腹腔镜在外科急腹症的应用

目的：总结腹腔镜在外科急腹症治疗中的应用价值。方法：回顾性分析32例急腹症患者行急诊腹腔镜检查与手术治疗的临床资料。结果：12例急腹症患者经腹腔镜探查后均明确诊断,7例行中转开腹手术,其余均成功行腹腔镜,手术均成功。结论：腹腔镜对于急腹症患者具有诊断及时、治疗可靠、创伤小,痛苦少康复快等优点,值得推广应用。     

腹腔镜治疗妇科急腹症疗效评价

目的：探讨腹腔镜手术诊治妇科急腹症的价值.方法：时2005-001～2008-12间的317例妇科急腹症患者应用腹腔镜手术情况进行回顾分析.结果：全部病人均在腹腔镜下完成手术,手术成功率100%.无术中术后并发症.结论：妇科急腹症患者应用腹腔镜手术创伤小、恢复快、效果好.     

腹腔镜在妇科急腹症中的应用探讨

目的探讨腹腔镜在妇科急腹症中的应用价值。方法应用电视腹腔镜技术对137例妇科急腹症患者实施腹腔镜急诊诊断及手术治疗。结果全部病例手术均获成功,痊愈出院。结论在妇科急腹症中,腹腔镜具有创伤小、痛苦轻、恢复快、并发症少等优点,可治疗大部分妇科急腹症,其应用前景非常广阔。     

普外急腹症中应用腹腔镜的临床分析

目的：探讨运用腹腔镜方法治疗普外急腹症的临床疗效。方法选择普外科收治的73例急腹症患者作为研究对象,随机分为实验组（37例）和对照组（36例）,实验组患者行腹腔镜术治疗,对照组患者行常规开腹术治疗,比较两组患者术中出血量、手术时间、术后排气时间、住院时间等疗效指标。结果实验组患者的术中出血量、手术时间、术后排气时间、住院时间均明显优于对照组,差异具有统计学意义（ P＜0.05）。结论临床上对急腹症患者采用腹腔镜术治疗,效果显著,是一种理想的、有效的治疗急腹症的方法。     

异位妊娠235例临床分析

异位妊娠是妇科常见急腹症之一,如处理不当,可产生严重后果,甚至死亡。传统的异位妊娠多采用开腹输卵管切除手术。近年来随着腹腔镜技术的广泛普及,阴式彩超、血HCG结果快速而准确的报告,使得腹腔镜手术及药物保守治疗在异位妊娠的早期诊断治疗中逐渐取代了传统的开腹手术。现就本院2007年1月-2007年12月收治的异位妊娠235例做回顾性分析,探讨腹腔镜手术及药物保守治疗在异位妊娠诊治中的价值。     

腹腔镜在急腹症中的应用(附68例临床分析)

目的:探讨腹腔镜用于检查、判断困难的急腹症和闭合性腹部创伤临床价值.方法:回顾性分析2001～2008-12,应用腹腔镜技术为68例急腹症患者实施腹腔镜手术治疗 的临床资料.结果:阳性探查患者,均及时进行了手术处理,无手术死亡病例,住院时间7～20 d,平均11 d.对2例阴性探查患者,避免了开腹手术探查创伤.结论:腹腔镜技术在急腹症中的应用具有独特优点,既可以明确诊断又可同时进行治疗,治疗效果可靠,值得临床进一步推广应用.     

腹腔镜技术在普外科急腹症手术中的应用

目的探讨腹腔镜技术在普外科急腹症中的诊疗效果。方法回顾性分析2007年12月—2012年12月我院经腹腔镜诊治的530例普外科急腹症病人的临床资料。结果 530例中成功施行腹腔镜手术治疗485例(91.5%);术中中转开腹手术治疗45例;12例腹腔镜术后出现并发症,其中2例为高碳酸血症,10例为切口感染,经治疗均痊愈出院;4例急性重症胰腺炎患者术后因多器官功能衰竭,感染性休克死亡。结论急诊腹腔镜探查术不仅可以对病因不明的急腹症作出明确诊断,还能提供可靠的手术治疗,腹腔镜诊治技术在普外科急腹症治疗中的应用,具备创伤小、并发症少、恢复快等优点。     

腹腔镜手术和开腹手术对于妇科肿瘤患者凝血功能和免疫指标的影响

目的：对比分析不同手术方式对于妇科肿瘤患者凝血功能和免疫功能的影响。方法将接受手术治疗的317例妇科肿瘤患者分为腹腔镜组165例（腹腔镜手术治疗）和开腹组152例（开腹手术治疗）,在手术治疗前后分别检测凝血功能指标（包括血浆凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、纤维蛋白原以及血小板）和免疫功能指标（包括IgG、IgA、IgM抗体和CD3＋、CD4＋、CD8＋T淋巴细胞亚群比例）变化,对比两组间检测结果的差异性。结果手术后两组的PT、APTT、FIG都出现了明显波动,开腹组PT、APTT、FIG明显区别于腹腔镜组,组间数据明显差异（ P＜0.05）;手术后,两组免疫球蛋白IgG含量、T淋巴细胞亚群比例均有明显变化,手术后对照组的CD3＋、CD4＋、CD8＋波动幅度明显高于腹腔镜组,组间对比,P＜0.05,差异有统计学意义。结论腹腔镜手术和开腹手术都能够引发妇科肿瘤患者凝血功能和免疫功能变化,腹腔镜手术作为微创手术,对于患者机体的应激性损伤更微小。     

腹腔镜在急腹症中应用体会

目的:探讨应用腹腔镜诊断和治疗外科急腹症的价值。方法:回顾分析腹腔镜在247例外科急腹症应用的临床资料。结果:247例外科急腹症病例,均经腹腔镜获明确诊断,其中223例腔镜下完成治疗性手术,24例中转开腹手术,无死亡病例。结论:腹腔镜技术在外科急腹症诊断及治疗具有独特的优势,既可明确诊断,又能同时进行治疗,具有良好的临床应用价值。     

腹腔镜手术治疗输卵管妊娠30例临床观察

目的：探讨腹腔镜手术治疗输卵管妊娠的临床应用价值。方法：纳入输卵管妊娠患者60例,随机分为腹腔镜组和开腹组,各30例。腹腔镜组予腹腔镜手术治疗,开腹组按常规开腹手术治疗。观察两组患者的手术时间、术中出血量、术后肛门排气时间、尿HCG转阴时间、术后平均住院时间及手术并发症情况。结果：与开腹组比较,腹腔镜组术中出血量较少、术后肛门排气时间明显减短、平均住院时间明显缩短,经统计学检验,差异有明显统计学意义（P〈0.05）;腹腔镜组和开腹组在手术时间、尿HCG转阴时间比较无显著性差异（P〉0.05）。结论：腹腔镜手术治疗输卵管妊娠,其创伤小、出血量少、术后恢复快、并发症少、疗效确切,可以保留患者的生育功能,提高其生存质量。     

Cost Analysis of FDG PET for Managing Patients with Ovarian Cancer

Monte Carlo simulation analysis was used to compare the cost of managing recurrent ovarian cancer patients with and without the use of positron emission tomography (PET) scanning. Assumptions in the management pathway were: (1) a positive PET scan led to either laparoscopy or laparotomy, followed by chemotherapy (true positive PET) or follow-up (false positive PET); (2) a negative PET scan resulted in continued follow-up (true negative PET) or laparotomy (false negative PET); and, (3) a laparotomy led to chemotherapy or follow-up. In this simulation, sensitivity and specificity of FDG PET for recurrent ovarian cancer varied from 72-91% (mean 83%) and 69-95% (mean 85%), respectively, as defined by the ROC curve. Using a prevalence rate of 30% for recurrent ovarian cancer, the mean PET false negative rate was 5%. Thus, when using PET to manage the diagnostic evaluation, the number of unnecessary laparotomies was reduced from 70% to 5%, with 35% of patients undergoing laparoscopy for recurrent disease instead of laparotomy. If laparotomy is used in place of laparoscopy, unnecessary surgery can be avoided in 30% of patients. Costs for procedures were based both on hospital charges, and Medicare reimbursement rates. Cost savings per patient ranged from $1,941 to $11,766, assuming that follow-up evaluation was similar for both groups. Estimated cost savings were due to the need for fewer surgical procedures when using PET in the diagnostic evaluation, the reimbursement rate scheme employed, and whether laparotomy or laparoscopy was used in the management algorithm for PET positive patients. In conclusion, FDG PET can reduce unnecessary invasive staging procedures and save health care costs when used appropriately in the management of patients with recurrent ovarian cancer.     

腹腔镜子宫肌瘤剔除术的卫生经济学研究

目的：对腹腔镜及开腹子宫肌瘤剔除的手术效果和成本进行比较分析。方法：回顾性分析了乌鲁木齐总医院107例子宫肌瘤剔除术患者的一般资料、手术效果、总成本及其构成。其中腹腔镜54例,开腹53例。结果：①腹腔镜子宫肌瘤剔除手术时间短,术中出血少,术后恢复快;与开腹组比较具有显著差异（P〈0．01）;②腹腔镜组直接医疗费用为（6255．99±739．55）元,高于开腹组（5675．55±569．64）元（P〈0．01）;腹腔镜组直接非医疗费用为（475．76±126．94）元,低于开腹组（559．09±128．97）元（P〈0．05）;腹腔镜组误工费为（1358．57±257．68）元,低于开腹组（2158．34±274．52）元（P〈0．01）;腹腔镜组总计费用为（8090．32±968．75）元,与开腹组（8410．45±684．98）元差异未达显著性水平（P〉0．05）。结论：腹腔镜子宫肌瘤剔除术后恢复快,成本并不比开腹手术高。     

急诊腹腔镜联合自体血液回收机救治休克型异位妊娠

目的:研究急诊腹腔镜手术联合自体血液回收机救治休克型异位妊娠的安全性和有效性。方法:采用回顾性队列研究的方法,对我院2008-01～2011-12间急诊腹腔镜或开腹手术联合自体血液回收机救治休克型异位妊娠患者的一般资料、手术效果、术后恢复情况及术中术后并发症进行比较。其中腹腔镜手术32例,开腹手术24例。结果:①腹腔镜组自体血回输速度快(22.3±4.0)min vs(40.9±4.5)min、异体输血率低(11.8%vs 38.5%)、术后体温恢复快(3.3±0.9)d vs(4.8±1.3)d、住院天数短(4.7±1.1)d vs 5.8±1.2)d,与开腹组比较具有显著差异(P<0.05);②两组自体血回输量、术后血红蛋白、术后最高体温及住院费用之间无显著差异,两组术中术后均无严重并发症。结论:急诊腹腔镜联合自体血液回收机可快速有效回输自体血,显著减少异体输血,使腹腔镜手术治疗休克型异位妊娠更为安全有效。     

腹腔镜诊治腹部外伤

目的 研究腹腔镜在腹部外伤诊断与治疗中的价值。方法 回顾性分析58例应用腹腔镜诊断与治疗腹部外伤的效果。结果 经腹腔镜探查58例全部明确诊断。同时进行治疗56例,2例无需手术处理,避免了不必要的开腹手术,中转开腹15例,无并发症和死亡病例。结论 腹腔镜诊治腹部外伤具有安全性高、诊断率高、创伤小的优点,既能避免盲目观察而延误病情,又减少了不必要的开腹。     

Critical study of the methods available for detecting hepatic metastases (author's transl)

Based on a review of data in the published literature, and the results of their personal experience in the Antoine-Lacassagne Centre in Nice, the authors discuss the different techniques employed for the detection of hepatic metastases: biological tests, liver needle biopsy, laparoscopy, laparotomy, hepatic angiography, scintigraphy, ultrasonography, and computed tomography. In 90 p. cent of cases liver biological tests and ultrasonography were sufficient to eliminate or confirm the presence of hepatic metastases. When there is no correlation between the results of the different non-traumatic techniques, one is justified in proposing a liver biopsy under laparoscopy.     

急性胆源性胰腺炎52例临床分析

目的探讨急性胆源性胰腺炎（ABP）的治疗方法。方法回顾性分析我院近年来收治的52例ABP患者的临床资料,对ABP的各种治疗方法与疗效进行分析。结果52例患者均治愈。根据有无胆管梗阻和ABP的轻重程度分别采取保守治疗、治疗性ERCP、内镜下胰管支架引流术、腹腔镜以及开腹手术的治疗方法。所有患者均首先采取保守治疗。对于有显著胆道梗阻的重症ABP患者采用治疗性ERCP的方法;ERCP失败的5例患者实施经内镜下胰管支架植入术,临床效果明显。除仅有1例患者因重症胰腺炎伴胰腺坏死伴感染而行手术治疗之外,其他所有患者的胆道病变均在胰腺炎治愈后1个月行外科处理。结论ABP治疗以保守治疗为主,对于部分伴胆道梗阻的病例可以采用治疗性ERCP和胰管内支架引流的方法。总之,ABP的治疗需要对具体的情况采取个体化的治疗方案。     

腹腔镜胆囊切除术中转开腹原因分析

目的：了解腹腔镜胆囊切除术中转开腹的原因。方法：对820例腹腔镜胆囊切除术其中16例中转开腹的病例分析。结果：820例腹腔镜胆囊切除术中中转开腹16例，中转手术率1．95％，中转开腹的主要原因为：慢性萎缩性胆囊炎8例(50％)；急性化脓性胆囊炎4例(25％)；胆囊动脉出血2例(12．5％)；与横结肠致密粘连1例(6．25％)；副肝管损伤1例(6．25％)。结论：腹腔镜胆囊切除术中转开腹的主要原因为：腹腔内的严重粘连、急性粘症水肿、坏疽、血管损伤、胆管损伤。     

Use of helical CT in assessment of crossing vessels in pelviureteric junction obstruction

AIM: The purpose of this study is to confirm the accuracy of non-invasive helical computed tomography (CT) with multiplanar reformatting in the diagnosis of crossing vessels in patients with pelviureteric junction (PUJ) obstruction. MATERIALS AND METHODS: Nineteen patients with confirmed PUJ obstruction underwent CT of the renal area with intravenous contrast medium. Patients shown to have crossing vessels had to undergo a pyeloplasty by open surgery or laparoscopy. Patients with no vessels could have their PUJ obstruction safely treated with less invasive techniques such as balloon dilatation. RESULTS: Fourteen patients were shown to have crossing vessels. Of these, 10 had their relationship to the PUJ confirmed at a subsequent laparotomy. Of the remaining four patients, one was lost to follow-up and two were unwell due to unrelated disease. The other patient had already had a vessel moved at a previous laparotomy. Of the five patients without obstructing vessels, two were confirmed not to have a related vessel at laparotomy, one has undergone balloon dilatation and the other two were lost to follow-up. CONCLUSION: Helical CT is an accurate and non-invasive method of demonstrating crossing vessels in PUJ obstruction. Diagnosis of these vessels has a major role in the choice of therapeutic treatment.     

腹腔镜与开腹手术治疗异位妊娠的临床对比研究

目的通过与开腹手术比较,探讨腹腔镜治疗异位妊娠的临床疗效。方法选择2010年1月～2012年1月64例因异位妊娠在我院进行手术治疗的患者,随机分为研究组和对照组,研究组采用腹腔镜手术,对照组采用开腹手术,比较两组的术中术后情况。结果研究组平均手术时问、肛门排气时间、住院天数短于对照组。术中出血量和镇痛例数少于对照组,差异均有统计学意义（P〈0．01）。两组切口甲级愈合率和月经恢复情况差异无统计学意义（P〉O．05）,工作恢复时间和性生活恢复时间研究组均短于对照组（P〈O．05或〈0．01）。住院费用研究组显著高于对照组,差异有统计学意义（P〈O．01）。结论腹腔镜手术具有创伤小、术后恢复快等优点,但住院费用较高,临床上应根据具体情况决定是否采用腹腔镜手术治疗异估奸娠．     

Hysterosalpingography in the evaluation of infertility

Hysterosalpinography (HSG) was performed in 220 women for evaluation of infertility. Laparoscopy or laparotomy for final assessment of tubal patency were carried out in 110. HSG revealed a normal tubal patency in 66.8 per cent, whereas abnormal patency was found in 24.1 per cent. At operation, 85.7 per cent of the HSG diagnoses were confirmed. A clear correlation existed between previous lesions in the genital tract and pathologic findings at HSG and operation. The pregnancy rate following HSG was 15.4 per cent. It is concluded that HSG is of great value in the initial evaluation of infertility. The findings facilitate the decision regarding the final operative procedure: laparoscopy or laparotomy.