腹腔镜与传统开腹阑尾切除术临床对比分析

目的对比分析腹腔镜下阑尾切除术与传统开放式阑尾切除术的疗效。方法回顾2010～2012年收治、行腹腔镜下阑尾切除术的急性阑尾炎患者49例（观察组）,及同期收治、行开放式阑尾切除术的急性阑尾炎患者44例（对照组）,比较两组手术时间、术中出血量、疼痛评分、术后肛门排气时间、术后并发症发生情况、住院时间及住院费用等,评价其综合疗效。结果临床情况：两组患者手术时间无显著性差异（P〉0.05）;观察组的术中出血量、疼痛评分、术后肛门排气时间、住院时间及住院费用均少于或小于对照组（P〈0.05）;并发症发生情况：观察组术后并发症发生率4.1%,显著低于对照组11.4%（P〈0.05）。结论腹腔镜下阑尾切除术较传统开放式阑尾切除术创伤小、恢复快、并发症发生率低,患者住院时间和医疗费用少,适用于多种阑尾炎的临床推广。     

鼻内窥镜联合柯-陆氏手术治疗真菌性鼻窦炎临床分析

目的：观察鼻内窥镜联合柯-陆氏手术对真菌性鼻窦炎的临床疗效。方法：功能性鼻内窥镜术联合柯-陆氏手术。结果：真菌性鼻窦炎经手术治疗,病变清除彻底,引流通畅,疗效好,术后随访1～2年无复发。结论：鼻内窥镜联合柯-陆氏手术治疗真菌性鼻窦炎疗效好。     

比较腹腔镜手术与传统开腹手术治疗胃十二指肠溃疡穿孔的效果研究

目的研究比较腹腔镜手术与传统开腹手术治疗胃十二指肠溃疡穿孔的效果。方法入选研究对象为80例胃十二指肠溃疡穿孔患者,其于2018年1月~2019年3月入院治疗,随机将其平均分为对照组与干预组,对照组应用传统开腹手术治疗,干预组选择腹腔镜手术治疗,对比两组手术指标、VAS评分与并发生发生率。结果与对照组比较,干预组各项手术指标较优,VAS评分降低,并发生发生率较低,差异有统计学意义(P 0.05)。结论对胃十二指肠溃疡穿孔患者实施腹腔镜手术治疗的临床效果明显优于传统开腹手术的治疗效果。腹腔镜手术治疗不仅可以缩短手术时间、术中出血量以及住院时间,同时也能够大大降低患者术后的疼痛感,减少患者术后并发症的发生率,促进患者早日康复出院。     

腹腔镜与开腹手术治疗异位妊娠的效果比较

目的比较腹腔镜手术与开腹手术两种术式对异位妊娠的治疗效果。方法对异位妊娠患者行腹腔镜手术65例和开腹手术54例的临床资料进行回顾性分析,比较两组手术的失血量、术后镇痛、肛门排气时间、术后并发症、住院时间、术后发热、术后应用抗生素的时间、腹部瘢痕、留置导管时间、术后通畅率等临床指标。结果腹腔镜组和剖腹手术组在术中失血量[（37．5±15．6）ml与（21．3±9．5）Ⅱ11]、术后镇痛（82％与26％）、肛门排气时间[（32．6±7．8）h与（19．4±4．2）h]、术后并发症（46％与17％）、住院时间[（7．6±1．9）d与（3．3±1．1）d]、术后发热（74％与24％）、术后应用抗生素的时间[（6．3±2．2）h与（3．6±1．2）h]、腹部瘢痕（无与有）、留置导管时间[（29．5±4．6）h与（7．4±2．3）h]、术后通畅率等方面有明显差异（P〈0．05）。结论腹腔镜手术治疗异位妊娠优于传统开腹手术。     

腹腔镜与开腹手术治疗异位妊娠的效果比较

目的通过对腹腔镜与开腹手术治疗异位妊娠疗效的对比分析,探讨腹腔镜手术治疗异位妊娠的优越性。方法腹腔镜手术68例(腹腔镜组)与开腹手术68例(开腹手术组)术中及术后恢复情况进行回顾性比较。结果腹腔镜组与开腹组手术治疗异位妊娠的手术成功率、手术时间、术中出血量分别为100%vs100%、(62.2±16.5)minvs(53.5±10.2)min、(45.64±26.58)mlvs(58.18±25.37)ml,两组相比无统计学意义(P>0.05);腹腔镜组与开腹组手术治疗异位妊娠术后胃肠道反应及疼痛发生例数、排气时间、及住院时间分别为7.35%vs32.35%、10.29%vs76.47%、(15.42±6.15)hvs(40.37±5.96)h、(3.94±1.27)dvs(7.64±1.95)d,两组相比有统计学意义(P<0.05)。结论腹腔镜手术治疗异位妊娠具有创伤小、术后恢复快,,并发症少,住院天数少,美容等优越性。     

创伤性脾损伤的保守手术与根除治疗对比分析

目的：探讨创伤性脾损伤的保守手术与根除治疗的对比效果。方法：将40例创伤性脾损伤患者平分为两组,对照组采用开腹全脾切除术,治疗组采用保守手术治疗。结果：经过治疗后,治疗组的有效率为95.0%,对照组的有效率为75.0%,治疗组的有效率明显好于对照组（P〈0.05）。对照组发生并发症8例,其中肺部感染7例,粘连性肠梗阻1例;治疗组发生并发症2例,其中肺部感染1例,粘连性肠梗阻1例。两组并发症经对症治疗后均获得治愈,两组并发症对比差异有统计学意义（P〈0.05）。结论：相对于根除治疗,保守手术治疗创伤性脾损伤能提高治疗疗效,降低并发症,值得推广应用。     

A systematic review and meta-analysis of the safety profile of fast-track surgery for colorectal surgery

Background

The aim of this study was to evaluate the safety profile of fast-track surgery (FTS) compared to standard care in elective colorectal surgery involving segmental colonic and/or rectal resection.

Methods

All of the randomized controlled trials (RCTs) and non-randomized controlled clinical trials (CCTs) on FTS for colorectal surgery were analyzed with the Cochrane systematic review. Database retrievals of Medline, Embase and Cochrane was were conducted, together with two published FTS meta-analyses. Two reviewers independently assessed the quality of the studies, extracted the relevant data and performed a cross-check. A metaanalysis was performed with RevMan 5 software.

Results

A total of 15 studies were reviewed in this study, including 13 articles in English and 2 articles in Chinese, of which 7 were RCTs and 8 were CCTs. The overall rates of morbidity and readmission in the FTS group were lower compared to patients who underwent the conventional treatments (conventional treatment group or control group) in the RCTs but tended to increase in the CCTs. There were no statistically significant differences between the FTS group and the control group regarding ileus, anastomotic leakage, abdominal distention, nausea and vomiting, urinary retention and infection of the incisional wound.

Conclusion

The overall rates of morbidity and readmission in the FTS group were similar or even lower compared to the control group in RCTs, with an increasing trend in the CCTs. Further discussion is needed as to why the results of the RCTs were not repeated in the CCTs, especially with regard to the causes of readmission. It should also be determined whether an early discharge might cause a delay in the diagnosis of some complications, and thereby the occurrence of serious complications. If a number of severe complications occurred due to an early discharge, the value of FTS would be in question.     

腹腔镜与开腹手术治疗异位妊娠的护理比较分析

目的通过比较腹腔镜与开腹手术治疗异位妊娠护理的异同,探讨腹腔镜手术治疗异位妊娠的优越性。方法将本院2008年1月至2009年2月异位妊娠患者分为腹腔镜组43例和开腹组42例,比较两组护理特点及术后恢复情况。结果两组患者手术及恢复顺利,术后无并发症。比较两组手术时间、术中出血量及血β-HCG恢复天数均无明显差异（P〈0.05）;术后腹腔镜组的肛门排气时间、下床活动时间、切口疼痛时间、术后输液天数、住院天数均低于开腹组（P〈0.05）,差异有统计学意义。结论腹腔镜手术治疗异位妊娠具有创伤小、术后恢复快,并发症少,住院天数少等优越性,同时节省了护理时间,提高了护理工作的效率,值得临床推广和使用。     

腹腔镜直肠癌手术与传统开腹直肠癌手术的临床效果比较

目的 探究腹腔镜手术与传统开腹手术用于直肠癌治疗的临床效果.方法 选取2010年6月至2014年6月我院收治的直肠癌患者46例,随机分为对照组(23例)和观察组(23例),其中对照组采取传统开腹手术治疗,观察组接受腹腔镜直肠癌根治术治疗.比较两组患者的临床疗效及随访情况.结果 与对照组相比,观察组手术时间较长,而术中出血量、切口总长度、肛门排气时间、导尿管留置时间、肠道功能恢复时间和住院天数等显著缩短,差异具有统计学意义(P＜0.05);两组患者在并发症发生率、远处转移率、局部复发率和3年无瘤生存率方面比较,差异无统计学意义(P＞0.05).结论 两种治疗方法具有相似的近期和远期疗效,但腹腔镜直肠癌根治术在减轻创伤、促进肠道恢复、缩短住院时间等方面更具优势,值得推广应用.     

腹腔镜手术器械灭菌方法的探讨

目的：探讨腹腔镜手术器械安全可靠的消毒灭菌方法。方法：对我科常用的5种腹腔镜手术器械消毒灭菌方法进行比较．分析其主要的优缺点和使用上的注意事项。结果：低温等离子灭菌和江日waywin-2000型医用内窥镜灭菌最能适用腹腔镜手术需要。结论：采用低温等离子灭菌和江日-2000型医用灭菌器最适用于腹腔镜手术器械的灭菌,它们既保证了灭菌的安全可靠,反复消毒对器械损伤小,又能满足腹腔镜连台手术器械的周转,缩短了围手术时间,从而提高了医疗护理质量。     

Molecular imaging for cancer diagnosis and surgery

Novel molecular imaging techniques have the potential to significantly enhance the diagnostic and therapeutic approaches for cancer treatment. For solid tumors in particular, novel molecular enhancers for imaging modalities such as US, CT, MRI and PET may facilitate earlier and more accurate diagnosis and staging which are prerequisites for successful surgical therapy. Enzymatically activatable “smart” molecular MRI probes seem particularly promising because of their potential to image tumors before and after surgical removal without re-administration of the probe to evaluate completeness of surgical resection. Furthermore, the use of “smart” MR probes as part of screening programs may enable detection of small tumors throughout the body in at-risk patient populations. Dual labeling of molecular MR probes with fluorescent dyes can add real time intraoperative guidance facilitating complete tumor resection and preservation of important structures. A truly theranostic approach with the further addition of therapeutic agents to the molecular probe for adjuvant therapy is conceivable for the future.     

腹腔镜与开腹手术治疗异位妊娠的效果比较

目的对比分析腹腔镜与开腹手术治疗异位妊娠的临床效果。方法选择2010年1月～2013年1月于本院进行治疗的120例异位妊娠患者,按照治疗方法将其分为两组,治疗组（n=60）行腹腔镜手术治疗,对照组（n=60）行开腹手术治疗,比较两组的术中出血量、不良反应等指标。结果治疗组的术中出血量、手术时间、排气时间、腹痛消失时间和住院时间均明显少于对照组,差异有统计学意义（P〈O．01）;治疗组伤口疼痛发生率和不良反应发生率分别为3．33％和11．67％,明显低于对照组的15．00％和35．00％,差异有统计学意义（P〈O．05）;治疗组的恢复工作、恢复家务劳动时间均明显短于对照组,差异有统计学意义（P〈O．01）。结论腹腔镜手术治疗异位妊娠的临床疗效更为显著,可于临床推广应用。     

快速康复在老年结直肠癌患者手术中的应用

目的 提高老年人结直肠癌术后的康复速度,减少并发症,缩短住院时间.方法 回顾分析我科2008年1月-2010年12月收治的100例65 ～ 88岁老年人结直肠癌手术的临床资料,随机分成快速康复外科组和传统手术组.结果 快速康复外科组:下床时间(13±3.5)h,排气时间(36±9.2)h,排便时间(52±8.3)h,饮食时间(18±6.2)h,住院时间(6.2±1.8)h,住院总费用(1.85±0.3)万元.传统手术组:下床时问(72±5.6)h,排气时间(78±18.6)h,排便时间(120±16.8)h,饮食时间(96±20.5)h,住院时间(12.0±1.8)h.住院总费用(2.66±0.38)万元,与传统手术组比较有显著差异.并发症无差异.结论 快速康复理念在老年人结直肠癌手术中应用可行且安全.     

Combination of surgery and chemotherapy for small-cell bronchial carcinoma

In several test model systems using spontaneous metastasizing experimental tumours, convincing data indicate the importance of the tumour burden left after surgery for the efficacy of the combination of surgery and chemotherapy. Early removal of the primary tumour by radical surgery for cure seems to improve the conditions for chemotherapy. Since 1979, in nine different departments of thoracic surgery, patients with small-cell carcinoma of the lung (SCCL) have been randomized after surgery for cure to receive a new sequential intermittent polychemotherapy (sq.CT) of 3 different alternating drug combinations given intermittently over 1 year, or one 4-drug combination chemotherapy (CT) given intermittently over 3 years. The calculation of their life table curves at 1 August 1984 indicated an improvement in the 4-year survival rate of 23 patients receiving sq.CT to about 50%, compared with a survival rate of about 30% for 29 patients receiving CT. The number of patients is still too small for firm conclusions to be drawn, but it is concluded that surgery for SCCL seems to be an advisable measure for the efficacy of aggressive intermittent long-term polychemotherapy. However, this can only be proved in large cooperative studies.