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经腹腔镜结肠肝曲癌的幽门下淋巴结清扫

目的 探讨对结肠肝曲癌行经腹腔镜幽门下淋巴结清扫的可行性及必要性。 方法 回顾性分析笔者所在医院科室 2013 年 1 月至 2016 年 11 月期间 27 例行腹腔镜下经中间入路的扩大右半结肠癌 D3 根治术患者的临床资料。 结果 27 例患者均行腹腔镜下经中间入路的扩大右半结肠癌 D3 根治术，无中转开腹。术后发生切口感染 2 例，炎性肠梗阻 1 例，肺部感染 1 例，无吻合口漏及吻合口出血发生。每例标本切取的淋巴结数目为 12～31 枚，平均 19.3 枚/例；伴淋巴结转移 20 例，淋巴结转移率为 74.1%；共清扫淋巴结 521 枚，发生转移淋巴结 191 枚，淋巴结转移度为 36.7%；全部标本中共切除幽门下淋巴结 78 枚，发生转移 25 枚，幽门下淋巴结转移度为 32.1%。 结论 把握好适应证，选择合适的患者，结肠肝曲癌行腹腔镜下扩大右半结肠癌 D3 根治术，幽门下淋巴结清扫是有必要的，也是切实可行的。

Impact analysis of ventilation mode on pulmonary complications after laparoscopic weight loss surgery for patients with obese

ObjectiveTo explore the effect of different ventilation modes on pulmonary complications (PCs) after laparoscopic weight loss surgery in obese patients. MethodsThe obese patients who underwent laparoscopic weight loss surgery in the Xiaolan People’s Hospital of Zhongshan from January 2019 to June 2023 were retrospectively collected, then were assigned into pressure-controlled ventilation-volume guaranteed (PCV-VG) group and volume controlled ventilation (VCV) group according to the different ventilation modes during anesthesia. The clinicopathologic data of the patients between the PCV-VG group and VCV group were compared. The occurrence of postoperative PCs was understood and the risk factors affecting the postoperative PCs for the obese patients underwent laparoscopic weight loss surgery were analyzed by multivariate logistic regression analysis. ResultsA total of 294 obese patients who underwent laparoscopic weight loss surgery were enrolled, with 138 males and 156 females; Body mass index (BMI) was 30–55 kg/m2, (42.40±4.87) kg/m2. The postoperative PCs occurred in 63 cases (21.4%). There were 160 cases in the PCV-VG group and 134 cases in the VCV group. The anesthesia time, tidal volume at 5 min after tracheal intubation, peak inspiratory pressure and driving pressure at 5 min after tracheal intubation, 60 min after establishing pneumoperitoneum, and the end of surgery, as well as incidence of postoperative PCs in the PCV-VG group were all less or lower than those in the VCV group (P<0.05). The indicators with statistical significance by univariate analysis in combination with significant clinical indicators were enrolled in the multivariate logistic regression model, such as the smoking history, American Society of Anesthesiologists classification, hypertension, BMI, operation time, forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, and intraoperative ventilation mode. It was found that the factors had no collinearity (tolerance>0.1, and variance inflation factor<10). The results of the multivariate logistic regression analysis showed that the patients with higher BMI and intraoperative VCV mode increased the probability of postoperative PCs (P<0.05). ConclusionsFrom the preliminary results of this study, for the obese patients underwent laparoscopic weight loss surgery, the choice of ventilation mode is closely related to the risk of developing postoperative PCs. In clinical practice, it is particularly important to pay attention to the risk of postoperative PCs for the patients with higher degree obesity.

Application of Technique of Duodenoscope Before and after Laparoscopic Cholecystectomy

目的　探讨内镜逆行胰胆管造影(ERCP)检查及内镜治疗在腹腔镜胆囊切除(LC)术前、术后的应用价值。 方法　对61例拟行LC的患者术前或术后行ERCP检查，发现异常再行内镜治疗。结果　LC术前行ERCP者42例中39例显影，其中37例伴有其他胆管疾病，占94.9%。术后行ERCP者19例均显影，总的插管成功率为95.1%。LC术前或术后42例行EST治疗，4例行EPBD，2例行ERBD，15例行ENBD，另4例在行ERCP检查后改开腹手术，取石成功率为92.9%。结论　诊治性ERCP在LC前、后的应用，对进一步明确诊断、选择手术方式、预防LC的并发症和提高LC的成功率具有重要价值。

腹腔镜下胆囊切除术及并发症分析

目的　探讨腹腔镜下胆囊切除术及并发症相关原因。 方法　2008年1月－2011年10月对82例患者行腹腔镜胆囊切除手术，其中发生出血、胆漏和胆管损伤并发症4例。 结果　78例（95.12%）顺利完成手术，手术时间100～160 min，出血量30～80 mL。3例患者术中因胆囊动脉出血、胆管缺损转为开腹术式；另1例术后第2天发生胆源性腹膜炎并发症，再行开腹探查，经相关处置，4例患者均获治愈。 结论　腹腔镜下胆囊切除术虽具有创伤小、痛苦轻、恢复快、住院时间短等微创效果，但实际手术过程中仍会出现出血、胆漏、胆总管损伤等并发症，需要引起足够重视。

Experience Summary on Group No.6 Lymphadenectomy of Laparoscopic Gastrectomy with D2 Lymph Node Dissection for Distal Gastric Cancer in 141 Cases

ObjectiveTo study the significance, methods, and technique of group No.6 lymphadenectomy of the laparoscopic gastrectomy with D2 lymph node dissection for distal gastric cancer. MethodsThe relevant data of the 141 examples of group No.6 lymphadenectomy of the laparoscopic gastrectomy with D2 lymph node dissection for distal gastric cancer from Jan.1, 2008 to Dec.31, 2011 were retrospectively analysized. ResultsOne hundred and forty-one patients were successfully completed the group No.6 lymphadenectomy of laparoscopic distal gastrectomy with D2 lymph node dissection. With the number of cases of operation increasing, the operation time, bleeding volume, incidence rate of complication, and the number of operation transit cases stepped down year by year, and the number of the lymph node dissection stepped up (P < 0.000 1). No case died of the lymphadenectomy of the group No.6 lymph node. The medium vessels of colon, pancreas, and the gastroduodenal artery were the anatomic landmarks of the group No.6 lymphadenectomy. The space between the anterior lobe and the posterior lobe of transverse mesocolon and the prepancreatic space were the important surgical plane to carry out the group No.6 lymphadenectomy. ConclusionsOnly a team shall complete a certain amount of the operation, take the medium vessels of colon, pancreas, and the gastroduodenal artery as the anatomic landmark, accurately identify the space between the anterior lobe and the posterior lobe of transverse mesocolon, and the prepancreatic space, and take operation on the correct surgical plane, shall the group No.6 lymphadenectomy conform to the principle of the radical cure of the tumour and achieve the aim of the minimal invasion.

Influence of indirect calorimetry-guided nutritional support on energy metabolism, cellular immunity and oxidative stress in patients with colorectal cancer after laparoscopic surgery

Objective To study the effect of indirect calorimetry-guided nutritional support on energy metabolism, cellular immunity and oxidative stress in patients with colorectal cancer after laparoscopic surgery. Methods A total of 96 patients with colorectal cancer after laparoscopic surgery in our hospital from December 2019 to December 2021 were selected and randomly divided into the control group (used the formula prediction method to guide enteral nutrition support, n=48) and the observation group (used indirect calorimetry to guide enteral nutrition support, n=48). The target resting energy expenditure (REE) value and nutritional support energy intake were compared between the two groups. The cellular immune indexes (CD3+, CD4+, CD8+, CD4+/CD8+) and oxidative stress indexes [serum superoxide dismutase (SOD), malondialdehyde (MDA), the changes of glutathione peroxidase (GSH-Px)], and the changes of REE at different time points (1 day before operation and 1, 2 and 3 days after operation) of the two groups were compared. The incidence of complications in the two groups were observed. Results The target REE value of the observation group was lower than that of the control group (P＜0.05), and there was no significant difference in the enteral energy intake and parenteral energy intake compared with the control group (P＞0.05). After treatment, CD3+, CD4+ and CD4+/CD8+ in the two groups were lower than those before treatment (P<0.05), and CD8+ was higher than before treatment (P<0.05). The levels of CD3+, CD4+ and CD4+/CD8+ in the observation group after treatment were higher than those in the control group (P<0.05) , while the level of CD8+ in the observation group was lower than that in the control group (P<0.05). After treatment, the levels of SOD and GSH-Px in the two groups were lower than those before treatment (P<0.05), and the levels of MDA were higher than those before treatment (P<0.05). The levels of GSH-Px and SOD in the observation group were higher than those in the control group (P<0.05), while the level of MDA in the observation group was lower than that in the control group (P<0.05). There was no significant difference in the REE value between the two groups at 1 day before operation (P>0.05); compared with the 1 day before operation, the REE values of the two groups at 1, 2, and 3 days after operation were significantly increased, and there was a statistically significant difference between the two groups at each time point (P<0.05), but the REE value at 3 days after operation was significantly lower than that at 1 and 2 days after operation (P<0.05). The REE values in the observation group were lower than those in the control group at 1, 2 and 3 days after operation (P<0.05). The incidence of complications in the observation group was 6.25%, which was lower than 20.83% in the control group (P<0.05). Conclusion Enteral nutrition support guided by indirect calorimetry in colorectal cancer patients after laparoscopic surgery can help reduce postoperative energy consumption, improve cellular immune function and oxidative stress response, and reduce the risk of postoperative complications, which is worthy of promotion.

婴幼儿腹腔镜下先天性食管裂孔疝修补术围手术期护理

目的　总结婴幼儿腹腔镜下食管裂孔疝修补术围手术期的护理方法与经验，以提高护理质量。 方法　对2011年6月－2012年10月收治的8例先天性食管裂孔疝患儿行腹腔镜下食管裂孔疝修补术的护理方法及要点进行回顾性分析。 结果　患儿均顺利完成手术，1例术后第2天开始发热，并持续高热伴咳嗽，经补液、抗感染、雾化吸入等治疗，1周后体温恢复正常，伤口愈合良好，但仍有咳嗽，经儿内科会诊以支气管肺炎转入儿内科治疗。其他患儿无并发症发生，痊愈出院。经随访，8例患儿无腹痛腹胀，无疝复发，无食管狭窄等发生。 结论　术前加强饮食指导、体位护理、皮肤护理，术后做好呼吸道管理、胃管护理、积极抗感染治疗，预防肺部并发症等有效护理措施是婴幼儿腹腔镜下先天性食管裂孔疝修补手术成功的关键。

妇科腹腔镜术中体位相关并发症分析及护理对策

【摘要】 目的 探讨腹腔镜手术中不同护理方式对非切口疼痛相关并发症发生率的影响。 方法 2007年11月-2009年12月，将112例腹腔镜患者随机分成两组，观察组采取麻醉前安置好体位，术后常规低流量给氧6 h及术后第1天低流量吸氧4 h，并予术后肩背部按摩护理方式；对照组采取术中麻醉后摆体位，术后常规低流量给氧6 h。观察术后两组患者发生下肢疼痛、腰骶部酸痛、肩背部酸痛发生情况。 结果 观察组下肢疼痛、肩背部酸痛发生率均低于对照组（Plt;0.05）。 结论 腹腔镜患者采取麻醉前安置体位，术后6 h及术后第1天低流量吸氧4 h，配以肩背部按摩及体位改变的护理方式可降低手术并发症发生率。

Research Progress of Laparoscopy for Gallbladder Carcinoma

The Observation of Retroperitoneal Laparoscopic Decortication of 6 Adrenal Cysts

目的:分析经后腹腔镜肾上腺囊肿去顶减压术的疗效,安全性和临床价值。方法:我院2004年12月至2007年12月6例经后腹腔镜肾上腺囊肿去顶减压临床资料进行回顾分析。结果:经后腹腔镜5例肾上腺囊肿患者顺利切除去顶,其中左侧肾上腺囊肿3例,右侧肾上腺囊肿3例。1例转开放,为双侧肾上腺囊肿。平均手术时间(45.73±1.32)min,平均术中出血量(7.35±0.45)mL。平均住院天数(7.67±0.24)天,平均术后住院天数(5.0±0.11)天。结论:经后腹腔镜肾上腺囊肿去顶减压是一种安全,有效且可行的治疗方式,必要时应及时转开放。