目的 探讨腹腔镜与小切口直肠癌根治术对患者机体细胞免疫功能的影响。方法 选取2010年1月至2011年6月期间我院行腹腔镜及小切口直肠癌根治患者102例,其中腹腔镜组53例,小切口组49例。 采用流式细胞仪测定患者术前1d及术后第1及第5天外周血中CD3、CD4+、CD8+、CD19及NK细胞比例的变化,研究不同手术方式对患者细胞免疫功能的影响。结果 术后第1及第5天,腹腔镜组和小切口组患者的CD3、CD4+、CD8+、CD19及NK细胞比例(数)均较术前明显降低(P<0.05)。同腹腔镜组比较,小切口组术前及术后CD3、CD4+、CD8+、CD19及NK细胞比例(数)的差异均无统计学意义(P>0.05)。结论 腹腔镜与小切口直肠癌根治对患者机体细胞免疫功能的无明显影响。
目的通过对247例小切口阑尾切除术临床体会的总结,探讨以小切口作阑尾切除术的优点、手术适应证、禁忌证以及手术注意事项。方法对247例小切口阑尾切除术病例在手术要点、手术时间、切口长度、术后恢复情况、并发症等方面进行分析,结合文献资料加以总结。结果在手术中开腹、寻找阑尾及关腹均有其特定要求; 手术时间平均18 min,术后拆线及术后住院时间平均分别为4.8 d和4.6 d; 伤口愈合: 甲级235例,乙级9例,丙级2例。结论小切口阑尾切除术具有切口小、外观美、创伤小、恢复快以及经济节省、加快病床周转等诸多优点,是一个值得推广的手术。
目的 探讨嵌顿环状混合痔的手术治疗方法。 方法 回顾性总结我院1998年1月至2002年1月采用小切口外剥内扎硬注术治疗嵌顿环状混合痔30例临床经验。 结果 30例患者手术过程顺利,手术时间平均50 min,平均住院时间10 d,术后并发肛门Ⅰ度水肿4例,术后当天排尿困难1例,经对症治疗后痊愈出院。本组病例术后随访1年均无复发。 结论 该术式能迅速减轻患者痛苦,且疗效满意。
目的探讨原发性甲状旁腺机能亢进(PHPT)小切口单侧探查的适应证和探查经验。方法对我科1992年1月至2001年12月所作的26例小切口单侧探查病例的临床病理资料进行回顾性分析。结果小切口单侧探查26例,成功25例。结论对诊断明确且准确定位者先采取定位侧小切口; 冰冻切片证实为甲状旁腺肿瘤,且病理学特点与其临床表现、实验室检查和定位诊断相符者可仅行单侧探查。
Objective To compare clinical outcomes and safety between minimally invasive mitral valve replacement via right minithoracotomy (mini-MVR) and traditional mitral valve replacement (MVR). Methods Clinical data of 68 patients with valvular heart diseases who underwent mini-MVR from February 2009 to December 2011 in Wuhan Asia Heart Hospital were retrospectively analyzed. There were 36 males and 32 females in this mini-MVR group with their mean age of 34.2±11.2 years. Preoperatively, there were 21 patients with mitral stenosis (MS), 17 patients with mitral insufficiency (MI), 30 patients with MS and MI, and 19 patients with tricuspid insufficiency (TI). Another 200 patients with valvular heart diseases who underwent traditional MVR during the same period were included as the control group. There were 86 males and 114 females in the control group with their mean age of 49.4±13.2 years. Preoperatively, there were 85 patients with MS, 66 patients with MI, 49 patients with MS and MI, and 76 patients with TI. Hospital mortality, aortic crossclamp time, length of intensive care unit (ICU) stay, postoperative chest tube drainage, reexploration for bleeding and postoperative morbidities were compared between the two groups. Results There was no in-hospital death in the mini-MVR group. There was no statistical difference in hospital mortality, cardiopulmonary bypass time, incidence of reexploration for bleeding, postoperative arrhythmias, dialysis-requiring acute renal failure and wound infection between the two group (P>0.05). Aortic crossclamp time of the mini-MVR group was significantly longer than that of the control group. But postoperative mechanical ventilation time (10.2±3.1 h vs. 15.2±7.1 h, P=0.008), chest tube drainage(92.0±28.0 ml vs. 205.0±78.0 ml, P=0.000), blood transfusion (0.8±1.6 U vs. 1.9±2.1 U, P=0.006), length of ICU stay (14.0±8.0 h vs. 26.0±12.0 h, P=0.003) and length of hospital stay (14.8±4.6 d vs. 19.7±3.2 d, P=0.006)of the mini-MVR group were significantly shorter or less than those of the control group. Conclusion The safety of mini-MVR is comparable to that of traditional MVR without causing higher postoperative morbidities, while the postoperative recovery after mini-MVR is better than traditional MVR.
Abstract: Objective To evaluate video-assisted thoracic surgery(VATS)and minimal incision thoracotomy(MIT)lobectomy for early stage non-small cell lung cancer patients and the impact upon postoperative quality of life(QOL). Methods A prospective randomized controlled trial was conducted. From January 1, 2008 to December 10, 2011, the qualified patients with early stage NSCLC were recruited and randomized to VATS group (57 patients)and MIT group(49 patients), totally 106 patients,57 males and 49 females, aged 57.60 years. The quality of life was assessed using Lung Cancer Symptom Scale (LCSS) before operation and at 1,3,6,9,12 months after operation. Results There were no significant differences between the 2 groups in age, sex, the location of tumor, tumor pathologic stage, pathological types, postoperative complications, tumor size, operative time, operative bleeding and air leak days. There were no symptoms after operation at the VATS group worse than the leve before operation. Five major symptoms, including appetit(1.04±0.71 vs.2.00±0.83, F=6.357,P=0.021), fatigue (4.55±1.17 vs.10.19±2.10, F=4.721,P=0.043), dyspnea(2.18±0.86 vs.10.26±2.05, F=10.020,P=0.005), normal activity(5.16±1.70 vs.17.60±3.17, F=12.319,P=0.002)at the MIT group were deteriorated significantly at 1 month after the operation (P<0.05). Conclusion The VATS will lead to better quality of life for the patients with early stage NSCLC after surgery and lead to a smooth postoperative recovery.