Objective To investigate a new way for the treatment of severe acute pancreatitis (SAP). Methods The clinical data of 59 cases of SAP were analyzed, and they were divided into two groups: LAI group and control group. In LAI group, 30 cases were treated mainly by local arterial infusion (LAI). In control group, 29 cases were treated by intravenous infusion. Results Compared with control group, the results of LAI group were much better in abdominal pain relief, recovery of intestinal function, reducing the complications, shorter antibiotictime, decreasing the incidence of secondary systemic infection. The mortality of SAP class Ⅱ in LAI group and control group were 35.71% and 66.67% respectively. Conclusion LAI is a new way for the treatment of SAP.
Objective To introduce the total mesorectal excision (TME)under the laparoscope and with the ultrosonic scalpel. Methods Under the laparoscope and with the ultrosonic scalpel, total mesorectal excision in 3 patients was performed. In operation, alone the parietal layer of pelvic fascia and inside the automatic nerve trunk, the mesorectum was excised with the ultrasonic scalpel. Results Three patients got final recovery, no damage to the viscera in operation occurred. Average hemorrhage amount was about 100ml. Intestinal function recovered within 24 hours, average in hospital time was 10.3 days. After 4 months, 3 patients got good living quality without recurrence and metastasis.Conclusion TME under the laparoscope is a new progress of less damageable operation. Compared with the traditional open laparotomy,it has some advantage. But it requires high technology and expensive equipments, and the case is still very limited in use.
目的 探讨腹腔镜在原因不明腹痛诊断和治疗中应用的可行性。方法 总结分析44例原因不明的腹痛经腹腔镜诊治的临床资料。结果 全组44例患者均获病理学诊断，其中诊断为腹腔结核23例，肠粘连17例，小肠平滑肌肉瘤、非霍奇金病、晚期胃癌、腹茧症各1例。24例（54.6%）明确诊断后予以内科治疗，17例（38.6%）同时采用腹腔镜治疗，2例（4.5%）中转开腹，1例（2.3%）明确诊断后延期接受开腹手术治疗。所有病例经腹腔镜检查和治疗后，除1例晚期胃癌患者因延期开腹行姑息性手术后恢复差而死亡，其余无并发症发生。结论 腹腔镜是诊断和治疗原因不明腹痛的有效手段，部分病例为后续治疗提供了可靠的依据，部分病例可同时在腹腔镜下完成治疗手术。
Objective To summarize the clinical therapeutic efficacy of emergent laparoscopic cholecystectomy （LC） and emergent open cholecystectomy （OC）. Methods One hundred and thirty-three patients with acute cholecystitis from March 2011 to June 2012 in this hospital were randomly divided into emergent LC （ELC） group and emergent OC （EOC） group. The examination and treatment before and after operation were the same. The clinical data before and during operation， postoperative complications， and recovery conditions were observed and compared. Results There was no obvious difference of the clinical data before operation between the ELC group and EOC group （P＞0.05）. Also， there were no significant differences of the operation time， biliary duct injury rate， postoperative bleeding rate， and reoperation rate in two groups （P＞0.05）. The time of postoperative anal exsufflation， time of out-of-bed activity， and postoperative hospital stay in the ELC group were significantly shorter than those in the EOC group （P＜0.05）， the poor incision healing rate in the ELC group was significantly lower than that in the EOC group （P＜0.05）， and the intraoperative blood loss in the ELC group was significantly less than that in the EOC group （P＜0.05）. Conclusions ELC as compared with EOC， are less intraoperative blood loss， less postoperative complications， more rapid recovery， and do not increase operation time. In a hospital with skilled LC technique， ELC is safe and feasible， has obvious advantages of minimal invasion.
Objective To evaluate the clinical effectiveness of laparoscopic and open appendectomy. Methods Literatures relating to randomized controlled trials in English and Chinese on the comparison of clinical effectiveness after laparoscopic and open appendectomy in appendicitis from PubMed，Wiley Online Library，Medline，Embase，Cochrane，CNKI，VIP，CBM databases were extracted，and methodological quality was evaluated by two reviewers independently with designed extraction form. The Cochrane Collaboration’s RevMan 4.2.2 software was used for data analysis. The wound infection，hospitalization time，operation time，hospitalization expenses，and peritoneal abscess were compared between laparoscopic and open appendectomy. Results Eight published reports of eligible studies were extracted. Compared with the open appendectomy， laparoscopic appendectomy had significant differences in lower wound infection rate 〔OR=0.19，95%CI （0.09，0.38），P＜0.000 01〕， longer operation time 〔WMD=3.66，95%CI （0.50，6.82），P=0.02〕，and more hospitalization expenses〔WMD=503.96，95%CI （337.23，670.70），P＜0.000 01〕.But there were no significant differences in hospitalization time〔WMD=-0.11，95%CI （-3.64，3.43），P=0.95〕 and incidence rate of peritoneal abscess 〔OR=1.40，95%CI （0.23，8.64），P=0.71〕 between laparoscopic and open appendectomy. Conclusions The wound infection rate is lower，but the operation time is longer，the hospitalization expenses is more in laparoscopic appendectomy as compared with open appendectomy. There are no statistically significant differences of hospitalization time and incidence rate of abdominal abscess between laparoscopic and open appendectomy.
Objective To investigate the method of the treatment on cholecystolithiasis combined with calculus of common bile duct (CBD) by laparoscopy with combination of choledochoscope and duodenoscope and its significances. Methods Forty-two patients with cholecystolithiasis combined with calculus of CBD were treated by laparoscopy with combination of choledochoscope and duodenoscope from Jan. 2007 to Dec. 2008 in this hospital. Under general anesthesia, laparoscopic cholecystectomy was performed first, then the anterior wall of CBD was opened, calculus of CBD was treated by choledochoscope and duodenoscope intraoperatively. Then primary suture of the CBD was performed under laparoscope and nasobiliary drainage duct was placed. Results One case was converted to laparotomy, 41 cases succeeded and left hospital after being taken off the nasobiliary drainage duct in 5-7 d. No case died, no bile leakage, no bleeding or perforation of upper digestive tract, and no acute pancreatitis happened after operation. Conclusion Laparoscopy with combination of choledochoscope and duodenoscope treating cholecystolithiasis combined with calculus of CBD is a safe, effective and quickly recovering method with less sufferings and trauma.
目的探讨经脐单孔腹腔镜联合胃镜治疗微小胃间质瘤(gastric stromal tumors, GIST)的可行性和临床疗效。 方法回顾性分析我院2010年10月至2011年5月期间行经脐单孔腹腔镜联合胃镜治疗微小GIST 30例患者的临床资料。 结果30例病灶直径（1.0±0.2） cm（0.5～2.0 cm），术后病理检查均证实为极低危险程度GIST。 24例在单孔腹腔镜辅助下成功完成内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）； 3例因ESD术中发生胃壁穿孔而改行内镜全层切除术（endoscopic full-thickness resection, EFR），其中2例继续在单孔下完成穿孔修补术，1例于左上腹壁另加一 Trocar，在双孔下完成穿孔修补术； 另3例因ESD剥离瘤体困难，改行胃局部切除术，其中2例继续在单孔下完成手术，1例在双孔下完成手术。 ESD成功率为80.0%（24／30），经脐部单孔完成率为93.3%（28/30）。手术时间（87.5±10.3） min （45～150 min）。 全组术后（4.3±0.5） d （3～8 d）出院。术后随访期3～7个月（平均4.6个月），均无病变复发。 结论经脐部单孔腹腔镜联合胃镜治疗微小GIST是安全可行的，早期疗效令人满意。