目的探讨腹腔镜在胆瘘或肠瘘诊治中的应用价值。 方法回顾性分析2008年11月至2013年4月期间广西壮族自治区桂东人民医院和广西壮族自治区民族医院收治的应用腹腔镜诊治的12例胆瘘或肠瘘患者的临床资料。 结果12例患者中胆瘘7例，肠瘘5例，均在手术后发生，均经腹腔镜探查后确诊。12例患者均在腹腔镜下行再次置管引流、缝闭迷走胆管或肠瘘管等处理。手术时间60～170 min、（90±19）min，住院时间3～7 d、（4±1）d，术中出血量20～150 mL、（70±12）mL，术后均顺利康复出院。术后12例患者均获访，随访时间为1个月～5年，平均随访时间为36个月，未发现胆瘘或肠瘘复发者。 结论腹腔镜探查有助于胆瘘或肠瘘的诊断，并可达到微创手术治疗的目的。
目的 探讨冲击法在甲状腺功能亢进症（简称甲亢）围手术期处理中的应用价值。 方法 对2006年2月至2011年1月期间笔者所在医院收治的36例应用传统方法和32例应用冲击法进行围手术期处理的甲亢患者的临床资料进行回顾性分析，比较采用两种不同术前准备方法的患者在住院时间、术后并发症、住院费用及甲状腺激素水平变化的差异。 结果 2组患者手术过程均顺利，术后均未出现窒息、呼吸困难、声嘶、呛咳、甲状腺危象等并发症。术前准备时间、住院时间和住院费用在冲击法组分别是（8.09±1.03） d、（10.69±1.45） d和（2 230.78±220.74）元，传统方法组分别是（15.83±1.61） d、（17.97±1.44） d和（5 549.69±560.55）元，冲击法组明显短于或少于传统方法组（P＜0.05）。在给药后第7天，冲击法组患者的FT3和FRT4水平下降幅度均高于传统方法组（P＜0.05）。 结论 冲击法在甲亢围手术期处理中是安全可靠的，是甲亢的一种快速术前准备方法。
目的评估PK刀在腹腔镜阑尾切除（LA）中的应用价值。方法回顾性分析广西桂东人民医院2009年6月至2010年6月期间68例行LA患者的临床资料，其中PK刀组34例，高频电凝钩组34例，比较2组患者的手术时间、术中出血量、术后肠道功能恢复时间及住院时间。结果所有手术均获成功，无中转开腹及术后大出血等并发症发生，PK刀组较高频电凝钩组的手术时间明显缩短(Plt;0.05)、术中出血量明显减少(Plt;0.05)及术后肠道功能恢复时间更快(Plt;0.05)； 住院时间2组间差异无统计学意义(Pgt;0.05)。结论PK刀具有凝固均匀、完全、热损伤少、止血效果好、操作简单等优点，可选择性地应用于LA。
ObjectiveTo explore the effect of partial splenic embolization on splenectomy plus devascularization of esophageal and gastric vein. MethodsTwenty three cirrhosis patients with portal hypertension combined the hypersplenism (partial splenic embolization group), who received partial splenic embolization in our hospital from June 2010 to June 2015, as well as 30 cirrhosis patients with portal hypertension combined the hypersplenism without undergoing partial splenic embolization in the same period (non-partial splenic embolization group), were collected retrospectively. All patients underwent splenectomy plus devascularization of esophageal and gastric vein. Comparison of operation time, intraoperative blood loss, intraoperative blood transfusion volume, postoperative total flow of abdominal drainage tube, postoperative gastrointestinal function recovery time, hospital stay, and the incidence of complication was performed. ResultsThe operation time[(3.56±0.70) h vs. (1.78±0.28) h], intraoperative blood loss (900 mL vs. 250 mL), intraoperative blood transfusion volume (800 mL vs. 200 mL), postoperative total flow of abdominal drainage tube (450 mL vs. 150 mL), postoperative gastrointestinal function recovery time[(43.38±18.68) h vs. (27.60±12.39) h], hospital stay (12 d vs. 7 d), and incidence of incision infection[34.8% (8/23) vs. 10.0% (3/30)] of partial splenic embolization group were all higher or longer than those corresponding indexes of non-partial splenic embolization group (P < 0.05). All patients of 2 groups were followed up by telephone visit for 6-58 months, and the median was 28-month. There was no recurrence of gastrointestinal hemorrhage during the follow-up period. ConclusionsSplenectomy is more difficult, and maybe has more intraoperative blood loss and complications for cirrhosis patients with portal hypertension combined the hypersplenism, who received partial splenic embolization ever. For these patents, the recovery time is longer. We should make choice of partial splenic embolization or splenectomy directly according to the patients' situation, to implement individualized treatment, so we can make the biggest benefit for patients.
Objective To evaluate the clinical value of ureteroscope in cholelithiasis treated by laparoscopic surgery. Methods The clinical data of 36 patients admitted because of hepatolithus with ureteroscope combination in laparoscopic surgery from February 2007 to September 2009 in Guidong People’s Hospital of Guangxi were analyzed retrospectively. Results In 33 cases, stones were removed once by ureteroscope in laparoscopic surgery with residual stones (in 3 cases residual stone were removed secondarily through T tube) and the other 3 cases were transferred to laparotomy forcedly due to bleeding of biliary duct and vessels of porta hepatis and tearing of bile duct. During operation, blood loss was 30-280 (94.51±54.70) ml; operation time was 110-260 (147.22±48.45) min; recovery time of bowel movement was 1-3 (2.03±0.76) d; postoperative hospitalization time was 6-13 (7.12±1.65) d (some discharged with T tube); the time of patients of T tubes pulled out was 28-45 (38.92±6.52) d. Bile leakage happened in 1 case and infection of biliary tract in 1 case, no complications such as biliary stricture or bile duct bleeding were found after operation. Conclusions Treatment of intrahepatic bile duct or a single extra-hepatic sand-like stones with ureteroscopy usage in laparoscopic surgery is feasible and less invasive. It is a minimally invasive treatment for intra- or extra-hepatic stones due to rapidly postoperative rehabilitation.
目的 探讨腹腔镜胆囊切除术（LC）中因胆囊破裂致腹腔残留胆石对术后机体的影响。方法 2001年3月至2009年8月期间广西桂东人民医院对750例胆囊结石患者进行了LC，术中穿破胆囊30例（4.0%），其中术后发现腹腔内残留胆石者10例（1.3%）。回顾性分析该10例患者的临床和随访资料。结果 本组患者住院时间2～7 d，平均4 d。随访2～36个月（平均10个月），CT、X线或B超检查8例患者腹腔仍残存明显胆石，其中1例合并有腹腔脓肿，给予抗炎治疗后症状消失（脓肿较小）； 另2例腹腔残存胆石消失。10例患者均无慢性腹痛、表皮窦道形成、肠梗阻、腹腔肿瘤等并发症。随访期间10例患者肝功能及T细胞水平与术后第2天比较，差异无统计学意义（P＞0.05），WBC水平则明显降低（P＜0.05）。结论 LC中如果无法寻找到遗留于腹腔的微小胆石时，只要常规腹腔冲洗，术后预防性应用抗生素，少数残留于腹腔的小胆石对术后机体无严重不良影响。