新辅助化疗联合完全腹腔镜下胃癌D2淋巴结清扫对老年胃癌患者临床疗效分析

目的探讨新辅助化疗联合完全腹腔镜下胃癌D2淋巴结清扫对老年胃癌患者的临床疗效。方法选自2014年12月至2017年12月收治的97例胃癌患者,按照随机数字表法分为2组,对照组(52例)接受D2淋巴结清扫胃癌根治术治疗;观察组(45例)术前采用XELOX化疗方案,化疗完2周后行完全腹腔镜下胃癌D2淋巴结清扫胃癌根治术。比较2组患者近期疗效,包括手术时间、手术中出血量、淋巴结清扫数目、术后并发症及随访1年复发情况及远处转移情况等。结果观察组患者近期总有效率显著高于对照组,1年复发率显著低于对照组(P0.05);两组患者其他指标,包括手术时间、术中出血量、淋巴结清扫数目和术后并发症比较差异无统计学意义(P0.05)。结论老年胃癌患者采用新辅助化疗联合完全腹腔镜下胃癌D2淋巴结清扫有很好的临床疗效,值得推广。     

腹腔镜与开腹手术治疗胃癌临床效果比较

目的探讨腹腔镜与开腹手术两种术式治疗胃癌近远期疗效差异。方法研究对象选取我院2008年2月~2010年5月收治胃癌患者130例,采用随机抽签法分为对照组(65例)和观察组(65例),分别行常规开腹和腹腔镜胃癌根治术式治疗;比较两组患者围手术期临床指标,淋巴结清扫数目及随访生存率等。结果观察组患者切口长度、术中出血量、术后排气时间及住院时间均显著优于对照组(P0.05);两组患者淋巴结清扫数目和随访生存率比较差异无统计学意义(P0.05)。结论相较于常规开腹术式,腹腔镜胃癌根治术式治疗胃癌可有效减少术中创伤,提高切口美观性,并有助于缩短术后康复时间;同时两种术式在保证淋巴结清扫效果和术后生存时间方面效果接近。     

原发性胃癌腹腔镜下淋巴结清扫的效果分析

目的比较原发性胃癌患者腹腔镜下根治术与传统开腹胃癌根治术对淋巴结清扫的效果,为临床胃癌患者根治术的选择提供参考。方法选择2012年5月-2017年12月在该院择期行胃癌根治术的患者126例为研究对象,根据其手术方式的不同分为观察组和对照组,其中观察组65例,采用腹腔镜根治术;对照组61例,采用开腹根治术。比较两组患者淋巴结清扫情况、切口长度、术中失血量、手术时间、术后住院时间、术后下床活动时间、排气时间、术后并发症及肿瘤复发率。结果观察组与对照组在清扫淋巴结总数上差异无统计学意义(t=-0.89,P=0.373);在第1站清扫数上差异无统计学意义(t=-0.23,P=0.815);在第2站清扫数上差异无统计学意义(t=-1.71,P=0.089),腹腔镜手术少于开腹手术。观察组患者的切口长度、术中失血量、术后住院时间、术后下床活动时间及排气时间明显小于对照组,差异均有统计学意义(P0.05);观察组患者的手术时间长于对照组患者,差异有统计学意义(P0.05)。观察组并发症发生率为6.2%,其中切口感染1例,胸腔积液1例,肺部感染2例。对照组并发症的发生率为9.8%,其中切口感染2例,胸腔积液1例,腹腔出血1例,肺部感染2例,两组比较,差异无统计学意义(χ2=0.58,P=0.445)。结论腹腔镜胃癌根治术可达到与开腹手术同样的淋巴结清扫效果,且具有创伤小和恢复快等优点,可用于治疗原发性胃癌。     

腹腔镜辅助下与开腹胃癌根治术治疗进展期远端胃癌临床对照研究

目的 探讨腹腔镜辅助下进展期远端胃癌根治术的可行性及近期疗效.方法 远端胃癌患者93例随机分为2组,A组49例行腹腔镜辅助下远端胃癌根治术,B组44例行开腹远端胃癌根治术,比较2组手术时间、术中失血量、淋巴结清扫数目、胃肠道功能恢复时间、住院时间、术后并发症发生率及术后1,7,10dC反应蛋白水平.结果 A组手术时间长于B组(P＜0.05),术中失血量、切口长度、术后排气时间、住院时间及术后并发症发生率低于B组(P＜0.05);2组吻合方式比例及淋巴结清扫数目比较差异无统计学意义(P＞0.05);2组术后1,7,l0dC反应蛋白水平差异均有统计学意义(P＜0.05).结论 腹腔镜辅助下胃癌根治术治疗进展期远端胃癌安全、可靠,创伤小,近期疗效优于开腹手术.     

腹腔镜辅助胃癌根治术的疗效及安全性分析

目的探讨腹腔镜辅助胃癌根治术的疗效及安全性。方法回顾性分析2010年5月至2013年8月该院收治的40例胃癌患者的临床资料。接受腹腔镜辅助胃癌根治术的20例患者作为观察组,接受开腹胃癌根治术的20例患者作为对照组,观察2组患者疗效及安全性。结果观察组切除肿瘤约（5.4±0.3）cm,淋巴结清扫数目（11.1±4.2）枚;对照组切除肿瘤约（5.3±0.5）cm,淋巴结清扫数目（11.3±4.3）枚。2组术后病理诊断均未见切缘有癌细胞,观察组在根治性方面与对照组比较,差异无统计学意义（P〉0.05）。观察组术中出血量、首次下床活动时间、排气时间、首次进食时间、止痛药物使用次数、住院时间均显著低于对照组,差异有统计学意义（P〈0.05）。结论腹腔镜辅助胃癌根治术能达到胃癌开腹根治术的疗效,并且近期疗效显著。腹腔镜辅助胃癌根治术也可能广泛应用于进展期胃癌,而不仅适合于治疗早期胃癌。     

腹腔镜辅助与开腹D2根治术淋巴结清扫治疗远端进展期胃癌的效果对比

目的对比分析腹腔镜辅助与开腹D2根治术淋巴结清扫治疗远端进展期胃癌的临床疗效。方法选取远端进展期胃癌患者60例,采用随机数表法分成观察组和对照组,每组30例。对照组给予开腹D2根治术淋巴结清扫治疗,观察组给予腹腔镜辅助下行胃癌D2根治术淋巴结清扫治疗,比较两组手术治疗情况。结果观察组手术时间长于对照组,出血量、切口总长度、住院时间少于对照组,差异有统计学意义(P0.05)。观察组清扫淋巴结总数(21.02±1.15)个,对照组清扫淋巴结总数(20.89±0.85)个,两组比较差异未见统计学意义(t=0.4979,P0.05);观察组术后并发症发生率(6.67%)低于对照组(56.67%);随访6~32个月观察组1年内死亡1例(3.33%),复发5例(16.67%),对照组死亡2例(6.67%),复发3例(10.00%)。结论腹腔镜辅助下行胃癌D2根治术淋巴结清扫治疗,可缩短患者康复时间,减少术后并发症。     

腹腔镜下胃癌D2淋巴结清扫的临床疗效及中期随访报告

目的比较腹腔镜胃癌D2根治术与开腹手术的疗效,探讨腹腔镜胃癌D2根治术的可行性。方法选取浙江省瑞安市人民医院2008年10月-2013年8月收治的胃癌患者,根据患者采取的手术方式不同分为两组,其中175例腹腔镜手术患者纳入腹腔镜组,163例开腹手术患者纳入开腹组。比较两组患者的术中及术后情况、淋巴结清扫数目、并发症及肿瘤根治程度等。结果腹腔镜组清扫淋巴结(26.3±13.9)枚,开腹组清扫淋巴结(26.8±10.2)枚,差异无统计学意义(t=-0.40,P=0.684)。腹腔镜组术中出血情况以及术后排气时间均优于开腹组。腹腔镜组患者术后住院时间小于开腹组,组间比较差异有统计学意义(P0.05)。腹腔镜组的3年生存率为92.00%,与开腹组92.63%相比较,差异无统计学意义(χ2=1.54,P=0.262)。结论腹腔镜胃癌D2根治术具有安全、术后恢复快和创伤小等优点,同时能够达到与开腹组相近的淋巴结清扫效果。     

腹腔镜胃癌根治术和开腹手术对胃癌患者胃肠激素水平的影响

目的探讨腹腔镜和开腹胃癌根治术对胃癌患者胃肠激素水平的影响。方法回顾性选择2014年5月至2016年10月行胃癌根治术的患者100例,按照手术方法分为对照组和观察组,每组50例,分别施行传统的开腹手术和腹腔镜胃癌根治术。比较两组患者手术前后各种胃肠激素的变化、手术时间、手术出血量等围手术期数据,以及淋巴结清扫数量、术后并发症与手术后的转归情况。结果手术后,对照组患者的胃动素、生长抑素水平降低,血管活性肠肽水平增高,差异均具有统计学意义(P0.05);观察组患者的各项胃肠激素指标数据与手术前相比均未出现明显变化,差异均无具有统计学意义(P0.05);两组患者的淋巴结清扫数量比较,差异无具有统计学意义(P0.05);观察组患者的手术出血量、切口长度、手术后首次排气时间、肠鸣音恢复时间、住院时间比较低于对照组患者,手术时间高于对照组患者,差异均具有统计学意义(P0.05);两组患者的各类术后并发症数据差异均无具有统计学意义(P0.05);观察组患者病死率低于对照组患者,差异具有统计学意义(P0.05)。结论与开腹胃癌根治术相比,腹腔镜胃癌根治术可以降低各种胃肠激素在手术后的变化幅度,缩短患者胃肠道的恢复时间,提高患者的生存率和生存质量,值得临床推广应用。     

腹腔镜与开腹手术治疗胃癌临床效果比较

病例资料均来源于我院近期收治胃癌患者120例,以随机抽样法分为A组和B组各60例;A组患者采用传统开腹胃癌根治术式治疗,B组患者则采用微创腹腔镜胃癌根治术式治疗;比较两组患者围手术期临床指标,淋巴结清扫数目及远期生存率等。B组患者切口长度、术中出血量、术后进食时间及住院时间均显著优于A组(P0.05);两组患者手术时间比较差异无统计学意义(P0.05);两组患者淋巴结清扫数目比较差异无统计学意义(P0.05);两组患者1年、3年及5年生存率比较差异无统计学意义(P0.05)。腹腔镜术式治疗胃癌在提高美观性,减少手术创伤及加快术后恢复进程方面优于开腹术式,且未影响远期预后。     

腹腔镜下胃癌根治术D2淋巴结清扫的可行性分析

目的探讨腹腔镜下实施D2淋巴结清扫胃癌根治术的可行性与安全性。方法选取我院2011年1月~2013年12月收治的66例胃癌患者。随机分为观察组和对照组各33例。对照组采用腹腔镜辅助下实施胃癌根治术进行治疗,观察组采用完全腹腔镜下实施胃癌根治术治疗。术后比较两组患者手术时间、术后首次排气时间、住院时间、术中出血情况、并发症。结果观察组手术时间明显长于对照组,差异有统计学意义(P0.05),但观察组术后首次排气时间、住院时间、术中出血情况、并发症均好于对照组,差异有统计学意义(P0.05)。结论完全腹腔镜下实施D2淋巴结清扫胃癌根治术,虽手术时间较长,但能有效减少患者并发症,且能缩短患者的住院时间,对患者胃肠功能恢复较快,值得在临床上进行推广并应用。     

电子手术申请单与手术排班系统的改进与应用

目的完善电子手术申请单内涵,改进手术排班系统,满足手术需求,使手术室整体资源高效运转。方法重整电子手术申请及手术排班工作流程,规范了电子手术申请单内容的填写,完善了手术患者的信息,也设置了临床医师提交和取消手术申请单的权限,建立了急诊手术的绿色通道,为手术患者的术前准备工作提供依据和保障。结果运行3个月期间,特殊仪器设备与器械安排有误、手术信息取消、手术切口分类与手术安排有误等不良情况发生率明显下降。结论该系统为手术室整体资源共享,确保手术患者的安全,提高工作效率等方面提供了保障。     

Minimally invasive valve surgery: different techniques and approaches

Less invasive approaches to cardiac surgical procedures are being developed in an effort to decrease patient morbidity and enhance postoperative recovery in comparison with conventional methods. Although full median sternotomy has been the standard surgical approach to the heart for more than 30 years, minimally invasive techniques using limited incisions are rapidly gaining acceptance. Potential advantages of a small skin incision include less trauma and tissue injury, leading to a less painful and quicker overall recovery, as well as shorter hospital stays for patients. Decreasing the size of the skin incision for minimally invasive valve surgery to significantly less than the cardiac size requires specific access to the valve to be repaired or replaced. Thus, various minimally invasive techniques and approaches have been described for aortic and mitral valve surgery [111]. This article will review the different minimally invasive techniques and approaches, as well as early results and outcomes for aortic and mitral valve surgery.     

急诊Ⅰ期手术和控制性手术治疗肝胆外科损伤的临床效果比较

目的比较急诊Ⅰ期手术和控制性手术治疗肝胆外科损伤的临床效果。方法以2017年5月至2018年5月我院接收的68例肝胆外科损伤患者作为研究对象,根据治疗方法的不同将其分为参照组和控制性手术组,各34例。参照组采用常规急诊Ⅰ期手术治疗,控制性手术组采用控制性手术治疗。观察两组治疗前及治疗1周后的pH值、体温、血浆凝血酶原时间(PT)、手术时间、住院时间、治疗1周后的并发症发生情况及治疗2周后的死亡率。结果治疗1周后,两组pH值、体温明显高于治疗前,PT明显短于治疗前,且控制性手术组优于参照组(P<0.05)。控制性手术组的手术时间明显短于参照组,住院时间明显长于参照组(P<0.05)。治疗1周后,控制性手术组的并发症总发生率明显低于参照组(P<0.05)。治疗2周后,控制性手术组的死亡率明显低于参照组(P<0.05)。结论相比于常规急诊Ⅰ期手术,肝胆外科损伤患者通过控制性手术治疗的临床价值显著,值得在临床上推广应用。     

History and current status of bariatric and metabolic surgeries in East Asia

Morbid obesity and obesity‐related comorbidities are major public health problems around the world, including in East Asia. Although Asian populations have been shown to have an elevated risk of type 2 diabetes mellitus, hypertension, and hyperlipidemia at a relatively lower BMI than Western populations, the Asian perspective on bariatric and metabolic surgeries has not been actively discussed until recently. Bariatric surgery in East Asia has undergone a paradigm shift since the first laparoscopic vertical bariatric surgery was performed in Taiwan in 1998, which was subsequently followed by the introduction of laparoscopic adjustable gastric banding, Roux‐en‐Y gastric bypass, and mini‐gastric bypass. Since 2006, use of laparoscopic sleeve gastrectomy has remarkably increased because of its ease, speed, and safety. With regard to metabolic surgery, a randomized controlled trial in Taiwan demonstrated that laparoscopic Roux‐en‐Y gastric bypass is more effective than laparoscopic sleeve gastrectomy for surgical treatment of poorly controlled type 2 diabetes mellitus and metabolic syndrome. In this article, we describe the history of bariatric procedures, revision surgeries, weight‐loss effect, and metabolic surgeries in Asian populations, and we also discuss minimally invasive bariatric surgery with some important citations.     

The past,present and future of minimally invasive spine surgery: A review and speculative outlook

Abstract

In the last 25 years of spinal surgery, tremendous improvements have been made. The development of smart technologies with the overall aim of reducing surgical trauma has resulted in the concept of minimally invasive surgical techniques. Enhancements in microsurgery, endoscopy and various percutaneous techniques, as well as improvement of implant materials, have proven to be milestones. The advancement of training of spine surgeons and the integration of image guidance with precise intraoperative imaging, computer- and robot-assisted treatment modalities constitute the era of reducing treatment morbidity in spinal surgery. This progress has led to the present era of preserving spinal function. The promise of the continuing evolution of spinal surgery, the era of restoring spinal function, already appears on the horizon. The current state of minimally invasive spine surgery is the result of a long-lasting and consecutive development of smart technologies, along with stringent surgical training practices and the improvement of instruments and techniques. However, much effort in research and development is still mandatory to establish, maintain and evolve minimally invasive spine surgery. The education and training of the next generation of highly specialized spine surgeons is another key point. This paper will give an overview of surgical techniques and methods of the past 25 years, examine what is in place today, and suggest a projection for spine surgery in the coming 25 years by drawing a connection from the past to the future.     

腹部手术患者术前心理需求的调查分析

目的了解胃肠、胆囊手术患者术前心理需求,为制定更加个性化的护理措施提供依据。方法选择2008年11月~2009年3月在本院普外科实施胆囊胃肠择期手术患者共148例,其中腹腔镜胆囊切除手术患者73例,其他经腹手术患者75例,采用自行设计调查问卷对患者进行心理需求的调查,并对调查结果进行分析。结果共同心理需求为:①手术的安全性;②术后的恢复及手术对自己的影响;③术后放置引流管及引起的并发症;④胃肠功能恢复的时间;⑤患者对主刀医生的期望主要为经验丰富、技术好。个体差异心理需求为:疼痛及术后护理方法。结论择期手术患者的心理需求存在其共性特点和个体差异,对于护理措施的制定具有指导意义。     

腹腔镜胆囊切除术治疗胆结石的效果及对患者胃肠功能的影响

目的研究腹腔镜胆囊切除术治疗胆结石的效果及对患者胃肠功能的影响。方法选取我院2016年1月至2019年1月收治的156例胆结石患者作为研究对象,按手术方式的不同将其分为对照组(63例,开腹手术)和观察组(93例,腹腔镜胆囊切除术)。比较两组的治疗效果。结果观察组的治疗总有效率与结石清除率显著高于对照组,差异具有统计学意义(P<0.05)。观察组的肛门首次排气时间、肠鸣音恢复时间、正常排便时间及正常进食时间均短于对照组,差异具有统计学意义(P<0.05)。术后,两组的血清GAS、MTL、SS水平均降低,但观察组均优于对照组,差异具有统计学意义(P<0.05)。术后1 d,两组的GGT、TBIL、AST及ALT水平均升高,但观察组低于对照组(P<0.05);术后5 d,观察组的GGT、TBIL、AST及ALT水平均低于对照组,差异具有统计学意义(P<0.05)。结论相较于传统开腹手术,腹腔镜手术治疗胆结石对患者胃肠功能及肝功能影响小,治疗有效率高,值得临床进一步推广和应用。     

The importance of differentiating between elective and emergency postoperative critical care patients

Purpose

The purpose of the study is to demonstrate the importance of separately analyzing data on elective and emergency surgery patients admitted postoperatively to intensive and intermediate care units.

Materials and Methods

A prospective observational study was performed in a tertiary care university hospital to assess the demographic and clinical differences between emergency and elective surgical patients (>14 years old). Group 1 included patients transferred to a floor bed or the ambulatory surgery unit for discharge home after a short stay (<12 hours) in the postanesthesia care unit. Group 2 patients were admitted to the cardiothoracic intensive care unit (ICU), neurosurgical ICU, general ICU, or for an extended intermediate care postanesthesia care unit stay (>12 hours).

Results

In groups 1 (n = 1059), there were significant differences between the elective and emergency patients. Emergency, as compared with elective group 2 (n= 1883) patients, experienced more severe preexisting illnesses (ie, had higher American Society of Anesthesiology classifications), underwent different and shorter operations, required prolonged postoperative mechanical ventilation, required longer ICU stays, and had higher mortality.

Conclusions

Substantial differences between elective and emergency surgery patients have important implications when conducting and reporting research on the nature, extent, and outcome of postoperative ICU care.