三孔与单孔腹腔镜切除术式治疗急性阑尾炎合并胆囊结石的疗效对比

目的探讨三孔与单孔腹腔镜胆囊阑尾联合切除术式治疗急性阑尾炎合并胆囊结石临床疗效差异。方法研究对象选取该院及临汾市人民医院2012年8月-2015年8月收治急性阑尾炎合并胆囊结石患者共110例,以随机抽签法分为对照组(55例)和观察组(55例),分别采用三孔和单孔腹腔镜下胆囊阑尾联合切除术式治疗;比较两组患者手术相关临床指标、Brown手术满意度评分、手术前后抑郁焦虑视觉模拟评分法(VAS)及术后并发症发生率等。结果观察组患者切口长度明显短于对照组(P0.05);观察组患者手术操作用时则明显长于对照组(P0.05);观察组患者术后抑郁焦虑VAS评分均明显低于对照组、治疗前(P0.05);同时两组患者术后并发症发生率比较差异无统计学意义(P0.05)。结论相较于三孔腹腔镜术式,单孔腹腔镜胆囊阑尾微创联合切除治疗急性阑尾炎合并胆囊结石可有效缩短切口长度,改善手术美观性和术后负面情绪,且未导致术后并发症风险上升。     

Uniportal versus three-port video-assisted thoracoscopic surgery for spontaneous pneumothorax: a meta-analysis

Background

Whether or not uniportal video-assisted thoracoscopic surgery (VATS) is beneficial for spontaneous pneumothorax remains inconclusive. This meta-analysis aimed to summarize the available evidence to assess the feasibility and advantages of uniportal VATS for the treatment of spontaneous pneumothorax compared with three-port VATS.

Methods

Eligible publications were identified by searching the Cochrane Library, PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data databases and CQVIP. Odds ratios (OR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated to compare dichotomous and continuous variables, respectively.

Results

This meta-analysis was based on 17 studies and included a total of 988 patients with spontaneous pneumothorax. No death was reported during the perioperative period. Compared with three-port VATS groups, there was a statistically significant difference in uniportal VATS groups regarding postoperative hospital stay (SMD= −0.58; 95% CI: −1.04 to −0.12; P=0.01), paresthesia (OR=0.13; 95% CI: 0.07 to 0.24; P<0.00001), visual analogue pain score (VAS) at 24 hours (h) (SMD= −0.87; 95% CI: −1.07 to −0.68; P<0.00001), VAS at 72 h (SMD= −0.49; 95% CI: −0.68 to −0.30; P<0.00001), and patients satisfaction scale (PSS) at 24 h (SMD= −0.81; 95% CI: −1.21 to −0.41; P<0.0001), PSS at 48 h (SMD= −0.69; 95% CI: −1.08 to −0.29; P=0.0007). However there was no statistically significant difference on the recurrence (OR=0.79; 95% CI: 0.42 to 1.46; P=0.45), operative time (SMD= −0.23; 95% CI: −0.21 to 0.67; P=0.31), length of postoperative drainage (SMD= −0.17; 95% CI: −0.40 to −0.07; P=0.16), VAS at 48 h (SMD= −0.40; 95% CI: −1.47 to 0.67; P=0.46), and PSS at 72 h (SMD= −0.13; 95% CI: −0.52 to −0.25; P=0.50).

Conclusions

The results for mortality, recurrence, operative time, and length of postoperative drainage were similar between uniportal and three-port VATS. Uniportal VATS resulted in reduction in postoperative pain and paresthesia as well as an improvement in patients’ satisfaction. This meta-analysis indicated that using uniportal VATS to treat spontaneous pneumothorax was safe and feasible, and it may be a better alternative procedure because of its advantage in reducing postoperative pain and paresthesia.     

改良三孔法腹腔镜阑尾切除术58例报告

目的：探讨改良三孔法腹腔镜阑尾切除术的临床价值。方法2011年10月～2014年2月我院行改良三孔法腹腔镜阑尾切除术58例。自耻骨联合上方约2 cm阴毛处,做2个长约5 mm横形切口,两切口相距3～5 cm,分别置入5 mm trocar,作为2个操作孔,处理阑尾及其系膜,阑尾根部用套扎线套扎,切除阑尾,阑尾标本装入异物袋取出。结果58例均顺利完成改良三孔法腹腔镜阑尾切除术,手术时间20～80 min,平均35 min;术后住院时间3～7 d,平均4 d。术后2例穿刺口感染,换药处理后切口愈合良好。58例随访3～12个月,平均8个月,无一例出现穿刺口疝和粘连性肠梗阻等并发症。结论改良三孔法腹腔镜阑尾切除术,术后瘢痕更隐蔽,美观效果更好。     

Three-Port Versus Five-Port Laparoscopic Distal Gastrectomy for Early Gastric Cancer Patients: A Propensity Score Matched Case-Control Study

ABSTRACT

Aim: The aim of this study was to evaluate the feasibility and safety of three-port laparoscopic distal gastrectomy (TP-LDG) as a reduced port laparoscopic gastrectomy. Materials and Methods: We retrospectively identified 146 patients preoperatively diagnosed with early gastric cancer who underwent five-port laparoscopic distal gastrectomy (FP-LDG) or TP-LDG between May 2013 and July 2016. A propensity score matching analysis was used to create patient groups (48 patients in each group) matched for sex, age, body mass index, previous abdominal surgery history, and American Society of Anesthesiologist score. The short-term surgical outcomes between TP-LDG and FP-LDG were compared. Results: The TP-LDG group had a statistically shorter umbilical wound length [3.4 (range, 3.0–4.0) cm vs. 3.9 (range, 3.7–4.0) cm, p = .000], shorter operative time [230 (range, 190–310) min vs. 250 (range, 180–320) min, p = .036], and lower estimated blood loss [68 (range, 20–180) mL vs. 80 (range, 40–150) mL, p = .005] compared to that in the FP-LDG group. However, there was no specific superiority regarding inflammatory profiles. Complication rates were also similar (8.4% TP-LDG vs. 12.6% FP-LDG, p = .504). Conclusions: TP-LDG is a feasible and safe surgical procedure for the patients with early gastric cancer and provides the benefit of better cosmesis.     

两孔式胸腔镜肺叶切除术和传统三孔式胸腔镜肺叶切除术临床效果比较

目的：对比两孔式胸腔镜肺叶切除术（TPTL）与传统三孔式胸腔镜肺叶切除术（TTTL）的临床应用效果,阐述TPTL在临床治疗中的意义及价值。方法：回顾性分析行胸腔镜下肺叶切除的124例患者的临床资料。124例患者按照所行术式的不同分为TPTL组60例（采用TPTL、淋巴结廓清术）和TTTL组64例（采用TTTL、淋巴结廓清术）。比较2组患者手术时间、术中出血量、术后盐酸哌替啶用量、术后拔除胸引管时间、术后住院时间和术后6个月患侧上肢活动后不适者的例数。结果：TPTL组患者切口长度［（4.0±0.2）cm］小于TTTL组患者切口长度［（6.2±0.3） cm］(P<0.05);TPTL组患者术后盐酸哌替啶的用量［（125±35） mg］小于TTTL组患者术后盐酸哌替啶的用量［（240±46） mg］（P<0.05）。TPTL组有2例患者术后6个月患侧上肢活动后不适,TTTL组有11例患者术后6个月患侧上肢活动后不适。2组患者手术时间、术中出血量、术后胸引管拔除时间和术后住院时间比较差异无统计学意义(P>0.05)。结论：与TTTL比较,TPTL可以减小切口长度、减轻患者术后疼痛、提高患者术后生活质量。     

三孔套扎法腹腔镜胆囊切除术的临床应用与研究

目的探讨三孔套扎法腹腔镜胆囊切除术(LC)的可行性和临床应用价值。方法2000年6月￣2002年12月235例患者在全麻下采用三孔套扎法行LC,脐部皮肤皱褶处戳10mm孔置腹腔镜,剑突下偏右戳5mm孔为主操作孔,右锁骨中线下2cm戳5mm孔为辅助操作孔,采用自制腹腔镜圈套器套扎胆囊管和胆囊动脉替代钛夹,切除胆囊从脐部孔取出。2003年1月￣12月将100例LC随机分为传统组(n=50)和三孔套扎组(n=50)进行前瞻性研究,比较手术时间、术中出血量、胆囊破裂、术后疼痛和术后并发症等。结果临床应用235例,三孔套扎法成功完成218例(92.8%),17例(7.2%)改为传统的四孔LC,手术(50.2±19.6)min。临床前瞻性研究表明,三孔套扎法与传统LC相比,尽管手术时间较长(P<0.05),但术后疼痛进一步减轻(P<0.05),术中出血量、胆囊破裂和术后并发症等没有增加(P>0.05)。结论三孔套扎法LC具有更加微创性,且体内无金属异物残留,是安全的和可行的。     

三孔法腹膜外途径腹腔镜下Burch术治疗女性压力性尿失禁25例疗效分析

目的探讨腹腔镜下经腹膜外途径膀胱颈Cooper韧带悬吊术(Burch手术)治疗女性压力性尿失禁的有效性和安全性。方法采用经腹腔镜下腹膜外途径为25例女性压力性尿失禁患者施行Burch手术。自肚脐下2cm处切开皮肤并制造腹膜外空间,用2-0薇荞线将尿道旁侧的阴道壁肌层"8字"缝合后再缝合到同侧Cooper韧带上。结果所有手术均成功,手术时间29~50min,平均(36.2±8.4)min。术中出血量5~20mL,术后肛门通气时间3~28h,平均(18.6±10.2)h,术后住院时间4~7d。23例均获得随访,随访时间2月~4年,所有病例均无感染、膀胱损伤、排尿困难、复发等并发症。结论腹腔镜下经腹膜外途径Burch术是治疗压力性尿失禁的有效方法,具有创伤及疤痕小、恢复快、住院时间短的优势。     

The Cosmetic Benefit of Three-Port Laparoscopic Cholecystectomy and Umbilical Trocar Insertion

Abstract: From April 1991, we performed successful laparoscopic cholecystectomy (LC) on 221 patients. Among them, 198 patients were treated using the standard procedure based on four-trocar insertion. We developed a new three-port LC, which might have several cosmetic advantages, and used it with 23 selective patients with non-inflammatory cholecystolithiasis. LC was conducted in all of the patients without any technical difficulties using the three ports method. The mean operating time was 52 minutes and was 10 minutes longer than for four-port LC. As regards the cosmetic benefits, a 10-mm port for the laparoscope was inserted through the inside of the umbilicus. This wound scar cannot be distinguished from the normal umbilical configuration after complete wound healing and there are only two small recognizable surgery scars. We believe this three-port method has more cosmetic advantages, and its application could be gradually extended. (Dig Endosc 1994; 6 : 49–51)     

改良脐周三孔与常规单孔在腹腔镜胆囊切除术中的效果比较

目的 对比改良的脐周三孔术式和常规单孔术式在腹腔镜胆囊切除术（laparoendoscopic cholecystectomy,LC）中的临床疗效。方法 对2018年1月至2019年12月上海中医药大学附属曙光医院行LC的90例符合纳入标准的胆囊良性病变患者进行前瞻性分析,采用随机数字表法分为脐周三孔组（n=45）和单孔组（n=45）,单孔组采用脐部2 cm单切口,经专用port完成LC;脐周三孔组采用一个1 cm和两个5 mm常规port、5 mm腹腔镜头和常规器械完成LC。两组患者由同一组医师完成手术,比较两组的术中情况和近期随访结果。结果 与单孔组相比,脐周三孔组术后6 h疼痛评分[（4.1±1.7）vs（6.8±2.5）,t=5.210,P=0.029]和术后24 h疼痛评分[（2.9±0.9）vs（4.7±1.7）,t=4.742,P=0.036]均降低,手术时间缩短[（35.8±11.0）min vs （51.2±27.3）min,t=4.617,P=0.039],手术费用降低[（8 829.6±1 726.3）元 vs（14 315.1±2 163.7）元,t=5.926,P=0.024],术后切口感染发生率降低[4.4%（2/45）vs 17.8%（8/45）,χ2 =4.050,P=0.045]。两组手术中转率、出血量、住院时间、排气时间、美容满意度等指标无统计学差异（P＞0.05）。结论 改良的脐周三孔术式安全、便捷,相比常规单孔术式降低了术后疼痛和手术费用,可以在胆囊良性疾病的腹腔镜手术中选择性运用和推广。     

A novel approach for 25-gauge transconjunctival sutureless vitrectomy to evaluate vitreous substitutes in rabbits

AIM: To improve the standard three-port vitrectomy for establishing and evaluating an endotamponade model in rabbits. METHODS: Three ports were prepared near the third eyelid of rabbits, and the infusion port was placed at the inferior nasal quadrant with the inserted cannula linking with a self-designed handheld rigid infusion catheter. All right eyes of rabbits underwent a modified 25-gauge vitrectomy and were subsequently filled with balanced salt solution, silicone oil, and eight-arm polyethylene glycols (8-arm PEGs) hydrogel separately for comparison. Ophthalmic examinations were performed regularly to record the changes after the surgery. RESULTS: Successful vitrectomy was achieved among 44 chinchilla rabbits. The mean operation time was 4.51±1.25min. Four eyes (9.1%) presented limited lens touch and two eyes (4.5%) showed retinal touch during surgery. Incision leakage was found in three eyes (6.8%) after surgery. There was no endophthalmitis, hemorrhage, or retinal detachment during the observation period and ophthalmic examinations after the implantation of vitreous substitutes. CONCLUSION: The modified technique of the standard vitrectomy applied in the endotamponade model in rabbits shows excellent safety and practicality.