腹腔镜手术治疗子宫恶性肿瘤的护理配合

目的探讨腹腔镜手术治疗子宫恶性肿瘤的临床效果和护理配合.方法对8例早期子宫恶性肿瘤患者行腹腔镜下广泛全子宫切除+双侧附件切除+双侧盆髂淋巴结切除术.观察手术时间,平均出血量及术后恢复情况.结果 6例子宫内膜癌患者,平均手术时间220min,平均出血量200ml;2例子宫颈癌患者,平均手术时间240min,平均出血量350ml.术中无一例脏器损伤,术后平均住院8天.结论腹腔镜手术创伤小,恢复快,对早期子宫恶性肿瘤具有较好治疗效果,术中、术后要求有良好的医护配合.     

腹腔镜手术治疗子宫恶性肿瘤的护理配合

目的 探讨腹腔镜手术治疗子宫恶性肿瘤的临床效果和护理配合。方法 对8例早期子宫恶性肿瘤患者行腹腔镜下广泛全子宫切除 双侧附件切除 双侧盆髂淋巴结切除术，观察手术时间，平均出血量及术后恢复情况。结果 6例子宫内膜癌患者，平均手术时间220min，平均出血量200ml；2例子宫颈癌患者，平均手术时间240min，平均出血量350ml，术中无一例脏器损伤，术后平均住院8天。结论 腹腔镜手术创伤小，恢复快，对早期子宫恶性肿瘤具有较好治疗效果。术中、术后要求有良好的医护配合。     

腹腔镜子宫全切除术与开腹手术的临床效果分析

目的 研究分析子宫切除术中分别运用常规开腹式切除以及腹腔镜式切除的临床效果。方法 选取2014年5月~2016年5月本院收治的65例行腹腔镜子宫全切除术患者作为实验观察组,另选取65例行传统子宫全切除术患者作为常规对照组,对比分析两组患者实施手术后各项观察指标及并发症发生情况。结果 实验观察组患者的术中出血量、肛门排气时间、术后下床活动时间、住院时间均显著优于常规对照组,差异具有统计学意义（P＜0.05）;而在术后镇痛方面,实验观察组人数明显少于常规对照组,并且创口均为甲级愈合,两组间差异具有统计学意义（P＜0.05）。实验观察组患者术后切口感染、切口液化发生率均显著低于常规对照组,差异具有统计学意义（P＜0.05）。结论 使用腹腔镜子宫全切除手术具有对患者造成的创伤小、术中出血量较少、对腹腔内环境的影响小、术后恢复速度快且无明显瘢痕等显著优势,具有较高的临床推广价值。     

腹腔镜下宫颈癌根治术与传统开腹手术的对比研究

目的 对比研究腹腔镜下宫颈癌根治术和传统开腹宫颈癌根治术的临床疗效、安全性、术后生活质量等。方法 选择湖南省肿瘤医院妇瘤科2014年5月~2016年12月因宫颈癌行手术的患者200例,根据手术方式分为两组,各100例。开腹组采用传统开腹手术,腹腔镜组采用腹腔镜下宫颈癌根治术治疗,对比两组患者的手术情况、并发症、术后恢复情况以及FACT-G评分。结果 腹腔镜组前50例手术时间为（280.0±32.5）min,长于开腹组的（190.0±23.2）min,差异具有统计学意义（P＜0.05）,但腹腔镜组中按照时间顺序后50例手术时间为（200.0±22.6）min,与开腹组相比,差异无统计学意义（P＞0.05）。腹腔镜组中出血量（125.3±48.2）ml,少于开腹组的（230.0±70.2）ml,统计学意义显著（P＜0.01）。腹腔镜组中淋巴结清扫数目多于开腹组,差异具有统计学意义（P＜0.05）。腹腔镜组术中损伤、切口愈合不良、淋巴囊肿发生率与开腹组比较,差异无统计学意义（P＞0.05）。腹腔镜组尿潴留发生率为35.00%,高于开腹组的12.00%,差异具有统计学意义（P＜0.05）。腹腔镜组术后48 h疼痛评分、肛门排气时间、术后住院日及术后FACT-G评分均优于开腹组,差异具有统计学意义（P＜0.05）。结论 腹腔镜手术治疗宫颈癌疗效确切,具有创伤小、恢复快、术后生活质量高等优点。     

传统开腹手术与腹腔镜手术治疗卵巢囊肿临床疗效对比研究

目的 观察对比开腹手术与腹腔镜手术治疗卵巢囊肿的各自临床效果.方法 将243例卵巢囊肿患者随机分为治疗组128例和对照组115例.对照组给予开腹手术治疗,治疗组给予腹腔镜手术治疗,观察两组患者的手术时间、术中出血量、并发症及住院时间,同时对患者随访观察3年.结果 治疗组术中出血量少于对照组,术后并发症发生率低于对照组,住院时间短于对照组,差异均有统计学意义(P＜0.05);治疗组手术时间短于对照组,但差异无统计学意义(P＞0.05).结论 腹腔镜手术治疗卵巢囊肿其临床疗效较为显著,大大减少了手术伤口及术中的出血量,同时也降低了对卵巢功能的损害,避免了永久性的服药,值得临床推广应用.     

腹腔镜和开腹手术治疗化脓性阑尾炎的对比研究

目的探讨腹腔镜阑尾切除术治疗化脓性阑尾炎的临床应用价值。方法回顾分析113例化脓性阑尾炎的手术治疗病例,其中行腹腔镜阑尾切除术61例（LA组）,行开腹阑尾切除术52例（OA组）。比较两组的手术时间、术中出血量、术后肛门排气时间、术后疼痛程度、术后住院时间、切口感染率和住院费用。结果 LA组中有4例中转开腹。LA组的住院费用和术中出血量高于OA组（P〈0.05）,术后疼痛程度和切口感染率较OA组低（P〈0.05）。两组患者在手术时间、术后住院时间和术后肛门排气时间的差异无统计学意义（P〉0.05）。结论腹腔镜和开腹手术治疗化脓性阑尾炎各有优势,临床工作中应根据患者具体病情和医师的手术经验合理选用。     

腹腔镜下全子宫切除术的手术配合

目的 探讨如何做好腹腔镜下全子宫切除术的手术配合工作.方法 总结160例腹腔镜下全子宫切除术的护理配合经验.结果 160例患者均获得满意疗效.结论 充分的术前准备,完善的器械设备系统,手术室护士娴熟的配合技术,做好术后的仪器处理,是手术成功的关键.     

腹腔镜与开腹手术治疗小儿复杂性阑尾炎的对比研究

目的 对比腹腔镜阑尾切除术与开腹阑尾切除术治疗复杂性阑尾炎的疗效。方法 总结2016年8月~2017年8月在新乡医学院第一附属医院行手术治疗的91例复杂性阑尾炎患儿资料,根据入院顺序随机将患儿分成观察组与对照组。观察组42例行腹腔镜阑尾切除术,对照组49例行开腹阑尾切除术,统计分析两组的手术时间、术中出血量、疼痛程度、术后恢复情况、并发症发生率、住院时间及总费用等指标,比较有无组间差异。结果 LA组在术后疼痛评分、下床活动时间、肠道功能恢复时间、总并发症、切口感染、术后肠梗阻、住院时间、总费用方面优于OA组,差异有统计学意义。OA组在手术时间上优于LA组,差异具有统计学意义（P＜0.05）。两组在术中出血量、腹腔残余感染方面,虽然LA组低于OA组,差异无统计学意义（P＞0.05）。 结论 LA治疗小儿复杂性阑尾炎安全有效,与OA相比具有手术创伤小、术后恢复快、术后并发症少,住院时间短,住院总费用低等优势。     

腹腔镜手术与开腹手术治疗粘连性肠梗阻临床疗效对比研究

目的：对比分析腹腔镜手术与开腹手术治疗粘连性肠梗阻的临床效果。方法将277例粘连性肠梗阻患者随机分为治疗组149例和对照组128例。对照组给予开腹手术治疗,治疗组给予腹腔镜手术治疗,手术结束后观察两组临床疗效。结果治疗组总有效率为92.62%高于对照组的77.34%,差异有统计学意义(P<0.05)。结论采用腹腔镜治疗粘连性肠梗阻较传统开腹手术具有术中创面小、方便止血,术后恢复快,再次粘连发生率低等优点,因此值得在临床上应用推广。     

腹腔镜与开腹手术治疗局限性前列腺癌的临床疗效对比研究

目的 对比腹腔镜与开腹手术治疗局限性前列腺癌的临床疗效.方法 回顾分析我院2008年1月～2010年10月的共诊断收治的前列腺癌患者61例,其中行腹腔镜前列腺癌根治术36例,开腹手术25例,比较两种术式的临床疗效.结果 两组在手术时间和盆腔引流管保留时间差异无统计学意义(P>0.05).腹腔镜组优于传统开腹手术的治疗效果,且并发症发生率低(P<0.05).结论 腹膜外途径腹腔镜前列腺癌根治术具有患者创伤小、术后康复快、并发症发生率低等优点,值得临床推广应用.     

Early experiences of robotic-assisted laparoscopic liver resection

PURPOSE: The surgical robotic system is superior to traditional laparoscopy in regards to 3-dimensional images and better instrumentations. Robotic surgery for hepatic resection has not yet been extensively reported. PATIENTS AND METHODS: Between March and May 2007, we performed 3 robot-assisted left lateral sectionectomies of the liver. Case 1 had a hepatocellular carcinoma (HCC), case 2 had colon cancer with liver metastasis, and case 3 had intrahepatic duct stones. RESULTS: All patients had successful operation and recovered without complications. Shorter length of hospital stays, earlier start of oral feeding and less amount of ascites were found. However, case 1 had recurrent HCC at 3 months after operation. CONCLUSION: Robotic-assisted liver surgery is still a new field in its developing stage. In patients with small malignant tumors and benign liver diseases, robotic-assisted laparoscopic resection is feasible and safe. Through experience, the use of robotics is expected to increase in the treatment of benign diseases and malignant neoplasms. However, careful patient selection is important and long-term outcomes need to be evaluated.     

Survival rates of patients who undergo minimally invasive surgery for endometrial cancer with cervical involvement

Objective: Compare the oncologic outcomes of patients with intermediate-risk endometrial cancer who were staged by minimally invasive surgery with the outcomes of patients who underwent open surgery.Methods: Data from 206 patients with intermediate-risk endometrial cancer who were treated between January 2009 and January 2019 were reviewed. The patients'' data were retrieved from five institutions. The patients were divided into two groups: those who underwent open surgery and those who underwent minimally invasive surgery. Tumor characteristics, recurrence rate, disease-free survival, and overall survival were compared according to surgical approach.Results: Among the 206 patients included in this study, 76 underwent open surgery (36.9%) and 130 underwent MIS (63.1%). In patients with stage IB endometrial cancer, the recurrence rate, disease-free survival, and overall survival were not significantly different between those who underwent minimally invasive surgery and those who underwent open surgery. However, in patients with stage II endometrial cancer, the recurrence rate was significantly higher among those who underwent minimally invasive surgery (37.5% vs. 5.3%, p = 0.013). Patients with stage II endometrial cancer who underwent minimally invasive surgery had a significantly lower disease-free survival (p = 0.012) than those who underwent open surgery, however, the overall survival (p = 0.252) was similar between the two groups.Conclusion: Minimally invasive surgery results in less favorable survival outcomes than open surgery in patients with stage II endometrial cancer.     

Comparison of video-assisted minilaparotomy, open, and laparoscopic partial nephrectomy for renal masses

Purpose

Minimally invasive management of small renal tumors has become more common. We compared the results of partial nephrectomy by video-assisted minilaparotomy surgery (VAMS), open, and laparoscopic techniques.

Materials and Methods

We retrospectively compared clinicopathological, oncological, and functional outcomes in 271 patients who underwent partial nephrectomy for renal tumors at one institution from 1993 to 2007; including 138 by VAMS, 102 by open, and 31 by laparoscopic technique.

Results

Mean follow-up was 47.7±29.1 months. No statistically significant differences in the three groups were found in tumor size, tumor location, estimated blood loss, complication rate, preoperative glomerular filtration rate (GFR), and GFR at last follow-up. Ischemic time was shorter in the open (26.9 min) and VAMS (29.3 min) groups than in the laparoscopic group (31.0 min, p=0.021). Time to normal diet and hospital stay were shorter in the VAMS (1.8 days and 5.4 days) and laparoscopic (1.8 days and 4.7 days) groups than in the open group (2.4 days and 7.3 days, p=0.036 and p<0.001, respectively). Of 180 patients with cancer, positive surgical margins occurred in 2 of 82 patients (2.4%) in the VAMS group, none of 75 patients in the open group, and 3 of 23 patients (13.0%) in the laparoscopic group (p=0.084). In the VAMS, open, and laparoscopic groups, 5-year disease-free survival was 94.8%, 95.8%, and 90.3% (p=0.485), and 5-year cancer-specific survival was 96.3%, 98.6%, and 100%, respectively (p=0.452).

Conclusion

Partial nephrectomy using VAMS technique provides surgical, oncologic, and functional outcomes similar to open and laparoscopic techniques.     

腹腔镜手术与开腹手术治疗子宫肌瘤的比较分析

目的　探讨腹腔镜手术对子宫肌瘤的治疗价值。方法　 12 0例子宫肌瘤患者随机分为腹腔镜手术组和剖腹手术治疗组 ,对两组手术时间、术中出血量、手术并发症、术后恢复情况及疾病复发进行比较分析。结果　 60例腹腔镜手术时间平均 12 8.6min ,术中出血平均 92 .4ml ,剖腹手术组手术时间平均 10 4.3min ,术中出血平均 88.2ml。腹腔镜和剖腹手术组术后并发症发生率分别为 7.7%和 15 %。腹腔镜组手术时间明显长于剖腹手术组 (P <0 .0 1)。结论　腹腔镜下子宫肌瘤切除术用于治疗子宫肌瘤具有创伤小、并发症发生率低的优点     

腹腔镜胃十二指肠溃疡穿孔修补的探讨

目的 探讨腹腔镜胃十二指肠溃疡穿孔修补术的手术方法及操作要点。方法 采用腹腔镜下缝合修补溃疡穿孔76例。结果 腹腔镜下缝合修补溃疡穿孔均获成功，无中转开腹，无死亡病例，无癌性穿孔，无并发症发生。结论 腹腔镜消化性溃疡穿孔修补术创伤小，并发症少，操作简单，且集诊断及治疗于一体，显示了微创外科的优越性，是目前适合普及的治疗消化性溃疡穿孔的手术方法。     

Comparison of abdominal and minimally invasive radical hysterectomy in patients with early stage cervical cancer

Purpose: The aim of this study was to compare survival outcomes of open radical hysterectomy and minimally invasive radical hysterectomy (MIS) in early stage cervical cancer.Methods: A retrospective analysis of 148 patients with stage IB1 - IIA2 cervical cancer who underwent either minimally invasive or open radical hysterectomy. Tumor characteristics, recurrence rate, disease-free survival (DFS), and overall survival (OS) were compared according to surgical approach.Results: In total, 110 and 38 patients were assigned to open surgery and MIS groups. After a medical follow-up of 42.1 months, the groups showed similar survival outcomes (recurrence rate, DFS, and OS). However, in patients with tumor size >2 cm, recurrence rate was significantly higher in MIS group (22.5% vs 0%; p=0.008). And in patients with tumor size >2 cm, MIS group showed significantly poorer DFS than open surgery group (p=0.017), although OS was similar between the two groups (p=0.252).Conclusion: In patients with tumor size >2 cm, MIS was associated with higher recurrence rates and poorer DFS than open surgery. However, in patients with tumor size ≤2 cm, MIS did not seem to compromise oncologic outcomes.     

超声引导下乳腺肿块旋切术及其临床应用

目的　探讨超声引导下微创旋切手术对乳房肿块的诊断与治疗。方法　对 78例 10 5处乳腺肿块进行了超声引导下旋切术 ,评价其诊治效果。结果　 78例 10 5处乳腺肿块中 ,6 0例 85处乳腺肿块临床诊断为乳腺纤维腺瘤 ,均被Mammotome微创旋切切除 ,平均旋切 18次 ,平均时间 2 5min ;10例为乳腺可疑病灶 ,8例临床诊断为乳腺癌 ,均经Mammotome微创旋切术确诊。所有操作无一例失败 ,皮肤伤口仅 3mm ,并发症轻微。结论　超声引导下乳腺肿块旋切术操作方便易学 ,对乳腺小纤维腺瘤切除彻底 ,皮肤疤痕微小 ;对可疑病灶能及时明确诊断 ,合理治疗。     

腹腔镜前路L5～S1椎间盘手术的血管解剖观察

目的:阐明髂间三角区内血管的分布规律,为腹腔镜前路L5～S1椎间盘手术提供安全靶区。方法:31例经动脉灌注红色乳胶的成人防腐固定腰椎标本,年龄58.2岁。观测并分析髂间三角内与腹腔镜前路L5～S1椎间盘手术相关的血管解剖数据。结果:L5～S1椎间盘的高度、宽度分别为(1.87±0.21)cm、(5.07±0.60)cm;主动脉杈(AB)与髂总静脉汇合处(CCIV)分别位于L5～S1椎间盘上缘(3.97±1.24)cm、(2.75±1.46)cm处;夹角分别为(52.4±12.0)°、(78.4±22.1)°;骶正中动脉(MSA)存在于所有的标本中,在L5～S1椎间盘上、下缘处的外径分别为(0.16±0.04)cm、(0.14±0.05)cm;上、下缘水平到右髂动脉(RIA)的距离分别为(2.02±0.81)cm、(2.74±0.83)cm。左髂静脉(LIV)到右髂动脉的平均距离为3.60cm,占椎间盘宽度的71.3%(32.3%～124.4%)。结论:髂间三角内的血管解剖能满足腹腔镜前路L5～S1椎间盘手术要求,可作为手术治疗椎间盘疾患的选择靶区。     

机器人在外科领域应用现状

机器人是机电一体化和现代生产自动化的典型代表,手术机器人则是现代远程信息技术、智能化工程技术与微创外科技术结合的精美之作。目前它在医学中得到广泛应用,并具有常规手术无法比拟的优点。本文从手术机器人的发展历史、手术机器人的优点和缺点、机器人手术的形式、医用机器人在各外科领域的广泛应用等方面进行了综述,并对机器人在医疗领域的发展提出了展望。     

经皮穿刺微创术治疗颈椎间盘突出症的现状

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