经脐单孔腹腔镜与传统腹腔镜手术治疗异位妊娠的临床研究

目的:探讨经脐单孔腹腔镜与传统腹腔镜手术治疗异位妊娠的临床研究。方法:选择我院2015年1月～2018年11月期间就诊的异位妊娠患者56例,根据其入院治疗时间的先后顺序随机分为观察组和对照组各28例,对照组患者用传统的腹腔镜手术进行治疗,观察组给予经脐单孔腹腔镜手术进行治疗。对比分析两组患者治疗后的手术相关指标、疼痛评分、患者满意度评分以及术后并发症等情况。结果:观察组患者的手术时间长于对照组,且两组患者术中出血量及住院时间对比无差异,P0.05;观察组患者的VAS评分低于对照组,且观察组患者的满意度评分显著高于对照组,P0.05;观察组患者术后并发症发生率(3.57%)低于对照组(25.00%),P0.05。结论:经脐单孔腹腔镜手术治疗异位妊娠效果较好,此种手术方式可减少患者的疼痛程度,手术安全性较高,术后美容效果较好,患者满意度较高,临床值得推广应用。     

单孔腹腔镜手术治疗82例异位妊娠的临床疗效

目的观察单孔腹腔镜手术治疗82例异位妊娠的疗效与预后情况。方法回顾性分析2017年8月～2018年8月我院妇产科82例异位妊娠患者临床资料,41例行传统三孔腹腔镜手术归入对照组,41例行单孔腹腔镜手术归入观察组,比较两组手术结果、皮质醇水平、术后并发症、术后疼痛与腹壁美观度情况。结果观察组手术时间显著长于对照组,差异有统计学意义(P0.05),而术后住院时间显著短于对照组,差异有统计学意义(P0.05);两组术中出血量、术后排气时间及术后血人绒毛膜促性腺激素(β-HCG)恢复时间比较,差异无统计学意义(P0.05);术前24h至术后72h,两组皮质醇水平先上升后下降,但组间比较差异无统计学意义(P0.05),观察组术后24h皮质醇水平显著低于对照组,差异有统计学意义(P0.05);观察组术后并发症发生率显著低于对照组,差异有统计学意义(P0.05);术后24h,观察组VAS评分显著低于对照组,差异有统计学意义(P0.05);术后2个月,观察组术后腹壁美容满意度评分显著高于对照组,差异有统计学意义(P0.05)。结论单孔腹腔手术治疗异位妊娠具有加快患者康复、减轻术后应激与疼痛、降低术后并发症发生率、提高腹壁美容效果的优势,有利于患者预后。     

腹腔镜手术治疗异位妊娠疗效分析

目的 观察腹腔镜手术与开腹手术治疗异位妊娠的临床效果.方法 将2010-04-2011-02三亚市人民医院行手术治疗的异位妊娠患者100例随机分为观察组50例(腹腔镜手术)和对照组50例(开腹手术),对两组的治疗效果进行比较.结果 两组术后肛门排气时间、下床时间,住院时间、术后镇痛比例、术中出血量相比较,差异有统计学意义(P<0.05).结论 腹腔镜手术治疗异位妊娠优势明显,是治疗异位妊娠的首选治疗方式.     

腹腔镜与开腹手术治疗异位妊娠疗效比较

目的 分析腹腔镜与开腹手术治疗异位妊娠的疗效.方法 腹腔镜手术(A组)治疗异位妊娠40例,开腹手术(B组)治疗异位妊娠40例.观察两组手术时间、术中出血量、术后肛门排气时间、术后下床活动时间、留置导管时间、平均住院时间.结果 A组和B组的手术时间、术中出血量、术后肛门排气时间、术后下床活动时间、留置导管时间、平均住院时间比较差异均有统计学意义(P＜0.05).结论 在严格掌握适应证的前提下,腹腔镜组治疗异位妊娠的效果优于开腹手术组.     

腹腔镜手术治疗卵巢异位妊娠临床疗效观察

选取2011年8月~2015年8月我院妇科住院治疗的46例卵巢异位妊娠患者。分为腔镜组和常规组各23例。腔镜组行腹腔镜下手术治疗,常规组行开腹探查切除术治疗。分析对比两组患者手术效果及术后并发症发生情况。结果腔镜组患者手术时间、住院时间、肛门排气时间均短于常规组(P0.05),腔镜组术中出血量低于常规组(P0.05),腔镜组术后HCG恢复正常时间与常规组比较,差异无统计学意义(P0.05)。腔镜组出现腹胀6例、皮下瘀斑8例、切口感染2例,均分别少于常规组的9例、15例、8例,差异具有统计学意义(P0.05),但两组出现腹痛、恶心、呕吐的例数无区别,差异无统计学意义(P0.05)。腹腔镜下行卵巢异位妊娠手术的患者对于医生的操作水平以及手术技巧要求较高,术中出血量低,恢复时间较快,安全性较高。     

单孔腹腔镜与传统腹腔镜治疗异位妊娠的疗效比较

目的比较单孔腹腔镜与传统腹腔镜治疗异位妊娠的疗效。方法回顾性分析2017年1月～2019年10月在我院接受腹腔镜手术治疗的60例异位妊娠患者的临床资料,将采用单孔腹腔镜手术治疗的的132例患者归为单孔组,将采用传统腹腔镜手术治疗的28例患者归为传统组,比较两组患者的疗效、临床指标(住院、手术、下床活动以及胃肠功能恢复正常时间)以及术后并发症情况。结果相较于传统组,单孔组治疗总有效率较高,且术后并发症发生率较低,差异有统计学意义(P<0.05);相较于传统组,单孔组住院时间、手术时间、下床时间以及胃肠功能恢复正常时间均较短,差异有统计学意义(P<0.05)。结论异位妊娠患者采用单孔腹腔镜手术治疗的疗效较好,可缩短术后恢复时间,降低并发症的发生概率。     

腹腔镜手术与开腹手术治疗异位妊娠的对比研究

目的:比较腹腔镜手术与开腹手术治疗异位妊娠的临床效果.方法:选择2010年3月-2012年1月在上海市第六人民医院金山分院治疗的248例异位妊娠患者,并将其随机分为2组,每组124例.治疗组采用腹腔镜手术治疗,对照组采用开腹手术治疗.比较2种手术方式的手术时间、术中出血量,以及患者的住院时间、术后排气时间、下床活动时间等围手术期情况,并比较并发症发生率、输卵管通畅率及疼痛情况.结果:治疗组患者手术时间略长于观察组,但差异无统计学意义(P＞0.05);治疗组患者的住院时间、术中出血量、术后排气时间、下床活动时间、导尿管留置时间以及抗生素应用时间[(3.9±1.1)d、(21.6±12.1)mL、(21.2±6.2)h、(10.9±2.6)h、(11.3±0.9)h及(2.2±0.6)d]均明显低于对照组[(5.8±1.0)d、(49.9±15.4)mL、(28.7±4.4)h、(25.6±3.3)h、(27.4±4.2)h及(3.1±0.9)d],差异均有统计学意义(P均＜0.05);治疗组患者术后并发症发生率[i.6 ％(2/124)]明显低于对照组[7.3 ％(9/124)],且输卵管通畅率[88.7％(110/124)]明显高于对照组[52.4％(65/124)],差异有统计学意义(P＜0.05);治疗组患者在术后2h、12h内的疼痛评分与对照组比较差异无统计学意义,但24 h、36 h的疼痛评分[(1.4±0.5)分及(1.1±0.2)分]明显低于对照组[(2.8±0.8)分及(1.9±0.3)分],差异有统计学意义(P＜0.05).结论:采用腹腔镜手术治疗异位妊娠,可以明显减少患者的住院时间、排气时间、康复时间,并且手术时出血量少.患者疼痛耐受性也优于开腹手术,值得临床推广应用.     

单孔腹腔镜对比传统腹腔镜手术治疗输卵管妊娠的临床效果分析

目的探究输卵管妊娠行单孔腹腔镜手术治疗的可行性。方法选取2015年7月～2017年10月收治的81例输卵管妊娠者为研究对象,根据手术方式不同分为对照组38例和观察组43例。对照组行传统腹腔镜手术,观察组行单孔腹腔镜手术,对比两组围手术期、术后恢复及手术并发症情况。结果观察组术后恢复(住院时间、排气时间、βHCG降至正常时间、疼痛评分)均显著低于对照组,术后并发症显著少于对照组(P0.05);观察组手术时间显著长于对照组,差异有统计学意义(P0.05)。结论输卵管妊娠行单孔腹腔镜手术治疗,创伤小、术后恢复快、并发症少,但手术时间较长。     

腹腔镜在异位妊娠中的临床应用

目的探讨腹腔镜在异位妊娠治疗中的临床应用。方法选择2011年3月至2013年3月禹州市妇幼保健院收治的160例异位妊娠患者,根据随机数字法分为对照组和观察组,每组80例,分别给予开放手术和腹腔镜手术,观察比较两组手术时间、术中出血量、排气时间、下床活动时间、住院时间,以及并发症发生率。结果与对照组相比,观察组手术时间、术中出血量、排气时间、下床活动时间、住院时间均明显缩短,术后并发症发生率显著降低,差异有统计学意义（P〈0.05）。结论腹腔镜手术治疗异位妊娠,具有损伤小、恢复快、并发症少等微创优点,明显提高临床疗效。     

经脐单孔腹腔镜在妇科良性病变手术中的护理

目的探讨经脐单孔腹腔镜手术在妇科良性病变手术中的护理。方法选取本院行腹腔镜手术治疗的妇科良性病变患者101例,随机将其分为单孔组50例和传统组51例。比较分析2组手术时间、术中出血、住院时间、术后疼痛、护理满意度等指标,总结单孔腹腔镜手术的术前、术中、术后护理方法。结果异位妊娠单孔组的手术时间长于传统组,差异有统计学意义(P0.05);术中出血量2组比较无统计学差异(P0.05);子宫肌瘤单孔组住院时间少于传统组,2组术后疼痛程度比较单孔组优于传统组;单孔组术后护理满意率高于传统组。结论为了配合单孔腹腔镜新技术的开展,手术室护士要做好充分术前准备,熟悉手术步骤,术中配合和护理精准到位,术后做好监护和预防措施,才能保证手术顺利完成,促进术后康复,为患者提供更优质满意的服务。     

Pediatric laparoscopy

SIGNIFICANT DEVELOPMENTS in minimally invasive surgery (MIS) for the adult population have led to increased application of MIS techniques for pediatric patients.LAPAROSCOPY IS THE MOST COMMON MIS procedure used in pediatrics. Traditional surgical procedures that are now being performed laparoscopically include gastrostomy, pyloromyotomy, and repair of congenital diaphragmatic hernia and imperforate anus.ALL PERIOPERATIVE TEAM MEMBERS must be prepared to provide appropriately sized instruments and equipment to facilitate use of MIS techniques in the pediatric population and must ensure safe patient care to achieve optimal patient outcomes. AORN J 88 (August 2008) 211-236. © AORN, Inc, 2008.     

Bedside laparoscopy

The improved technical sophistication of laparoscopy offers an attractive highly accurate diagnostic modality at the bedside for critically ill patients who are confined to the ICU and intensive monitoring unit and who are in need of timely abdominal evaluation. If the surgeon understands the physiologic effects of peritoneal insufflation and considers them during the procedure, the patient tolerates the procedure well. It is important to limit insufflation pressures and laparoscopy time. The author also recommends using the open Hasson technique. Its primary use is diagnostic in penetrating and blunt trauma and in the obscure abdomen. It has been successfully employed therapeutically for acalculous cholecystitis, abscess drainage, and correction of placement of gastrostomy tubes and peritoneal dialysis catheters. It helps avoid risky transport trips and negative or nontherapeutic laparotomy with its known associated risks.     

Diagnostic laparoscopy

The value of surgical laparoscopy for various therapeutic interventions has been well established. In recent years, the interest of gastroenterologists in this method has revived, since laparoscopy can provide additional information for the staging of oncological and liver diseases. The introduction of miniature lenses may have contributed to this process, and an increasing number of physicians are using minilaparoscopy due to its safety and easy handling. Surgical studies have mainly focused on the evaluation of laparoscopic ultrasound for the detection of liver and lymph-node metastases. In specialized centers, laparoscopic ultrasound is also used for the estimation of locoregional pancreatic tumor spread, but the diagnostic impact of the method, particularly in colorectal carcinoma, still remains to be determined. Remarkably, the number of publications from gastroenterology departments has tended to increase in comparison with last year's review.     

Diagnostic laparoscopy

Diagnostic laparoscopy continues to play an important role in the accurate evaluation of patients with abdominal disorders. Combined with laparoscopic ultrasound, it is highly accurate in the staging of intra-abdominal malignancies, and it is superior to transcutaneous ultrasonography and computed tomography. Other important applications include the evaluation of patients with acute and chronic abdominal pain, acute abdomen, peritonitis, and blunt and penetrating abdominal trauma. Laparoscopy now rests firmly in the hands of surgeons. The majority of last year's papers originated from departments of surgery; papers on laparoscopy in hepatic disorders are sorely missing in this year's review.     

Diagnostic laparoscopy

Since the early part of the 20th century, diagnostic laparoscopy has become an important tool in the armamentarium of surgeons and gastroenterologists alike. Its indications have expanded from initial attempts at tamponading internal hemorrhage to avoidance of unnecessary laparotomies with accurate staging of malignancies, treatment of a multitude of intra-abdominal pathologies, and even as a resource for evaluating blunt abdominal trauma and chronic abdominal pain. Its accuracy has been demonstrated in the evaluation of chronic liver diseases, in comparison with other diagnostic modalities. Many further technical advances have been introduced in recent years. Gastroenterology training programs should include formal diagnostic laparoscopy training as part of their curriculum.     

Diagnostic laparoscopy

Diagnostic laparoscopy is increasingly being used to aid decision-making in the treatment of serious diseases. The majority of papers on the topic published during the last year have been concerned with preoperative assessment of malignant diseases of the gastrointestinal tract, and have shown that laparoscopy alone--or, even better, in combination with laparoscopic ultrasonography--is able to identify metastatic disease and therefore to reduce significantly the risk of unnecessary laparotomies. New techniques such as the application of fluorescent dyes may improve these results even further. Surgeons are increasingly using diagnostic laparoscopy in patients with acute abdomen and abdominal trauma--a minimally invasive strategy that should also be supported by gastroenterologists. Close cooperation between surgeons and gastroenterologists can also be promoted by using laparoscopy in critically ill patients in intensive-care units when a decision needs to be taken on whether or not laparotomy should be performed. The technique of diagnostic laparoscopy is returning to widespread use after a period of decline.     

Diagnostic laparoscopy

Each diagnostic procedure needs to be viewed in the context of all the other available diagnostic tools, and therefore has to be reevaluated periodically. This is also true of diagnostic laparoscopy, whether performed by gastroenterologists in patients under sedoanalgesia or by surgeons in patients under general anesthesia. Publications during the previous year have shed light on many important issues. Despite its greater expense, fluorescence laparoscopy may have advantages over white-light laparoscopy in the diagnosis of small tumor seeding. The unchanged superiority of laparoscopy over other imaging modalities for detecting small superficial liver metastases and peritoneal seeding has been clearly demonstrated. Whether cytological investigation of peritoneal washing can add relevant information to laparoscopy remains a matter of debate. Diagnostic laparoscopy before surgery has proved to be effective in many fields, including traumatology. The use of diagnostic laparoscopy in certain clinical circumstances, such as the early postoperative period after major cardiac surgery using extracorporeal circulation, appears promising. A transgastric approach to the peritoneal cavity for diagnostic and therapeutic purposes, the feasibility of which has been demonstrated in a porcine model, is an exciting innovation with as yet unforeseeable implications.