目的探讨腹腔镜胆囊切除术（LC）再手术原因及预防措施。方法回顾分析我院1994年6月至2000年6月760例腹腔镜胆囊切除术后再手术的9例临床资料。结果9例中胆管损伤3例，胆总管结石2例，胆瘘2例，出血2例。再手术率为1．18%。再手术的方法： 胆总管探查、取石、T管引流2例，胆囊管、副肝管、胆囊动脉结扎术4例，胆总管原位吻合、T管支撑引流1例，胆肠吻合2例。9例全部治愈。结论胆管损伤、胆瘘、胆道出血及胆管残余结石等并发症是腹腔镜胆囊切除术后再手术的根本原因； 其次是术式选择不当，手术时机不当，初期技术操作不熟练以及未重视术中胆道造影的重要性所致。
目的 总结腔内修复术治疗主动脉夹层的经验。方法 选择2011年7月至2013年1月期间我院住院的胸主动脉夹层患者15例，术前均采用CTA评估，全部行腔内修复术。结果 15例患者采用腔内修复手术全部成功，手术时间95～165min，（120±26） min；失血量30～160mL，（68±34） mL。10例采用经股动脉入路，5例采用经股动脉及肱动脉入路。13例单一破口者各植入支架1枚，手术全部成功。15例患者未发生截瘫，无一椎基底动脉缺血症状，无下肢缺血改变，无伤口感染及腹股沟区淋巴瘘。2例存在Ⅱ型内漏，未经处理自行闭合。随访胸腹主动脉CTA扫描显示覆膜支架均未移位，未发现植入支架后并发近端夹层者。结论 腔内修复术治疗主动脉夹层是一种有效的治疗方法，具有安全性高、术后并发症少、治疗效果好等优点。
Objective To compare the effect of laparoscopic surgery and open surgery on the blood coagulation state in patients with gastric cancer, and to provide evidence for the prevention measurement of thrombosis in perioperative period. Methods One hundred patients with gastric cancer who received treatment in our hospital from Feb. 2014 to Aug. 2014, were randomly divided into laparoscopy group and laparotomy group, 50 patients in each group. The patients in laparotomy group were treated by traditionally open surgery, while patients in the laparoscopy group accepted laparoscopic surgery. The clinically therapeutic effect of 2 groups was compared. Results ① Operative indexes. The operation time, blood loss, anal exhaust time, hospital stay, and morbidity of laparoscopy group were all lower than those of laparotomy group (P<0.05). ② Coagulation function. Compared with preoperative indexes, the prothrombin time (PT) at 24 h after operation in laparoscopy group and laparotomy group were both shorter (P<0.05), but there was no significant difference in activated partial thromboplastin time (APTT) and international normalized ratio (INR) between the 2 time points (before operation and 24 h after operation) in both 2 groups (P>0.05). Both at 2 time points (before operation and 24 h after operation), there was no significant difference in PT, APTT, and INR between 2 groups (P>0.05). ③ Fibrinolysis indexes. Compared with preoperative indexes, the fibrinogen (FIB) and D-dimer at 24 h after operation in laparoscopy group and laparotomy group were higher (P<0.05). The FIB and D-dimer at 24 h after operation in laparoscopy group were both higher than those of laparotomy group (P<0.05). ④ Follow-up results. There was no significant difference in metastasis rate, recurrence rate, and mortality between the 2 groups (P>0.05), but the incidence of thrombus was higher in laparoscopy group than that of laparotomy group (P<0.05). Conclusions In the treatment of patients with gastric cancer, laparoscopic surgery has the advantages of less trauma, less blood loss, less complications, and so on. Laparoscopic surgery and open surgery both can lead to hypercoagulable state, but the effect of laparoscopic surgery is stronger than open surgery.
目的探讨全腹腔镜下肝切除的可行性、安全性及手术技巧。 方法回顾性分析2010年7月至2013年3月期间我院行全腹腔镜下肝切除20例病例（腹腔镜组），其中肝海绵状血管瘤10例，原发性肝细胞癌6例，肝内胆管结石4例。与同期25例开腹肝切除手术（开腹组）进行比较。 结果2组患者一般临床资料比较差异无统计学意义（P＞0.05），具有可比性。腹腔镜组术后有1例出现胆汁漏（＜100 mL/d），经通畅引流7 d后停止，未发现腹腔积液后拔除引流管，顺利恢复；术后1～2 d逐步恢复饮食，5～7 d出院，原发性肝细胞癌患者病理检查切缘未发现残余病灶。腹腔镜组术后切口疼痛持续时间明显短于开腹组〔（1.67±0.52）d比（3.39±0.63）d，t=2.266，P=0.035〕。无一例切口出现感染及脂肪液化。腹腔镜组和开腹组的手术时间比较差异无统计学意义〔（110.29±25.11）min比（100.95±24.32）min，t=0.731，P=0.415〕，腹腔镜组的术中出血量明显少于开腹组〔（345.11±45.21）mL比（506.72±58.32）mL，t=25.10，P＜0.001〕，住院时间也明显短于开腹组〔（3.57±1.52）d比（6.39±3.63）d，w=15.00，P=0.005〕。 结论全腹腔镜下肝切除（特别是肝脏边缘及左外叶病灶）是安全、可行的，较开腹手术其具有微创、住院时间短、术中出血量少、手术并发症少等优点。