Objective To investigate the clinical effect of self-pulling latter transection functional end-to-end esophagojejunostomy(SPLT-FETE) in total laparoscopic gastrectomy(TLTG). Methods The clinical data of 18 patients who underwent total laparoscopic gastrectomy (self-traction and transection anastomosis) surgery in the Department of general surgery of Wuhu Traditional Chinese Medicine Hospital Affiliated to Anhui College of Traditional Chinese Medicine from March 2023 to February 2024 were selected for the study. And compared with the clinical data of 20 patients with laparoscopic total gastrectomy (circular anastomosis group) completed by the same surgical team from December 2021 to February 2023. The intraoperative and postoperative conditions and the postoperative complication rate of the two groups were analyzed and compared. Results All patients successfully completed the operation, and there was no positive margin and perioperative death.The operation time for patients in the observation group was shorter than that of the control group (225.89±26.19)min vs.(244.65±22.05)min,P=0.022, and the length of the auxiliary incision was shorter (6.06±0.998)cm vs.(10.20±1.06)cm,P<0.001, with statistically significant differences. No significant difference was found between the two groups in intraoperative blood loss, the number of lymph node dissection, the first postoperative exhaust time, postoperative hospitalization days and the operation-related complication rate(P>0.05). Conclusions The self-traction and transection functional end-to-end esophagojejunostomy used in total laparoscopic gastrectomy is safe, feasible, and easy to master, making it worthy of clinical promotion.
目的:探讨通过两孔法腹腔镜置管术行腹膜透析的临床效果及安全性.方法:回顾分析2018 年7 月至2021 年7 月为100 例患者行腹膜透析的临床资料,根据治疗方式分为观察组(n=56,两孔法腹腔镜置管术)与开腹组(n=44,传统开腹置管).比较两组手术情况,记录治疗前、治疗后1 个月生化指标(血肌酐、血尿素氮、钙、磷)及生活质量变化,并统计两组不良反应.结果:观察组手术时间、术中出血量、术后疼痛时间、住院时间均少于开腹组,差异有统计学意义(P＜0.05);治疗后1 个月,两组血肌酐、血尿素氮、钙、磷均较治疗前降低(P＜0.05),两组间差异无统计学意义(P＞0.05);两组躯体功能、物质生活、情感职能、社会功能等评分均较治疗前升高(P＜0.05),观察组上述评分均高于开腹组(P＜0.05).观察组并发症发生率低于开腹组(5.36%vs.18.18%,P＜0.05).结论:通过两孔法腹腔镜置管术行腹膜透析具有微创的特点,可快速缓解疼痛,促进术后康复,提高患者生活质量,安全性较高.
目的:探讨腹腔镜胰十二指肠切除术中胰背动脉(DPA)的解剖规律、变异类型及处理方法.方法:回顾分析2022 年1 月至2023 年4 月53 例腹腔镜胰十二指肠切除术患者的临床资料,通过1mm薄层增强CT阅片及手术录像回放观察DPA的出现率、发出位置、根部直径、走行特点及术中处理方式.结果:1 mm薄层增强CT中DPA的检出率为77.4%(41/53),直径平均(0.26±0.07)cm,术中DPA或其分支发现率为88.7%(47/53).发自肠系膜上动脉占48.9%(23/47),发自脾动脉占34.0%(16/47),发自腹腔干动脉占12.8%(6/47),其他发出点占 4.3%(2/47),其中 1 例发自肝总动脉,1 例发自结肠中动脉.其中来自腹腔干系统的DPA均走行于脾静脉后方,于脾静脉足侧分支进入胰腺;来自肠系膜上动脉的DPA有 2例走行于脾静脉后方,于脾静脉头侧进入胰腺;余均于脾静脉足侧进入胰腺.DPA左支主要以单支进入胰腺,1 例发现左支进入胰腺前已有明显分支.2 例保留DPA左侧分支,离断右侧支,余均解剖出DPA后于根部离断.结论:腹腔镜胰十二指肠切除术中DPA出现率较高,主要发自肠系膜上动脉与脾动脉,变异多见,走行相对固定,结合术前薄层增强CT及高清腹腔镜仔细解剖均可准确定位DPA,根部离断是安全、可行的.
目的:比较单孔与多孔腹腔镜子宫内膜癌手术的治疗效果.方法:回顾分析2019年11月至2021年2月采用腹腔镜手术治疗的子宫内膜癌患者的临床资料,其中68例行单孔腹腔镜全子宫双附件切除+盆腔淋巴结清扫术(观察组),83例行多孔腹腔镜全子宫双附件切除+盆腔淋巴结清扫术(对照组).对比分析两组出血量、手术费用、手术时间、住院时间、术后引流管留置时间、术后尿管留置时间、术后24 h疼痛评分、术后患者满意度、术中并发症、术后切口并发症、2年内肿瘤复发率.结果:两组手术均顺利完成,无中转开腹或单孔中转多孔手术的病例,两组术中失血量、术后引流管留置时间、术后尿管留置时间差异无统计学意义(P>0.05);观察组手术费用多于对照组[(7524.3±523.6)元vs.(5520.2±412.6)元],手术时间长于对照组[(144.14±47.63)min vs.(127.25±45.27)min],住院时间短于对照组[(2.55±0.63)d vs.(3.05±0.45)d],术后24 h疼痛评分低于对照组[(2.74±1.42)vs.(5.62±1.75)],术后患者满意度评分高于对照组[(17.70±1.72)vs.(14.95±1.96)],差异有统计学意义(P<0.05);两组术中并发症发生率(2.94％vs.2.41％)、术后切口并发症发生率(1.47％vs.3.61％)、2年肿瘤复发率(1.47％vs.1.20％)差异无统计学意义(P>0.05).结论:单孔腹腔镜治疗子宫内膜癌是安全、可行的,相较多孔腹腔镜手术,切口数量少、切口美观、术后疼痛轻、住院时间短,可提高患者满意度.
目的:评估病态肥胖症患者行腹腔镜袖状胃切除术前的心理状态,并进一步探讨影响其心理状态的潜在临床指标.方法:回顾分析2020 年10 月至2021 年8 月拟行腹腔镜袖状胃切除术的病态肥胖症患者的临床资料,通过心理量表评估其体重内在化歧视、睡眠质量、饮食行为、自尊、生活质量、焦虑及抑郁水平,并与临床指标进行Pearson相关性分析,探讨影响心理状态的潜在因素.结果:最终纳入271 例病态肥胖症患者,平均(31.98±7.32)岁,体重指数平均(41.93±7.84)kg/m2,男86 例(31.73%).经评估,其体重内在化歧视量表平均(50.67±11.73)分,匹兹堡睡眠质量指数量表平均(7.12±3.57)分,生活质量量表平均(64.96±18.50)分,健康变化平均(32.84±20.88)分,100 例(36.90%)存在不同程度的焦虑,108 例(39.85%)存在不同程度的抑郁,各基线指标与心理状态显著相关.结论:病态肥胖症患者具有较高的体重内在化歧视、焦虑及抑郁水平,较低的睡眠质量、健康变化得分及生活质量水平.术前心理状态受一系列临床指标影响.严格的术前心理评估有助于制定围手术期个体化的心理干预措施.
