不同时间电针对直肠癌开腹手术患者围术期应激反应和免疫功能的影响

目的观察不同时点电针对直肠癌开腹手术患者围术期应激反应及免疫功能的影响。方法240例择期行直肠癌根治性开腹手术而住院的患者,随机分为A组、B组、C组、D组,每组60例。A组设为空白对照组,B组于手术前1 d、C组于手术前1 d和麻醉诱导前30 min、D组分别于手术前1 d、麻醉诱导前30 min及手术后1 d行电针。分别于手术前1 d电针前(T1)、麻醉诱导前电针前(T2)、术毕(T3)和手术后1 d电针后(T4)4个时间采集患者空腹外周静脉血,用Sysmex血细胞分析仪对白细胞与中性粒细胞进行计数;ELISA检测急性期C反应蛋白(CRP)与热反应蛋白70(HSP70)以及细胞因子白介素6(IL-6)、干扰素(IFN-g)、白介素4(IL-4)水平,并计算IFN-g与IL-4比值;采用流式细胞仪测定CD4、CD8的细胞含量并计算两者比值。结果HSP70与CRP水平、白细胞数与中性粒细胞数、IL-4与IL-6水平变化趋势均一致,4组T1、T2时间比较,差异无统计学意义(P>0.05);A组与B组T3和T4时间比较,差异无统计学意义(P>0.05);C组、D组T3和T4时间显著低于A组与B组(P<0.05);D组T4时间显著低于C组(P<0.05);4组T2时间与T1时间比较差异无统计学意义(P>0.05),T3时间高于T2时间(P<0.05),T4时间低于T3时间(P<0.05)。IFN-g变化不显著(P>0.05),IFN-g/IL-4、CD4/CD8变化趋势与以上相反。结论电针术前使用对直肠癌患者无显著疗效,但能够减轻术后应激反应和免疫抑制,并且随着电针次数的合理增加疗效更加显著。     

腹腔镜结合术中内窥镜治疗结直肠良性病变13例分析

目的 探讨腹腔镜手术结合术中内窥镜治疗结直肠良性病变的方法和临床意义.方法 回顾性分析2004年6月至2006年12月13例结直肠良性病变以腹腔镜结合术中内窥镜治疗的患者的临床资料.结果 结肠多发性息肉1例,息肉3枚,直径1.5 cm～2.5 cm,乙状结肠、降结肠和直肠上段单发息肉或腺瘤11例,病变直径1.5 cm～3.0 cm,降结肠憩室并出血1例,直径1 cm,全部患者均在腹腔镜下结合术中内窥镜定位,经腹壁小切口找到定位处肠管切开后完整切除病变或缝扎憩室.无术后并发症.结论 腹腔镜结合术中内窥镜治疗结直肠良性病变定位准确、创伤小、安全有效,适合结直肠大部分位置良性疾病的治疗.     

腹腔镜辅助阴式子宫切除术与经腹子宫切除术的前瞻性随机对照研究

目的　比较评估腹腔镜辅助阴道子宫切除术与经腹子宫切除术两种手术的临床效果。方法　 12 0例妇科良性疾病患者需行子宫切除术 ,但有经阴道子宫切除术的相对禁忌证、子宫不超过孕 16周 ,随机分成两组 ,甲组 (6 0例 )行腹腔镜辅助阴式子宫切除术 ,乙组 (6 0例 )行经腹子宫切除术。结果　两组患者年龄、产次、术前血红蛋白水平、子宫平均重量、术中失血、手术时间的差异无显著性 (P >0 .0 5 )。甲组术后疼痛程度、术后住院时间明显少于乙组 (P <0 .0 1) ,两组均未出现严重手术并发症。结论　腹腔镜辅助阴式子宫切除术具有创伤小、恢复快、住院时间短等优点 ,妇科医师经过良好的腹腔镜手术操作技能培训 ,能对大部分原不宜行阴式子宫切除术而需行经腹子宫切除术的患者行腹腔镜辅助阴式子宫切除术。     

Appendizitissonographie durch chirurgen — Erfahrungssache? Eine prospektive studie

A number of studies have shown that ultrasound has an advantage over physical examination in the diagnosis of acute appendicitis. Most of these studies were conducted by experts in the field of ultrasonography. In this study the influence of experience on the results of the sonography of actue appendicitis were evaluated. All 203 patients admitted to our unit between December 1990 and December 1992 were examined physically and sonographically by a team of surgeons consisting of one experienced sonographer and six inexperienced surgical trainees. Laparotomy was performed in 136 patients (46%). Appendicitis was demonstrated histologically in 119 cases (39.4%). Initial clinical findings were positive in 87 (28.8%). Sonography was positive in 119 patients (39.4%). The 163 patients not operated on demonstrated other pathology on ultrasound in 60 cases (19.9%). The rate of negative laparotomies amounted to 7.2% in our study. Sensitivity and specificity for the sonographic diagnosis were 92% and 95%, respectively. They were only 81% and 80% for physical examination. Overall accuracy was 92% for sonography. Sensitivity and specificity for the inexperienced surgeons were 87% and 93%, respectively, while the experienced surgeon reached values of 97% and 98%, respectively. The results of both groups are comparable with values in the literature, suggesting that ultrasound evaluation of appendicitis is not a diagnostic tool limited to a few experienced sonographers.     

Laparoscopy or laparotomy for the management of endometrial cancer.

OBJECTIVE: The aim of this study was to evaluate the feasibility of laparoscopy in the management of early stage endometrial cancer. METHODS: Fifty-two patients with endometrial cancer who underwent surgical staging consisting of total hysterectomy, bilateral salpingo-oophorectomy with pelvic lymph node dissection, and cytology between 1998 to 2002 were included in the study. Laparotomy and laparoscopy were randomly offered to patients upon admittance. RESULTS: Of 52 patients, 26 underwent laparotomy and the remaining 26 underwent laparoscopic staging surgery. No significant difference existed between the demographic characteristics of the 2 groups. The mean number of harvested lymph nodes was 18.2 in the laparoscopic group and 21.1 in the laparotomic group (P>0.05). Pelvic lymph node metastases were detected in 7.7% of the patients in the laparoscopy group and 15.4% in the laparotomy group, and the difference was not significant. Adjuvant radiotherapy was applied later to 42.3% of the laparoscopy group and 38.5% of the laparotomy group. Operative morbidity was higher in the laparotomy group mainly because of postoperative wound infection, and the patients in the laparotomy group had a longer hospital stay. CONCLUSION: Laparoscopic surgery is a method that can be applied as well as laparotomy in the management of endometrial cancer. Lymph node number and detection of lymph node metastasis did not differ significantly in laparotomic and laparoscopic approaches. Wound infections were more frequent in laparotomies.     

Abdominal Stab Wounds in Children: an 18-Year Experience

Objective: Evaluation of the diagnosis, management, and the role of selective treatment in children with abdominal stab wounds. Patients and Methods: 59 children (56 male and three female) were included in the study. The patients' median age was 11.8 years (range, 5–14 years). Time between injury and admission was about 3 h. Laparotomy was performed in 44 patients (74%). Solid organ injury was detected in 32 of these patients (73%) and could not be observed in twelve (27%). 15 patients (26%) were treated conservatively, and only one (6.6%) underwent laparotomy during the follow-up. The stomach was the most frequently injured organ (ten patients), followed by the intestines (nine patients). Types of surgical treatment were as follows: primary suture in 28 patients, resection-anastomosis in three, and osteotomy in two. Results: Some prognostic factors such as presence of abdominal organ evisceration and pneumoperitoneum were not significantly correlated with intraabdominal organ injury, whereas some other risk factors such as acute abdomen on admission (p < 0.002) or abdominal clinical and hemodynamic findings (p < 0.001) showed significant correlation with intraabdominal organ injury. The relative risk (odds ratio) of developing an intraabdominal organ injury was > 2 for patients with signs of an acute abdomen on admission. Postoperative complications were observed in five patients with organ injuries. None of our patients died. Conclusions: Conservative treatment can be safely performed in most children with abdominal stab injuries. Signs of major internal hemorrhage or generalized peritonitis are an absolute indication for emergency operation for abdominal stab wounds. Peritoneal penetrations, free air on the abdominal X-ray, and omental or intestinal evisceration are poor indicators of significant organ injuries, and patients presenting these signs shold be closely followed up for developing acute abdominal symptoms. Received: November 2, 2001; revision accepted: February 15, 2002     

透明质酸钠粉雾剂防治开腹术后腹腔粘连的实验研究

为观察透明质酸钠粉雾剂防治开腹术后粘连的作用并探讨其作用机制，将30只大鼠均分为A、B两组，开腹摩擦回肠肠管形成腹腔粘连，B组损伤局部应用透明质酸钠粉雾剂，3周后观察粘连状况。结果两组共死亡3只，A组Ⅱ级粘连3只，Ⅲ级10只；B组0级、Ⅰ级及Ⅲ级各为2、11和1只，经秩和检验两组有显著性差异（P＜0．05）。表明透明质酸钠粉雾剂可有效防止或减轻大鼠术后腹腔粘连，为临床防治开腹术后粘连及其并发症提供了一种简便、有效的方法。     

急诊腹腔镜治疗出血性宫外孕202例临床分析

目的探讨急诊腹腔镜治疗出血性宫外孕的可能性、优越性。方法回顾分析1998年8月~2005年10月急诊腹腔镜出血性宫外孕402例,随机分为腹腔镜组202例,开腹组200例。比较两组手术时间、并发症、术后病率、术后输卵管通畅情况。结果腹腔镜比开腹手术住院时间短、术后恢复快、并发症少、术后病率少。手术时间,腹腔镜组(1998年8月~2001年12月)比开腹手术组长,(2002年1月~2005年10月)短于开腹组,结论腹腔镜手术应用于急腹症出血性宫外孕,当休克早期,在抗休克的同时行腹腔镜手术较安全、有效,病人术后恢复快、不增加并发症,更适应有生育要求患者。     

腹腔镜与开腹胆囊癌根治术治疗早期胆囊癌疗效的Meta分析

目的:比较早期胆囊癌行腹腔镜与开腹胆囊癌根治术的临床疗效。方法:计算机检索英文及中文数据库关于腹腔镜与开腹手术治疗早期胆囊癌的对照研究,检索截止时间为2019年12月。对纳入的文献进行质量评价与数据提取后,采用RevMan 5.3软件进行Meta分析。结果:共纳入8项研究、462例患者,其中腹腔镜组214例,开腹组248例。Meta分析结果显示,与开腹组相比,腹腔镜组术中出血量少(WMD=-113.44,95%CI=-163.58~-63.30,P<0.00001),并发症发生率低(OR=0.51,95%CI=0.27~0.96,P=0.04)、术后住院时间短(WMD=-5.03,95%CI=-6.61~-3.46,P<0.00001)、术后局部复发率低(OR=0.42,95%CI=0.20~0.87,P=0.02),两组手术时间(WMD=-22.39,95%CI=-52.02~7.24,P=0.14)、淋巴结清扫数量(WMD=-0.86,95%CI=-2.34~0.62,P=0.25)差异无统计学意义。结论:相较开腹胆囊癌根治术,腹腔镜胆囊癌根治术治疗早期胆囊癌是安全、可行的,在减少术中出血、缩短术后住院时间、降低术后并发症发生率与术后局部复发率等方面具有优势。     

右半结肠癌No.206组淋巴结转移的观察研究

目的:分析右半结肠癌No.206组淋巴结转移的规律,为淋巴结的清扫提供临床参考。方法:回顾性收集2015年1月至2019年12月完成的111例右半结肠癌根治术患者的临床资料。观察指标:人口学特征、手术与术后恢复情况、术后病理学检查、随访及生存情况。结果:111例患者中男59例,女52例,中位年龄60岁。肿瘤部位回盲部9例,升结肠37例,结肠肝曲62例,横结肠右侧3例。患者均顺利完成右半结肠癌根治术,其中腹腔镜手术79例,开放手术8例,达芬奇手术24例;腹腔镜手术中1例中转开腹。手术时间110(98,115)min,术中出血量30(20,50)mL,术后肛门排便时间4(3,5)d,术后住院7(6,8)d。术后总并发症发生率9.9%(11/111),其中切口感染、脂肪液化5例,乳糜瘘5例,吻合口出血1例。病理标本肿瘤TNM分期Ⅰ期17例、Ⅱ期44例、Ⅲ期49例、Ⅳ期1例。淋巴结检出27(23,31)枚,阳性淋巴结检出0(0,2)枚,淋巴结转移率为44.14%(49/111)。No.206组淋巴结检出数为3(1,4)枚,阳性淋巴结检出数为0(0,0)枚,淋巴结转移率为0.9%(1/111)。术后102例(91.9%)获得随访,9例失访,随访7~65个月,中位随访时间23个月。5年总生存率86.3%,5年无病生存率73.4%。结论:右半结肠癌No.206组淋巴结转移率较低,如果术前或术中评估怀疑No.206组淋巴结转移或局部进展期肝曲结肠癌,建议清扫No.206组淋巴结。