目的 总结磁锚定技术(MAT)辅助经脐单孔腹腔镜袖状胃切除术(TUSILSG)的医护配合经验.方法 收集接受MAT辅助TUSILSG治疗的12例肥胖症患者的临床资料,总结围术期护理及术中医护配合的关键点和注意事项.结果 术前做好患者的手术前准备及物品准备;术中及时关注手术进程,准确传递手术器械,避免锚定磁体和内置抓钳与其他手术器械的相互吸引,从而使手术顺利进行;术后做好转运和复苏护理,促进患者康复.12例患者均顺利完成手术,术后未发生相关并发症,且对脐部切口的美容效果满意.结论 MAT辅助TUSILSG是一种新型术式,手术过程默契的医护配合是手术顺利完成的关键.

Objective:To summarize the experience of laparoscopic concurrent surgery in the treatment of colon cancer liver metastasis and pelvic metastasis, and to explore its safety and feasibility in the treatment process.Methods:A retrospective analysis of the clinical data and diagnosis and treatment process of a patient with liver metastasis from colon cancer and pelvic metastasis in the First Affiliated Hospital of Xi′an Jiaotong University in Jun. 2021.Results:The patient received simultaneous laparoscopic resection of the right colon for liver metastatic cancer, complete hysterectomy and bilateral adnexectomy, and R0 resection was successfully achieved. The total operative time was 330 min, and the bleeding was 100 ml. Peritoneal hyperthermic perfusion chemotherapy was assisted. Pathological results showed that colonic ulcerative moderately differentiated adenocarcinoma invaded the deep myometrium of the uterine wall and bilateral ovarian cervix, infiltrated in liver tissue, and metastatic in periintestinal lymph nodes (2/30). The abdominal CT and tumor markers showed no abnormalities one month after the operation. At present, the patient is continuing to follow up closely.Conclusions:Simultaneous laparoscopic surgery is safe and feasible for the treatment of colon cancer liver metastases and pelvic metastases. It also has the advantages of less trauma, fast recovery, and beautiful incisions. The MDT mode plays an important role in improving the clinical benefits of patients and is worthy of promotion.

目的:比较吲哚菁绿荧光显像系统引导下的腹腔镜技术与传统腹腔镜技术在肝肿瘤切除术中发现微小肝内转移病灶的能力及切缘距离.方法:选取2018年7月至2020年6月因原发性肝癌行荧光腹腔镜肝脏切除术的11例患者为研究组,并选取同期行普通腹腔镜肝脏切除术的24例原发性肝癌患者为对照组,对比两组术中发现微小肝内转移病灶情况及切缘距离.结果:两组分别发现术前未确认的肝内转移病例2例(2/11,2/24),在具备熟练术中B超技术的情况下,与传统腹腔镜技术相比,荧光显像技术在发现肝内转移病灶能力方面差异无统计学意义(P=0.395);但荧光显像技术较传统腹腔镜技术可确保较宽的切缘(P=0.034).结论:吲哚菁绿荧光显像技术应用于腹腔镜肝脏肿瘤切除术中可有效确保肿瘤切缘获得较好的距离.

腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy, LSG)已经成为治疗肥胖及代谢性疾病的主要手术方式之一,因其创伤小、操作相对简单、手术时间短、治疗效果确切,越来越多的减重外科医生及患者选择该手术.据国际肥胖与代谢病外科联盟统计,2016年全球实施的减重手术总数为685874例;其中634897例(92.6%)为首次手术,50977例为修正性手术(7.4%).其中最主要的手术方式为LSG,占总数量的53.6%[1].据美国减肥及代谢外科学会统计,2017年美国的LSG手术比例已经达到59.39%[2].虽然LSG术后总的并发症只有7.5%～13%[3,4],但仍有部分严重的并发症可能导致患者休克、甚至死亡[4,5],胃漏就是其中之一,处理不当的话可能导致严重后果.由于LSG术后胃漏的治疗难度大、时间长,因此其往往是专科医师在临床中遇到的最大的困难与挑战.现报道一例袖状胃切除术后胃漏的诊治.

本研究应用超声仪观察胆囊结石行开腹胆囊切除术后有无腹壁粘连,进而评价医用防粘连膜的效用. 1 资料与方法 1.1 研究对象 2007年10月-2008年12月因胆囊结石在我院接受开腹胆囊切除术患者33例,男12例,女21例,年龄18～75岁,平均(43.1±19.8)岁.

Objective To observe the clinical efficacy and safety of absorbable anti-adhesion membrane after abdominal operation by ultrasonagraphy.Methods Thirty-three patients with gallstone underwent cholecystectomy,anti-adhesion membrane was set in abdominal cavity during operation. One month later,the paradoxical motion of abdominal organs and abdominal wall was observed in the upper,middle and lower parts of incision by ultrasonagraphy.The intestinal gas and contents was used to be the standard,if the contradictory movement with natural breathing was ≥1 cm,it was not necessary to make deep breath and passive movement;if the contradictory movement with natural breathing was1 cm,it was necessary to make deep breath and passive movement.Results In a number of natural breathing cycle,the contradictory movement of abdominal organs ≥ 1 cm was in 10 of 33 patients who set the anti-adhesion membrane in abdominal cavity,while 1 cm in 22 cases,and after deep breath and passive movement,the contradictory movement was 1 cm in these 22 cases.Conclusion The anti-adhesion membrane set in abdominal cavity can prevent abdominal adhesion after abdominal surgery.

自1991年腹腔镜技术应用于脾脏外科手术以来,腹腔镜脾脏手术得到广泛发展.我国于1994年开展腹腔镜脾脏切除术(laparoscopic splenectomy LS),到目前为止,全腹腔镜下脾切除加贲门周围血管离断术(laparoscopic splenectomy with perisoph-agogastric devascularization)的报道较少.该文就西安交通大学医学院第一附属医院2007年1月至2007年7月间完成的5例腹腔镜脾切除加断流的手术报告如下.

目的:探讨腹腔镜胆囊切除术后(LC)出现恶心呕吐的原因及预防措施.方法:对采用同种麻醉药物的108例腹腔镜胆囊切除术患者及100例开腹胆囊切除术患者进行对照观察.结果:腹腔镜胆囊切除术后恶心呕吐的发生率为28.70%,开腹胆囊切除则为8%,前者恶心呕吐的发生率明显高于后者.结论:CO2气腹是造成腹腔镜胆囊切除术后恶心呕吐的主要原因,其发生与手术时间、气腹压力大小有关;采用低气腹压和缩短手术时间可以减少LC术后恶心、呕吐的发生.

目的探讨胰管结石诊断与手术治疗方法。方法回顾性分析收治11例胰管结石患者的临床资料。结果患者均缺乏特异性症状,其中6例出现(54.5%)上腹疼痛伴肩背部放射痛。11例均行B超检查,诊断阳性率为54.5%(6/11);均行CT,阳性率100%;6例行逆行胰胆管造影(ERCP),阳性率100%;6例行磁共振胰胆管成像(MRCP),阳性率100%。患者均采用手术治疗,8例采用胰管切开取石,胰管-空肠Roux-en-Y吻合术,3例合并胰头癌者行胰十二指肠切除,均将结石取出。术后随访3个月,随访率100%。结论以ERCP为主的多种诊断方法联用可提高胰管结石的诊断准确率。手术治疗仍有其重要的意义,首选胰管切开取石,胰管-空肠Roux-en-Y吻合术,合并胰头癌者应行胰十二指肠切除术。

肥胖能引起身体很多疾病,其中胆囊炎、胆结石、胆石症等胆道疾病的发病率在我国近年有增高的趋势.虽然这些病发生的原因十分复杂,而且至今尚未完全清楚,但不少临床研究发现,胆结石的发生常与"4F"现象密切相关,即40岁以上、生过4个孩子、肥胖、女性易患,(因40、4、肥胖和妇女的英文字头均为F).也就是说,中年肥胖者特别是女性应注意"保胆".

失重性肌萎缩是阻碍航天事业发展的重要因素之一,但其发生机制尚不十分清楚.本文结合近几年来关于失重/模拟失重条件下肌肉形态结构及动力学改变的研究新进展,分析比较了现有对抗措施的效果.

目的:左、右肝管及其汇合部损伤是腹腔镜胆囊切除术(LC)胆管损伤的最严重类型,处理十分棘手,通过对15例胆管损伤的分析,总结经验教训.方法:回顾性分析LC致15例左、右肝管及其汇合部损伤的原因及处理方法.结果:LC术中发现胆管损伤10例,行肝门部胆肠Roux-en-Y吻合4例,无症状随访1～58个月;行胆管断端对端吻合5例,均再次行胆肠Roux-en-Y吻合,4例无症状,随访16～56个月,1例手术失败,先后5次手术.1例左、右肝管外引流,等待再次手术.LC术后发现胆管损伤5例,行胆肠Roux-en-Y吻合1例(术后第1天);行左、右肝管引流2例,术后3月行胆肠Roux-en-Y吻合,无症状随访12～18月;2例行右肝管外引流,等待再次手术.结论:术者的过于自信,求速度,操作不当是造成此类胆管损伤的主要原因,左、右肝管成形,胆肠Roux-en-Y吻合是此类胆管损伤修复的最佳方式.手术应请有丰富临床经验与技术的医师来完成.

Objective High bile duct injury is a severe complication in LC,and its treatment is difficult.In this study,data from 16 patients with high bile duct injury were analyzed .Methods The cause and treatment approach of the 16 cases were retrospectively analyzed.Results The injury was found in 11 cases during the operation.Roux en Y choledchojejunostomy were performed in 5 cases who were followed up for 1 to 58 month.5 patients underwent end to end bile duct anastomosis and 4 of them were followed up for 16 to 56 month without any symptom.One patient underwent 5 times of operation because of the failure of primary reparation.The bile duct drainage were performed in 1 case.5 case injury were found after LC.The choledchojejunostomy were manipulated in 1 case one day after the operation.Bile duct drainage were performed in 2 patients and Roux en Y choledchojejunostomy were carried out 3 month after the operation.They were followed up for 12 to 18 month.Another 2 patients underwent right hepatic duct drainage to wait for the next operation.Conclusions The main cause of bile duct injury is improper manipulation and self conceit.The left and right hepatic duct plastic and Roux en Y choledchojejunostomy is the optimal performance.The operation should be carried out by experienced surgeon.

目的:通过对胆总管探查术致胆总管下段损伤的病例分析,总结经验教训.方法:回顾性分析6例胆总管下段损伤的诊治过程.结果:术中发现胆管损伤3例,其中1例行胆管修补、T管引流、腹腔引流,2例行T管引流、腹腔引流,3例均治愈.术后发现胆管损伤3例,分别于术后第4、10、40天再次行腹膜后坏死组织清除,腹腔引流,1例痊愈,2例死亡.结论:金属胆道探子强行通过胆总管下端或刮匙刮除下端嵌顿结石是造成胆管损伤的主要原因,胆道镜检查及胆道造影有助于早期发现胆管损伤,T管引流及腹腔局部引流通畅与预后关系极大.

近年来,电视腹腔镜已广泛应用于腹部外科的各个领域,为数十万患者解除了病痛.随着设备的不断更新与完善、技术的日益成熟,腹腔镜在微创外科领域大显身手,从早期的胆囊切除到阑尾切除、疝修补术发展到目前腹腔各个器官的手术.但在胆道外科的应用还处于尝试和经验积累阶段.我院自1997-10至2000-06开展腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)500例,术中经胆囊管胆道造影12例,腹腔镜胆总管探查(Laparoscopic common bile duct exploration,LCBDE)5例,现就治疗体会总结如下.

一般资料:收集2000年5月至2001年8月于中国医科大学第二临床学院小儿外科经皮囊内注射自体骨髓治疗的小儿骨囊肿8例(肱骨2例,股骨颈3例,股骨干1例,颈骨1例,尺骨1例).男3例,女5例,年龄6～16岁,中位年龄11岁.术后随访6～20个月,平均随访(9.12±4.55)个月.

尽管肝脏位置相对隐蔽，但它仍是最易受伤的腹部器官[1-8].在腹部器官损伤中，肝外伤的发生率已超过脾破裂而跃居首位[1，9，10].其他器官的伴随损伤、难以控制的大出血以及并发症的形成依然是肝外伤死亡的主要原因[11-17].虽然在过去的几十年中，肝外伤的死亡率已大大降低[5，18-23]，肝外伤的外科处理对外科医生来说仍然是一个挑战.为探讨提高肝外伤救治成功率的有效途径，对我院1980-01/2000-01记录完整的217例肝外伤资料进行了回顾对比分析，报告如下.

Objective　To study the effects of ethanol injection for treatment of primary liver cancer.Methods　Eighty seven patients of primary liver cancer received 573 times of percutaneous injection of ethanol guide by B-ultrasound or CT.Results　6 months, 1 and 2 year survival rates, were respectively 95.4%，78.3%，47.7%. The main symptoms of abdominal pain and appetite were straightened up obviously. Conclusion　This method is effective for the patients with small primary hepatocellular carcinoma.

目的探讨提高肝外伤救治成功率的有效途径.方法对1990年1月～20 00年1月10年间收治的118例肝外伤病例进行分析.结果手术治疗80例,保守治疗38例,与肝外伤相关并发症发生率为16.1%(19/118),病死率为5.9%(7/ 118).结论 B超、CT等现代影像学检查手段提高了肝外伤的诊断和监测水平,更多的肝外伤患者可采用非手术治疗.对血液动力学持续不稳定的患者,积极手术是治疗成功