手镜

The uncovered tracts and the liver wound surface were managed by some of the methods combined such as high frequency electrocoagulation, titanium clamp, suture, hemostatic gauze oppression, argon-beam coagulation, protein glue adherence, and Endo-GIA switcher. The total operative outcome, operating time, blood loss, postoperative complications and postoperative hospital stay were summarized in order to assess feasibility and safety of the clinical laparoscopic liver resection.Results: 1. Laparoscopic liver resection with clamp dissection method needs only the ordinary laparoscopic equipment. It has a low cost but causes a little more bleeding. 2. Laparoscopic liver resection operated by microwave tissue coagulation method had very little bleeding when dissecting hepatic parenchyma. The operative field is clear and the cost is low. It is a safe, convenient and effective method. 3. Ultrasound dissector is a relatively ideal appliance for laparoscopic liver resection at present because ofless bleeding during operation. But the speed is slow thus prolongs the operation time. Its separating intensity is not strong enough, and it can only be applied to patients without hepatic cirrhosis. 4. Ligsure has clamp dissection and electrocoagulation functions. It can carbonize hepatic tissue including the tracts whose diameters are less than 7mm. It has some advantage in dissecting. However, it has the shortcomings of the clamp dissector during coagulating. 5. Hand-assisted laparoscopic liver resection can make use of the flexibility and feeling of the operators left hand.

结果：1、钳夹分离切肝法不需特殊仪器设备，只要具备常规的腹腔镜器械即可实施，成本低，肝断面较易渗血；2、微波固化切肝法肝实质出血很少，视野清晰，成本低，操作简单，是一种安全、简便、有效的方法；3、超声刀是目前较为理想的切肝器械，术中出血少，但是，切割速度慢，手术时间长，而且，切割强度有限，适用于无肝硬化的肝切除；4、Ligsure具有挤压粉碎及高频电凝止血两大功能，可使包括7~以下管道的肝组织碳化、形成焦痴，具有一定的优势，但是，也存在分离钳电凝止血的缺点；5、手辅助腹腔镜肝切除可以利用术者左手的灵活性及手感，便于术中显露、分离、控制出血等，可随意协助右手及助手的主要操作，缩短了手术时间，大大提高了腹腔镜肝切除的安全性，李朝龙等的改良方法，同样达到了手辅助目的，又节省了费用；6、小切口腹腔镜辅助切肝法可以使用剖腹肝切除常规器械及剖腹肝切除技术，操作简单、可靠，适用于肝左外叶切除及右肝第V段切除；7、Endo一GIA切肝法在离断肝组织的同时闭合管道结构，多用于肝左静脉、门静脉分支、管径较大胆管的切割，缺点是不能用于较厚肝组织的切割，而且价格昂贵；8、临床巧例腹腔镜肝切除均获得成功，手术时间最短1.5h，最长sh，平均125 min，多数在100 min左右，手术出血量最少50 ml，最多500 ml，平均1 78 ml，除2例合并严重肝硬化的原发性肝癌患者术后出现少量腹水，1例术后发生胆漏外，其余无并发症，发生胆漏的1例患者术后住院40d，多数在术后一周左右出院，术后住院时间5一40d，平均gd。

Methods: 1. Experimental laparoscopic liver resection: We selected pigs as experimental models aiming to approach human beings physiological and anatomical condition. After CO2 pneumoperitoneum was established, the ligaments around liver were dissociated. Livers were cut off by the methods such as clamp dissection, microwave tissue coagulator, ultrasound dissector, Ligsure dissection, hand-assisted, short abdominal incision laparoscopy-assisted, and Endo-GIA switcher. The operation time and bleeding volume were compared between different methods of laparoscopic liver resection. The advantages and limitations of different methods were summarized. 2. Clinical laparoscopic liver resection: 15 cases with tumors in segment V of anterior right lobe or segments II, III of left lateral lobe or segment IV of left internal lobe were selected in this study. The liver diseases included hepatocellular cancer, hepatic cavernous hemangioma and hepatic focal nodular hyperplasia. The ligaments around liver were dissociated after CO2 pneumoperitoneum established. Laparoscopic liver resection were carried out by some of the methods combined such as clamp dissection, microwave tissue coagulator, hand-assisted, short abdominal incision laparoscopy-assisted, ultrasound dissector, rotation and suction dissector.

1、实验性腹腔镜肝切除：以猪为实验动物，旨在接近人体的生理、解剖环境下进行实验，建立操作空间后游离肝脏周围韧带，采用钳夹分离切肝法、微波刀切肝法、超声刀切肝法、Ligsure切肝法、手辅助腹腔镜肝切除法、小切口腹腔镜辅助切肝法、Endo-GIA切肝法等方法实施腹腔镜下肝切除，比较不同切肝方法的手术时间、出血量，总结各种方法的优越性及其局限性。2、临床腹腔镜肝切除：选择肿瘤位于肝右前叶第Ⅴ段、肝左外叶第Ⅱ、Ⅲ段及左内叶第Ⅳ段的15例患者，病种包括原发性肝癌、肝海绵状血管瘤、肝脏局灶性增生，建立气腹后游离肝脏周围韧带，采用钳夹分离断肝、微波刀固化后断肝、手辅助腹腔镜肝切除、小切口腹腔镜辅助肝切除、超声刀断肝、旋吸断肝等多种方法分离切线肝组织，暴露管道结构，再采用高频电凝、钛夹夹闭、缝扎止血、止血纱布覆盖、氩气刀止血、生物胶止血、Endo-GIA处理等多种方法相结合处理肝断面，统计手术完成情况、手术时间、手术出血量、术后并发症及术后住院时间等，评价腹腔镜肝切除的可行性及安全性。

The company operating various types of Color: If hand mirror, comb mirror, mirror Taiwan, the company now has various models of advanced computer injection equipment companies paid great attention to the use of personnel and training, with the enterprise has grown and developed a pool A large number of management and professional and technical personnel, has become the enterprise to meet the challenges of the new century and the development of strong backing.

公司主要经营各式化妆镜：如手镜、梳镜、台镜，现公司拥有各种型号先进的电脑注塑设备；公司十分注重人才的利用与培养，随着企业的不断壮大，凝聚和培养了大批的管理和专业技术人才，已成为企业迎接新世纪的挑战和发展的坚强后盾。

Mirror of mind switch:This small hand mirror manifests its power once per day against a creature that sees its reflection within it,as a gaze attack with a range of 30 feet.

心灵交换镜子：这个小手镜对30英尺范围内看到自身影像的生物起作用，每天可使用一次。

Materials and Methods: Campare gasless hand-assisted laparoscopic surgery, carbon dioxide pneumoperitoneum laparoscopic surgery and operation on Cholecystectomy, colorectal resections, according to the study of operation time, expense in hospital, number of days, pathologic type, extension of radical cure, and analysis of the blood lymphocytes, immune function of erythrocyte, we could ascertain the application value of gasless hand-assisted laparoscopic surgery.

材料与方法：对比研究非气腹手助腹腔镜手术、CO_2气腹腹腔镜手术及开腹手术，从早期的胆囊切除手术的临床应用过渡到结直肠癌根治手术，分别从手术时间、住院费用、住院天数、病理分型、根治范围等进行对比研究，然后从人体外周血淋巴细胞、红细胞等免疫功能方面作进一步分析，以确定非气腹手助腹腔镜手术在临床中的应用价值。

In the process of colorectal cancer resections, gasless hand-assisted laparoscopic surgery had obvious difference with carbon dioxide pneumoperitoneum laparoscopic surgery and operation on operation time, expense in hospital, number of days, pathologic type, extension of radical cure, and analysis of the blood lymphocytes, immune function of erythrocyte because gasless assisted laparoscopic surgery had litter disturb, litter wound, in litter pain, fast function recover, litter complications and hospital stay days.

在结直肠癌手术中，非气腹手助腹腔镜手术、CO_2气腹腹腔镜手术和开腹手术比较，其在手术时间、住院费用、住院天数、病理分型、根治范围等方面有明显差异，非气腹手助腹腔镜手术对机体干扰少，创伤少、术后疼痛轻、功能恢复快、术后并发症少、住院时间短。

Compared with acute-phase reaction and erythrocytic immune function, neutrophilic counts, interleukin-6, natural killer cells, C-reaction protein between gasless hand-assisted laparoscopic surgery and carbon dioxide pneumoperitoneum laparoscopic surgery, we found there were obvious difference on N/L rate, CRP, IL-6, Which provided evidence for evaluate the gasless hand-assisted laparoscopic technique superiority to the traditional surgery, and treatment for clinical immune modulation.

通过非气腹手助腹腔镜、CO2气腹腹腔镜和开腹手术创伤后出现的急性期反应和红细胞免疫功能的检测，中性粒细胞计数、IL-6，NK，CRP浓度等APR指标检测，发现非气腹手助腹腔镜结直肠癌手术术后中性粒细胞／淋巴细胞、CRP、IL-6等免疫指标的变化情况较腹腔镜组、开腹组有明显区别，为评价此手术技术是否较传统方法优越和临床免疫调节治疗提供依据。

During the Song and Yuan Dynasties the bronze mirrors appeared in all shapes: round, rectangular, rhomboidal, octagonal, and those with a handle.

宋、元时期出现了圆镜、长方镜、棱镜、八棱镜和带柄手镜等。

During the Song and Yuan Dynasties the bronze mirrors appeared in all shapes: round, rectangular, rhomboidal, octagonal, and those with a handle.

宋，元时期出现了圆镜，长方镜，菱镜，八棱镜和带柄手镜等。

During the Song and Yuan Dynasties the bronze mirrors appeared in all shapes: round, rectangular, rhomboidal, octagonal, and those with a handle.

元时期出现了圆镜，宋，长方镜，菱镜，八棱镜和带柄手镜等。

This one mode pays close attention to network credence foundation of the businessman very much.

这一模式非常关注商人的网络信用基础。

Cell morphology of bacterial ghost of Pasteurella multocida was observed by scanning electron microscopy and inactivation ratio was estimated by CFU analysi.

扫描电镜观察多杀性巴氏杆菌细菌幽灵和菌落形成单位评价遗传灭活率。