【摘要】目的探讨经乳房途径行腔镜甲状腺切除术的可行性。方法2003年12月至2004年6月期间我科行腔镜甲状腺切除术27例。于两侧乳晕及乳头间切口放置3个trocar，分离胸前皮下和颈阔肌深面，注入CO2建立手术操作空间，CO2压力为5~6 mm Hg，超声刀切割、分离甲状腺组织和甲状腺血管。结果13例行甲状腺肿块切除术，11例行一侧腺叶次全切除术，3例行双侧甲状腺次全切除术。手术时间70~140 min，平均（97±34.2） min； 术中出血20~40 ml，平均（34±9.7） ml； 术后住院时间3~5 d，平均（3.6±0.8） d。27例手术均获成功，无一例中转手术及并发症发生。结论经乳房途径的腔镜甲状腺切除术安全、可靠，颈部无疤痕，美容效果好。
ObjectiveTo evaluate the changes of nutritional status following sleeve gastrectomy with ileal interposition duodenojejunal bypass operation in treatment of nonobese type 2 diabetes mellitus. MethodsA total of 47 patients submitted to sleeve gastrectomy with ileal interposition duodenojejunal bypass operation from March 2009 to November 2011 in this hospital were retrospectively analyzed. Serum iron, calcium, vitamin B12, folic acid, albumin (Alb), hemoglobin (Hb), glycosylated hemoglobin (HbA1c), and body mass index (BMI) were assessed before operation and on 6, 12, 24, and 36 months after operation. Results①The values of Alb, Hb, HbA1c, and iron after operation were significantly lower than those of the corresponding values before operation (P < 0.01), the values of calcium, vitamin B12, folic acid, and BMI had no significant differences between after operation and before operation (P > 0.05).②The incidences of the lower Alb and lower iron after operation were significantly higher than those before operation (P < 0.01), the other indexes had no significant differences between after operation and before operation (P > 0.05). ConclusionsSleeve gastrectomy with ileal interposition duodenojejunal bypass operation is an effective treatment of nonobese type 2 diabetes mellitus. However, nutritional deficiency is one of its side effects, which should be properly diagnosed and handled in order to improving the patient's quality of life and preventing related complications.
目的 探讨腹腔镜全直肠系膜切除术盆腔自主神经保留的可行性及对术后性功能的影响。方法 对我院2004年2月至2006年5月期间21例中低位直肠癌患者施行腹腔镜全直肠系膜切除保留盆腔自主神经手术，调查了解患者术后性功能情况。结果 21例患者性功能均存在,绝大多数(18例)患者勃起功能良好。结论 腹腔镜下全直肠系膜切除术保留盆腔自主神经是可行的，患者性功能恢复满意。
目的 探讨隐蔽三孔法腹腔镜阑尾切除术的应用。方法 患者取头低左侧卧位。在脐缘切口插入10 mm的套管，放入腹腔镜。在腹腔镜监视下分别于耻骨结节左、右侧阴毛生长区作10 mm、5 mm切口，两切口相距8~10 cm。术者通过耻骨上途径完成阑尾切除操作。结果 192例痊愈出院，无一例手术中转，平均手术时间（25±4.32） min，平均住院时间（5±0.79） d。切口甲级愈合，基本不留疤痕。无手术并发症发生。结论 隐蔽三孔法腹腔镜阑尾切除术具有美容效果好、创伤小、并发症少等优点。
ObjectiveTo compare the effect of robotic thyroidectomy and endoscopic thyroidectomy on the voice function. MethodsThe clinical data of 181 patients with differentiated thyroid cancer admitted to Panzhihua Central Hospital of Sichuan Province from March 2022 to June 2023 were analyzed retrospectively. According to the operative mode, this patients were divided into two groups: the endoscope group (n=91) and the robot group (n=90). The subjective and objective acoustic indicators were compared between the two groups at 1 day before operation and 1 week, 1 month and 3 months after operation. ResultsThere were no significant difference in voice handicap index (VHI)-10 scores between the two groups at different time points before and after operation (P>0.05). There were no significant difference of VHI-10 scores between preoperative and different postoperative phases in the robot group (P>0.05). The score of VHI-10 at different postoperative phases in the endoscopic group was higher than that at 1 d before operation (P<0.05). The incidence of voice dysfunction (VHI-10 score ≥8) was 1.1% (1/90), 1.1% (1/90) and 0.0% (0/90) in the robot group, 1.1% (1/91) , 2.2% (2/91) and 0.0% (0/91) in the endoscope group at 1 week, 1 month and 3 months after operation respectively, there were no significant difference between the two groups (P>0.05). The fundamental frequency of patients in the endoscopic group was lower than that at 1 d before operation (P<0.05), and there was no significant difference between each phase after operation and at 1 d before operation of fundamental frequency in the robot group (P>0.05). The fundamental frequency of patients in the endoscopic group was lower than that in the robot group at 1 week after operation (P<0.05). The maximum phonation time of each phase after operation in the robot group was not significantly different from that at 1 d before operation (P>0.05). The maximum phonation time of 1 week after operation in the endoscopic group was shorter than that at 1 d before operation (P<0.05) and also shorter than that in the robot group (P<0.05). There were no significant difference in fundamental frequency perturbation, amplitude perturbation, harmonic noise ratio and voice disorder severity index between the two groups at different phases before and after operation (P>0.05). ConclusionCompared with endoscopic thyroidectomy, the voice function of robotic thyroidectomy via bilateral axillary breast approach is better.
目的探讨防止限制性门腔静脉侧侧分流术后吻合口扩大的方法。方法对32例肝硬变门脉高压症患者行限制性门腔静脉分流术，术中采用不吸收缝线连续缝合门腔静脉吻合口前后壁形成自然的限制环，以防止术后吻合口的扩大。结果32例患者于术后3～36个月行彩超或螺旋CT检查，显示门腔静脉吻合口均无扩大； 术后再出血率为3.1%（1/32），肝性脑病发生率为6.3%（2/32）； 术后≤6个月时肝功能均有不同程度改善，与术前比较其差异有显著性（P＜0.001）； 全部病例随访6~49个月，随访率为100%。结论改良的限制性门腔静脉侧侧分流术是治疗肝硬变门脉高压症的有效方法。
ObjectiveTo investigate the voice function before and after surgery in patients undergoing axillary thyroidectomy with da Vinci robotic Xi system. MethodsSeventy female patients who underwent robotic thyroid cancer radical resection in Panzhihua Central Hospital from March 2022 to March 2023 were selected. The voice dysfunction index scale VHI-10, auditory perception evaluation scale GRBAS and voice analysis software were used to evaluate the voice function of patients subjectively and objectively at 1 day before operation, 1 week and 3 months after surgery. ResultsThe operative time was (128.13±48.36) min, the amount of blood loss was (16.36±8.23) mL. There were no significant differences in the points of function, physiology and emotion evaluated by VHI-10 scale at 1 week and 3 months after operation compared with those before operation (P>0.05). There were no significant differences in the three characteristics points of voice roughness, breathiness, and strain evaluated by GRBAS scale at 1 week and 3 months after operation (P>0.05). At 1 week after operation, the total hoarseness grade and asthenia evaluated by GRBAS scale were increased in different degrees as compared with those before operation and the difference was statistically significant (P<0.05), while the total hoarseness grade and asthenia points were decreased at 3 months after operation and there was no significant difference as compared with that before operation (P>0.05). Voice acoustic analysis results showed that there were no significant differences in fundamental frequency, jitter, shimmer and harmonic to noise ratio of the patients between at 1 week or 3 months after operation and before operation (P>0.05). The maximum phonation time (MPT) of patients was decreased at 1 week after operation as compared with that before operation, and the difference was statistically significant (P<0.05). The MPT of the patients recovered at 3 months after operation, and there was no significant difference as compared with that before operation (P>0.05). The dysphonia severity index (DSI) of patients at 1 week after surgery was decreased as compared with that before surgery, and the difference was statistically significant (P<0.05). The DSI was increased at 3 months after operation and there was no significant difference as compared with that before operation (P>0.05). ConclusionRobot radical thyroidectomy via axillary breast is safe and can protect the voice function.