腹腔镜下全子宫切除术的临床评估

目的：对腹腔腔镜下全宫切除的临床价值进行评估。方法：对４３ 例因诊断为子宫肌瘤（３３ 例） 、子宫腺肌症（６例） 及子宫内膜增殖症（４ 例） 的患者行腹腔镜下全子宫切除术,对同时期１２１ 例具有同样适应症的患者行腹式全子宫切除手术。比较两组病人术中术后情况。结果：两组病人的手术时间、术中出血量无显著性差异,腹腔镜下全子宫切除术的手术时间与子宫增大有关,术中出血量与手术时间及子宫大小无关;行腹腔镜下全子宫切除术的病人手术损伤及术后阴道残端出血发生率无增高,术后疼痛的发生率明显减少,术后使用抗菌素时间、术后住院时间及术后恢复正常活动的时间缩短。结论：腹腔镜下全子宫切除术虽不能完全代替腹式全宫切除术,却是一种安全、可靠,适于临床广泛开展的手术方式。     

Animal model of bile duct dilatation created with minimally invasive surgery

RATIONALE AND OBJECTIVES: The purpose of the study was to evaluate a method of producing obstruction of the common bile duct and concomitant biliary duct dilatation in an animal model. MATERIALS AND METHODS: Laparoscopic placement of a double-balloon occlusion device was used to produce common bile duct obstruction and bile duct dilatation in pigs. RESULTS: One week after the procedure, common bile duct obstruction and dilatation of the biliary tree were demonstrated with either percutaneous transhepatic cholangiography or percutaneous cholecystography. CONCLUSION: The use of this method is technically feasible and provides a useful subacute and chronic animal model of common bile duct obstruction and dilatation of the biliary tree for percutaneous interventional training and research purposes.     

腹腔镜子宫切除34例临床分析

目的:探讨腹腔镜下子宫切除的手术方法。方法:选择子宫肌瘤31例及子宫腺肌症3例为手术对象。8例作子宫全切除,26例为子宫次全切除。以电刀凝切方法分离子宫旁韧带,子宫的游离可达Ⅲ～Ⅳ级。结果:31例顺利完成手术,手术成功率91.2％。未发生邻近脏器损伤。结论:腹腔镜子宫切除手术创伤小,但难度较常规开放手术大,预防术中出血与邻近脏器损伤是手术成功的关键。     

Why laparoscopic cholecystectomy today?

Traditional open cholecystectomy became the gold standard of surgical treatment for symptomatic gallstone disease during the last century. In spite of its good results, clinicians have been trying to establish effective nonsurgical methods of eliminating gallstones. Although oral, percutaneous, or retrograde litholysis can be used effectively for cholesterol stones, these represent only 10% of all gallstones. Moreover, intracorporeal lithotripsy is an invasive method, and while extracorporeal shock wave lithotripsy is a promising procedure, even after careful selection, only 70%–80% of the patients become stone-free within 1 year. In fact, none of the methods which leave the gallbladder intact are free of complications, and they are followed by 50% stone recurrence within 5 years. Since 1987, laparoscopic cholecystectomy has become the procedure of choice as it is safe and only minimally invasive. We believe that the laparoscopic technique is a promising way to the surgery of the future.     

Laparoscopic Assisted Surgery for Crohn''''s Disease an Initial Experience and Results

SurgicaltreatmentisoftenrequiredforpatientswithCrohn'sdiseasewhohaveintestinalstrictureand/orfistula[4.1o.13].Rapidevolutionoflaparoscopicintestinalsurgery,continuousadvancementofinstru-mentation,performanceofmoreextensiveandcom-p1exprocedureshaveledtotheapplicationoflaparo-scopictechniquesinthetreatmentofCrohn'sdis-ease[3'9'12J.Recentreportshavedemonstratedthat,comparedwithtraditional"open"resection,laparo-scopicintestinalsurgeryresultsindecreasedpostoper-ativepain,earlierreturnofintestinalf…     

Day-case laparoscopy: a comparison of prophylactic opioid, NSAID or local anesthesia for postoperative analgesia

BACKGROUND: The study was aimed to evaluate the analgesic efficacy, postoperative comfort, recovery characteristics and side effects of three different analgesic agents administered prophylactically. METHODS: Eighty patients undergoing day-case minor operative laparoscopy were randomly allocated into four groups to receive tenoxicam 20 mg i.v. (Group T), fentanyl 100 microg i.v. (Group F), 5 ml of bupivacaine 2.5 mg/ml for infiltration of trocar sites (Group B), 30, 10 and 5 min before incision respectively. Bupivacaine, 35 ml, 2.5 mg/ml was also administered into the pelvic cavity in Group B. Group P received only placebo. Postoperative pain, analgesic requirements, first response to verbal stimulus, first analgesic requirement, ability to walk without help, to drink and to void, blood pressures, SpO2 and respiration rates were recorded in the PACU. Postoperative pain was evaluated by verbal rating scale. Pain scores, analgesic requirements and side effects were evaluated by telephone calls until the 48th postoperative hour. RESULTS: Postoperative pain scores were lower and time to requirement of rescue analgesics was longer in groups F and B compared to Group P. In the PACU, analgesic requirements were lower in Group B, compared to Group P. Nausea and vomiting were increased in Group F. CONCLUSION: Tenoxicam 20 mg i.v. was found to be ineffective whereas bupivacaine was superior to other groups in reducing pain and analgesic requirements. Bupivacaine also increased time to first analgesics and obtained better recovery characteristics, underlining its value in prophylactic pain management compared to the other two agents.     

经腹膜外腹腔镜前列腺癌根治术(附10例报告)

目的 探讨经腹膜外途径腹腔镜前列腺癌根治术（extraperitoneal laparoscopic radical prostatcctomy，eLRP）的应用价值。方法 2005年4月-2006年1月前列腺癌10例。年龄62-78岁。平均68．5岁。病史2周～6年。患者均接受腹膜外途径腹腔镜前列腺癌根治术。结果 手术时间210～380min，平均245min。术中出血量500～1200mL，平均850mL。所有患者均于术后2周拔除导尿管，3例出现尿漏。3例术后出现轻度尿失禁。经辅助治疗后好转。随访1～10月。未见肿瘤复发，PSA0～0．08ng／mL。结论 eLRP是一种安全，有效的方法，值得临床推广。     

Reproductive outcome after laparoscopic myomectomy for intramural myomas in infertile women with or without associated infertility factors

Aims:   To evaluate reproductive outcome after laparoscopic myomectomy for intramural myomas in infertile women with or without associated infertility factors.
Methods:   A retrospective study was carried out in 30 infertile women with intramural myomas measuring ≥50 mm in diameter and treated using laparoscopy.
Results:   The overall rate of spontaneous intrauterine pregnancy was 50.0% (15 patients). Of 13 patients with infertility factors associated with the uterine myomas, three (23.1%) became pregnant, whereas 12 of 17 patients (70.6%) with no other associated infertility factor became pregnant. No uterine ruptures were observed. All pregnancies were spontaneous and 13 occurred within 1 year of the operation. In the 10 patients who gave birth by Cesarean section, no adhesions were found on the myomectomy scar.
Conclusions:   On the basis of these results, laparoscopic surgery for myomas appears to offer comparable results to laparotomy. In infertile patients with intramural myoma, pregnancy rates are affected by the presence of other infertility factors associated with the uterine myomas. (Reprod Med Biol 2006; 5 : 31–35)     

氯诺昔康用于腹腔镜卵巢肿瘤切除术后镇痛的临床观察

目的:评价氯诺昔康持续静脉镇痛用于腹腔镜卵巢肿瘤切除术后的临床效果.方法:择期行腹腔镜卵巢切除术的患者60例,随机平均分为氯诺昔康组和对照组两组.氯诺昔康组(n=30)应用PCA镇痛(每次l mL,总量40 mg/48 h),并于手术结束前半小时静脉注射氯诺昔康8 mg.术后行疼痛评分(BCS)及不良反应的观察.对照组(n=30)为空白对照.结果:氯诺昔康组术后BCS评分显著高于对照组.两组的不良反应发生率无显著性差异.结论:腹腔镜卵巢肿瘤切除术后应用氯诺昔康静脉持续镇痛,效果确切,不良反应少.     

A case of recurrent cholangitis after bile duct injury during laparoscopic cholecystectomy: Value of scintigraphy with Tc-99m GSA and hepatobiliary scintigraphy for indication of lobectomy

A 39-year-old woman with acute cholecystitis and gallstones underwent laparoscopic cholecystectomy. She suffered from recurrent episodes of cholangitis due to injury of the major bile ducts during laparoscopic cholecystectomy. Hepatobiliary scintigraphy with Tc-99m Sn-N-pyridoxyl-5-methyltryptophan was performed. Although normal bile excretion was found from the left hepatic duct to the percutaneous transhepatic biliary drainage (PTBD) tube, excretion from the right hepatic lobe was prolonged. Scintigraphy with Tc-99m diethylenetriaminepentaacetic acid-galactosyl human serum albumin demonstrated atrophy of the right hepatic lobe and enlargement of the left hepatic lobe. Cholangiography via the PTBD tube revealed complete obstruction of the left hepatico-jejunal anastomosis and could not enhance the right intrahepatic bile duct. A right hepatic lobectomy was performed because of the atrophy, glissonitis and the absence of an appropriate bile duct for reconstruction. Postoperatively she was active and exhibited no evidence of recurrent cholangitis.