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
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.
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.
目的:探讨经后腹腔镜手术治疗直径≥6.0cm的肾上腺肿瘤的安全性和效果。方法:对我院近5年收治经后腹腔镜手术治疗的直径≥6.0cm肾上腺肿瘤患者的临床资料进行回顾分析,27例患者年龄24～76岁,男性10例,女性17例,肿瘤直径6.0～8.5 cm。病理结果为:髓质脂肪瘤9例,肾上腺皮质腺瘤7例,肾上腺嗜铬细胞瘤6例,节细胞神经瘤3例,肾上腺皮质腺癌1例,肾上腺转移瘤1例。结果:24例患者顺利切除肿瘤,另外3例患者术中转开放手术,平均手术时间(119.46±36.65) min,术中估计出血量(80.14±36.48) mL,术后进食时间(1.88±0.82) d,术后引流管留置时间(2.05±0.65) d,术后住院时间(6.21±1.84) d。 结论:在技术熟练的前提下,直径≥6.0 cm的肾上腺肿瘤经后腹腔镜手术治疗仍然安全、微创。
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.
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.
【Abstract】Objective To investigate the value of laparoscopy in the diagnosis and treatment of small bowel diseases.Methods Data of thirtythree cases of small bowel diseases receiving laparoscopy in this hospital from May 2000 to February 2004 were analyzed retrospectively. Results All cases underwent laparoscopy successfully and no complication was observed. The mean operative time was 65 min.The mean intraoperative blood loss was 30 ml. Postoperative pain was mild. Flatus and feces were passed about 32 hours after treatment and the mean postoperative hospital stay was 7 days. The pathologic examination showed: 18 benign and 6 lowgrade malignant stromal tumors, 5 Meckel’s diverticula and 4 NonHodgkin’s lymphomas. No recurrence occurred in 33 cases during the followup for 10 to 36 months.Conclusion Laparoscopy is a very useful and minimally invasive technique in the diagnosis and treatment of small bowel diseases. It is simple, safe, effective and worthy of be clinically applied.