伴有肠梗阻的结直肠癌腹腔镜辅助手术

目的探讨对伴有肠梗阻的结直肠癌患者在腹腔镜辅助下行结直肠癌根治切除术同时一期吻合的可行性。方法对6例伴肠梗阻的结直肠癌患者行腹腔镜辅助下结直肠癌根治切除一期吻合手术。结果手术均获得成功。5例伴不全肠梗阻患者行腹腔镜辅助结直肠癌切除一期吻合术:1例伴完全肠梗阻患者行手辅助腹腔镜乙状结肠癌切除一期吻合术。无中转开腹和并发症发生。手术时间平均200(150-240)min,出血量平均60(20～100) ml。术后住院时间8-11 d。术后随访8-28个月,未见癌肿复发转移。结论对于伴肠梗阻的结直肠癌患者行腹腔镜辅助下肿瘤根治术一期吻合是可行的。     

腹腔镜下结直肠癌肝转移一期手术23例临床疗效

目的探讨腹腔镜下治疗结直肠癌肝转移一期的安全性及有效性。方法回顾分析2011年1月至2013年6月行结直肠癌肝转移手术的43例患者的临床资料,将23例患者同时行腹腔镜切除肝转移灶切除术纳入腹腔镜组,20例患者同时行开放性肝转移灶切除术患者纳入开腹组。采用SPSS 23.0软件进行分析,中位生存时间、生存率及术后并发症比较采用χ2检验;计量资料采用(x珋±s)表示,比较采用独立样本t检验,生存分析采用Kaplain-Meire法计算生存率。P0.05表示差异有统计学意义。结果腹腔镜组患者手术时间及术后腹腔引流管留置时间较开腹组显著减少(P0.05);两组患者术中出血量、术后肛门排气时间及术后住院时间差异无统计学意义(P0.05);两组患者术后生存率相近,无围手术期死亡病例,术后均未见严重术后并发症。结论腹腔镜下结直肠癌肝转移一期联合切除安全可行,具有较好的疗效。     

同时性结直肠癌肝转移一期切除术后并发症相关因素分析

目的:探讨同时性结直肠癌肝转移一期切除术后并发症的相关影响因素及预防措施。方法:2009年6月至2018年6月解放军总医院普通外科行同时性结直肠癌肝转移一期切除术的241例,统计并发症发生情况,分析影响因素,对危险因素进行评估分析。结果:241例行同时性结直肠癌肝转移一期切除术的患者术后共42例发生并发症,发生率为17.4%。其中,吻合口瘘19例(7.9%),腹腔出血7例(2.9%),肠梗阻15例(6.2%),切口感染21例(8.7%),腹腔感染6例(2.5%),肺部感染3例(1.2%)。单因素分析结果显示,高龄、手术方式、术前合并症、原发肿瘤位置、术中失血量是腹同时性结直肠癌肝转移一期切除术后并发症发生的相关因素(P<0.05)。Logistit回归分析显示,影响同时性结直肠癌肝转移一期切除术后并发症发生的独立危险因素为高龄、术前合并症、手术出血量(P<0.05),腹腔镜手术则是其保护因素(P<0.05)。结论:吻合口瘘和出血是同时性结直肠癌肝转移一期切除术后常见并发症,高龄、术前合并疾病、手术出血量较多是同时性结直肠癌肝转移一期切除术后并发症发生的危险因素,而采取腹腔镜手术则可减少并发症的发生。     

后腹腔镜及手助腹腔镜肾上腺切除术治疗肾上腺肿瘤(附21例报告)

目的 :探讨腹腔镜微创手术治疗肾上腺肿瘤的适应证及手术方法。方法 :对 18例直径小于 6cm的肾上腺肿瘤患者行后腹腔镜肾上腺切除术 (后腹腔镜组 ) ;对 3例最大直径为 10～ 17cm的肾上腺肿瘤患者行手助腹腔镜肾上腺切除术 (手助腹腔镜组 ) ,并观察手术时间、术中出血量、胃肠功能恢复时间和住院时间。结果 :2 1例患者中 ,2 0例成功。其中后腹腔镜组手术时间 2 5～ 135min ,平均 (82 .8± 31.1)min ,术中出血量 6 5～ 16 0ml,平均 (113.4± 31.8)ml,均未输血。手助腹腔镜组手术时间 180～ 2 10min ,术中出血量 80～ 6 0 0ml。两组患者均于术后 2天排气 ,1～ 3天下床活动 ,术后住院 3～ 7天。结论 :与开放手术相比 ,后腹腔镜肾上腺手术具有创伤小、出血少、恢复快等优点 ;手助腹腔镜为巨大肾上腺肿瘤切除提供了微创手术的新方式。     

手助腹腔镜结直肠癌根治术111例短期疗效分析

目的 探讨手助腹腔镜手术在结直肠癌根治术中的应用经验及临床效果.方法 回顾性分析111例手助腹腔镜结直肠癌根治术患者的临床资料.结果 108例患者顺利完成手术.中转开腹率2.7%（3/111）;手术时间（155±45）min,术中出血量（129±80）ml;淋巴结清扫（12.6±5.8）枚;术后肠功能恢复时间（65.4±10.1）h,术后并发症发生率4.5%（5/111）;术后住院时间（9.6±2.2）d;随访时间（11.8±2.8）个月,未见肿瘤复发及穿刺孔种植转移.结论 手助腹腔镜结直肠癌根治术在保留微创优势的同时降低了手术难度,安全可靠.     

腹腔镜结直肠癌切除术联合射频消融治疗肝转移癌

目的 探讨腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌的临床价值.方法 2001年12月至2006年7月成都市第三人民医院对22例结直肠癌合并同时性肝转移的患者施行腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌,术后通过增强CT检查评价消融灶固化效果.采用X2检验分析疗效.结果 本组22例患者中8例肝转移癌为多发,16例有合并症.对31个肝转移癌进行RFA治疗,未发生相关并发症;术后平均住院时间为(14±5)d,无手术死亡.5例因消融不完全进行重复RFA,4例消融灶复发(2例重复RFA);6例死亡(2例死于消融灶复发).消融灶复发率为18%(4/22),病死率为27%(6/22).肝转移癌直径≥2.0 cm者RFA后消融灶复发率高于直径＜2.0 cm者(x2=5.867,P＜0.05).结论 腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌,为多发性肝转移癌、合并基础疾病、高龄、手术耐受差和肿瘤切除困难的结直肠癌患者提供了治疗的机会.     

手助腹腔镜结直肠癌根治术111例短期疗效分析

目的 探讨手助腹腔镜手术在结直肠癌根治术中的应用经验及临床效果.方法 回顾性分析111例手助腹腔镜结直肠癌根治术患者的临床资料.结果 108例患者顺利完成手术.中转开腹率2.7%(3/111);手术时间(155±45)min,术中出血量(129±80)ml;淋巴结清扫(12.6±5.8)枚;术后肠功能恢复时间(65.4±10.1)h,术后并发症发生率4.5%(5/111);术后住院时间(9.6±2.2)d;随访时间(11.8±2.8)个月,未见肿瘤复发及穿刺孔种植转移.结论 手助腹腔镜结直肠癌根治术在保留微创优势的同时降低了手术难度,安全可靠.     

结直肠癌伴不可切除的同时性肝转移的腹腔镜治疗

目的:探讨结直肠癌伴有同时性不可切除肝转移灶的腹腔镜治疗的可行性及临床应用价值。方法:回顾分析2011年6月至2012年12月31例结直肠癌伴不可切除的同时性肝转移患者的临床资料及随访结果。按原发灶手术切除方式分为两组,A组行开腹手术切除结直肠癌原发灶(n=18),B组行腹腔镜手术(n=13)。术后均采取mFOLFOX6方案化疗。对比分析两组患者手术时间、术中出血量、术后排气时间、术后住院时间、术后接受首次化疗时间及治疗效果。结果:31例均成功施行结直肠癌切除术,腹腔镜组无一例中转开腹及严重并发症发生。术后患者行mFOLFOX6方案化疗至少2个周期。经统计学分析发现,两组患者手术时间、治疗效果差异无统计学意义(P>0.05),但腹腔镜组术中出血量明显减少(P<0.01),术后排气时间明显缩短(P<0.05),术后住院时间明显减少(P<0.05),术后接受首次化疗的时间明显缩短(P<0.05)。结论:对于不可切除的同时性结直肠癌肝转移患者,行腹腔镜原发肿瘤切除是安全、可行的;与开腹手术相比,腹腔镜手术治疗结直肠癌伴不可切除的同时性肝转移,在切除原发灶的手术中具有出血量少、创伤小、术后肠功能恢复快、住院时间明显缩短并促进术后早期化疗等优势。腹腔镜手术对原发肿瘤及转移灶的治疗效果与开腹手术无明显差别,具有良好的临床应用价值。     

结直肠癌肝转移的腹腔镜微创治疗

目的:探讨腹腔镜手术治疗结直肠癌肝转移的临床疗效。方法:回顾分析2008~2014年收治的62例结直肠癌并肝转移患者的临床资料,其中15例行腹腔镜切除结直肠癌同期行肝转移癌切除(手术组),47例患者采用腹腔镜切除结直肠癌同期行肝转移癌射频消融(radio frequency ablation,RFA)。结果:手术组手术时间平均(4.6±1.1)h,术中出血量平均(610±275)ml。RFA组手术时间平均(4.1±1.3)h,术中出血量平均(410±115)ml。两组3个月肝转移癌复发率相近,约1/3,手术组1年、3年、5年生存率分别为53%、50%、50%,RFA组分别为49%、48%、45%。结论:腹腔镜结直肠癌切除同期行肝转移癌切除及射频消融术患者创伤小、康复快,手术安全、有效,可避免二期手术的创伤,延长结直肠癌晚期患者的生存时间。     

腹腔镜下结直肠癌及肝转移癌一期同时切除术的临床应用

目的：探讨腹腔镜下一期同时切除结直肠癌和肝转移癌的安全性及可行性。方法回顾性分析2011年1月至2013年10月期间在中山大学孙逸仙纪念医院完成的腹腔镜下结直肠癌和肝转移癌一期同时切除手术的11例患者的病例资料,对该术式的可行性（中转开腹率、手术时间及术中出血量）、安全性（术后并发症）及疗效（术后恢复、复发及生存情况）进行评估。结果全组11例患者手术均取得成功,无中转开腹病例。手术时间（284．6±28．8） min,术中出血量（322．7±75．4） ml,术后肛门排气时间（2．9±0．7） d,术后住院时间（12．3±1．9） d。全组患者术后未出现肠瘘、胆瘘、腹腔大出血、腹腔感染及肝功能衰竭等并发症。术后随访时间3～35月,除1例患者因肿瘤转移死亡外,其余病例未见肿瘤复发。结论对于经过选择的合适病例,腹腔镜下同时切除结直肠癌和肝转移癌是安全、可行的。     

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.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

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.