腹腔

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。

From April 2000 to June 2002, 512 cases of laparoscopical urologic operation have been performed through transperitoneal and retroperitoneal or extraperitoneal approach: 41 cases of nephrectomy, 36 cases of radical nephrectomy, 10 cases of nephroureterectomy with cystoscopic en bloc excision of the distal ureter and bladder cuff, 3 cases of partial nephrectomy, 78 cases of partial adrenalectomy or resection of adenomas, 71 cases of total adrenalectomy, 17 cases of ureterolithotomy, 122 cases of decortication of renal cyst, 1 case of Anderson-Hynes dismembered pyeloplasty, 7 cases of renal pedical lymphatics disconnection, 2 cases of relative living donor nephrectomy.

本课题通过对223例肾疾病、149例肾上腺疾病、17例输尿管结石病人进行腹腔镜及后腹腔镜手术，其中肾囊肿去顶术140例、单纯肾切除术41例、根治性肾切除术36例、肾输尿管全切及输尿管口膀胱袖套状切除术10例、后腹腔镜肾部分切除术3例、Anderson-Hynes肾盂成形术1例、肾蒂淋巴管离断术7例、腹腔镜和后腹腔镜活体亲属供肾切取术各1例、肾上腺部分或单纯肿瘤切除术78例、肾上腺全部切除术71例、输尿管切开取石术17例。记录手术时间、手术中失血量、肠道功能恢复时间及并发症，将结果与传统开放手术和国外学者的腹腔镜手术结果进行比较，对数据进行统计分析。

Of them,194 cases had been conducted sterility explorations,148 ectopic pregnancy operations,91 ovarian multiple cyst operations,49 myomectomy,47 enucleation of ovarian multiple cysts,29 laparoscopic cholecystectomies,24 teratoma resections,2 ruptuure of corpus luteum operations,2 appendectomies,repair in perforation of uterus,eyewinker extraction in abdominal cavity.Tubal ligation and communicating branch lidation of great saphenous vein.

在连续硬膜外加静脉麻醉下为602例行腹腔镜手术，其中不孕症宫腹腔镜探查术194例，宫外孕手术148例，多囊卵巢手术91例，子宫肌瘤切除术49例，卵巢囊肿切除术47例，胆囊切除术29例，畸胎瘤切除术24例，黄体破裂修补术12例，盆腔脓肿引流术2例，阑尾切除术2例，腹腔镜子宫穿孔修补，腹腔异物取出，输卵管结扎，大隐静脉交通支离断等各1例。

Rats living over 96h were considered survival. To observe the protective effects of ALR gene on acute liver injury rat, thirty-six rats that were injected peritoneally with 50% CCl4 of 2ml/kg were divided into the flowing 6 group according to doses (50?g/kg and 200?g/kg ) and administration routes of pcDNA3-ALR DNA 4h after CCl4 injection: group 1, model group; group 2, ALR gene of 50μg/kg was injected venally; group 3, ALR gene of 200?

另取36只大鼠按2ml/kg腹腔注射50% CCL4，染毒后4h按不同剂量（50μg/kg 和200μg/kg ）、不同注射途径（尾静脉注射、腹腔注射和联合注射）随机分为六组。1组：模型组，不注射ALR基因； 2组：尾静脉注射ALR基因 50μg/kg； 3组：尾静脉注射ALR基因 200μg/kg； 4组：腹腔注射ALR基因 50μg/kg； 5组：腹腔注射ALR基因 200μg/kg； 6组：联合注射（尾静脉和腹腔各注射ALR 基因100μg/kg）。

This topic intends to set up the animal model of apositia with the function of central inhibition to investigate the pharmacological effect of Shanzha Maiya granula and research the functional mechanism of the Chinese medicines for invigorating spleen to promote digestion in view of braingut petide-appestat.

CLAIRE报道LP50μg/kg单独腹腔注射可以降低大鼠进食量，LP 50μg/kg和8～16μg/kgCCK联合腹腔注射效果更佳，两者联合腹腔注射后与LP单独腹腔注射后大鼠食量比较差异有统计学意义，Scott等报道第三脑室注射LP 7μg/kg和腹腔注射CCK 2μg/kg都有降低食欲的作用。

The abdominal wall in the left lower quadrant, 2 finger breadths (3 cm) cephalad and 2 finger breadths medial to the anterior superior iliac spine, has been shown to be thinner and with a larger pool of fluid than the midline and is usually a good choice for needle insertion for performance of a therapeutic paracentesis.27 The right lower quadrant may be a suboptimal choice in the setting of a dilated cecum or an appendectomy scar.

在过去，常常将腹部正中线耻骨与肚脐中间定为穿刺点，现在，由于腹腔穿刺引流大量液体以及腹中部脂肪厚度增加，左下腹成为腹腔穿刺部位（表1），在左下腹部中线至髂前上棘连线上2指宽（3cm）与距髂前上棘2指宽，已经显示较中部脂肪少及腹水较多是治疗性腹腔穿刺好的首选部位27，在盲肠有扩张或阑尾切除术后瘢痕时右下腹是次选的穿刺部位，应避开腹壁下动脉，这些血管走行在耻骨与髂前上棘之间的中线然后在腹直肌中向上行走，，腹壁可见的侧支循环亦应该避开，腹腔镜检查发现侧支循环可出现在中线并且在腹腔穿刺时有导致血管破裂的风险28。

Results:All 55 patients were diagnosed and treated by laparoscopic procedure successfully including 7 laparoscopic intestinal local resections,10 laparoscopic intestinal diverticular resections,37 laparoscopic partial intestinal resections and 1 laparoscopic right hemicolectomy.

结果：腹腔镜探查不仅明确了所有患者小肠出血的原因，而且同时实施了相应的腹腔镜手术，其中包括7例完全腹腔镜下小肠肿瘤局部切除术；10例腹腔镜下小肠憩室切除术；37例腹腔镜辅助下小肠肠段切除术；1例腹腔镜辅助下右半结肠切除术。

objective to explore the best method of nursing in laparoscopic operation of subtotal hysterectomy with pk scapel.methods ninety seven patients under going operation of laparoscopic subtotal hysterectomy with pk scapel were slected.the bleeding volume,operation time and methods of nursing including machine check,proceeding and maintenance of instruments.results bleeding volume was lessened significantly and good nursing during operation can improve safety and success rate of losh.conclusion good nursing with well knowledge of pk scapel,accurate proceeding and sterilization and skilled cooperation plays a key role in assurance of the success of losh.

摘 要］目的：探讨在腹腔镜下使用pk刀行子宫次全切除术配合的方法。方法：对97例使用pk刀在腹腔镜下行子宫次全切除术配合进行总结，主要是检查测试仪器功能，按操作程序密切配合手术，术后正确彻底的清洗、保养、消毒与灭菌。结果：在腹腔镜下应用pk刀切除子宫，出血量明显减少，组织损伤小，97例的手术中除1例粘连严重中转开腹外，其余手术均顺利完成，无并发症发生。结论：护士加强对pk刀的应用学习，正确掌握操作规程和灭菌方法，以及娴熟的腹腔镜配合技术是手术顺利进行的有力保证。［关键词］腹腔镜；pk刀；子宫次全切除术；护理配合

Methods We retrospectively reviewed the clinical data of 321 cases of laparoscopic hysterectomy, including 201 classic intrafascial supracervical hysterectomy, 24 laparoscopic supracervical hysterectomy, 51 laparoscopic assisted vaginal hysterectomy, and 45 total laparoscopic hysterectomy. We compared the time of operation, the blood loss during operation and the restitution after operation in four groups, About the time of operation, the two methohs of amputating cervix were significantly longer than the two methods of remaining cervix.

对321例腹腔镜子宫切除术进行回顾性分析，其中腹腔镜鞘膜内子宫切除术201例，腹腔镜次全子宫切除术24例，腹腔镜辅助阴式子宫切除术51例，腹腔镜全子宫切除术45例，比较4种子宫切除术式的手术时间，出血量，术后恢复的情况。

Breath, muscle contraction of the buttocks; arch body, as far as possible to hold his head, right leg straight towards the ceiling (peg-leg knee in order to avoid muscle tension).

呼气，收缩臀部肌肉；拱起身体，尽量抬起头来，右腿伸直朝向天花板（膝微屈，以避免肌肉紧张）。

The cost of moving grain food products was unchanged from May, but year over year are up 8%.

粮食产品的运输费用与5月份相比没有变化，但却比去年同期高8％。