经脐单孔腹腔镜全子宫切除术治疗子宫良性疾病的效果观察

目的 观察经脐单孔腹腔镜全子宫切除术治疗子宫良性疾病的有效性及安全性.方法 回顾性分析福建医科大学附属龙岩第一医院2019年7月至2020年5月因子宫良性疾病,施行腹腔镜下全子宫切除术的80例患者的临床资料,根据手术方法的不同将患者分为传统腹腔镜组和单孔腹腔镜组,每组40例.比较两组手术时间、术中出血量、术后1 d视觉...     

经脐单孔腹腔镜全子宫切除术患者的护理

目的总结经脐单孔腹腔镜全子宫切除术的护理经验,为该术的护理提供临床借鉴。方法选取2014-01～2017-12实施经脐单孔腹腔镜全子宫切除术患者80例,对其临床资料进行回顾性分析并总结护理经验。结果 80例患者手术均获成功,无术中、术后严重并发症发生。术后切口疼痛评分平均得分为(1.10±0.26)分,术后肛门排气平均时间为(24.00±8.24) h,平均住院时间为(6.56±0.82) d,脐部切口美容满意度为(4.81±0.38)分。出院后至3个月随访,患者对腹壁切口美容效果满意,脐部切口愈合好,无明显瘢痕,均未发生手术切口不良愈合、切口感染、切口疝等情况,大小便正常。结论在经脐单孔腹腔镜全子宫切除术围手术期采取积极、有效的护理措施,可减少手术并发症的发生及加快患者的康复速度。     

腹腔镜子宫切除术

腹腔镜子宫切除术是指在腹腔镜下或在腹腔镜辅助下进行的子宫切除术。分为腹腔镜辅助阴式子宫切除术 (L AVH)、腹腔镜全子宫切除术 (TL H)、腹腔镜次全子宫切除术 (L SH)和腹腔镜筋膜内子宫切除术 (CISH)等。1　 L AVH是以腹腔镜手术开始 ,阴道手术结束 ,至少在腹腔镜下处理附件的子宫切除术。其适应证有子宫肌瘤或腺肌病 ,功血 ,盆腔子宫内膜异位症 ,子宫内膜异常增生 ,早期子宫内膜癌 ,适于经阴子宫切除但切除附件困难者等。禁忌证有子宫超过14周妊娠大小 ,阴道狭窄 ,盆腔严重粘连 ,手术者阴道手术不熟练等。并发症有输尿管、膀胱…     

腹腔镜联合阴式全子宫切除术与经腹全子宫切除术的临床效果比较

目的比较腹腔镜联合阴式全子宫切除术与经腹全子宫切除术的临床效果。方法分析43例采用腹腔镜联合阴式全子宫切除术(LAVH)患者的临床资料,并与同期抽取的50例经腹全子宫切除术(TAH)患者进行比较。结果两组手术均顺利,未出现手术并发症,在术中出血量、肛门排气时间、住院时间,LAVH组均少于TAH组(P<0.01);而手术时间LAVH组长于TAH组(P<0.01)。结论 LAVH术后恢复快、伤口美观、愈合好,值得临床推广应用。     

腹腔镜下行阴式子宫全切术与开腹子宫全切除术的临床效果比较

目的探讨腹腔镜辅助下阴式子宫全切术的临床应用及疗效。方法选取2012-06~2015-06该院收治的子宫良性病变患者86例,其中行腹腔镜辅助下行阴式子宫全切术43例(观察组),行传统开腹子宫全切除术43例(对照组),分析比较两组手术出血量、手术时间、下床活动时间、住院时间及术后并发症等。结果 86例患者均顺利完成手术,观察组术中出血量少于对照组(P0.01),下床活动时间、住院时间短于对照组(P0.01),观察组手术时间长于对照组(P0.01),术后并发症发生率低于对照组(P0.01),两组均无输尿管损伤及膀胱损伤发生。结论腹腔镜辅助下阴式子宫全切术有创伤小、安全系数高、住院时间短等优点,且术后并发症少,值得推广应用。     

全子宫切除术四种术式临床效果对比分析

目的探讨全子宫切除术的最佳术式。方法对362例患者行全子宫切除术,其中行改良经腹全子宫切除术102例（TAH组）、新式经阴全子宫切除术86例（TVH组）、腹腔镜辅助下阴式全子宫切除术98例（LAVH组）、腹腔镜下全子宫切除术76例（LTH组）,比较四组手术效果。结果 TVH组、TAH组手术时间、术中出血量均明显少于另两组（P均〈0.05）;TAH组术后镇痛率明显高于其他三组（P均〈0.01）;术后排气时间、住院时间均明显长于其他三组（P均〈0.05）;LAVH、LTH组住院费用明显高于另两组（P均〈0.05）。结论临床应根据患者的个体情况、术者经验及设备条件合理选择术式,尽量选择微创术式。一般情况下TVH为首选。     

经脐单孔腹腔镜手术与传统腹腔镜手术应用于子宫内膜癌分期手术的效果对比研究

目的探讨经脐单孔腹腔镜在子宫内膜癌分期手术治疗中的安全性及可行性,以拓展经脐单孔腹腔镜在妇科恶性肿瘤手术中的应用。方法选取广西壮族自治区人民医院妇科2014-06～2018-06收治的100例子宫内膜癌患者作为研究对象,按手术方式分为观察组和对照组,各50例。观察组行经脐单孔腹腔镜子宫内膜癌分期手术,对照组行传统腹腔镜子宫内膜癌分期手术。对患者的术中、术后情况进行对比分析。结果两组手术时间、术中出血量、盆腔淋巴结清扫个数、切口愈合不良、术后病率及术后排气时间差异无统计学意义(P0. 05)。观察组住院天数短于对照组,术后24 h视觉模拟量表(Visual Analogue Scale,VAS)评分明显低于对照组,术后美容效果较对照组满意,差异有统计学意义(P 0. 05)。结论经脐单孔腹腔镜手术应用于子宫内膜癌分期手术是安全、可行的,且具有术后恢复快、疼痛少、美容效果好、住院天数少等优点,值得推广。     

改良腹腔镜下子宫次全切除术治疗子宫良性病变40例效果观察

目的探讨改良腹腔镜下子宫次全切除术(LSH)治疗子宫良性病变的临床效果。方法将80例拟行手术治疗的子宫良性病变患者随机分为观察组和对照组各40例,分别行改良LSH和传统腹腔镜下子宫次全切除术,观察两组术中出血量、手术时间及术后恢复情况。结果两组术后下床时间、住院时间、住院费用无明显差异,但观察组术中出血量、手术时间、肛门排气时间明显少于对照组(P均<0.01)。改良腹腔镜下子宫次全切除术的临床疗效明显优于传统腹腔镜下子宫次全切除术。结论改良LSH治疗子宫良性病变可明显缩短手术时间,减少术中出血、缩短术后康复时间,且不增加手术费用。     

改良腹腔镜筋膜内子宫切除术与腹腔镜子宫全切术的临床应用效果比较

［摘要］　目的　探讨改良腹腔镜筋膜内子宫切除术与腹腔镜子宫全切术的临床应用效果。方法　选择2010-05～2013-03该院行腹腔镜筋膜内子宫全切术及腹腔镜子宫全切病例162例,根据手术方法不同分为观察组（腹腔镜筋膜内子宫切除术）及对照组（腹腔镜子宫全切术）各81例,对两组手术时间、术中出血量、术后病率、住院费用、住院床日、术后性生活恢复、息肉、残端感染、副损伤进行比较。结果　两组手术时间,术中出血量、术后病率、住院费用、住院床日、术后性生活时间、息肉、残端感染、副损伤比较差异均有统计学意义（P<0.05）。结论　改良腹腔镜筋膜内子宫切除术副损伤少,术中出血量少,值得临床推广。     

腹腔镜与开腹子宫切除术的对比研究

近年来，腹腔镜手术的适应证不断扩大，但手术难度也大。为此，我们对腹腔镜子宫全切及开腹子宫全切病例进行对比，藉此分析两种术式对机体的影响．评估腹腔镜子宫切除术的临床效果。     

Comparative study of safety and outcomes of single-port access versus conventional laparoscopic colorectal surgery

Background

Single-port access (SPA) offers cosmetic advantages in addition to the well-recognised benefits of conventional multi-port laparoscopic (CL) surgery, and can be carried out using standard straight instruments. We report the outcomes of our early experience with SPA colorectal resections in comparison with CL surgery.

Methods

We compared the following data, patient characteristics, operating time, morbidity, operative mortality, length of hospital stay and tumour variables, of patients who underwent SPA right, left, sigmoid and total colon resections, as well as high anterior resections and panproctocolectomies, with that of patients who underwent equivalent conventional laparoscopic (CL) operations. The 40 SPA and 78 CL patients studied underwent surgery between February 2008 and September 2011.

Results

There was no difference between the SPA and CL operations, as regards the patient’s sex (55.0 vs. 62.8?% males, p?=?0.411), comorbidity (ASA I 10.0 vs. 12.8?%; ASA II 57.5 vs. 59.0?%; ASA III 32.5 vs. 25.6?%; ASA IV 0 vs. 2.6?%, p?=?0.722) and body mass index (26.2 vs. 28.0?kg/m², p?=?0.073). However, SPA patients were younger (mean age 54.1 vs. 64.8?years, p?=?0.001), and malignancy was a less common indication for surgery (25.0 vs. 71.8?%, p?<?0.001). There were no conversions to open surgery, and one death occurred in the CL group (1.3?%). Mean operating time (162 vs. 170?min, p?=?0.547), median post-operative hospital stay (4 vs. 4?days, p?=?0.255) and morbidity (7.5 vs. 12.8?%, p?=?0.538) were comparable.

Conclusions

SPA laparoscopic surgery appears safe in the hands of experienced laparoscopic surgeons, with no increase in operating time, length of stay, morbidity and mortality. Selection of patients with indications for surgery for benign disease may be of importance to ensure an oncologically safe initial uptake of SPA colorectal practice.     

Comparison of hospital costs for single-port and conventional laparoscopic colorectal resection: a case-matched study

Background

Whether single-port laparoscopic (SPL) colorectal resection is cost-effective in comparison to conventional laparoscopy remains unclear. The aim of this study is to compare hospital costs for single-port versus conventional laparoscopic colorectal resections.

Methods

Patients with available cost data who underwent (SPL) colorectal resection between December 2007 and December 2010 were matched with conventional (multiport) laparoscopic (CL) counterparts for age, gender, American Society of Anesthesiologists score, body mass index, operation type and year of surgery. Patients who underwent hand-assisted laparoscopic surgery were not included in the study. Direct hospital costs for the two groups were compared.

Results

There were 90 patients in the SPL group and 90 patients in the CL group. Age (p = 0.79), gender (p = 0.88), body mass index (p = 0.82), American Society of Anesthesiologists score (p = 1) and diagnosis (p = 0.85) were similar in both groups. Operation type (p = 1), estimated blood loss (p = 0.17) and length of hospital stay (p = 0.06) were comparable between the groups. Operation time was significantly shorter in the SPL group (p < 0.001), thus anesthesia cost was significantly lower in this group (p = 0.003). Total costs (p = 0.5), operating room (p = 0.65), nursing (p = 0.13), pharmacy (p = 0.6), radiology (p = 0.27), professional (p = 0.38) and pathology/laboratory (p = 0.46) costs were similar between the two groups.

Conclusions

Single-port laparoscopic colorectal resection can be performed with comparable hospital costs to conventional multiport laparoscopy.     

腹腔镜辅助阴式全子宫切除术与开腹全子宫切除术的临床效果比较

目的对比分析腹腔镜辅助阴式全子宫切除术(LAVH)与开腹全子宫切除术(TAH)的临床效果及安全性。方法分析2013-01~2016-01该院收治的68例接受全子宫切除患者的临床资料,随机分为观察组和对照组各34例,观察组接受LAVH治疗,对照组接受TAH治疗,对比两组治疗效果及住院费用。结果观察组在切口长度、术中出血量、排气时间、术后疼痛率、住院时间及并发症发生率显著低于或短于对照组,手术时间和住院费用高于对照组(P均0.05)。结论 LAVH与TAH各具优势,前者有创伤小、安全性高、恢复快、住院时间短的优点,但是费用高,临床上应合理选择。     

Transanal single-port laparoscopic total mesorectal excision in the treatment of rectal cancer

Our objective was to report of our first experience with transanal total mesorectal excision (TME) of rectal cancer using single-port equipment, a pure natural orifice transluminal endoscopic surgery (NOTES) procedure, and to discuss the advantages and disadvantages of the technique. A patient with rectal cancer was selected according to preoperative evaluation criteria. Purse-string sutures were placed into the rectum distal to the tumor using the procedure of prolapse and hemorrhoids (PPH) anoscope. A full-thickness incision of the rectal wall was made circumferentially below the purse string and a three-channel cannula was inserted. The artificial orifice was insufflated. The entire mesorectum was dissected upward according to the principles of TME. Pneumoperitoneum was created by opening the rectouterine pouch. The sigmoid colon and its mesentery were dissected, and the inferior mesenteric vessels were ligated and divided. After dissection of a sufficient length of sigmoid colon, the PPH anoscope and the three-channel cannula were removed. The rectum and sigmoid colon were brought out through the anus. The tumor was resected. After removal of the specimens, a stapled end-to-end anastomosis was fashioned between the rectum and the sigmoid colon. Operative time was 300 min. The mesorectum was completely removed with negative distal and circumferential margin. The final pathological stage was pT3N1M0, with one positive lymph node (1/12). The patient recovered uneventfully after surgery. Pure-NOTES performed as transanal single-port laparoscopic TME for rectal cancer appears to be feasible and safe.     

Totally laparoscopic total gastrectomy using the modified overlap method and conventional open total gastrectomy: A comparative study

BACKGROUNDAlthough several methods of totally laparoscopic total gastrectomy (TLTG) have been reported. The best anastomosis technique for LTG has not been established.AIMTo investigate the effectiveness and surgical outcomes of TLTG using the modified overlap method compared with open total gastrectomy (OTG) using the circular stapled method.METHODSWe performed 151 and 131 surgeries using TLTG with the modified overlap method and OTG for gastric cancer between March 2012 and December 2018. Surgical and oncological outcomes were compared between groups using propensity score matching. In addition, we analyzed the risk factors associated with postoperative complications.RESULTSPatients who underwent TLTG were discharged earlier than those who underwent OTG [TLTG (9.62 ± 5.32) vs OTG (13.51 ± 10.67), P < 0.05]. Time to first flatus and soft diet were significantly shorter in TLTG group. The pain scores at all postoperative periods and administration of opioids were significantly lower in the TLTG group than in the OTG group. No significant difference in early, late and esophagojejunostomy (EJ)-related complications or 5-year recurrence free and overall survival between groups. Multivariate analysis demonstrated that body mass index [odds ratio (OR), 1.824; 95% confidence interval (CI): 1.029-3.234, P = 0.040] and American Society of Anaesthesiologists (ASA) score (OR, 3.154; 95%CI: 1.084-9.174, P = 0.035) were independent risk factors of early complications. Additionally, age was associated with ≥ 3 Clavien-Dindo classification and EJ-related complications.CONCLUSIONAlthough TLTG with the modified overlap method showed similar complication rate and oncological outcome with OTG, it yields lower pain score, earlier bowel recovery, and discharge. Surgeons should perform total gastrectomy cautiously and delicately in patients with obesity, high ASA scores, and older ages.