目的 探讨超声刀和单极电刀在甲状腺微小乳头状癌手术中的应用效果.方法 从2014年2月至2016年2月进入我院实施甲状腺微小癌手术治疗的患者中抽取110例患者进行回顾性分析,根据术中使用器械的不同进行分组,将术中使用超声刀实施手术的55例患者纳人超声刀组,将术中使用单级电刀实施手术的55例患者纳人电刀组.两组均进行为期2年的随访,比较两组临床指标、甲状旁腺功能、术后并发症发生率.结果 与电刀组比较,超声刀组手术用时较短,手术切口较小,术中线结数量较少,差异均有统计学意义(t = 11.655,P-0. 000; t =5.113, P = 0. 000; t = 18. 497; P =0. 000);手术后,两组甲状旁激素、血清钙离子水平均低于手术前,且超声刀组上述指标高于电刀组,差异有统计学意义(t = 8.118, P=0. 000; t =9.802, P=0. 000);超声刀组术后并发症发生率9. 09％ (5/55),低于电刀组的14. 55％ (8/55),但差异无统计学意义(P＞0.05).结论 在甲状腺微小乳头状癌手术中应用超声刀的效果较好,可减少术中出血量,且对甲状旁腺、喉返神经功能影响较小,还可在一定程度上降低并发症发生率,利于改善预后.

早期胃癌合并胃神经鞘瘤文献报道较少。本病例应用内镜黏膜下剥离术完整切除胃底近贲门早期胃癌，应用内镜联合腹腔镜顺利切除胃体黏膜下肿物，术后病理证实为胃神经鞘瘤。

Objective To compare the safety and short-term efficacy of open surgery and laparoscopic surgery for color-ectal cancer with intestinal obstruction .Methods 38 cases of colorectal cancer with intestinal obstruction were randomly divided into the control group and the experimental group ,each with 19 cases,the control group were treated with open surgery , the exper-imental group were treated by laparoscopic surgery ,safety and follow-up evaluation of the 2 groups were compared .Results Com-pared with the control group ,amount of bleeding during surgery ,intestinal function recovery time ,out of bed activity time and hos-pitalization time of the experimental group were shorter (P<0.05).In the experimental group,clinical total efficiency was high-er,postoperative complications and 1-year recurrence rate was lower (P<0.05).Conclusion Laparoscopic surgery for patients with colorectal cancer with intestinal obstruction is safe and effective ,it can reduce the trauma of patients ,long-term efficacy is good,it is worthy of clinical application .

为了探讨腹腔镜直肠癌前切术后早期吻合口并发症的发生原因及防治措施,回顾性分析215例腹腔镜直肠癌前切术后早期吻合口并发症发生情况及处理方法.结果显示,吻合口出血10例(4.65％,10/215);发生时间≤24 h6例,＞24 h4例;2例保守治疗;1例术中腔镜下缝合止血,2例术中经肛缝合止血,3例术后经肛缝合止血,1例合并吻合口漏经腹缝合止血并行结肠造口术,均成功止血;1例经肛简单缝合止血失败后合并吻合口漏,感染性休克死亡.吻合口漏5例(2.33％,5/215);发生时间为术后3～7 d;3例结肠造口术后痊愈;2例非手术治疗患者,1例保守成功,1例合并吻合口出血,感染性休克死亡.结果表明,腹腔镜直肠癌前切术后发现吻合口出血或吻合口漏应积极再手术治疗,慎重选择保守治疗方案.

<正>骶前囊肿是发生在骶骨和直肠之间的间隙内的肿瘤,也称直肠后肿瘤,多见于中年女性,男女比通常是1∶3。本病发病隐匿,发展缓慢,早期无症状,发展到一定程度容易继发感染,临床诊断及误诊率较高,手术切开或自行破溃后伤口经久不愈,或多次手术治疗导致高位直肠瘘,治疗难度大,严重影响患者生活质量。笔者将收治的3例骶前囊肿伴感染患者进行回顾性分析报道如下。

Objective To investigate the advantage of Dannang Recipe No.2 in rapid recovery after Laparoscopic Cholecystectomy.Methods 84 patients with LC were randomly divided into 2 groups(n = 42),Fast track surgery(FTS) group and Dannang Recipe No.2 group.FTS groop perioperatively were treated according to FTS ideas,which including no gastric tube and catheter placed,4 hours prior to surgery for oral administration containing 10% glucose of 100ml,6 hours after the operation can be a small amount of water,and then slowly transition to a common food and strive for the first bed in allowing the patient body condition and then over to the bed activities.Dannang Recipe No.2 group by 4 hours prior to surgery oral Dannang Recipe No.2,1(100ml),the day after operation in 6h to take the 1(100ml).Others were the same as FTS group.Observation of the 2 groups of patients with first exhaust time,first defecation time,the incidence of nausea and vomiting after eating.Results The time of defecation and exhaust of Dannang Recipe No.2 group was significantly less than the FTS group(P <0.05).The incidence of nausea and vomiting of Dannang Recipe No.2 group was less than FTS group(P <0.05).Conclusion The use of Dannang Recipe No.2 in LC during operation period could be faster,more effective in promoting gastrointestinal function of patients after LC recovery and reduce the incidence of nausea and vomiting after eating.It was worthy of popularizing in clinical treatment.

Objective:To explore the clinical application of laparoscopic radical operation for rectal cancer.Method:The clinical data of 220 cases with rectal cancer treated by laparoscopic radical operation from June 2006 to December 2011 were analyzed retrospectively.Result:The operation was successfully performed in 218 cases,2 cases were transferred to open procedures and no case died during perioperative period.The average operative time was(156.32±43.46)min,the mean blood loss was(95.44±46.38)ml,and a mean of(13.62±4.83) lymphnodes were resected.The patients had no massive haemorrhage during the operation.The average recovery time of postoperative bowel function was(2.64±0.73)d,and the average postoperative hospital stay was(10.42±5.53)d.Incisional infection occurred in 4 cases,and 2 cases suffered from postoperative anastomotic leakage.Anastomotic bleeding occurred in 2 cases and 3 cases suffered from pulmonary infection.Patients were followed up for 6-60 months after operation,local recurrence were found in 11 cases(5.05%) and metastasis were found in 31 cases(14.22%).Conclusion:Laparoscopic radical resection of rectal cancer is safe,feasibility,with less trauma,more rapid recovery and less complications.It is in conformity with the surgical oncologic principles and deserves promotion and wide application.

目的 探讨腹腔镜直肠癌根治术的安全性和可行性.方法 回顾分析28例腹腔镜直肠癌手术的临床资料.结果 28例顺利完成腹腔镜手术,2例中转开腹,中转率7.1%;腹腔镜Dixon术20例,腹腔镜Miles 术6例;手术平均时间233min,术中平均失血215ml,术后胃肠功能恢复时间平均56h,术后住院天数平均10.5d.手术切除淋巴结平均为11.6个,无术后出血、吻合口漏、死亡病例发生.随访2～24个月未发现切口种植、局部复发和远处转移.结论 腹腔镜直肠癌手术创伤小,术后恢复快,近期效果好.

Objective:To evaluate the safety and feasibility of laparoscopic operation on colorectal cancer in primary hospital.Methods:Ten cases of laparoscopic operations on colorectal cancer were performed from June 2006 to November 2006,including 3 cases of sigmoidectomy,5 cases of Dixon's operation,and 2 cases of Miles's operation.Results:Ten cases of laparoscopic operations were completed.The mean operative time was 210min and the average blood loss was 180ml.The average post-operative convalescence of intestinal peristalsis was 28 hours.The average length of postoperative hospital stay was 9 days.The number of lymph nodes excised was 5-16.The mortality and morbidity were zero and there was no conversion.Conclusions:Laparoscopic operation on colorectal cancer has advantages of minimal invasion,less blood loss,quick recovery of intestinal peristalsis,short hospitalization and less complications.It is feasible to develop laparoscopic operation on colorectal cancer as long as the characteristics of colorectal anatomization could be mastered.