腹腔镜手术对良性卵巢肿瘤患者内皮素、IL-6及C-反应蛋白的影响

[目的]研究腹腔镜手术对卵巢良性肿瘤患者机体应急反应的影响。[方法]2007年9月～2008年9月60例卵巢良性肿瘤患者随机分为腹腔镜组30例和开腹手术组30例。比较两组术前和术后1、3、5d内皮素（ET）、白细胞介素（IL-6）、C-反应蛋白（CRP）的变化。[结果]腹腔镜组术后第1dET显著下降（P〈0．05）,术后第3d恢复至术前水平：而开腹组手术前后ET无显著性变化。两组患者术后IL-6、CRP水平均增高（P〈0．01）,且开腹组显著高于腹腔镜组（P〈0．01）,术后第5d腹腔镜组IL-6恢复至术前水平;术后第5d两组CRP水平仍显著高于术前水平（P〈0．05）．且开腹组显著高于腹腔镜组（P〈0．05）。[结论]腹腔镜手术对卵巢良性肿瘤患者相比开腹手术应急反应轻．强度小．持续时间短。     

腹腔镜全胃D2根治术与开腹手术治疗胃上部癌的比较研究

目的探讨腹腔镜全胃D2根治术治疗胃上部癌的安全性、肿瘤根治性以及术后早期疗效。方法接受腹腔镜全胃D2根治术（腹腔镜手术组）的122例胃上部癌患者为研究对象,同期采用传统开腹全胃D2根治术（传统开腹组）的132例为对照。两组性别、年龄、肿瘤位置、病理类型和TNM分期差异均无统计学意义。结果传统开腹组及腹腔镜手术组在手术时间[（235．78±31．56）min比（256．43±54．08）min]、出血量[（326．69±89．73）ml比（158．31±62．98）m1]、切口长度[（16．53±2．34）cm比（5．51±1．15）cm]、胃肠道恢复时间[（4．22±0．91）d比（3．31±0．83）d]、术后首次进食流质时间[（5．78±0．95）d比（5．56±0．78）d]和术后住院时间【（12．62±2．89）d比（11．18±1.78）d]差异有统计学意义（均P〈0．001）。两组的淋巴结清除数目及并发症差异均无统计学意义（均P〉0．05）。结论腹腔镜全胃D2根治术是一种安全、微创的手术方法。腹腔镜全胃D2根治术与传统开腹全胃D2根治术可获得相同的淋巴结清扫范围及良好的早期疗效,但较开腹手术有创伤小、术后恢复快等优势。     

腹腔镜手术治疗良性卵巢肿瘤21例

[目的]探讨腹腔镜下卵巢良性肿瘤的手术价值。[方法]21例良性卵巢肿瘤患者行腹腔镜手术治疗，同时25例良性卵巢肿瘤病人行开腹手术作对照研究。[结果]两组比较手术时间无显著性差异（P〉0．05），手术出血量腹腔镜组（70．2±9．5）ml，开腹组（120．1±14．7）ml，有显著性差异（P〈0．01），肛门排气时间腹腔镜组（21．2±3．2）h，开腹组（33．1±4．4）h，有显著性差异（P〈0．01），平均住院日腹腔镜组（4．8±1．9）d，开腹组（9.3±2．1）h，有显著性差异（P〈0．01）。[结论]腹腔镜手术治疗良性卵巢肿瘤可减少手术出血量，缩短平均住院日，严格掌握适应证及禁忌证的情况下，可作为良性卵巢肿瘤的首选方法。     

腹腔镜卵巢良性肿瘤切除手术对患者免疫功能的影响

[目的]研究腹腔镜卵巢良性肿瘤手术对机体Th1／Th2、共刺激分子平衡的影响。[方法]选择2007年9月～2008年9月卵巢良性肿瘤患者60例．分为腹腔镜组30例．开腹手术组30例。比较两组围手术期白细胞介素4（IL-4）、γ干扰素（IFN-γ）的水平和CD28、CTLA-4的表达。[结果]开腹组术后IL4水平和CTLA-4的表达明显升高,分别在术后24h（35．41±3．66pg／ml）和术后48h（4．02％±0．85％）最高;而IFN-γ水平和CD28表达下降均在术后6h最低（1．36±0．27pg／ml,40．24％±3．78％）。腹腔镜组术后各指标均无明显变化：两组间有显著性差异（P〈0．05）。[结论]腹腔镜手术对Th1/Th2、共刺激分子平衡无显著影响,对机体免疫功能影响小。     

开放与后腹腔镜肾囊肿去顶术的比较

目的 比较开放与后腹腔镜肾囊肿去顶术的临床价值.方法 对35例开放肾囊肿去顶术和43例后腹腔镜肾囊肿去顶术的临床资料进行比较,统计分析两种术式在手术时间、术中平均出血量、术后住院天数、下床时间、肠蠕动恢复时间等的差别.结果 所有手术均获成功.开放手术组和后腹腔镜组手术时间分别为(70.45±3.57)min、(52.12±1.74)min;术中出血量分别为(55.13±5.12)ml、(18.42±3.58)ml;术后下床时间分别为(96.14±3.18)h、(40.28±1.42)h;术后住院天数分别为(9.15±0.16)d、(5.41±0.24)d.两组间比较差异有统计学意义(P＜0.01);肠蠕动恢复时间分别为(42.34±2.31)h、(35.13±1.73)h,两组间比较差异有统计学意义(P＜0.05).结论 后腹腔镜肾囊肿去顶术在手术时间、术中出血量和术后下床时间、肠蠕动恢复时间等方面明显优于开放手术.     

腹腔镜在远端胃癌D2根治术中的应用价值

[目的]对比腹腔镜下手术与传统开腹手术在远端胃癌D2根治术治疗中的价值。[方法]50例远端胃癌患者分为对照组(即单纯开腹手术组)和试验组(即腹腔镜下手术组),每组均为25例。比较两组患者的手术时间和出血量,术后患者的恢复情况(包括排气时间、进食时间、下床时间、止痛药的使用情况)、患者的住院天数、手术切口长度、清扫淋巴结数、手术并发症等。[结果]试验组的手术时间(218.9±35.6)min长于对照组(168.1±23.9)min,但是术中出血量(129.3±56.1)ml少于对照组(180.0±23.1)ml。试验组术后恢复情况优于对照组:排气时间为(2.2±0.8)dvs(3.3±1.2)d;进食时间为(4.2±1.3)dvs(7.1±0.9)d;下床时间为(5.6±1.1)dvs(8.3±1.4)d。试验组的住院天数少,同时伤口长度小,均有统计学意义(P<0.05)。[结论]腹腔镜下行远端胃癌D2根治术,临床治疗效果明显优于传统开腹手术。     

腹腔镜与开腹手术治疗子宫肌瘤的疗效比较

目的探讨腹腔镜与开腹手术治疗子宫肌瘤的临床效果。方法选取2012年1月至2013年1月间我院收治的80例子宫肌瘤患者,随机为观察组和对照组,每组40例。观察组患者采用腹腔镜手术方式进行治疗,对照组患者采用开腹手术方式进行治疗,比较两组患者的临床治疗效果。结果观察组患者手术时间为（1.5±2.2）h,手术出血量为（90.34±34.34）ml,术后下床活动的时间为（2.1±1.1）h,住院天数为（7.5±4.2）d。对照组患者手术之间为（1.9±2.8）h,手术出血量为（120.23±43.32）ml,术后下床活动时间为（3.4±2.1）h,住院天数为（10.2±7.2）d。两组比较,差异均有统计学意义（P〈0.05）。结论腹腔镜手术治疗子宫肌瘤手术时间短、出血量低、术后恢复快、住院时间短,值得临床推广。     

腹腔镜全直肠系膜切除术49例低位、超低位直肠癌保肛手术应用分析

[目的]比较腹腔镜全直肠系膜切除术(TME)与传统开腹直肠癌根治术在直肠癌保肛治疗中的应用效果。[方法]选取2009年6月至2011年2月在宁波市第二医院确诊为直肠癌的患者101例,分为腹腔镜组(49例)和开腹组(52例)。[结果]腹腔镜组的手术时间、术后肛门排气时间、留置导尿时间、术后住院时间分别为150.4±30.2min、2.6±0.2d、2.8±0.7d及9.5±2.6d,开腹组分别为168.1±41.3min、3.8±0.7d、4.9±0.6d及15.4±3.7d,腹腔镜组均短于开腹组P<0.05。术中出血量腹腔镜组(92.7±24.1ml)少于开腹组(144.8±23.6ml)(P<0.05)。肿瘤大小、切除标本长度、清扫淋巴结数目及肿瘤远端切缘长度方面与开腹组比较差异无统计学意义(P>0.05)。但是腹腔镜组手术费用、住院总费用要高于开腹组(P<0.05)。腹腔镜组术后切口感染(2.0%)、肠黏连(2.0%)、术后尿潴留(4.0%)明显少于开腹组(P<0.05)。吻合口瘘发生率两者差异无统计学意义(P>0.05)。[结论]腹腔镜TME技术应用于低位、超低位直肠癌保肛手术中疗效确切,具有手术时间短、出血量少、肛门恢复排气时间快、术后并发症发生率低等优点,值得临床推广。     

腹腔镜与开腹全子宫切除术的比较

目的: 比较腹腔镜全子宫切除术与开腹全子宫切除术的临床效果.方法: 回顾性分析2006年7月-2008年3月我院腹腔镜子宫全切除术60例和传统子宫全切除术68例的临床资料,比较2种术式的术中出血量、排气时间、术后下床活动时间,住院时间、术后疼痛剂使用.结果: 腹腔镜子宫切除术60例,术中出血量(120.3±30.4)ml,平均住院时间(5.6±0.7)d,术后排气时间平均(24.9±11.6)h,术后下床活动时间(23.2±5.7)h.腹腔镜组术后镇痛5例,切口全部甲级愈合,显著低于开腹子宫切除术组,两组比较差异有统计学意义(P<0.05).结论: 两种子宫全切除术术式各有其优势且不能完全替代,应根据病人情况、外科医生的技术水平和医院的条件综合考虑术式.腹腔镜组具有创伤小、出血少,腹腔内环境干扰小、恢复快、腹部无疤痕等优点.     

腹腔镜手术治疗卵巢良性肿瘤45例

[目的]探讨腹腔镜手术治疗卵巢良性肿瘤的手术效果。[方法]选择2004年5月至2005年5月因卵巢良性肿瘤进行腹腔镜手术治疗患者共45例,设为A组,并选择同期进行开腹手术的患者50例,设为B组,对其手术时间、术中出血量、手术后恢复情况等进行比较。[结果]两组手术均成功,A、B两组手术时间无显著差异,但A组术中出血量、术后病率、抗生素的应用及住院天数均少于B组,两组有显著的差异。[结论]腹腔镜手术治疗卵巢良性肿瘤具有损伤少、效果好、恢复快、住院时间短等优点。     

内窥镜黏膜切除术

Endoscopic mucosal resection is indicated in limited esophageal carcinomas with infiltration of the mucosa. As submucosal cancer is combined with a rate of lymph node metastasis in up to 30%,mucosectomy is not the procedure of choice. The main techniques of endoscopic mucosal resection are the “suck and cut” technique using a cap on the endoscope or a ligation device to create a pseudocroup of the carcinoma. Submucosal injection of saline or other solutions is recommended prior to diathermic mucosectomy in order to reduce the risk of perforation or haemorrhage. The long term results of endoscopic mucosal resection show tumor specific 5 year survival rates of about 97% especially if the indication is restricted to ml and m2 mucosal carcinomas.     

Endoscopic Mucosal Resection

Endoscopic mucosal resection is indicated in limited esophageal carcinomas with infiltrationof the mucosa.As submucosal cancer is combined with a rate of lymph node metastasis in up to 30%mucosectomy is not the procedure of choice.The main techniques of endoscopic mucosal resection arethe “suck and cut” technique using a cap on the endoscope or a ligation device to create a pseudoeroupof the carcinoma.Submucosal injection of saline or other solutions is recommended prior to diathermicmucosectomy in order to reduce the risk of perforation or haemorrhage.The long term results of endoscopicmucosal resection show tumor specific 5 year survival rates of about 97% especially if the indication isrestricted to ml and m2 mucosal carcinomas.     

Resection of liver metastases

The result of liver resection for metastases must be calculated against the natural history without therapy, for which Wagner has found a 5-year-survival rate of only 0 to 3%. From 1970 to 1983 at our surgical unit altogether 80 liver metastases were resected by atypical resection or hemihepatectomy with a primary lethality rate of 28% in the first and 8% in the second period of survey. However, this rate has been further reduced since 1983 by the introduction of the CUSA, intraoperative sonography and the use of segmental liver resection. Since October 1984 altogether 110 liver metastases were resected with a primary lethality of only 5%. Our present 5-year-survival rate for curatively resected liver metastases specifically in colorectal cancer, calculated by the actuarial method, is 32%.     

隆凸切除重建术

目的 探讨隆凸切除重建术在肺癌及气管下段癌治疗中的意义及手术经验。方法 采用ＳＴＡＴＡ５．０软件建立１６例隆凸切除重建术的病历资料数据库并进行统计分析,生存率用直接法计算。结果 本组右肺上叶切除隆凸重建术７例、右肺全肺切除隆凸重建术５例、纯隆凸切除隆凸重建术３例及左全肺切除隆凸重建术１例。术后并发症发生率５０．０％（８例１２次）,术后３０天死亡率１８．８％（吻合口瘘２例,术后大出血１例）。本组有２     

胸腔镜切除纵隔良性肿瘤22例

目的：探讨胸腔镜在纵隔肿瘤治疗上的作用。方法：分析22例采用胸腔镜治疗的纵隔肿瘤特点及手术技巧。结果：22例纵隔肿瘤均顺利施行胸腔镜治疗，无术中转开胸手术及手术死亡者。结论：对于纵隔囊肿、部分纵隔良性肿瘤可施行胸腔镜治疗，胸腔镜治疗与传统开胸手术相比具有损伤小、恢复快等优点，值得推广。     

Endoscopic Resection of Sinonasal Malignancies

Malignant tumors of the sinonasal tract are rare, accounting for only 1% of all malignancies. Although they are associated with substantial histological heterogeneity, surgery plays a key role in their management. This review addresses the evolution of current treatments in view of the introduction of endoscopic resection techniques. The absence of facial incisions and osteotomies, decreased hospitalization time, better control of bleeding, improved visualization of tumor borders, and reduced morbidity and mortality rate are the major advantages of endoscopic techniques in comparison to traditional external approaches. The major criticisms focus on oncologic results in view of the short/intermediate follow-up of large series, which have commonly grouped together several histologies that may be associated with different prognoses. Since prospective studies contrasting the results of endoscopic and craniofacial resections are difficult to carry out given the rarity of the disease together with ethical issues, the creation of a large database would favor the analysis of several variables related to the patient, tumor, and treatment on survival performed on a large number of patients.     

柱状对比传统经腹会阴联合切除术治疗低位进展期直肠癌的疗效观察

目的探讨柱状经腹会阴联合切除术(CAPR)和传统腹会阴联合切除术(APR)治疗低位进展期直肠癌的临床疗效。方法选取低位局部进展期直肠癌患者80例,分为柱状经腹会阴联合切除术组即CAPR组,44例;传统腹会阴联合切除术组即APR组,36例。根据2组患者的随访资料及临床病理,比较分析2组患者的性别、年龄、肿瘤在肠壁的位置、肿瘤下缘距离肛门的长度、术前是否化疗、TNM分期、手术时间以及术中出血量和术后并发症出现几率、术后生存率、环周切缘阳性率、肿瘤的转移和复发率等数据。结果 CAPR组的手术时间、术后出血量、骶前引流时间及住院时间等与APR组比较,差异无统计学意义(P>0.05);但直肠穿孔、CRM阳性、骶尾骨不适及性功能障碍发生率2组差异有统计学意义(P<0.05)。CAPR组手术后并发炎症发生率为20.45%,APR组为16.67%,差异无统计学意义(P>0.05)。CAPR组术后转移率为9.68%,APR组术后转移率为22.22%,2组对比差异无统计学意义(P>0.05)。2组患者手术后复发及总体生存率相比较,差异无统计学意义(P>0.05)。结论与APR相比较,CAPR治疗低位进展期直肠癌能够更好地降低环周切缘阳性率和局部复发率、减少术中穿孔,但CAPR术后出现男性性功能障碍、骶尾骨不适发生率高于APR,还需要继续进行观察研究。     

不进行血管重建的颈动脉切除术

不进行血管重建的颈动脉切除术是包括术前颈动脉压迫锻炼与微机脑血流数据测定仪检测脑侧支循环相结合,在锻炼合格的情况下进行肿瘤与受累动脉一并切除的新型术式。本术式自1979年首例成功以来,到1990年共行此术17例(其中15例曾在外院作过1～3次手术),均因病变上界较高,或浸润较广,切除肿瘤及颈动脉后,颈内动脉残端过短,无法进行血管重建。17例术后并发症2例,包括术后健侧肢体活动减弱,1月后完全恢复及术后死于窒息(阻塞性声门水肿)各1例,术后1及3年分别因癌转移及复发死亡各1例,14例2～11年健在,脑供血良好,未出现任何脑血管并发症。     

Resection of perihilar biliary schwannoma

Introduction

Schwannomas are usually benign nerve sheath tumors, which typically arise in the head, neck, spinal cord and extremities. Schwannoma of the biliary tract is an extremely rare finding. Patients generally lack symptoms and seek medical attention when tumor growth causes obstructive jaundice. Preoperative diagnosis is difficult and resection is the treatment of choice.

Methods

A 54 year-old female with history of back and right labia minor melanoma for which she underwent complete excision and right inguinal lymph node dissection more than 10 years ago, was evaluated for new onset gastroesophageal reflux symptoms and found to have markedly abnormal liver enzymes. Imagining studies revealed intrahepatic ductal dilatation and a 5.2 cm mass in the porta hepatis that was not consistent with cholangiocarcinoma or hepatocellular carcinoma. Multiple percutaneous biopsies of the mass failed to provide a definitive diagnosis. With a high clinical suspicion of metastatic melanoma and no other evident sites of disease, operative intervention was undertaken for diagnosis and definitive treatment.

Results

Diagnostic laparoscopy was performed initially, but access to the mass was difficult, given its location. Subsequently, the patient underwent laparotomy, with tumor excision, common bile duct resection and hepato-jejunostomy. Pathologic examination and analysis were consistent with cellular schwannoma. Postoperatively, the patient recovered uneventfully, and liver function studies returned to normal.

Conclusion

Schwannomas are uncommon tumors, which very rarely arise from the biliary tract and cause biliary obstruction. Exploration is indicated in order to establish the diagnosis and to render definitive treatment.     

Endoscopic Resection of Sinonasal Cancers

Sinonasal malignancies, a rare group of tumors, are characterized by histological heterogeneity and poor survival. As improvements in image-guidance and endoscopic technologies became incorporated into head and neck oncologic and neurosurgical practice, the application of these technologies and techniques to the surgical management of sinonasal malignancy began. Over the past decade, there has been increasing evidence regarding the safety and oncological effectiveness of these techniques. Several institutions have reported their experience with endoscopic surgery and have shown reduced morbidity, better quality of life, and survival outcomes equivalent to those of open surgery in carefully selected patients. Endoscopic cranial base surgery is a rapidly evolving field. We review the literature on oncological outcomes, safety, quality of life, and recent technological advances.