免气腹妇科腹腔镜置入第1套管针法的探讨

目的探讨免气腹妇科腹腔镜置入第1套管针方法的安全性及可行性。方法383例腹腔镜手术采用两种第1穿刺方法进入腹腔。研究组280例,切开脐孔皮肤、皮下脂肪及筋膜,套管针直接穿刺置入;对照组103例,气腹形成后进行套管针穿刺置入。结果研究组从切开皮肤到气腹形成、腹腔压力达15mmHg,置入腹腔镜最短时间1min,最长时间9min,平均(1.74±0.859)min;对照组最短时间5min,最长时间11min,平均(7.33±1.375)min。两组比较差异有显著性(P<0.01),两组均无血管、器官损伤并发症。结论免气腹套管针直接穿刺置入方法,减少了气腹针穿刺充气这一操作步骤,可以避免气腹针穿刺不当引起的并发症,能够迅速进入腹腔实施手术,值得推广应用。     

腹腔镜手术经脐正中的直接穿刺法临床观察

近年来我们在腹腔镜手术穿刺上改变了传统的穿刺方法而采取经脐孔正中的直接穿刺法，省略了气腹针穿刺这一过程，方法简单、并发症少、更美观。现总结如下。     

妇科免气腹腹腔镜手术79例临床分析

腹腔镜手术属微创手术,相对于开腹手术,其具有创伤小、出血少、恢复快、住院时间短等优点[1-3], 但在手术时间、手术器械和手术费用方面并不占优势,而免气腹腹腔镜手术(悬吊式腹腔镜手术),自1991年由日本的衣井秀雄和法国的Mouret分别用于胆囊切除术起,至1993年日本的井板惠一应用于妇科领域并进一步改良为单钢针皮下悬吊式腹腔镜手术起,发现在手术创伤小的基础上,在手术时间、器械应用和费用方面也存在一定的优势.本院自2007年10月至今开展免气腹腹腔镜手术79例,现报道如下.     

开放式腹腔镜套管针第一穿刺术982例分析

目的探讨开放式腹腔镜套管针第一穿刺术在妇科腹腔镜手术中的临床应用价值。方法回顾性分析982例妇科患者施行开放式腹腔镜套管针第一穿刺腹腔镜手术的情况。结果手术成功率为100%,仅1例网膜漏出,其余均无并发症。结论该术式简便、安全、操作时间短、成功率高,并发症少,易于推广,有临床实用价值。     

腹腔镜免气腹脐孔直接穿刺法2154例临床观察

自20世纪80年代以来,腹腔镜在临床上的应用越来越广,腹腔镜手术时需要在腹腔建立手术空间,利用气腹机将医用二氧化碳充入腹中,形成气腹,扩大腹腔镜的视野和手术操作空间.     

无气腹穿刺腹腔镜手术

目的 探讨无气腹穿刺腹腔镜手术的可行性与临床意义。方法 麻醉后在腹肌充分松弛的情况下，在脐周作1cm左右的皮肤切口，主刀和助手提脐部两侧腹壁皮肤，用穿刺锥直接穿刺，根据手感，当穿刺锥进入腹腔后，手掌离开穿刺锥，将trocar向内推进3～5cm，取出穿刺锥，接上气腹管建立气腹。结果 112例病人直接裸穿(无保护鞘)，无胃肠道和大血管损伤。结论 穿刺锥比较钝，只要操作技术熟练，不容易导致胃肠道和大血管损伤。放入第一支trocar时，不一定必须事先建立气腹。缺乏经验和操作粗暴是穿刺性损伤的主要原因。初学者不能盲目选择。     

腹部手术史者行妇科腹腔镜手术可行性探讨

目的：探讨腹部手术史患者行妇科腹腔镜手术的可行性,方法：收集379例腹部手术史教课行腹腔镜手术资料,分析不同手术类型的盆腹腔粘连情况和对腹腔镜手术并发症,中转开腹的影响,随机选取同期无手术史患者380例作对照。结果：腹部手术史者盆腹腔粘 率和中转开腹率分别为42．7％和13．4％,对照组两项指标分别为15．5％和4．2％,差异显著,妇外科复合手术,2次以上妇科手术比欠外科,单次妇科手术史者更高（P＜0．05）,妇科手术中,附件手术明显高于剖宫产术,结论：对妇科腹腕镜手术影响较大的是妇外科复合手术,2次以上妇科手术,附件手术,部宫产术及外科手术史影响不大,只要合理选择病例,对大多数腹部手术史者施行妇科腹腔镜手术是可行的。     

直接穿刺法在腹腔镜胆囊切除术中的应用

目的 探讨直接穿刺法在腹腔镜胆囊切除术中的可行性与临床价值.方法 通过2 431例患者的经验总结,提出直接穿刺法的手术指征和操作要领.结果 该组病例中发生大网膜损伤出血3例(0.12%),均在镜下止血成功.无内脏损伤和大血管损伤.结论 直接穿刺法是安全、简便的建立气腹通道的穿刺方法.     

腹腔镜免气腹手术40例报告

腹腔镜手术作为一种微创技术，近十年来在临床应用方面取得较快的发展。但由于ＣＯ２气腹的并发症及操作技术上受到一定限制，阻碍了腹腔镜手术的进一步拓展。我院从１９９５年１２月～１９９７年１２月采用免气腹的腹腔镜（ＧａｓｌｅｓＬａｐａｒｏｓｃｏｐｙＧＬＬＳ）...     

Transthoracic fundoplication after previous abdominal surgery: an alternate approach

Fundoplication for gastroesophageal reflux is a frequent procedure for pediatric surgeons. Reoperation in the abdominal cavity can be time-consuming and hazardous. Therefore, 33 patients (16 male and 17 female) with symptomatic gastroesophageal reflux after previous abdominal procedures had transthoracic fundoplications. Previous procedures included gastrostomy (18), Nissen fundoplication (12), ventriculoperitoneal shunt (9), omphalocele (4), paraesophageal hernia (3), necrotizing enterocolitis (2), abscess drainage (2), intestinal atresia (2), and abdominal burn (1). The three complications encountered were a bronchopleural fistula, esophageal leak, and small bowel obstruction. Of five deaths, one was related to operation. The remaining patients did not have recurrent reflux. Transthoracic fundoplication after previous abdominal surgery is effective and rapid, and it has a relatively low complication rate in high-risk patients. This approach avoids reentry into the abdominal cavity and allows precise repair.     

先前腹部手术对腹腔镜第一穿刺点的影响

目的 分析先前腹部手术对腹腔镜第一穿刺点的影响.方法 将我院妇科行腹腔镜手术患者1970例作为研究对象,其中有腹部手术588例,先前无腹部手术1 382例.所有患者脐孔第一穿刺按不同穿刺方法分为A组(常规气腹组),B组(切开皮肤穿刺组),C组(切开筋膜穿刺组)三组.结果 先前无腹部手术的1 382例患者中,第一穿刺点穿刺失败9例(0.6%),成功1373例;先前有腹部手术的588例患者中,失败10例(1.7%),成功578例(χ2＝4.756,P＜0.05).从失败例数和努力次数来看,A组与B组相比,差异无统计学意义(P＞0.05),C组与A组和B组相比,明显低于此两组(t＝18.75和t＝17.59,P＜0.01).先前无腹部手术患者,腹腔镜手术第一穿刺点三种方法并发症总体发生率2.5%(35/1 382).先前有腹部手术,并发症总体发生率为6.3%(37/588),两者相比,差异有统计学意义(χ2＝16.51,P＞0.01).C组并发症发生率与A组和B组相比差异有统计学意义(χ2＝10.403,P＜0.01),而A组与B组在并发症发生率方面差异无统计学意义(P＞0.05).结论 先前有腹部手术史可以影响腹腔镜第一穿刺的成功率与并发症的发生率,在有腹部手术患者中腹腔镜第一穿刺可采用切开筋膜穿刺方法.     

Endotoxemia after abdominal surgery

The blood level of endotoxin after operations in patients with digestive diseases, mainly liver cirrhosis and obstructive jaundice, and the complications most likely related to the presence of endotoxemia were investigated. Twenty-seven patients without either liver cirrhosis or obstructive jaundice showed a minimal elevation of the endotoxin level in blood, as shown by 6.1 +/- 3.9 (mean +/- S.E.) pg/ml at the first postoperative day and there was only one anastomotic leakage. On the other hand, 18 patients with liver cirrhosis showed a notable and persistent endotoxemia after surgery. The cirrhotic patients who especially underwent splenectomy and hepatectomy showed marked elevations of endotoxin level at the first postoperative day, with values of 151.0 +/- 46.1 pg/ml and 101.3 +/- 36.2 pg/ml, respectively, and one of these patients died of hepatic failure. Thirteen patients with obstructive jaundice developed endotoxemia evidenced by the value of 21.6 +/- 4.8 pg/ml at the first day after surgery. Among these patients, two had gastrointestinal bleeding and one developed disseminated intravascular coagulation (DIC). The markedly high and persistent levels of endotoxin in patients with liver cirrhosis or obstructive jaundice may be possibly related with the development of multiple organ failure (MOF).     

快速康复外科胃肠道手术不置胃肠减压管并早期进食的护理研究

目的 探讨快速康复外科胃肠道手术后,不留置胃肠减压管并早期进食的安全性及可行性.方法 以2008年1-6月行胃肠道手术的58例患者为观察组,不留置胃肠减压管并早期恢复进食.以2006年11月至2007年12月的62例胃肠道手术患者为对照组,术中放置胃肠减压管直至恢复肛门排气.比较两组病例术后肛门恢复排气时闻、咽喉疼痛、恶心、鼻咽部不适、急性胃扩张、切口感染、肺部感染、吻合口瘘等术后并发症发生率.结果 与对照组相比,观察组肛门恢复排气时间提前,差异有统计学意义(P<0.05),两组患者急性胃扩张、切口感染、肺部感染、吻合口瘘等并发症的发生率方面,差异无统计学意义(P>0.05),对照组患者诉咽喉疼痛、恶心呕吐、胃部不适明显较观察组增多(P<0.01).结论 胃肠手术后不放置胃肠减压管并早期恢复进食安全可行.有利于患者的快速康复.     

Feeding patients after abdominal surgery

Nutrition in hospital has been the focus of negative attention in recent years. Apart from the issues surrounding older people and nutrition (Odlund-Olin et al 1996), patients undergoing surgery might still be subject to inappropriate nutritional care and practice. Many are still fasted for long periods of time before surgery, and experience inappropriate regimes designed to wean them back onto normal eating and drinking patterns. This can lead to malnourishment and delayed healing. The author examines good practice in perioperative nutritional practice, designed to ensure that the patient recovers as quickly and as well as possible following abdominal surgery.     

Incentive spirometry after abdominal surgery

Patients face various possible complications after abdominal surgery. This article examines best practice in guiding and teaching them how to use an incentive spirometer to facilitate recovery and prevent respiratory complications.     

Validity of laparoscopy after abdominal surgery

The authors carried out a retrospective study to investigate the effect of previous abdominal surgery on the validity of laparoscopy. Laparoscopy was done in 2,000 patients with liver disease, between 1976 and 1985. Of these, 250 (12.5%) had undergone abdominal operations, and all presented with intraperitoneal adhesions. The whole surface of the liver was visible in 45.3%, but only in part in 46.2% of patients with upper abdominal operations (cholecystectomy, gastric surgery). Lower abdominal surgery (appendectomy, gynaecological operations) was associated with complete visibility of the liver in 97.5% of the cases. Laparotomy was followed by the highest incidence of non-visibility of the liver (28.5%). In the other 1,750 patients without abdominal operations, adhesions were detected only in 83 (4.1%) and the liver was entirely observable in 83.1% of these. In conclusion, previous abdominal surgery does not represent an absolute contraindication to laparoscopy, since risks are not as great as one might suppose. Although the view of the liver is sometimes impaired, laparoscopy retains its role in the assessment and therapy of liver disease, and avoids complications related to blind biopsy of the liver.     

高龄患者腹部手术后腹腔镜胆囊切除术13例临床分析

目的探讨高龄患者腹部手术后行腹腔镜胆囊切除术的可行性。方法回顾性分析13例高龄腹部手术史病人行腹腔镜胆囊切除术的资料,避开原有切口选择四戳孔法和三戳孔法,必要时采用开放法置入穿刺鞘,注重腹腔内粘连区的分离技巧。结果该组13例中11例成功完成手术,中转开腹2例,无手术并发症。结论严格注意适应证,具备熟练的操作技能,有腹部手术史的高龄患者行腹腔镜胆囊切除术是安全可行的。