直肠癌全直肠系膜切除经腹腔镜与开腹手术的临床对照研究

目的 :探讨经腹腔镜行全直肠系膜切除的可行性。方法 :36例直肠癌患者分别采用经腹腔镜或常规开腹手术行直肠癌根治术 ,比较两组围手术期的情况与切除标本 ,了解肿瘤切除的彻底性 ,肠旁淋巴结清扫数量的差异。结果 :两组切除标本的直肠系膜均完整 ;腹腔镜组与开腹组淋巴结数分别为 7 9± 0 7与 8 1± 0 9(P >0 0 5 ) ;直肠远切端均无癌细胞浸润 ;腹腔镜组失血 136± 2 1ml ,开腹组失血 35 7± 34ml,差异有高度显著性 (P <0 0 1) ,腹腔镜组手术后肠功能恢复早 (4 3± 5hvs 78± 12h ,P <0 0 5 ) ,围手术期并发症 2组无显著差别。结论 :在熟练掌握开腹全直肠系膜切除 (TME)的基础上经腹腔镜行TME是可行的 ,且患者创伤小、康复快 ,近期治疗效果与开腹手术无差别     

经腹腔镜行全直肠系膜切除的可行性研究

目的探讨经腹腔镜行全直肠系膜切除治疗直肠癌的可行性。方法比较经腹腔镜与开腹两组标本的直肠系膜完整性和肠旁 3站淋巴结清扫数目的差异。结果①两组各 2 0例直肠癌切除标本的直肠系膜均完整无破损。②腹腔镜组与开腹组N1的淋巴结数分别为 8 5± 3 6与10 6± 6 2 (P =0 334 ) ;N2 的淋巴结数分别为 3 7± 2 2与 2 4± 2 1(P =0 32 8) ;N3 的淋巴结数分别为2 4± 1 7与 2 0± 1 8(P =0 5 90 )。③直肠远切端均无癌细胞浸润。结论经腹腔镜行全直肠系膜切除是可行的     

腹腔镜全直肠系膜切除术治疗低位、超低位直肠癌的临床研究

目的探讨腹腔镜全直肠系膜切除在低位、超低位直肠癌手术中的安全性、肿瘤根治疗效和术后恢复情况。方法低位、超低位直肠癌患者136例行腹腔镜全直肠系膜切除64例(腹腔镜组),开腹全直肠系膜切除72例(开腹组),比较手术学指标、肿瘤根治疗效。结果腹腔镜组手术时间为(162.4±42.0)min,开腹组为(146.1±31.2)min;腹腔镜组出血量为(87.6±52.2)ml,开腹组为(199.4±95.8)ml,两组比较差异有统计学意义(P0.01)。两组保肛率、清除淋巴结数目和远切端距肿瘤的距离比较,差异无统计学意义(P0.05)。腹腔镜组直肠系膜完整性优于开腹组,两组比较差异有统计学意义(P0.05)。腹腔镜组对吗啡类镇痛药物的需要、肠功能恢复时间、住院时间均更少,差异有统计学意义[15.6%和30.6%,P0.05;(66.7±12.2)h和(99.9±19.1)h,P0.01;(7.7±1.0)d和(9.2±1.6)d,P0.01]。术后并发症发生率、随访局部复发率、总复发率、不同TNM分期的总复发率比较,差异均无统计学意义(P0.05)。结论腹腔镜全直肠系膜切除手术出血量少,更完整地直肠系膜切除,术后肠功能恢复快,镇痛的需要率低,住院时间短。     

腹腔镜直肠癌根治术与同期开腹手术的回顾性分析

目的 评价腹腔镜治疗直肠癌的可行性及近期临床疗效.方法 腹腔镜辅助下直肠癌手术64例,其中直肠癌Dixon手术51例(79.7%),经肛门内括约肌直肠癌根治术(ISR)1例,Hartmann术1例,Mile手术11例;开腹直肠癌根治术患者51例,其中直肠癌Dixon手术38 例(74.5%)、Mile手术11例,Hartmann术2例.比较两组患者的手术及术后情况.结果 两组均无术中、术后严重并发症和手术死亡病例,腹腔镜组有4例中转开腹手术.腹腔镜组术中失血量明显少于开腹组[(51.4±20.0)ml比(180.0±64.7)ml,P＜0.01].两组平均手术时间、保肛率、清除的淋巴结数量、直肠前切除肿瘤远端切缘长度组间差异无统计学意义(P>0.05).腹腔镜组术后胃肠功能恢复时间早于开腹组[(2.5±1.0)d比(3.8±1.2)d,P＜0.05],腹腔镜组住院时间短于开腹组[(10.6±2.8)d比(13.5±3.1)d,P＜0.05].腹腔镜组的术后镇痛需求率、肠功能恢复时间、进食流质时间、下床活动时间及住院时间均低于或少于开腹组(P<0.05);手术并发症发生率两组差异无统计学意义(P>0.05).平均随访18个月,腹腔镜组和开腹组患者复发率和总生存率分别是7.8%和9.8%,95.3%和96.1%,差异均无统计学意义(P>0.05).结论 腹腔镜直肠癌切除术安全、有效,具有可行性.     

腔镜与开腹低位直肠癌Miles术的对比研究

目的:探讨腹腔镜低位直肠癌Miles术的临床效果及应用价值.方法:回顾分析120例低位直肠癌Miles术患者的临床资料,其中腹腔镜组50例,遵循全直肠系膜切除原则行腹腔镜低位直肠癌Miles术;开腹组70例,行常规开腹手术.对比两组患者围手术期情况、淋巴结清扫数量、住院时间等指标.结果:两组标本直肠系膜均完整,腹腔镜组...     

腹腔镜下全直肠系膜切除治疗低位直肠癌的体会

【摘要】〓目的〓总结腹腔镜下全直肠系膜切除治疗低位直肠癌的手术体会。方法〓选择我院2007年3月至2012年6月收治的低位直肠癌患者,根据手术方法不同,选择腹腔镜下全直肠系膜切除术50例(腹腔镜组)和开腹下实施直肠癌全直肠系膜切除术50例(开腹组),对两组病人术中出血量、手术时间、术后肛门排气时间、住院时间、切除淋巴结总数、住院总费用、随访结果等资料进行对比及临床分析。 结果〓腹腔镜组术中出血量、手术时间、术后肛门排气时间、住院时间均较开腹组少(P均<0.05);术中淋巴结清扫、直肠远切端距癌灶最下缘距离与开腹组没有明显差异(P>0.05);腔镜组的术后并发症及术后复发均较开腹组少(P<0.05)。结论〓腹腔镜下全直肠系膜切除治疗低位直肠癌与开腹组相比,腹腔镜组在减少损伤及术后恢复方面优于开腹组。而且腹腹镜组术后复发率低于开腹组。     

腹腔镜直肠癌全直肠系膜切除术的学习曲线研究

目的 评估腹腔镜直肠癌全直肠系膜切除术不同阶段的手术效果,探讨腹腔镜结直肠外科医师缩短学习曲线的要点.方法 分析2006年1月至2009年10月由同组医师完成的120例腹腔镜直肠癌全直肠系膜切除术患者的临床资料.按手术先后次序分A、B、C 3组,每组40例,比较各组手术时间、术中出血量、中转开腹率、并发症发生率、住院时间、标本长度和淋巴结清扫数,分析不同阶段的手术效果.结果 3组病例在年龄、性别、病理分期、肿瘤部位、手术方式无显著差异,A组手术时间、出血量及术后住院时间高于B、C组,差异有统计学意义;B、C组间差异无统计学意义.A组中转开腹例数多于B、C组.各组检获淋巴结数目及标本长度无差异.结论 有丰富开腹直肠癌手术经验的固定手术团队,经过40例的学习曲线,可掌握腹腔镜直肠癌全直肠系膜切除手术.     

腹腔镜保肛全直肠系膜切除术治疗直肠癌的临床分析

目的 探讨腹腔镜保肛全直肠系膜切除术治疗直肠癌的手术方法及近期疗效.方法 回顾性分析2010年6月至2013年1月间30例直肠癌患者行腹腔镜保肛全直肠系膜切除术（腹腔镜组）,与同期32例直肠癌行开腹直肠前切除术（开腹组）作对照.结果 腹腔镜组术中失血（151.8±19.2）ml,明显少于开腹组（236.5±43.9） ml,P=0.000;手术时间腹腔镜组为（236.7±16.2）min,长于开腹组的（195.9±10.9）min,P=0.000;腹腔镜组肠道功能恢复为（2.4±0.6）d,早于开腹组的（2.9±0.5）d,P=0.001;且住院时间短（P=0.000）;腹腔镜组总并发症发生率低于开腹组[6.7％（2/30）、31.3％（10/32）,P=0.014,腹腔镜组吻合口漏1例、肠梗阻1例,开腹组吻合口漏2例、肠梗阻3例,开腹组切口感染2例、切口裂开和切口疝各1例,术后发生肺不张1例;腹腔镜组清扫淋巴结数目为（11.95±1.73）枚,开腹组为（11.65±1.40）枚（P=0.465）;肿瘤距下切缘距离腹腔镜组为（4.46±1.19） cm,开腹组为（4.58±0.68） cm（P=0.647）;下切缘阴性率均为100％,术后病理分期及生存时间两组间差异均无统计学意义（P＞0.05）,但腹腔镜组住院费用仍较高（P＜0.01）.结论 腹腔镜保肛全直肠系膜切除术治疗直肠癌创伤小、出血少、恢复快、并发症发生率低,根治效果与开腹术一样彻底,但住院费用高于开腹组,手术时间在学习曲线内长于开腹组.     

腹腔镜手术治疗直肠癌28例临床观察

为探讨腹腔镜下直肠癌手术的临床应用价值。对行腹腔镜下直肠癌根治术28例（腹腔镜组）、开腹直肠癌根治术34例（开腹组）的临床资料进行回顾性分析。结果显示,腹腔镜组与开腹组手术时间分别为（212±4.24）min和（182±29）min（P〉0．05）;术中平均出血量分别为（156±51）ml和（345±63）ml（P〈0．05）;恢复肠道功能的时间分别为（3．5±1．3）d和（6．2±2．1）d（P〈0．05）。两组在肠段切除长度、肿块至下切缘距离和淋巴结清扫范围方面差异无显著意义（P〉0．05）。结果表明,腹腔镜直肠癌根治术安全,经济,创伤小,恢复快。     

腹腔镜与开腹直肠癌手术的疗效观察

目的:通过对比腹腔镜直肠癌全直肠系膜切除术(total mesorectal excision,TME)与开腹直肠癌TME术中情况、术后恢复情况、近期随访情况,探讨腹腔镜直肠癌TME的安全性与可行性。方法:回顾分析2011年3月至2012年5月20例开腹TME(对照组)及2011年5月至2012年7月20例腹腔镜TME(观察组)患者的临床资料。结果:观察组术中出血量平均(70.0±25.5)ml,术后肛门排气时间平均(2.5±0.5)d,下床活动时间平均(3.3±1.5)d,平均住院(7.7±2.4)d,均明显优于对照组,差异有统计学意义(P<0.05),两组手术时间[(178.4±54.7)min vs.(150.8±33.4)min]、淋巴结清扫数量[(14.5±2.6)枚vs.(13.0±3.1)枚]、标本切除长度[(13.0±5.3)cm vs.(13.8±4.8)cm]差异均无统计学意义(P>0.05)。术后随访12~36个月,观察组局部复发1例,肝脏转移1例,对照组肝脏转移2例,尚无局部复发病例,两组差异无统计学意义(P>0.05)。结论:腹腔镜直肠癌TME是安全、可靠的,具有切口小、出血少、康复快等优势。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.