目的探讨腹腔镜手术中穿刺相关出血的常见原因及相应的对策。 方法对2000年5月至2010年10月期间我院腹腔镜手术中发生与穿刺相关出血的16例患者的资料进行回顾性分析。 结果16例患者中腹壁穿刺孔腹膜层出血7例，肌层出血5例，误伤大网膜血管3例，误伤后腹膜血管1例，均在术中及时发现。误伤大网膜血管病例予镜下止血，误伤后腹膜血管病例及时中转开腹手术，腹膜层及肌层出血病例分别给予电灼或缝扎止血。 患者均康复出院。 结论直视进腹、规范操作和抽吸滴水试验是避免腹腔镜手术穿刺时血管误伤及出血遗漏的有效方法。
Objective To compare the effects between laparoscopic and conventional open abdominal approaches on perineal wound healing for patients with rectal cancer. Methods The clinical data of 54 patients undergoing laparoscopic abdominal perineal resection (laparoscopy group) and 48 patients undergoing open abdominal perineal resection (open group) between January 2008 and December 2009 in this hospital were collected. Parameters including class A healing rate of perineal wound, duration of surgery, duration of perineal resection, blood loss during operation, anterosacral drainage, and serum albumin level on day 3 after surgery were compared between two groups. Results There was no significant difference of gender, age, tumor Dukes stage, preoperative albumin, or preoperative complications between two groups (Pgt;0.05). The class A healing rate of perineal wound (χ2=5.54, Plt;0.05) and serum albumin level on the third day after surgery （t＝3.92, Plt;0.01） in the laparoscopy group was significantly higher than those in the open group. In the laparoscopy group, duration of perineal resection （t＝6.64, Plt;0.01）, blood loss during operation （t＝6.05, Plt;0.01）, and anterosacral drainage （t＝12.86, Plt;0.01） were less than those in the open group. Conclusion The higher class A healing rate of laparoscopic approach for the patients with rectal cancer might be associated with the minimal invasiveness, less blood loss, and shorter duration.
Objective To investigate the effects of adenosine 2A receptor (A2AR) activation on oxidative stress in small-forsize liver transplantation. Methods A rat orthotopic liver transplantation model was performed using 40% graft, 18 recipients were given intravenously saline (control group), CGS21680 (A2AR agonist, CGS21680 group) or ZM241385 (A2AR antagonist, CGS21680+ZM241385 group) randomly. Aspartate aminotransferase (AST), enzymatic antioxidants 〔superoxide dismutase (SOD); catalase (CAT); glutathione peroxidase (GSH-Px)〕, non-enzymatic antioxidants 〔ascorbic acid (AA); glutathione (GSH); α-tocopherol (TOC)〕 and lipid oxidant metabolites malondialdehyde (MDA) were measured and analyzed at 6 h after reperfusion. Results Compared with the control group and CGS21680+ZM241385 group, A2AR activation increased the activities of SOD and GSHPx (Plt;0.05), reduced the productions of AST and MDA (Plt;0.05), increased the levels of AA, GSH and TOC (Plt;0.05) in CGS21680 group. But there was no significant change in CAT activity (Pgt;0.05) among 3 groups. Conclusions A2AR activation improves the antioxidant enzyme activities, promotes the production of antioxidants, and slowes down the increase in MDA level, depresses of the increase in AST activity. A2AR activation suppresses oxidative damage and increases the antioxidant capacity which in turn minimizes their harmful effects of ischemia-reperfusion in small-for-size liver transplantation.
Objective To study the effects of adenosine 2A receptor activation on activation, proliferation, and toxicity of T lymphocytes stimulated by phytohemagglutinin (PHA) in vitro. Methods A model of activated T cells was established by stimulating the cells with PHA. Those T cells were treated with different concentrations of adenosine 2A receptors agonist (0.01 μmol/L, 0.1 μmol/L, 1 μmol/L, and 10 μmol/L CGS21680). The expressions of CD69, CD25 and proliferation of T cells were measured by fluorescent antibody stain and flow cytometry. ELISA method was used to detect IL-2 and INF-γ levels. Results All concentrations of CGS21680 significantly inhibited the expressions of CD25 and CD69 on PHA-stimulated T cells surface and proliferation of T cells （Plt;0.05， Plt;0.01）. IL-2 and INF-γ secreted by T cells were significantly suppressed, too （Plt;0.01）. Conclusion Activation of adenosine 2A receptor can effectively inhibit the activation, proliferation, and toxicity of T cells in vitro.
目的 探讨腹腔镜下修补医源性结肠穿孔的可行性和手术技巧。方法 回顾性分析我院2007年 10月至2009年12月期间腹腔镜下修补医源性结肠穿孔手术6例患者的临床资料，其中诊断性肠镜检查结肠穿孔2例，治疗性肠镜结肠穿孔4例。结果 6例患者均顺利完成腹腔镜下手术, 无中转开腹。3例患者全腹腔镜下完成结肠穿孔修补，2例因破口较大在腹腔镜辅助下完成结肠穿孔修补，1例乙状结肠癌患者肠镜检查结肠穿孔后同时行腹腔镜下乙状结肠癌根治手术，术后未发生吻合口漏、残余感染等并发症。结论 腹腔镜下修补医源性结肠穿孔安全、可靠，临床效果肯定。
目的 探讨腹腔镜胃肠道手术中医源性脾损伤的发生原因和处理方法。方法 回顾性分析我院2007年12月至2009年2月期间125例行腹腔镜胃肠手术中出现的5例医源性脾损伤的临床资料。结果 5例脾损伤患者中腹腔镜胃手术4例，腹腔镜结肠手术1例； 按Pachter脾损伤分级，Ⅰ级3例，Ⅱ级2例。所有患者均经腹腔镜手术治疗治愈，电凝止血1例,小纱布压迫加电凝加止血纱布压迫止血4例。结论 腹腔镜胃肠手术中发生的脾损伤多为表浅的Ⅰ、Ⅱ级损伤,及时发现及正确处理十分重要。
目的 探讨腹腔镜胃肠道手术常见戳孔并发症的特点及防治对策。方法 回顾性分析我院78例行腹腔镜胃肠道手术后9例发生戳孔并发症患者的临床资料。结果 9例中戳孔感染4例，戳孔周围皮下瘀血和血肿2例，戳孔疝1例，皮下气肿2例，经采取拆除戳孔处缝线、通畅引流、换药、局部压迫、药物止血等相应处置，患者均痊愈出院。结论 戳孔并发症重在预防，其危害不容忽视。