Role of laparoscopy in the treatment of patients with endometrial cancer

Patients with endometrial cancer (EC) are conventionally staged by surgery. Depending on the tumor risk factors and the surgical findings, adjuvant treatment is indicated in the form of radiotherapy or chemotherapy. The FIGO guidelines on surgical staging are clear on the importance of assessing the presence of extra-uterine spread of disease, but are elusive on how extensive the surgical staging should be. Also, the role of lymphadenectomy and adjuvant radiotherapy in these patients is the object of controversy, as confirmed by recent results of clinical trials. With surgery remaining the cornerstone of treatment, the surgical approach associated with the least complications should be pursued, particularly since the association of surgery and radiotherapy can escalate the overall treatment morbidity. Therefore, in the last 15 years, laparoscopy has slowly been replacing the traditional midline laparotomy. The results of the few clinical trials and several retrospective studies are unanimous. The laparoscopic approach is feasible, safe and effective and has a lower complication rate as compared to laparotomy in all patients. The number of patients with endometrial cancer included in published studies so far is too low to achieve statistical significance with respect to survival outcomes. However, for some groups of patients, there are results from clinical trials showing that laparoscopy is the method of choice in view of the outstanding reduced surgical morbidity.     

下肢深静脉血栓形成的病因及治疗

目的分析下肢深静脉血栓形成的发病原因。方法回顾性分析240例下肢深静脉血栓形成的患者资料,并对部分患者进行随访。结果240例中有发病诱因者136例（56．7％）,未发现明确发病诱因者104例（45．3％）。结论恶性肿瘤及各种手术尤其妇产科手术后、创伤与骨折、住院卧床是导致下肢深静脉血栓形成的主要诱发原因。     

MALIGNANT MELANOMA OF THE EYELID AND CONJUNCTIVA

Four patients with malignant melanoma of the eyelid skin and 74 patients with conjunctival malignant melanoma are presented Surgery was recommended for eyelid lesions and local excision followed by cryotherapy for conjunctival lesions One patient with an eyelid skin malignant melanoma died and two patients with extensive malignant melanoma of the conjunctiva died Nodular lesions involving the lid margin have the worst prognosis of eyelid skin malignant melanomas, and the greater the extent of conjunctival involvement the worse the prognosis for conjunctival malignant melanomas The complications of cryotherapy are minor, but the follow-up period in this series is too short to comment on survival times.     

额颞大骨瓣减压术在幕上高血压脑出血外科治疗中的应用价值

目的探讨早期超早期额颞大骨瓣开颅减压手术治疗幕上大量高血压脑出血的临床疗效及应用价值。方法回顾性分析17例幕上大量高血压脑出血早期超早期行额颞大骨瓣开颅减压术的病例资料、手术疗效及随访结果。结果 17例患者均手术顺利,血肿全部清除10例,大部分清除7例。术后3个月,患者ADL（日常生活能力）分级：Ⅰ级2例（11.8%）、Ⅱ级4例（23.5%）、Ⅲ级6例（35.3%）、Ⅳ级3例（17.6%）、Ⅴ级2例（11.8%）。结论早期额颞大骨瓣开颅减压术治疗幕上大量高血压脑出血疗效确切,病死率和致残率低。     

室上嵴上室间隔缺损的外科治疗

本文报道５６例室上嵴上室间隔缺损的外科治疗。男３４例，女２２例，年龄３～３９岁。１９例合并主动脉瓣叶脱垂、主动脉瓣关闭不全或佛氏窦瘤破裂。经右房切口修补室缺２例，右室漏斗切口４７例，肺动脉切９７例。直接修补缺损２６例，补片修补３０例。主动脉瓣成形术１例，主动脉瓣置换术５例。５４例全愈出院，死亡２例。作者认为室上嵴上空间隔缺损应尽早手术，以免并发主动脉瓣损害和佛氏窦瘤破裂；中度主动脉瓣关闭不全可行主动脉瓣成形术，采用肺动脉切口优于右室漏斗部切口。     

腰椎间盘突出并神经根管狭窄的临床分析

目的：探讨腰椎间盘突出症合并神经根管狭窄的临床诊断和手术治疗。方法：对１９９２～１９９８年间,因腰椎间盘突出症合并神经根管狭窄４９例行手术治疗,术中均行神经根管扩大和探查,术后随访。结果：随访３９例,优２４例,良１１例,可３例,差１例,优良率８９．７％。结论：神经根管扩大和神经根探查减压是手术成功的关键。     

鼻咽缩窄术治疗儿童开放性鼻音

应用鼻咽缩窄术治疗儿童开放性鼻音１１例。用鼻咽侧位像、鼻咽录相、语图频谱分析和鼻气流计检测腭咽结构与言语声学的关系，并作为手术病例选择和疗效判断标准，１１例均获满意疗效。结合临床实际分析影响疗效的因素。     

卵巢癌膈下病灶手术处理对预后影响的初步循证评价

目的：目价卵巢癌膈下病灶手术处理的安全性及对预后的影响。方法：检索2000年1月1日至2010年12月31日间公开发表、关于卵巢癌手术中膈肌病灶处理的文献进行初步循证评价，探讨膈肌手术的安全性及临床价值。结果：12篇文献（753例患者）符合纳入标准。最常见的手术相关并发症是胸腔积液、其次为气胸、肺炎、膈下脓肿等。仅有1例手术相关死亡。膈肌手术组手术时间为78分钟～710分钟，住院时间为4天～146天。行膈肌手术的患者达到理想肿瘤细胞减灭术的比例高于未行膈肌手术患者，预后亦较好。结论：卵巢癌膈下病灶的处理是安全可行的，能提高患者理想肿瘤细胞减灭术的比例，从而改善患者的预后，但目前多为小样本回顾性研究，有待多中心前瞻性的临床试验的研究结果加以证明。     

眼前段严重外伤时人工晶状体植入方法的探讨

目的 探讨提高伴严重眼前段外伤的外伤性白内障后房人工品状体（PC-IOL）植入效果的手术方法，技巧。方法 34例34眼采用分次手术的方法完成，眼前段重建，白内障摘出和PC-IOL植入术。结果 34眼均顺利植入PC-IOL。术后2-16月矫正视力0.1者11眼，0.2-0.4者13眼，0.5-0.6者7眼，0.8-1.0者3眼。术后无严重并发症。结论 采用分次手术的方法可提高伴严重眼前段外伤的外伤姓白内障PC-IOL植入的效果。     

重症急性胰腺炎术后并发肠瘘的原因和治疗

目的：探讨重症急性胰腺炎（SAP）术后并发肠瘘的原因及防治手段。方法：对1996年1月至2000年12月间手术治疗的82例SAP进行回顾性分析，并对可能导致肠瘘发生的危险因素和采用的治疗方法进行总结。结果：82例手术治疗的SAP发生肠瘘20例，其中结肠兼15例，十二指肠兼5例，均出现在术后两周内，有胰腺感染的较无感染的发生率高（P＜0．05），早期手术（＜2周）较后期手术（＞2周）姓率高（P＜0．05）蝶形引流术较经后上腰引流术发生率高（P＜0．05）。结论：SAP术后的肠瘘与胰外炎性浸润，手术创伤以及手术时机的选择和手术方式有关。肠瘘的治疗应充分考虑原发病的状况，并根据肠兼的位置，局部炎症的情况，早期通过加强营养支持，保持瘘口周围引流通畅，多数肠瘘可自行愈合，后期少数不愈合肠兼可考虑手术治疗。