腹腔镜

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。

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。

Celioscope is an important instrument in surgery. With the improvement of celioscope skill, more diseases can be cured. At the same time the overuse of celioscope in surgical course has been a serious social issue.

腹腔镜手术是目前外科领域的一个重要方面，随着腹腔镜手术技巧的提高，越来越多的疾病可以通过腹腔镜手术得到治疗，但同时腹腔镜在外科治疗中过度应用也成为一个重要的社会问题。

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。

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。

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

objective to evaluate the clinical value of early diagnosis and therapy of suspicious ectopic pregnancy by laparoscopy.methods the clinical data of 53 suspicious tubal pregnancy patients were analyzed retrospectively,who had received laparoscopic operation in our hospital from january 2003 to december 2005.results all cases received laparoscopic operation,none was transferred to traditional surgery during the operation.46 cases were diagnosed as tubal pregnancy during the operation with pathologic proof.preoperative diagnosis rate was 86.8%.the salpingecstomy were performed in the 32 cases.the salpingotomy were performed in the 7 cases.conclusion the laparoscopic operation is the best choice in the early diagnosis and therapy of suspicious ectopic pregnancy,and it gain time for conservative therapy.but not too early.

目的 评价可疑异位妊娠患者腹腔镜早期诊治的临床价值。方法收集2003年1月～2005年12月收治的经腹腔镜手术治疗的可疑输卵管妊娠患者53例资料进行回顾性分析。结果 53例手术均经腹腔镜完成，无1例中转，术中诊断输卵管妊娠的46例，术前诊断率86.8%，32例行输卵管切除术，7例行保守性手术。结论腹腔镜手术是早期确诊可疑异位妊娠患者的最佳选择，也为保守性治理赢得时间，但不宜操之过急。

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。

Methods: From January 2004 to September 2006, 56 laparoscopic nephrectomies were performed. Hem-o-lok clips were used to control renal artery and vein in 38 cases, including 9 simple nephrectomies, 18 radical nephrectomies and 11 nephroureterectomies.

2004年1月至2006年9月我科行腹腔镜肾切除术56例，其中38例术中应用Hem-o-lok夹处理肾蒂血管，包括腹腔镜单纯肾切除9例，腹腔镜肾癌根治术18例，腹腔镜肾输尿管全长切除术11例。

The split between the two groups can hardly be papered over.

这两个团体间的分歧难以掩饰。

This approach not only encourages a greater number of responses, but minimizes the likelihood of stale groupthink.

这种做法不仅鼓励了更多的反应，而且减少跟风的可能性。