8例腹腔镜下早期卵巢癌肿瘤细胞减灭术的配合

总结了8例腹腔镜下早期卵巢癌肿瘤细胞减灭术的手术配合.术前做好特殊器械的准备工作和术前访视,术中做好患者体位管理,严格执行无瘤技术操作规程,熟练、准确地配合完成手术各个步骤是保证患者手术成功的关键.     

血管内治疗颅内动脉瘤术中并发症及防治

目的 总结血管内治疗颅内动脉瘤术中常见并发症及其防治经验.方法 回顾性分析福建医科大学省立临床学院近3年来采用血管内治疗的60例颅内动脉瘤患者的临床和随访资料并参考有关文献,探讨减少和处理术中并发症的操作技巧和经验.结果 60例患者血管造影共检出69个囊形动脉瘤和1个椎动脉夹层动脉瘤.65个囊形动脉瘤行血管内弹簧圈栓塞,其中支架辅助栓塞5例,球囊辅助栓塞3例.有50例患者的53个(81.5%)动脉瘤被完全栓塞,5例的8个动脉瘤被次全栓塞(12.3%),3例的4个(6.2%)被部分栓塞;治疗失败1例.1例椎动脉夹层动脉瘤行载瘤动脉闭塞.发生术中动脉瘤破裂4例;症状性血管闭塞2例;支架移位、弹簧圈脱出1例;术中血管痉挛15例.出院时恢复良好率达93.3%(mRS≤2分).随访55例(91.6%),时间1～24个月,恢复良好(mRS≤2分)51例(92.7%),死亡3例;随访期间无再出血和动脉瘤复发.结论 血管内治疗颅内动脉瘤疗效确切;提高于术操作技巧,减少和正确处理术中并发症有助于改善预后.     

乳腺癌术后早期并发症158例临床分析

目的 探讨乳腺癌术后早期并发症的发生原因及防治措施,以期降低乳腺癌术后早期并发症的发生率。方法 回顾分析了1990年1月至1999年6月我院乳腺癌手术病人158例,统计了术式及术后早期并发症的发生情况。结果 158例乳腺腺手术病人发生皮瓣坏死51例（32.3%）,皮下积液23例（14.6%)。结论 乳腺癌术后早期并发症的发生与手术切口的选择、术手腋窝的加压包扎及引流有关。     

机器人辅助腹腔镜精准肝切除的手术配合

目的探讨机器人辅助腹腔镜精准肝切除手术的护理配合。方法回顾性分析13例机器人辅助腹腔镜精准肝切除手术资料,对本组手术的术前准备、术中配合及紧急情况的处理进行总结。结果13例患者均成功接受了机器人辅助腹腔镜精准肝切除术,术前准备、术中配合、特殊情况应对及术后整理均不断改进,取得满意的护理效果。结论机器人手术方式扩展到多专科多种术式,准备与沟通、谨慎的安置与保护,是手术护理伴随手术技术发展呈现专科护士作用的重要保障。     

腹腔镜宫颈癌根治术并发症的临床分析

目的:通过回顾性分析腹腔镜宫颈癌根治术并发症的发生原因及结局,探讨减少并发症的可行性方法。方法:我院2006年5月～2008年12月间共进行宫颈癌根治术115例,其中腹腔镜宫颈癌根治术85例,分为单、双极电凝配合超声刀组,经腹宫颈癌根治术70例,腹腔镜组发生并发症6例,对其并发症的原因及结局进行比较分析。结果:腹腔镜单极电凝组4例出现并发症,双极电凝组2例出现并发症,单极电凝较双极电凝更易发生热损伤。结论:腹腔镜宫颈癌根治术并发症的发生与手术难度有关,采用双极电凝较单极电凝更安全,可减少热损伤并发症的发生。     

腹腔镜宫颈癌根治术并发症的临床分析

目的:通过回顾性分析腹腔镜宫颈癌根治术并发症的发生原因及结局,探讨减少并发症的可行性方法。方法:我院2006年5月～2008年12月间共进行宫颈癌根治术115例,其中腹腔镜宫颈癌根治术85例,分为单、双极电凝配合超声刀组,经腹宫颈癌根治术70例,腹腔镜组发生并发症6例,对其并发症的原因及结局进行比较分析。结果:腹腔镜单极电凝组4例出现并发症,双极电凝组2例出现并发症,单极电凝较双极电凝更易发生热损伤。结论:腹腔镜宫颈癌根治术并发症的发生与手术难度有关,采用双极电凝较单极电凝更安全,可减少热损伤并发症的发生。     

完全植入式静脉输液港手术方式及并发症研究进展

完全植入式静脉输液港(TIVAD)可以用于输注化疗药物和采集血液标本。在需要长期、间断地进行静脉输注等操作时,TIVAD是一个非常合适的选择,TIVAD的应用使肿瘤患者的生活质量得到了极大改善。TIVAD相关的并发症分为即刻并发症、早期并发症和后期并发症,提高手术、穿刺技术,或在超声或DSA引导下操作可以降低并发症的发生率。     

Effect of aromatherapy on cancer complications: A systematic review

PurposeThe aim of this study was to determine the effect of aromatherapy on cancer complications.MethodsIn this systematic review, international (PubMed, Web of Science, Scopus, EMBASE and CENTRAL) and national databases (SID and Magiran) were searched from inception of the databases to April 31, 2019. JBI and Jadad scales were used to assess the quality of the studies included.Resultsof 43 Studies conducted on 3239 cancer patients in 13 countries from 1995 to 2019, entered the final stage. The results showed that the aromatherapy improves the various physical and psychological complications, although few studies have shown that aromatherapy had no effect on skin reactions.ConclusionConsidering the various complications and costs in cancer patients, it seems that the aromatherapy can be used as a proper supplemental treatment to improve complications, although further studies are needed to determine the protocol and the standard dosage.     

卵巢癌减灭手术同期腹腔热灌注化疗的手术配合

总结了9例卵巢癌减灭手术同期腹腔热灌注化疗的手术配合,术中注意无菌操作及正常器官的保护与隔离,降低术后感染和癌细胞扩散的风险.在腹腔热灌注化疗中注意管路的通畅、液体的流量及有无渗漏污染切口周围正常组织;注意维护患者皮肤完整性,防止压力伤.     

Miles手术并发症的处理

目的探讨直肠癌手术并发症发生的原因、预防措施及处理方法。方法回顾性分析我院1977年1月至2004年12月间255例M iles手术主要并发症的临床资料。结果乙状结肠造瘘口并发症23例,骶前静脉出血5例,肠梗阻6例,会阴部伤口愈合不良11例,泌尿系统损伤7例。主要并发症的发生率为20.4%。结论直肠癌手术并发症重在预防,及时有效地处理这些并发症也很关键。必要的术前准备及正确的手术操作与处理是减少M iles手术主要并发症的有效方法     

后腹腔镜手术病人的系统化整体护理

目的 对308例泌尿科行后腹腔镜手术病人的整体护理进行总结，为教学和护理水平的进一步提高提供资料。方法 对泌尿外科308例已经手术的病人的整体护理进行回顾性研究，总结在心理、术前准备、术后恢复方面的护理经验。结果 在护士的系统化整体护理下，病人术前能积极配合手术准备，术后恢复顺利，对护理工作非常满意。结论 系统化整体护理对病人是非常必须的，能及时发现问题，促进病人顺利康复，提高满意度。     

Imaging of complications of laparoscopic cholecystectomy

Laparoscopic cholecystectomy has gained widespread acceptance for treatment of cholelithiasis. Because radiologists have aprimary role in recognizing and treating complications of this surgical technique, we reviewed the clinical records and imaging studies of 29 patients with complications after laparoscopic cholecystectomy. Complications included bile duct injuries (15 cases), retained common bile duct stones (seven cases), cystic duct stump leak (four cases), bowel perforation (two cases), abdominal abscess (two cases), intraperitoneal gallstones (2), and failure to diagnose malignant bile duct obstruction (one case). Twenty-two patients required reoperation, and one patient with bowel perforation died. Eleven of 15 bile duct injuries were imaged prior to hepaticojejunostomy. Nine of 11 were proximal bile duct injuries within 2 cm of the junction of the right and left bile ducts. Endoscopic retrograde cholangiography (ERC) identified the distal extent of injuries, but transhepatic cholangiography (THC) was necessary to fully evaluate the proximal extent of the bile duct abnormalities. ERC was used for diagnosis and treatment of the seven patients with choledocholithiasis. Abdominal films showed intraperitoneal gas in one patient with bowel perforation, intraperitoneal stones in a second patient, and intraabdominal abscess in one of two patients in whom abdominal films were performed. Computed tomography (CT), done in three patients with bowel perforation or abscess, showed the one duodenal perforation, and the two abscesses. CT also showed bilomas, intraperitoneal gallstones, and unsuspected malignancy. Imaging studies detected and defined complications after laparoscopic cholecystectomy in all cases.     

Radiology of cholecystectomy complications

Postoperative problems following simple removal of the gallbladder are infrequent. Radiographic studies may be valuable in suggesting or confirming the diagnosis when not clinically evident. Plain films, contrast studies, ultrasound, and computed tomography (CT) all can be useful modalities in this area. Several examples of complications related specifically to the operative field in cholecystectomy are reviewed.     

腹腔镜胆囊切除术并发症的预防

目的 预防腹腔镜行胆囊切除术并发症的发生。方法 对2001年1月～2004年4月施行电视腹腔镜胆囊切除术（laparoscopic cholecystectomy。LC）201例进行回顾性分析。结果 该组201例中1例发生胆总管损伤，及时发现并一期修复治愈，1例因术中出血及2例因粘连严重中转开腹手术，其余197例术后检查肝内外胆管及血清总胆红素正常。结论 为预防胆囊切除术中损伤肝、胆管，术后腹痛等不适症状的发生，必须严格掌握手术指征，遵守操作规程，轻柔准确操作，其并发症完全可以得到预防。     

小切口泌尿外科手术43例分析

目的 总结小切口在泌尿外科手术中的临床应用经验.方法 应用小切口施行泌尿外科手术43例,其中肾上腺肿瘤手术5例,肾切除手术9例,(肾肿瘤3例,囊性肾病和无功能肾积水3例,肾结核2例,炎症性肾萎缩1例),肾囊肿去顶减压术13例,肾积水肾盂成型术4例,肾盂或输尿管上段切开取结石术12例.结果 43例手术均获成功,切口长3～8 cm,手术时间平均80 min,术中出血平均100ml,所有患者均未输血,无周围脏器损伤等严重并发症.术后住院5～7 d.结论 小切口泌尿外科手术具有创伤小、安全、恢复快等优点,无需特殊设备,易在基础医院推广.

Abstract：

Objective To summarize the clinical experiences of mini-incision urological surgery.Methods The clinical data of 43 patients who received mini-incision surgery were reviewed retrospectively.The subjects included 5 adrenal tumor excisions,9 nephrectomy,13 unroofing of solitary renal cyst,4 pyeloplasty.12 pyelolithotomy and ureterolithotomy.Results All surgical procedures were successful in the 43 cases.The length of the incision ranged from 3 to 8 cm.The average operation time was 80 minutes and average blood loss was 100 ml. No patients needed blood transfusion during the operation.No serious complications such as the surrounding organ damage happened.The postoperative hospitalization was 5-7 d. Conclusion Mini-incision approach for urological operation has the advantages of minimal invasion,safety,rapid recovery and no requirement for special equipments.Its easy to be popularized in the primary hospital.     

直肠癌择期手术外科并发症的处理

目的 探讨直肠癌手术外科并发症的处理和预防。方法 回顾性分析196例直肠癌病人的临床资料,分析手术中和手术后近期并发症的类型、原因和处理方法。结果 196例直肠癌病人发生术中并发症3例（1．5％）,手术后并发症17例（8．7％）,包括骶前静脉大出血、前列腺出血、输尿管损伤、切口感染、吻合口漏、直肠阴道瘘、吻合口狭窄、急性尿潴留和造口坏死狭窄等。结论 直肠癌手术外科并发症可治可防,外科医生要加强围手术期管理,提高手术技能,以降低直肠癌手术并发症的发生率。     

腹腔镜与经腹宫颈癌手术并发症的对比分析

目的比较腹腔镜与经腹宫颈癌手术并发症,探讨腹腔镜手术的安全性,对两者并发症Clavien-Dindo分级及相关危险因素进行分析。方法回顾性分析2011年3月-2014年10月该院204例(选择215例,有11例失访)宫颈癌患者行广泛性子宫切除手术的临床资料。分为腹腔镜下广泛性子宫切除术(LRH)组和经腹广泛性子宫切除术(ARH)组。分析比较两者间术中、术后并发症及其危险程度和随访资料等,评估腹腔镜宫颈癌手术的安全性及分析并发症相关的独立危险因素。结果 204例研究对象中并发症归纳为4个等级。两组并发症发生率及危险程度比较差异均无统计学意义(P0.05)。两组间复发及死亡率比较差异无统计学意义(P0.05)。根据Logistic回归分析,ARH组严重程度为Ⅱ级以上术中并发症与手术时间有关,ARH组严重程度Ⅱ级以上并发症与年龄大于50岁的女性有关,ARH组术后严重程度为Ⅱ级以上并发症与超重(体质指数25)有关。结论通过对两组手术并发症及其危险程度的分析,得出两组安全性无差异,手术对有高危因素的患者需要全面进行评估,严格把握其适应证及禁忌证。     

彩色多普勒超声在颅内动静脉畸形切除术中的应用

目的 探讨颅内动静脉畸形切除术中彩色多普勒超声检查的应用价值与预后的关系.方法 在显微外科手术的基础上,将65例动脑静脉畸形患者随机分为A、B两组,A组34例动静脉畸形患者在术中接受术中超声检查,确定其畸形血管团的数目、位置、深度、大小、范围及其与周边组织结构的关系,探查供血动脉及引流静脉的数目及走行,以确定动、静脉畸...     

Long-term, tunneled, noncuffed central venous catheter in cancer patients (Vygon): safety, efficacy, and complications

Background Totally implantable or partially cuffed central venous catheters (CVC) are commonly used in cancer patients, but they are often expensive and may produce complications. To minimize costs, we have been using a low-cost, partially tunneled, silicone elastomer catheter with no Dacron cuff or antireflux valve (Vygon) since 2001. This study is a retrospective investigation of our experience using the Vygon catheter as a long-term CVC in patients with malignancy.Materials and methods A total of 458 Vygon catheters (Nutricath, Vygon) were percutaneously inserted by an interventional radiologist in 302 cancer patients. The median duration of catheter use was 93 days, mean 164.3 days (range 1–789). Main patient characteristics were as follows: number of male/female patients, 166/136; median age, 51 years; hematological/nonhematological patients, 189/113.Results Early complications were pneumothorax in six and hematoma in twelve of 458 implants, respectively. Thirteen out of 302 patients developed a catheter-related thrombosis. One hundred and thirty-five of 458 Vygon catheters required removal because of catheter-related complications: 68 accidental losses, 37 cases of febrile neutropenia suspected to be catheter-related, ten catheter dislodgements, ten catheter malfunctions, four local infections, three thromboses, two catheter ruptures, and one allergic reaction.Conclusion Vygon catheters do not seem to induce more early and late complications as compared with other more expensive devices, except for disadvantage of the high incidence rate of accidental losses.     

妇科腹腔镜手术并发症分析及防治

目的探讨妇科腹腔镜并发症发生原因和防治方法，提高手术的安全性。方法对该院2001年3月～2006年10月进行的2266例妇科腹腔镜手术的临床资料作回顾性分析。结果2266例腹腔镜手术中，发生并发症47例，占2．07％。其中持续性宫外孕13例、出血9例、肠损伤2例、膀胱损伤2例、盆腔化脓性感染1例，与恶性肿瘤有关2例、皮下气肿18例。并发症中需开腹处理的12例，再次腹腔镜治疗4例。结论腹腔镜手术部分并发症是严重的，应引起高度重视。正确掌握手术指征、严格按规范操作、避免粗心和盲目自信及遇到操作困难情况及时中转开腹是预防手术并发症的关键。术后必须严密观察及随访病人，以便及时发现各种意外，并给予适当处理。