目的 通过与开腹广泛全子宫切除术+盆腔淋巴结清扫术对比,评估腹腔镜下广泛全子宫切除术+盆腔淋巴结清扫术治疗早期宫颈癌的疗效及安全性。方法 研究对象为广东省揭阳市人民医院妇科2013年9月—2015年12月完成手术的宫颈癌Ia2期-IIa期患者200例,分为两组,治疗组:100例实施腹腔镜治疗,年龄32～67岁,平均(45±4.15)岁;对照组:100例开腹手术切除治疗,年龄35～61岁,平均(43±5.33)岁。两组比较手术时间、术中出血量、术后尿潴留及淋巴回流障碍发生率、住院时间、复发率及死亡率等。结果 腹腔镜手术均顺利完成,无一例中转开腹,与开腹手术相比,治疗组手术时间缩短(3.5±0.7)h,术中出血少(48.3±17.8)mL,肛门排气时间(1.2±0.7)d,住院时间短(15.2±0.5)d,手术并发症少(5/5%),均优于对照组手术时间(6.3±0.5)h,术中出血(221.4±102.1) mL,肛门排气时间(2.5±0.9) d,住院时间(18.7±0.9),手术并发症(27/27%),上述各项指标治疗组优于对照组,差异均有统计学意义(P均＜0.05)。结论 腹腔镜手术治疗早期宫颈癌疗效显著, 可显著降低患者术中出血量,缩短手术时间,减少术后并发症,缩短住院时间,两者术后生存率与复发率无统计学差别。

目的 探讨腹腔镜下卵巢癌减灭术联合化疗治疗卵巢癌的疗效。方法 选取2018年2月—2020年2月我院收治的68例卵巢癌患者,随机分为研究组和对照组各34例,对照组给予腹腔镜下卵巢癌减灭术,研究组给予腹腔镜下卵巢癌减灭术联合化疗。观察分析两组患者近期疗效、不良反应发生率、生存率以及相关手术情况等。结果 研究组近期疗效优于对照组(P＜0.05);研究组术后1年生存率高于对照组(P＜0.05),且并发症发生率低于对照组(P＜0.05);研究组理想减灭率优于对照组(P＜0.05),且腹水量及术中出血量少于对照组(P＜0.05),手术时间短于对照组(P＜0.05)。结论 减灭术联合化疗治疗卵巢癌可有效增强治疗疗效,降低多种化疗不良反应发生的可能性,并能使生存率得到进一步提升,可推广应用。

Objective To investigate the efficacy of laparoscopic ovarian cancer reduction combined with chemotherapy in the treatment of ovarian cancer. Methods A total of 68 ovarian cancer patients admitted to our hospital from February 2018 to February 2020 were randomly divided into study group and control group, 34 cases each. The control group was given laparoscopic ovarian cancer reduction surgery, while the study group was given laparoscopic ovarian cancer reduction surgery combined with chemotherapy. The short-term efficacy, incidence of adverse reactions, survival rate and related operation of the two groups were observed and analyzed. Results The short-term efficacy of the study group was better than that of the control group (P<0.05). The 1-year postoperative survival rate of the study group was higher than that of the control group (P<0.05), and the incidence of complications was lower than that of the control group (P<0.05). The ideal reduction rate of the study group was better than that of the control group (P<0.05), and the amount of abdominal water and intraoperative blood loss was less than that of the control group (P<0.05), and the operation time was shorter than that of the control group (P<0.05). Conclusion Laparoscopic ovarian cancer reduction combined with chemotherapy can effectively enhance the therapeutic effect, reduce the possibility of multiple adverse reactions of chemotherapy, and further improve the survival rate, which can be popularized and applied.

目的 分析加速康复外科措施在行腹腔镜辅助结直肠癌根治术治疗患者中的应用价值。方法 2017年6月—2018年8月,选取74例行腹腔镜辅助结直肠癌根治术患者进行研究,按照随机数字表法分为观察组、对照组,对照组实施常规康复外科措施,观察组实施加速康复外科措施,对比两组术后恢复情况、住院情况、应激反应及营养状态。结果 观察组术后首次排气时间、下床活动时间、早期进食时间及导管拔出时间短于对照组(P＜0.05);观察组住院时间、总住院费用少于对照组(P＜0.05);术前两组患者Hs-CRP(超敏C-反应蛋白)、ALB(白蛋白)、PA(前白蛋白)及Hb(血红蛋白)指标比较,差异无统计学意义(P＞0.05)。术后第3 d,观察组Hs-CRP、ALB、PA及Hb指标均优于对照组(P＜0.05)。结论 加速康复外科措施在腹腔镜辅助结直肠癌根治术患者中的开展价值显著。

Objective To analyze the value of accelerated rehabilitation surgery in the treatment of patients undergoing laparoscopic assisted radical resection of colorectal cancer. Methods From June 2017 to August 2018, 74 patients who underwent laparoscopic assisted radical resection of colorectal cancer were enrolled in the study. The patients were divided into observation group and control group according to the random number table method. The group implemented accelerated rehabilitation surgery measures to compare postoperative recovery, hospitalization, and immune function. Results The first exhaust time, the time of getting out of bed, the time of early feeding and the time of catheter extraction were shorter in the observation group than that in the control group(P<0.05). The hospitalization time and total hospitalization cost in the observation group were less than those in the control group(P<0.05). There were no significant differences in Hs-CRP(high-sensitivity C-reactive protein), ALB(albumin), PA(pre-albumin) and Hb(hemoglobin) between the two groups before surgery(P>0.05). On the 3rd day after operation, the indexes of Hs-CRP, ALB, PA and Hb in the observation group were better than those in the control group(P<0.05). Conclusion Accelerated rehabilitation surgery is of great value in the development of laparoscopic assisted colorectal cancer radical surgery.

目的 探讨观察静吸复合麻醉与全凭静脉麻醉对中老年妇科腹腔镜手术的作用。方法 以2016年8月—2018年8月为时间段,选择我院收治的86例中老年妇科腹腔镜手术患者,将其随机分成对照组、实验组,各组43例患者。对照组采取静吸复合麻醉方式,实验组采取全凭静脉麻醉方式。对比观察两组患者的麻醉效果,比较手术中的血流动力学指标,另外统计不良反应及术后认知功能障碍。结果 实验组麻醉起效时间、睁眼时间及拔管时间比对照组短,不良反应发生率及认知功能障碍发生率低于对照组,二组比较差异有统计学意义(P<0.05);手术中心率、氧饱和度、收缩压与舒张压比较,组间差异无统计学意义(P>0.05)。结论 和静吸复合麻醉比较,全凭静脉麻醉在中老年妇科腹腔镜手术中的应用价值更高,建议推广。

目的 对比小儿肠套叠的开腹手术与腹腔镜手术治疗的临床价值。方法 选定本院2017年1月—2020年1月收治的50例肠套叠患者,以双盲随机抽样法分组(每组样本容量25例),对照组采纳开腹手术治疗,观察组采纳腹腔镜手术治疗,对比两组手术指标、术中合并疾病探查率、并发症发生率、复套率。结果 观察组手术时间、下床活动时间、胃肠功能恢复时间及住院时间均比对照组短,观察组术中出血量比对照组低,观察组术中合并疾病探查率(68.00%)比对照组(40.00%)高,观察组并发症发生率(0)比对照组(32.00%)低,差异均有统计学意义(P＜0.05)。观察组复套率(0)与对照组(4.00%)比较,P>0.05。结论 腹腔镜手术治疗小儿肠套叠,创伤性较小、住院时间较短、术后炎症反应较轻、并发症发生率较低,且术中对合并疾病的探查率较高,值得借鉴。

Objective To compare the clinical value of laparotomy and laparoscopy in the treatment of intussusception in children. Methods 50 cases of intussusception patients in our hospital from January 2017 to January 2020 were selected and divided into two groups by double-blind random sampling method (25 cases in each group). The control group was treated with open surgery, and the observation group was treated with laparoscopic surgery. The operation indexes, intraoperative detection rate of combined diseases, incidence of complications and recurrence rate were compared between the two groups. Results The operation time, ambulation time, gastrointestinal function recovery time and hospitalization time in the observation group were shorter than those in the control group. The intraoperative blood loss in the observation group was lower than that in the control group. The detection rate of intraoperative diseases in the control group (68.00%) was higher than that in the observation group (40.00%), and the incidence of complications in the observation group (0) was lower than that in the control group 32.00%. The difference was statistically significant (P<0.05). The repetition rate of observation group (0) was higher than that of control group (4.00%), P>0.05. Conclusion Laparoscopic surgery in the treatment of pediatric intussusception has the advantages of less trauma, shorter hospitalization time, less postoperative inflammatory reaction, lower incidence of complications, and higher exploration rate of complications during operation, which is worthy of reference.

目的 观察腹腔镜下胆总管切开取石术中胆管一期缝合治疗胆总管结石的临床效果。方法 研究对象选取我院2016年3月—2017年3月术前诊断为胆总管结石且符合纳入标准的患者92例,采用随机法,将其分为一期缝合术组和T管引流术组各46例,两组患者均行腹腔镜下胆总管切开取石术,一期缝合术组行术中胆管一期缝合,T管引流术组行术中胆管T管引流。比较两组手术相关指标,住院时间,住院费用,术后并发症的发生率。结果 一期缝合术组在减少手术出血量、促进切口恢复、预防切口感染的发生率上优于T管引流术组（P < 0.05）;在住院时间、住院费用以及术后并发症的发生率上低于T管引流术组（P < 0.05）。结论 本次研究结果表明腹腔镜下胆总管切开取石术中胆管一期缝合的临床效果优于T管引流,可有效减少手术并发症,缩短病人的住院时间,是治疗胆总管结石理想的选择。

Objective To observe the clinical effect of primary suture in the treatment of common bile duct stones under laparoscopic common bile duct incision. Methods The subjects were enrolled in our hospital from March 2017 to March 2018. 92 patients with choledocholithiasis and met the inclusion criteria, were randomly divided into one-stage suture group and T-tube drainage group. Surgery-related indicators,length of hospital stay,hospitalization costs,and incidence of postoperative complications were compared. Results In the first-stage suture group,the incidence of surgical bleeding reduction,postoperative incision recovery,and prevention of wound infection were better than those in the T-tube drainage group （P < 0.05）. The incidence of hospitalization,hospitalization,and postoperative complications were lower in the first-stage suture group than in the T-tube drainage group（P < 0.05）. Conclusion The clinical effect of one-stage suture in laparoscopic common bile duct incision and stone removal is better than T-tube drainage,which may effectively reduce surgical complications and shorten the hospitalization time of patients. It is an ideal choice for the treatment of common bile duct stones.

目的 研究罗哌卡因阻滞用于胸腹腔镜联合食管癌根治术后镇痛的临床效果。方法 胸腹腔镜联合食管癌根治术患者60例,分为: 观察组(n=30),缝合切口时用0.25%盐酸罗哌卡因10 mL于切口局部浸润;对照组(n=30) 不做局部浸润麻醉处理;记录二组术后2 h、6 h、12 h、24 h、48 h的疼痛视觉模拟评分(VAS)及血浆皮质醇浓度。结果 观察组术后2 h、6 h、12 h VAS评分优于对照组,术后12 h观察组血浆皮质醇浓度低于对照组。结论 罗哌卡因术终阻滞术后12 h内镇痛效果明显。

Objective To evaluate the efficiency of postoperative analgesia with ropivacaine block after thoracoscopic-lapacoscopic esophagectomy (TLE). Methods Totally 60 patients with esophageal cancer underwent TLE were divided into two groups: observation group(n=30)with 0.25% ropivacaine hydrochloride solution 10 mL injection around incision before end of the operation; control group(n=30)without the treatment. The VAS and the plasma Cortisol concentration at 2 h、6 h、12 h、24 h、48 h after surgery were recorded. Results The VAS at 2 h、6 h、12 h after surgery in observation group was higher than that of the control group,but not at 24 h、48 h after surgery. The plasma Cortisol concentration in the observation group was higher than that of in the control at 12 hours postoperatively. Conclusion Ropivacaine block of incision is helpful to have analgesic effect within 12 hours after TLE.

目的 研究腹腔镜腹膜前疝修补术(TAPP)治疗腹股沟疝的微创性。方法 纳入我院96例腹股沟疝患者为研究对象,按随机数表法分为观察组和对照组各48例,观察组予以TAPP法进行治疗,对照组予以平片无张力修补术(Lichtenstein手术)。比较两组术中出血量、手术时间、术后进食时间、术后下床时间、住院时间及手术费用的差别,分析术后两组疼痛程度,同时观察术后并发症及复发情况。结果 观察组术中出血量少于对照组,术后进食时间、下床时间及住院时间短于对照组,手术时间长于观察组,手术费用高于对照组(P<0.05)。观察组疼痛程度为低于对照组(P<0.05)。随访1年,两组均无患者复发。观察组术后并发症发生率为14.58%低于对照组35.42%(P<0.05)。结论 TAPP治疗腹股沟疝临床疗效高,创伤小,恢复快,可降低术后疼痛感,具有微创性。

目的 探讨腹腔镜下输卵管积水既往手术史对血清AMH和卵巢储备功能的影响。方法 选择2016年1月—2016年12月期间在中山市博爱医院生殖内分泌科就诊拟行体外受精—胚胎移植术患者,按照既往的输卵管积水的不同处理方式将患者分为腹腔镜下双侧输卵管切除术组(A组,n=52)、腹腔镜下双侧输卵管开窗术组(B组,n=71)、双侧输卵管阻塞或通而不畅而无积水组(C组,n=96),比较各组在促排卵首日AMH、以及AFC、FSH、LH、E2、孕酮的差异,比较各组Gn治疗时间和用量,以及注射HCG日的成熟卵泡数的差异。结果 A组的AMH、LH低于B组和C组(P<0.05),而B组和C组间AMH、LH差异无统计学意义(P>0.05)。A组AFC水平低于C组(P<0.05),而E2水平高于C组(P<0.05)。A组的FSH高于B组和C组(P<0.05),B组和C组间FSH差异无统计学意义(P>0.05)。三组间孕酮差异无统计学意义(P>0.05)。A组的注射HCG日的成熟卵泡数低于B组和C组(P<0.05),而B组和C组间成熟卵泡数差异无统计学意义(P>0.05)。A组Gn用量高于B组和C组(P<0.05),而B组和C组间Gn用量差异无统计学意义(P>0.05)。三组间Gn治疗时间差异无统计学意义(P>0.05)。结论 通过AMH等指标检测,腹腔镜输卵管切除术会降低患者的卵巢储备功能,而开窗术则影响相对较小,对有生育要求的妇女应考虑行输卵管开窗术等方式以保护卵巢功能。

目的 研究子宫内膜异位症生育指数（EFI）评分对子宫内膜异位症（EMT）患者腹腔镜术后生育指导的应用价值。方法 对2015年3月—2017年4月于我院进行腹腔镜手术治疗的76例EMT患者进行EFI评分,并依据其结果施加相应生育指导,随访2年观察患者术后妊娠情况。结果 随访2年结果显示,76例患者共出现68例妊娠,且其妊娠率及自然妊娠率随EFI评分减少而降低,组间均有性差异（P<0.05）;68例妊娠患者足月分娩率为76.47%,同时不同EFI评分患者不良妊娠结局比较,组间均无显著性差异（P>0.05）。结论 腹腔镜手术能够提高EMT患者妊娠率及自然分娩率,同时可根据EFI评分,综合评估患者的生育状况,对于指导术后处理的选择以及指导后续治疗均有重要参考意义。

Objective To study the application value of uterine endometriosis index （EFI） on the postoperative reproductive guidance of patients with endometriosis （EMT）. Methods From March 2015 to April 2017,76 EMT patients in our hospital underwent laparoscopic surgery for EFI score. On the basis of corresponding guidance,the patients were followed up and observed for 2 years for results in postoperative pregnancies. Results The two-year follow-up period showed that there were 68 cases of pregnancy in 76 cases. Pregnancy rate and natural pregnancy rate decreased with the decrease of EFI score. There was a difference between the groups （P<0.05）. The monthly delivery rate of 68 cases was 76.47%. At the same time,there were no significant differences between the groups in the pregnancy outcomes of patients with different EFI scores （P>0.05）. Conclusion Laparoscopic surgery can improve pregnancy rate and natural delivery rate of EMT patients. At the same time,according to the EFI score,comprehensive assessment of the patient's reproductive status is important for guiding the selection of postoperative treatment and for guiding follow-up treatment.