Injury of the gallbladder beds on the liver during laparoscopic cholecystectomy of 178 cases for the last year waas analysed. Reoperations in 6 cases with one death due to major postoperative complications. These injuries could be classified into 3 degrees according to extent of liver parenchyma denuded in the bed . Degree Ⅰ, no liver was denuded in the bed with the fibromembranous lining intact (49 cases);Degree Ⅱ, liver denuded area was less than one half of the bed (90 cases);Degree Ⅲ, liver denuded area was greater than half of the bed ( 39 cases). There was close relationship between grade of the bed injury and the postoperative complication. Leaving the lining intact of the bed was most important during the lapatoscopic cholecystectomy in order to prevent complication from the bed. The method was discussed. Drainage of the subhapatic space was suggested when liver bed is denuded.
ObjectiveTo systematically review the effectiveness and safety of laparoscopy with postoperative gonadotropin releasing hormone agonist (GnRH-a) versus laparoscopy alone for endometriosis. MethodsRandomized controlled trials (RCTs) on laparoscopy with postopertative GnRH-a versus laparoscopy alone in treatment of endometriosis were retrieved in the following databases:the Cochrane Library (Issue 3, 2013), PubMed, EMbase, WanFang Data, CNKI, and CBM from inception to February, 2013. According to the inclusion and exclusion criteria, the literature were screened, the data was extracted and the methodological quality of the included studies was also assessed by two reviewers independently. Then, meta-analysis was performed using RevMan 5.1.7 software. ResultsA total of 15 RCTs involving 1 761 patients were included. There were statistically significant differences between the laparoscopy with postoperative GnRH-a group and the laparoscopy alone group in the following 4 aspects:the symptom relief rate (RR=1.24, 95%CI 1.16 to 1.33, P < 0.000 01), the recurrence of lesion (RR=0.35, 95%CI 0.24 to 0.51, P < 0.000 01), the recurrence of pain (RR=0.70, 95%CI 0.53 to 0.92, P=0.01), and the pregnancy rate (RR=1.43, 95%CI 1.25 to 1.65, P < 0.000 01). ConclusionLaparoscopy postoperative GnRH-a for endometriosis can enhance the symptom relief rate, reduce the recurrence of lesion and the recurrence of pain, and increase the pregnancy rate. But because of the limitation of the quality of the included studies and publication bias, the above conclusion should be verified by conducting more high quality RCTs.
Objective To investigate the way of closed establishment of pneumoperitoneum（CEPP） in patients with peritoneal cavity adhesion in laparoscopy, and to sum up the successful experience and the lesson of visceral injury. Methods CEPP experiences of 1 046 cases of peritoneal adhesion were retrospective analysed in 6 600 cases laparoscopy in our unit from September 1991 to September 1999.The difficulty of establishment of pneumoperitoneum was classified as real difficulty in establishment of pneumoperitonum (RDEPP) and false difficulty in establishment of pneumoperitonum (FDEPPD). RDEPP was due to Veress needle penetrating into viscera or peritoneal extensive adhesion in peritoneal cavity, and CO2 air flowing into difficulty. FDEPP was due to veress needle penetrating into extraperitoneum fat, round hepatic ligament or larger messentry. The formal situation required conversion to open laparotomy, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle direction or penetrating depth in second penetration. Results In this group 1 046 patients, 1 028 cases (98.3%) had been established pneumoperitoneum successfully by way of CEPP, 6 cases of RDEPP and 12 cases of FDEPP required open laparotomy. No complication related to CEPP had been found in this group except two cases visceral injury cured by laparotomy and repairment. Conclusion CEPP in patients with peritoneal adhesion is safe and feasible in laparoscopy. The main reason of CEPP failure is regarding FDEPP as RDEPP due to deficiency of experience and confidence of laparoscopist.
Objective To investigate the effects of hand assistant laporoscopic splenectomy plus pericardial devascularization on systemic stress responses. Methods Forty patients with cirrhotic portal hypertension were selected， 20 cases of which were underwent hand assistant laparoscopic splenectomy plus pericardial devascularization (LAP group)， and the other 20 were underwent open splenectomy plus pericardial devascularization (OP group). The levels of blood glucose （BG）, insulin (Ins), triiodothyronine （T3）, tetraiodothyronine （T4）, corticosteroid （CS） and other related clinical data were measured before operation and on day 1-3 after operation, which were compared between two groups. Results There was no statistical significance between two groups on those levels before operation. On day 1 after operation， BG and CS level in both two groups were higher than those before operation (P＜0.05), but they were recovered on day 2 after operation in LAP group (Pgt;0.05), and on day 3 after operation in OP group (Pgt;0.05). BG and CS level in OP group were markedly higher than those in LAP group on day 2 after operation (P＜0.05). On day 1 after operation， Ins, T3 and T4 level of two groups were lower than those before operation (P＜0.05), but they were recovered on day 2 after operation in LAP group (Pgt;0.05) and on day 3 after operation in OP group (Pgt;0.05). Ins, T3 and T4 level in OP group were lower than those in LAP group on day 2 after operation (P＜0.05). There was no significant difference in operation time between two groups (Pgt;0.05). But laparoscopic surgery had more advantages than conventional open surgery such as reducing bleeding quantity in operation, shortening recovery time of bowel and urinary bladder function and the length of stay. Conclusion Compared with laparotomy, the laparoscope not only imposes less impact on physical stress system, but also makes recovery after operation more quickly.
Objective To compare the differences in postoperative pulmonary function and quality of life between synchronous and combined mediastinoscopy with laparoscopic radical resection of esophageal cancer, providing evidence for selecting the optimal surgical approach. Methods A retrospective analysis was conducted on patients who underwent minimally invasive mediastinoscopic esophagectomy at Huaihe Hospital of Henan University from January 2023 to January 2025. Patients were divided into two groups based on surgical approach: the synchronized laparoscopic inflatable mediastinoscopy (SPIMSLE) group and the inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE) group. Propensity score matching (1 : 1) was applied to balance baseline characteristics. Perioperative indicators, pulmonary function (FEV1, FVC, FEV1/FVC ratio), postoperative complications, pain levels (NRS score), and quality of life were statistically analyzed. Results A total of 173 patients were enrolled, including 110 males, 63 females with a mean age of (62.5±6.2) years. After matching, each group comprised 80 patients. No significant differences were observed in gender, age, tumor location, or clinical stage (all P>0.05). The SPIMSLE group demonstrated superior outcomes: shorter operative time [(100.32±15.28) vs. (134.53±16.43) min, P<0.001], less intraoperative blood loss [(40.13±12.73) mL vs. (69.45±12.34) mL, P<0.001), and shorter postoperative hospitalization [(10.50±2.00) d vs. (12.50±2.50) d, P<0.001]. At 1-6 months postoperatively, the SPIMSLE group showed faster recovery in pulmonary function (FEV1, FVC, FEV1/FVC ratio, P<0.05), lower complication rates (16.25% vs. 40%, P<0.001), reduced pain (NRS score, P<0.05), and improved quality of life (P<0.05). No significant difference was noted in lymph node dissection (P>0.05). All patients were followed up until June 2025, with no recurrence, metastasis, or mortality among the 160 cases. Conclusion Compared to IVMTE, SPIMSLE offers shorter operative time, reduced blood loss, faster pulmonary recovery, fewer complications, milder pain, and better quality of life, demonstrating significant clinical advantages.
Objective To explore the clinical value of laparoscopy in the treatment of pancreatic diseases. Methods Twelve patients with pancreatic diseases received laparoscopic surgery. Among which 9 patients with cystic diseases, 4 cases underwent laparoscopic spleen-preserving distal pancreatectomy, 2 cases received distal pancreatectomy and splenectomy, and 3 cases underwent pancreatic cystectomy. Laparoscopic insulinoma enucleation was performed for 2 patients who suffered from insulinoma. Besides, a patient suffered from pancreatic carcinoma recurrence received left thoracoscopic splanchnicectomy. Results All the operations were accomplished successfully, including 8 total laparoscopic surgery and 4 laparoscopic assisted surgery. The average operative time was 225 min （range 100-420 min）, and the average volume of blood loss was 80 ml （range 2-150 ml）. Pancreatic fistula was observed in 1 patient which was cured by conservative therapy. The postoperative average hospital stay was 7.2 d （range 5-13 d）. The patient with recurrent pancreatic carcinoma survived for 6 months after operation and the pain-killing effect was satisfactory. With a follow-up of 10-36 months for other patients, the surgical effects were ideal and no recurrence occurred.Conclusion With the advantages of less trauma， less pain， fast recovery， and low morbidity rate, laparoscopic surgery is an effective and safe method for the treatment of pancreatic diseases, and thus may be widely used in the clinical settings in the future.
Objective To investigate the value of laparoscopy in resetting and repairing of inguinal incarcerated hernia. Methods Clinical data of 11 patients with acute inguinal incarcerated hernia treated with laparoscopy from March 2007 to February 2008 were reviewed, including 3 cases of direct inguinal hernia and 8 cases of oblique inguinal hernia. Results There were 7 patients with incarcerated hernia who were reset automatically after general anaesthesia, and 4 patients who were reset with laparoscopy. All the hernias were repaired with the transabdominal preperitoneal (TAPP) method after observed or improved the blood cycle of the incarcerated intestinal tract under laparoscopy. Average follow-up time was 6.6 months (2-12 months) after operation. Good recover and no recurrence were showed in all patients. Conclusion Laparoscopy is a safe technology in resetting and repairing of inguinal incarcerated hernia
目的探讨手辅助腹腔镜腹部肿瘤切除术手术技术。方法应用手辅助腹腔镜技术结合吻合器及超声切割止血刀完成直肠癌切除1例，乙状结肠癌切除2例，胃壁平滑肌瘤切除1例，胆囊、胆总管结石并左侧腹巨大肠系膜囊肿行胆囊切除、胆总管探查、囊肿切除1例。结果5例患者术后恢复良好，失血量最多为100 ml。结论手辅助腹腔镜技术操作安全，损伤小，将是腹腔镜大器官切除的新方向。