【摘要】目的 探讨低位直肠癌保肛手术的术式选择及其治疗效果。方法 回顾性分析我院1997年7月至2002年7月期间行低位直肠癌保肛手术治疗的90例患者的临床资料。结果 行低位直肠癌保肛手术者占同期的66.2%(90/136)。90例中距肛缘5 cm以内者14例，5~8 cm者76例； 行Dixon术84例，经肛门局部切除术4例，Parks术2例。术后发生吻合口漏8例，其中Dixon术7例，Parks术 1例； 肛门狭窄2例，其中Dixon术1例，Parks术 1例； 无手术死亡。90例患者术后均获随访,64例随访23~59个月，中位随访时间为39个月，其中Dixon术59例，Parks术2例，局部切除术3例。局部复发6例，其中Dixon术5例，局部切除术1例。 结论 Dixon术是低位直肠癌保肛手术的主要术式； 在严格掌握适应证的情况下，可考虑施行低位直肠癌的局部切除术。
Objective To explore the feasibility， operation method， and clinical application value of transumbilical single-port laparoscopic cholecystectomy （TUSP-LC） in treatment for children patients with benign gallbladder diseases. Methods The clinical data of 64 patients with benign gallbladder diseases from June 2009 to June 2011 were analyzed retrospectively. The patients were divided into TUSP-LC group （n=41） and convention three-port LC （CTP-LC group， n=23）. The operative time， intraoperative blood loss， conversion to CTP-LC or laparotomy， operative complications， and hospital stay were recorded. The pains were registered at 3，6，12，24，48， and 72h postoperatively using visual analog scale （VAS）. The patients were given satisfaction questionnaires with surgery at 6 time points （1 week， 2 weeks， 1 month， 3 months， 6 months， 12 months） during a 12 months follow-up. Results A total of 64 pediatric LCs were performed successfully， no patients were converted to laparotomy. Except for one case of incision infection in the CTP-LC group 〔4.35%（1/23）〕 and one case of incision infection and one case of ecchymoma in the TUSP-LC group 〔4.88% （2/41）〕， no other complications such as bile duct injury， bile leakage， and incision hernia happened， the total complication rate was not significant difference in two groups （P＞0.05）. The operative time 〔（47.54±18.71） min versus（45.33±10.58） min〕， intraoperative blood loss 〔（18.56±13.34） ml versus （17.28±12.53） ml〕， and hospital stay 〔（1.67±0.36） d versus （1.81±0.38） d〕were not significant differences in two groups （P＞0.05）. The VAS score was not statisticly significant within 24h in two groups （P＞0.05）， but which in the TUSP-LC group was significantly lower than that in the CTP-LC group after 24h postoperatively （P＜0.05）. During a 12 months follow-up， the score of satisfaction in the TUSP-LC group was significantly higher than that in the CTP-LC group （P＜0.05）. Conclusions TUSP-LC is a safe and feasible method in the children patients with benign gallbladder diseases. It can be performed with the same technical exposure and outcomes as multi-port laparoscopy， with the added benefit of relieving postoperative pain and little no scarring.
目的 探讨腹腔镜全结肠切除术在家族性腺瘤性息肉病（FAP）中的应用价值。方法 回顾性分析我院2008年1月至2009年10月期间收治的行腹腔镜全结肠切除术的4例FAP患者的临床资料，对手术安全性和术后恢复情况进行分析。结果 4例患者均顺利行腹腔镜全结肠切除术，无中转开腹，无手术并发症及死亡。腹部切口长6.0 cm，手术时间300～380 min（平均330 min），术中出血量90～250 ml（平均160 ml）。术后2～3 d肛门开始排气，术后住院时间7～11 d（平均9 d）出院。出院后大便稀薄，8～12次/d，给予易蒙停治疗后缓解。随访2～22个月（平均14个月），无近期并发症发生。结论 腹腔镜全结肠切除术治疗FAP安全、有效，近期效果良好。
目的探讨腹腔镜下不同的入肝血流阻断方法下行规则性或不规则性局部肝切除的手术方法及其临床应用。 方法回顾性分析2007年5月至2012年7月期间在江苏省苏北人民医院完成的25例腹腔镜肝切除术患者的临床资料，其中行规则性肝切除术14例，不规则性局部肝切除术11例。术后病理学检查证实原发性肝癌9例，肝血管瘤10例，结直肠癌肝转移1例，左肝内胆管结石5例。 结果本组25例均成功完成了腹腔镜肝切除术（其中合并胆囊切除术3例，合并胆囊切除及胆总管探查术1例），无中转开腹手术者。其中行区域性入肝血流阻断联合规则性肝切除术14例，应用自制的第一肝门阻断器行全肝入肝血流阻断联合不规则的局部肝切除术11例。手术时间（149.6±19.8）min（120～195 min），术中出血量（320±73.6）mL（180～460 mL），腹腔引流管放置时间3～11 d。有1例术后第3天出现胆汁漏，予以放置自制双套管冲洗后引流量逐渐减少，术后第11天顺利拔管；其余病例未发生胆汁漏、出血、感染等并发症。术后住院时间（8.6±2.4）d（5～13 d）。9例肝脏恶性肿瘤患者术后均获随访，截至2012年7月29日，其随访时间12～48个月，平均17个月，1年无瘤生存患者有7例。 结论腹腔镜肝切除术是安全可行的，肝脏血流阻断技术是其成功的关键和保障。左半肝或左外叶病灶可考虑行区域性入肝血流阻断联合规则性肝切除术；右半肝不规则的病灶或病灶较小时，应用自制的第一肝门阻断器行全肝入肝血流阻断联合不规则的局部肝切除术，是简洁、实用的方法，可避免切除过多的肝组织。
In recent years, day surgery has developed rapidly in China. Day surgery management has shifted from extensive to refined, but there are still many problems in the service system of day surgery in Chinese hospitals. In order to further optimize the allocation of medical resources, improve the level of medical service capacity, and build a “patient-centered, safe, efficient, and orderly” day surgery service system, Northern Jiangsu People’s Hospital has integrated big data, mobile internet, and artificial intelligence since 2019, creating a smart information big data platform. This paper summarizes the experience of Northern Jiangsu People’s Hospital in promoting the high-quality development of day surgery services in the whole hospital from five aspects of top-level design, diagnostic and therapeutic process, medical quality and safety, medical supporting services, and supervision mechanism, with a view to providing reference for the implementation of overall management of day surgery in the hospital.