar内置入10 mm 30°腹腔镜和腹腔镜器械,完成腹腔镜下阑尾切除术.结果 129例成功施行TUSILA,2例因阑尾周围粘连严重和阑尾后位中转开腹（中转率1.5%）.129例TUSILA手术时间25～130 min,平均40 min.无切口感染,术后1~3 d出院,平均2.6 d.129例TUSILA电话或门诊随访6个月,脐部切口瘢痕不明显,无脐疝出现,美容效果好.结论 TUSILA微创、美观、安全可行,值得推广.     

The suprahepatic approach. An easy laparoscopic access to the hiatus in obese patients

The conventional laparoscopic access to the gastroesophageal junction involves the retraction the left hepatic lobe upward. This approach could be particularly difficult in obese patients because of a huge fatty liver. The technique described here aims to overcome this difficulty be using a suprahepatic route by displacing the left lobe downward after dividing the left triangular ligament. This approach allows a good exposure of the gastroesophageal junction to perform a fundoplication or a gastric banding.     

Genital prolapse and colpocele. Coelioscopic sacrocolpopexy

Genito-urinary prolapse is a common disease that requires a global approach which includes all the compartments. Sacrocolpopexy with anterior and posterior mesh allows long-lasting anatomical restoration with a preservation of the sexual function. The laparoscopic approach is a modern and efficient answer for this functional surgery.     

Surgical management for slow-transit constipation

Less than 10% of patients with slow-transit constipation require surgical management after failure of medical treatment. Preoperative clinical, psychological and colorectal routine investigations (ie colonic transit test, anorectal manometry and defecography) are mandatory in order to highly select the patients. To day, the surgical management of slow-transit constipation consists of subtotal colectomy with ileorectal anastomosis, eventually by laparoscopic approach. Although, surgical management improves slow-transit constipation in two thirds of the patients, small bowel obstruction, abdominal pain and constipation recurrence can occur in 25%, 50%, and 10% of the patients respectively.