腹腔镜胆囊切除术治疗高龄患者急性胆囊炎的临床观察

目的：探讨腹腔镜胆囊切除术治疗高龄患者急性胆囊炎的应用价值。方法：回顾性分析2005年1月．2011年12月我院收治的210例65岁以上因急性胆囊炎实施胆囊切除术的老年患者的临床资料,按手术方式分为腹腔镜组（LC组）和剖腹胆囊切除术组（OC组）,分析和比较两组患者的手术时间、术后肠功能恢复时间及住院时间,术中出血、腹腔引流量和术后并发症的发生情况。结果：与OC组比较,LC组的手术时间、术后肠功能恢复时间及住院时间均显著缩短,差异有统计学意义（P〈0．01）;但两组之间术中出血、腹腔引流量和术后并发症的发生率差异均无统计学意义（P〉0．05）。LC组中转开腹10例,占7_35％;其中粘连严重导致胆囊三角解剖不清6例,无法控制的出血2例,结石嵌顿胆囊管2例。结论：老年急性胆囊炎患者在条件合适的情况下行腹腔镜胆囊切除术治疗有助于患者更快地恢复．具有较强的临床应用价值。     

Comparison of endoscopic-assisted transcervical and laparotomy insemination with frozen-thawed dog semen: A retrospective clinical study

The objective of this retrospective clinical study was to compare pregnancy rates obtained after the use of endoscopic-assisted transcervical catheterization (EIU) or laparotomy (SIU) for insemination of frozen-thawed dog semen. Healthy bitches from various breeds were inseminated with semen from multiple donors processed by different freezing centers. Data from 118 inseminations (78 EIU and 40 SIU) performed between 2009 and 2011 were analyzed. Insemination timing was based on vaginal cytology, serum progesterone concentrations, and vaginoscopy. A ureterorenoscope and a CH-5 Transcervical insemination catheter were used for EIU; 28 of the bitches in this group were inseminated twice with the second insemination less than 12 hours after the first. The numbers of live morphologically normal sperm (LMNS) were determined to characterize insemination doses. Overall, pregnancy rate was greater (P < 0.05) in the EIU group (65%) than in the SIU group (45%). Pregnancy rates were greater (P ≤ 0.06) when more than 100 × 10⁶ LMNS were inseminated regardless of insemination method; the greatest pregnancy rate was observed in the EIU group when this insemination dose was used (38/49; 78%). There was no significant difference in pregnancy rate whether one (69%) or two inseminations (64%) were performed in the EIU group. Complications in the SIU group included anesthetic-induced bradycardia during surgery, significant postsurgery pain, seroma formation over the abdominal incision, and delayed wound healing. No complications were noted during or after insemination in the EIU group. In conclusion, these results support the use of EIU as a noninvasive alternative to laparotomy for insemination of frozen-thawed dog semen. In addition, use of more than 100 × 10⁶ LMNS is also recommended for insemination.     

Renal Ischaemia Reperfusion Injury: A Mouse Model of Injury and Regeneration

Renal ischaemia reperfusion injury (IRI) is a common cause of acute kidney injury (AKI) in patients and occlusion of renal blood flow is unavoidable during renal transplantation. Experimental models that accurately and reproducibly recapitulate renal IRI are crucial in dissecting the pathophysiology of AKI and the development of novel therapeutic agents. Presented here is a mouse model of renal IRI that results in reproducible AKI. This is achieved by a midline laparotomy approach for the surgery with one incision allowing both a right nephrectomy that provides control tissue and clamping of the left renal pedicle to induce ischaemia of the left kidney. By careful monitoring of the clamp position and body temperature during the period of ischaemia this model achieves reproducible functional and structural injury. Mice sacrificed 24 hr following surgery demonstrate loss of renal function with elevation of the serum or plasma creatinine level as well as structural kidney damage with acute tubular necrosis evident. Renal function improves and the acute tissue injury resolves during the course of 7 days following renal IRI such that this model may be used to study renal regeneration. This model of renal IRI has been utilized to study the molecular and cellular pathophysiology of AKI as well as analysis of the subsequent renal regeneration.     

腹腔镜与开腹手术对胃癌根治术患者TNF-alpha和IL-6 水平的影响研究

目的:探讨腹腔镜与开腹手术对胃癌根治术患者肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平的影响.方法:选取自2011年3月至2013年5月期间来我院就医并行胃癌根治术的72例胃癌患者作为研究对象.并将所有患者随机平均分成腹腔镜组和传统开腹组各36例.其中,腹腔镜组行腹腔镜辅助下胃癌根治术,传统开腹组行传统开腹胃癌根治术.比较两组手术时间、术中出血量、肛门排气时间及住院时间;比较两组患者术前及术后血清TNF-α和IL-6水平.结果:腹腔镜组术中出血量、肛门排气时间及住院时间均明显低于对照组(P＜0.05)腹腔镜组术后TNF-α和IL-6水平明显低于开腹组(P＜0.05),两组比较有显著性差异(P＜0.05).结论:腹腔镜辅助下胃癌根治术较传统开腹胃癌根治术术后血清TNF-α和IL-6水平低,对机体免疫功能影响较小,可减少患者术后感染机会,值得在临床中推广应用.     

腹腔镜子宫肌瘤剔除术与开腹手术对子宫肌瘤患者内分泌状态、免疫功能和预后的影响

目的:探讨腹腔镜子宫肌瘤剔除术与开腹手术对子宫肌瘤患者内分泌状态、免疫功能和预后的影响。方法:选取2014年1月～2019年1月期间我院收治的子宫肌瘤患者90例,根据手术方式的不同将患者分为A组(n=44)和B组(n=46),A组予以开腹手术,B组予以腹腔镜子宫肌瘤剔除术,比较两组患者临床指标、内分泌状态、免疫功能、并发症及预后。结果:两组手术时间对比未见统计学差异(P0.05);B组术中出血量少于A组,住院时间、术后肛门排气恢复时间短于A组(P0.05)。两组术后1个月卵泡刺激素(FSH)、促黄体生成激素(LH)均较术前升高,雌二醇(E2)较术前降低(P0.05);B组术后1个月FSH、LH低于A组,E2则高于A组(P0.05)。两组术后1 d CD3~+、CD4~+、CD4~+/CD8~+均较术前降低,但B组高于A组(P0.05);CD8~+较术前升高,但B组低于A组(P0.05)。B组的并发症发生率低于A组(P0.05)。两组子宫形态正常率、复发率、月经转归正常率对比无差异(P0.05)。结论:与开腹手术相比,腹腔镜子宫肌瘤剔除术可明显减轻对子宫肌瘤患者机体内分泌状态、免疫功能的损害,促进患者术后恢复,减少并发症发生情况,同时还可获得与开腹手术相当的近期预后。     

阴式手术与开腹手术对子宫良性肿瘤患者炎性应激反应、盆底功能及性生活质量的影响

摘要 目的：探讨阴式手术与开腹手术对子宫良性肿瘤患者盆底功能、炎性应激反应及性生活质量的影响。方法：回顾性分析我院自2017年3月~2019年1月期间收治的子宫良性肿瘤患者78例的临床资料,上述患者根据手术方案的不同分为A组（n=38,给予开腹手术治疗）和B组（n=40,给予阴式手术治疗）,对比两组患者围术期指标、炎性应激指标[白介素-6（IL-6）、C反应蛋白（CRP）、皮质醇（Cor）]、盆底功能障碍发生率、并发症发生率及性生活质量。结果：B组术后排气时间、手术时间、住院时间、术后下床时间短于A组,术中出血量少于A组（P<0.05）。两组术后2 d 的IL-6、CRP、Cor均升高,但B组低于A组（P<0.05）。B组患者盆底功能障碍发生率为12.50%（5/40）,低于A组的36.84%（14/38）（P<0.05）。两组患者术后1年女性性功能指数量表（FSFI）评分均较术前增加,且B组高于A组（P<0.05）。B组术后并发症发生率低于A组（P<0.05）。结论：与开腹手术相比,阴式手术应用于子宫良性肿瘤患者,可有效改善围术期指标、炎性应激反应、盆底功能及性生活质量,减少并发症发生率。     

子宫内膜癌手术治疗的研究进展

子宫内膜癌是妇科常见恶性肿瘤之一,手术是其主要的治疗方式。尽管开腹手术是治疗子宫内膜癌的传统方式,但随着医学科技的不断发展以及人们对术后生活质量要求的提高,妇科肿瘤的外科治疗方式也随之发生了革命性的变化。从传统开腹手术、腹腔镜手术、单孔腔镜技术,到2005年美国FDA批准应用于妇科手术的达芬奇机器人手术系统,子宫内膜癌的手术治疗方式也有了更多的选择。与传统开腹手术相比,微创手术凭借其创伤小、恢复快等优点,在子宫内膜癌的应用越来越广泛,但临床应用时间较短,仍需大样本多中心的长期随访研究来证实其安全性和有效性。本文主要围绕以上几种手术方式治疗子宫内膜癌的最新观点及研究进展进行综述。     

腹腔镜和开腹手术在卵巢癌二次探查术中的应用效果比较

目的:比较腹腔镜和开腹手术在卵巢癌二次探查术中的应用效果和安全性。方法:选择2012年1月至2015年10月于我院就诊的卵巢癌患者58例,根据二次探查术的方式分成两组,腹腔镜组(28例)和开腹手术组(30例),观察比较两组患者手术时间、术中出血量、肛门首次排气时间、并发症发生率及二次探查的阳性率。对两组患者进行随访,比较两组患者二探术后的复发率及生存时间。结果:腹腔镜组肛门首次排气时间明显短于开腹组患者,术中出血量也均明显少于开腹组患者,具有非常显著性差异(P0.05),而两组的手术时间、并发症发生率和二探阳性率相近,两组之间比较,差异无统计学意义(P0.05)。二次探查术阳性和二次探查术阴性的患者中,腹腔镜组和开腹组的中位生存时间比较,差异无显著性(P0.05)。二次探查术阴性的患者中,腹腔镜组和开腹组患者随访期间的复发率比较,差异也无显著性(P0.05)。结论:腹腔镜二次探查术具有创伤小、并发症少、患者恢复快、患者易于接受等微创优势,且能取得与开腹二次探查术相当的安全性和准确性,可以作为卵巢癌二次探查术的手段之一。