目的:观察静脉应用小剂量氯胺酮超前镇痛法对接受腹腔镜下子宫切除手术患者术后疼痛及认知功能的影响。方法:38例择期接受腹腔镜下子宫切除术患者(ASA分级12)随机分为氯胺酮组和对照组。氯胺酮组于手术开始前5min静脉滴注氯胺酮015mg·kg-1,术中持续泵注3μg·kg-1·min-1至手术结束;对照组使用生理盐水。记录术中使用氯胺酮后心率,平均动脉压的变化;术后24h内静脉使用芬太尼的剂量,VAS疼痛评分,头晕、恶心、呕吐等不良反应,中枢神经系统症状以及术后2h患者认知功能。结果:两组患者在24h内静脉使用芬太尼的剂量,VAS疼痛评分,不良反应,中枢神经系统症状以及术后2h的认知功能方面没有统计学差异。〖HTH〗结论:〖HTSS〗静脉使用小剂量氯胺酮超前镇痛并不能减少术后芬太尼的用量,不能降低术后疼痛评分。尽管使用小剂量氯胺酮并没有增加患者术后的不良反应,也不影响患者术后认知功能障碍,不建议作为腹腔镜下子宫切除术患者常规使用。
目的 探讨腹腔镜阑尾切除术的临床经验和应用价值。方法 回顾性分析腹腔镜二孔法阑尾切除术 39例(二孔法组)和三孔法阑尾切除术70例(三孔法组)的临床资料。结果 顺利完成手术107例； 中转开腹2例,其中阑尾严重粘连1例,腹膜后阑尾1例。术后发生粘连性肠梗阻1例,经保守治疗痊愈出院。住院时间2~9 d,平均3 d。随访全部患者2~24个月,平均12个月,未发生其他并发症。结论 腹腔镜阑尾切除术具有创伤少、并发症发生率低及恢复快的优点,将成为阑尾切除术的首选术式。腹腔镜二孔法阑尾切除术操作简单,易于推广; 三孔法则具有处理复杂阑尾切除术的优势。
目的 探讨腹腔镜技术在急腹症诊治中的作用。方法 回顾性分析笔者所在医院2008年10月至2011年12月期间收治的128例急腹症患者应用腹腔镜技术进行诊治的临床资料。结果 127例均明确诊断，１例十二指肠迟发性破裂腹腔镜探查漏诊，患者2d后因腹痛剧烈而行剖腹探查术，发现为十二指肠破裂， 确诊率为99.2％。103例（80.5％）于腹腔镜下完成手术，11例（8.6％）中转开腹手术，14例经腹腔镜检查明确诊断后行保守治疗。所有手术患者术后无严重并发症发生，全部患者均痊愈出院。平均手术时间为72min （32 ～166min）；平均出血量为125ml （20～230ml）； 平均住院时间为5d （3～12d）。结论 急腹症应用腹腔镜技术是一种十分安全有效的方法，具有诊断治疗一体化、创伤小、恢复快，住院时间短等优点。
ObjectiveTo analyze the surgical effect, postoperative complications and effects on the body inflammatory response of laparoscopic gastroduodenal perforation repair, and to further evaluate the efficacy of laparoscopic perforation repair. MethodsWe retrospectively analyzed the clinical data of 123 patients with gastroduodenal ulcer perforation treated between February 2010 and February 2015. Among the patients, 65 underwent laparoscopic gastroduodenal ulcer perforation repair (laparoscopic group), and 58 underwent routine open gastroduodenal ulcer perforation repair (open group). Then, we compared the surgical effects (average bleeding volume, ambulation time, postoperative ventilation time, postoperative hospital stay), postoperative complications (wound infection, wound dehiscence, gastroduodenal fistula, abdominal abscess, intestinal obstruction), inflammatory reaction[preoperative and 1, 3, 5-day postoperative white blood cells (WBC) count, peripheral blood procalcitonin (PCT), C-reactive protein (CRP)] between the two groups. ResultsPatients in both the two groups underwent the surgery successfully. No patients in the laparoscopic group were transferred to open surgery. Compared with the open surgery, surgical bleeding volume, ambulation time, anal exhaust time and postoperative hospital stay of the laparoscopic group were significantly different (P < 0.05). Postoperative complications rate of the laparoscopic group was significantly lower than that of the open group (P < 0.05). One and 3-day WBC, PCT and CRP after surgery increased obviously in both the two groups. The above three indicators on the fifth day after surgery were not significantly different from those before the surgery in the laparoscopic group (P > 0.05), while they were significantly different from those before the surgery in the open group (P < 0.05). ConclusionsCompared with open perforation repair, laparoscopic perforation repair surgery is superior for its better surgical effects, fewer postoperative complications and lighter inflammatory response. It is a safe, effective and minimally-invasive treatment for gastroduodenal perforation.
ObjectiveTo compare the results of laparoscopic-endoscopic cooperative resection and open surgery for gasric stromal tumor. MethodsFrom January 2010 to March 2015, the clinical data of 56 cases undergoing laparoscopic resection for gasric stromal tumor and 53 cases of traditional operation selected during the same period were retrospectively compared. ResultsThere was no significant difference between two groups in patient's gender, age, body weight, size of tumor, tumor staging, method of operation, intraoperative conditions, postoperative overall complications, local recurrence, and distant metastasis. There were 1 case with the rupture of tumor and 1 case of open surgery transforming in laparoscopic group. In another group, there was the absence of the rupture of tumors. There was no mortality, stomach bleeding, stenosis or leakage occurred between two groups. In laparoscopic group, there were less operative blood loss and abdominal drainage, shorter time of postoperative anal exhaust time, fewer anodyne, a reduction of hospital stay than in convention operation group.However, laparoscopic resection required greater hospital costs and longer operative time. There were significant differences between two groups (P < 0.05). Conciusions With advantages of less blood loss and quicker recovery as compared to conventional operation. Laparoscopic-endoscopic cooperative resection for gasric stromal tumor has similar effect when it is performed by well selection of cases, skilled surgeon with experience on open resection for surgical treatment of gastric stromal tumor.
Objective To investigate the effect of laparoscopy combined with choledochoscopy on common bile duct (CBD) stones with primary suture of the CBD. Methods Totally 523 patients of gallbladder stone companied with CBD stones or choledochectasia (diameter ≥0.8 cm) from September 1998 to December 2008 were retrospectively analyzed. Results The primary suture of the CBD incision was successfully performed in 487 patients. The CBD stones were completely removed during the operation in 400 patients. Nothing was found in 87 cases. In 10 cases conversion to open surgery were performed and in 26 cases the T tube drainage was put into the CBD in choledocholithotomy. Average operative time was 90 min and average bleeding volume was 50 ml. All patients took food at 24 h, returned general activity on 2-3 d and discharged on 5 d after operation. Postoperative biliary leakage occurred in 29 cases with drainage average volume of 35 ml/d and continued 1-6 d, which were cured by non-operation therapy. Conclusions The primary suture of the CBD during the laparosocopy combined with choledochosopy in choledocholithotomy is a safe and effective operation with less invasion, less pain and quicker recovery. CBD incision suture without T tube drainage can be done when CBD stones are cleared completely and no stenosis is found in extrahepatic bile duct.
Objective To investigate the clinical effects and safety differences of open surgery and laparoscopy primary lesion resection combined with D2 lymph node dissection in the treatment of elderly patients with advanced gastric cancer. Methods One hundred and forty elderly patients with advanced gastric cancer were chosen and randomly divided into two group including open operative group (70 patients) with primary lesion resection combined with D2 lymph node dissection by open operation and laparoscopic surgery group (70 patients) with primary lesion resection combined with D2 lymph node dissection by laparoscopy; and the operative time, intraoperative bleeding amount, the levels of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of haemoglobin (Hb) after operation, the hospitalization time, the number of lymph node dissection, the survival rate with followed-up and postoperative complication incidence of both groups were compared. Results There was no significant difference in the operative time between 2 groups (P>0.05). The intraoperative bleeding amount, the level of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of Hb after operation and the hospitalization time of laparoscopic surgery group were significantly better than open operative group (P<0.05). The level of PaCO2 in operation of laparoscopic surgery group was significantly higher than open operative group (P<0.05). There were no significant difference in the gastric lymph node dissection number and the peripheral lymph node dissection number of gastric artery between 2 groups (P>0.05). There were no significant difference in the survival rates between the 2 groups after 3-year followed-up (P>0.05). The complication incidence after operation of laparoscopic surgery group was significantly lower than open operative group (P<0.05). The quality of life scores of patients in laparoscopic surgery group were significantly higher than those in open operative group on 7 days and in 3 months after operation, and the difference were statistically significant (P<0.05). Conclusion Compared with open operation, primary lesion resection combined with D2 lymph node dissection by laparoscopy in the treatment of elderly patients with advanced gastric cancer can efficiently possess the advantages including minimally invasive, shorter recovery time and less postoperative complications.