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Short-Term Outcome Analysis of Laparoscopy-Assisted Versus Open Surgery for Colon Cancer

Objective　The survival data of patients with colon cancer who were treated by laparoscopic-assisted surgery and open surgery three years after operation were analyzed and contrasted, which provided data to support the future treatment. Methods　The 217 patients who were cured by laparoscopic-assisted surgery and 193 patients who were cured by open surgery were followed up, and the rates of local recurrence, metastasis, implantative, and survival were contrasted and analyzed. Results　Three years after laparoscopic-assisted surgery and open surgery, the disease-free survival rate was 86.2% （187/217） and 85.5% （165/193）, respectively, and the overall survival rate was 91.2% （198/217） and 92.7% （179/193）, respectively, the difference between the two groups was not statistic significance（P＞0.05）. The differences of the rates of local recurrence, metastasis, and implantative between the two groups were not statistic significance（P＞0.05）. Conclusions　Laparoscopic-assisted surgery is similar with open surgery in the rates of local recurrence, forward metastasis, and overall survival. So laparoscopic-assisted surgery is a safe and radical curative surgery.

腹腔镜与开腹手术治疗 Mirizzi 综合征的临床疗效比较

目的 比较腹腔镜和开腹手术治疗 Mirizzi 综合征的临床疗效。 方法 回顾性收集解放军第 451 医院全军腹腔镜中心于 2010 年 1 月至 2014 年 12 月期间收治的 69 例 Mirizzi 综合征患者的临床资料，根据接受的手术类型分为腹腔镜组（n=36）和开腹组（n=33），比较腹腔镜组和开腹组患者的手术疗效。 结果 腹腔镜组患者的手术时间〔（56.2±19.4）min比（86.2±22.1）min〕、术中出血量〔（47.5±25.4）mL比（104.9±41.6）mL〕、术后进食时间〔（12.4±5.6）h比（29.2±10.4）h〕、术后排气时间〔（11.4±5.7）h比（25.4±6.6）h〕和住院时间〔（5.4±2.4）d比（8.9±3.1）d〕均短于开腹组，差异均有统计学意义（P<0.05）。术后腹腔镜组发生胆瘘 2 例，并发症发生率为 5.56%；开腹组发生胆瘘 1 例，肺部感染 1 例，并发症发生率为 6.06%，2 组患者的近期并发症发生率比较差异无统计学意义（P>0.05）。术后所有患者均获访，随访时间为 10～35 个月，中位数为 19 个月。随访期间，腹腔镜组和开腹组各有 1 例患者新发胆瘘，远期并发症发生率分别为 2.78% 和 3.03%，2 组患者的远期并发症发生率比较差异也无统计学意义（P>0.05）。所有患者随访期间均无胆管狭窄和结石残留发生。 结论 腹腔镜治疗Ⅰ型和Ⅱ型 Mirizzi 综合征安全有效，可减轻对患者的创伤并加快恢复，对于术前明确诊断的患者可首选腹腔镜治疗。

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。

Comparison of Proseal Laryngeal Mask Airway with Endotracheal Intubation in General Anesthesia during Gynecologic Laparoscopic Surgery

目的 探讨双管喉罩与气管插管用于全身麻醉妇科腹腔镜手术的安全性和可行性。 方法 2009年1月-5月择期妇科腹腔镜手术患者60例，ASAⅠ～Ⅱ级，随机分为喉罩组（P组）和气管插管组（T组）。记录入室基础值（T0），置罩（管）前（T1），置罩（管）后即刻（T2），置罩（管）后5 min（T3 ），拔除罩（管）即刻（T4），拔除罩（管）后5 min（T5）的收缩压（systolic pressure, SBP），舒张压（diastolic pressure, DBP），心率（heart rate, HR）和脉搏血氧饱和度（pulse oxygen saturation, SpO2），喉罩和气管插管控制呼吸时气腹前后不同时段的气道峰压（airway. maximum pressure, Pmax），潮气量（vital volume, VT）和呼气末二氧化碳分压（end tidal CO2, PETCO2）。记录插罩（管）成功率，及相关并发症。 结果 T2时T组SBP，DBP和HR显著高于P组（P＜0.05），两组术中通气均满意；Pmax，VT和PETCO2组间比较各时点无差异（P＞0.05）。气腹后Pmax和PETCO2组内比较均高于气腹前，差异有统计学意义（P＜0.05）。置罩（管）成功率组间比较差异无统计学意义，拔罩（管）期及术后24 h并发症，喉罩组明显低于气管导管组，差异显著（P＜0.05）。 结论 双管喉罩用于全麻妇科腹腔镜手术通气效果满意，安全可行。

胸腹腔镜联合食管癌根治术视频要点

Trocar Site Hernia Following Laparoscopy: A Case Report and Literature Review

目的 探讨腹腔镜术后Trocar部位疝的发生、分型和诊治方法。方法 1例77岁的女性患者，因“右附件囊性畸胎瘤”行腹腔镜右附件切除术，术后2 d出现右下腹Trocar部位疝并发肠梗阻，结合文献对其发生率、分型、发病因素、临床表现、诊治原则及预防进行分析。结果 手术证实部分小肠嵌顿于Trocar切口内，行小肠松解和切口缝合术，术后3 d痊愈出院。结论 Trocar部位疝并不少见，因素复杂，根据发生的时间和形态可将其分为早发型、迟发型和特殊型3型； 多需要手术治疗，缝合Trocar切口筋膜是有效的预防方法。

Standardized Techniques for Laparoscopic Radical Rectal Resection and Its Application Prospect: Outcomes in 433 Patients and Review of The Literature

ObjectiveTo standardize the techniques for laparoscopic radical rectal resection and discuss its application prospect. MethodsThe clinical data of 433 patients who underwent laparoscopic radical rectal resections from July 2003 to December 2010 in our hospital were reviewed retrospectively, and the different surgery procedures and the development prospect were explored. ResultsFive cases (1.2%) underwent handassistant laparoscopic procedures, 412 cases (95.2%) were done by laparoscopic-assisted operation, and the specimens were taken out with transanal pull-through technique in 16 cases (3.7%). In all of them, conversion to open procedures occurred in 11 patients (2.5%), and 290 (67.0%) patients were followed-up in 1 to 6 years, average in 2.7 years. Local recurrence occurred in 7 (2.4%) patients, while distant metastasis were diagnosed in 22 （7.6%） cases, and the overall mortality was 15.9% (46/290). There was no port-site metastasis occurred. ConclusionsFour-port laparoscopic rectal resection technique is also the clinical mainstream. Standardized laparoscopic procedure for rectal resections enhances the transformation of laparoscopic skills, and makes the operation predictable. Single incision procedure and natural orifice transluminal endoscopic surgery are future direction to explore.

帕瑞昔布钠超前镇痛在妇科腹腔镜术中的应用

【摘要】　目的　探讨帕瑞昔布钠超前镇痛对妇科腹腔镜术患者的影响。　方法　2009年9-10月随机选择行妇科腹腔镜术患者60例，分为试验组、对照组各30例。试验组手术前15 min静脉注射帕瑞昔布钠40 mg （10 mL），对照组注射生理盐水10 mL，记录术后1、2、4、6、12、24 h视觉模拟评分（VAS）。　结果　试验组VAS明显低于对照组，差异有统计学意义（Plt;0.05）。　结论　帕瑞昔布钠超前镇痛对妇科腹腔镜手术患者有较好的镇痛效果。

Clinical analysis of laparoscopic common bile duct reexploration in treatment of bile duct stones

Objective To evaluate safety, efficacy, and indications of laparoscopic bile duct reexploration in treatment of bile duct stones. Methods Fifty-seven patients with bile duct stones who underwent laparoscopic common bile duct reexploration (laparoscope group) and 62 patients with bile duct stones who underwent open common bile duct reexploration (laparotomy group) were included into this study from February 2013 to February 2017 in the Renmin Hospital of Wuhan University. The intraoperative and postoperative data of the patients were documented and analyzed. Results All the operations were performed successfully and all the patients had no extra-damage during the operation. One case was converted to the laparotomy due to the intraabdominal serious adhesion in the laparoscope group. Compared with the laparotomy group, the amount of intraoperative blood loss was less, the first time of anal exhaust was earlier, the rates of postoperative analgesia and incision infection were lower, and the length of hospital stay was shorter in the laparoscope group, there were significant differences (P<0.05). There were no significant differences in the operative time, the hospitalization expense, primary suture rate of common bile duct, and the rates of postoperative complications such as the bile leakage, bile duct stricture, and residual stone between the laparoscope group and the laparotomy group (P>0.05). Conclusion With experienced skills and strict surgical indications, laparoscopic common bile duct reexploration is safe and effective in treatment of bile duct stones, and it has some advantages including less bleeding, rapid recovery, and shorter hospitalization time.

Analysis of surgery conposition and postoperative follow-up in 1 078 cases of inguinal hernia

ObjectiveTo summarize the changes of inguinal hernia in The First Affiliated Hospital of Anhui Medical University in the past 7 years and the curative effect of each procedure.MethodsRetrospectively searched the clinical data of 1 078 patients with inguinal hernia operated in The First Affiliated Hospital of Anhui Medical University from January 2011 to December 2017. According to the surgical procedure, patients were divided into tissue repair group, laparoscopic hernia repair group (laparoscopic group), and open tension-free hernia repair group (open group). Subsequently, the patients of the open group were divided into the mesh plug technique group, the plain patch technique group, and the Ultrapro Hernia System (UHS) group. The postoperative of each procedure, such as recurrence, chronic pain, foreign body sensation, hard touch of the surgical site, male sexual function, and fertility status were compared.ResultsIn 1 078 patients, 52 patients underwent tissue repair, 889 patients underwent open tension-free hernia repair (687 patients were counted with mesh-seal tablets, 100 patients with plain patch count, 102 patients with preperitoneal hernia repair), and 137 patients underwent laparoscopic hernia repair. There was no significant difference in the incidence of total complication, chronic pain, foreign body sensation, and male sexual function decline in the laparoscopic group and the open group (P>0.05). However, the recurrence rate and hard touch of the surgical site rate of the laparoscopic group were lower (P<0.05), and the Numeric Rating Scale (NRS) score was also slightly lower (P=0.047). There was no significant difference in the incidence of the recurrence, chronic pain, foreign body sensation, and male sexual function decline between the three subgroups of the open group, but the total complication rate and hard touch of the surgical site rate in the UHS group were lower than those in the mesh plug group and the plain patch group (P<0.05).ConclusionsLaparoscopic repair of the inguinal herniorrhaphy has lower incidence of occurrence, it is worthy of clinical promotion. In the open tension-free surgery, the retroperitoneal herniorrhaphy may be a better choice.