ABSTRACT
Objective To investigate the effect of carbon dioxide (CO2) pneumoperitoneum with different duration periods on renal function.Methods Eighty-nine patients undergoing laparoscopic operations from October 2009 to December 2011 were divided into 3 groups according to operative time.The patients whose operative time was less than 1 hour belonged to group T1,between 1 hour and 2 hours belonged to group T2,and more than 2 hours belonged to group T3.The levels of serum creatinine,urinary creatinine,urinary microalbumin were detected at preoperation as well as 10 minutes,1 hour,24 hours after operation.Results There was no significant difference regarding of the endogenous creatinine clearance rate(Ccr) postoperatively between group T1 and T2 (P ＞ 0.05).The Ccr levels at 10 minutes after operation in group T3 was significant lower than at preoperation(P ＜0.05),and increased gradually at 1 h and 24 h after operation.The ratio of urinary microalbumin to urinary creatinine (A/C) increased at post-operation compared with at pre-operation in all 3 groups (P ＜ 0.05),but there was no significant difference between the 3 groups after operation (P ＞ 0.05).The renal function post-operation of patients over 60 years old was as same as that of patients less 60 years old in group T1 (P ＞ 0.05).However,the Ccr level in patients over 60 years old at post-operation was lower than that of patients less 60 years old in group T2 and T3 (P ＜ 0.05).Conclusion Long CO2 pneumoperitoneum could lead to the acute and obvious injury on renal function,especially in the patients over 60 years old.Fortunately,the renal function recovered to be normal gradually in a short time.
ABSTRACT
Objective To explore clinical effect of choledocholithotomy by laparoscopy-assisted choledochoelectroscopy and endoscopic retrograde cholangiopancreatography.Methods The clinical data of 126 gallstone and choledocholithiasis patients treated by laparoscopy-assisted choledochoelectroscopy(L group)and endoscopic retrograde cholangiopancreatography(E group)were analyzed retrospectively.In L group,the patients were performed LC and choledocholithotomy by laparoscopy-assisted choledochoelectroscopy directly,but in E group,the treatment procedures were finished by two steps.Firstly,the bile duct stones were carried out by ERCP,days later LC operations were performed.Between the two groups,the hospital days,costs,the rate of residual stone,the rate of bihary infection or panereatitis and the rate of stone recur were compared.Results In the two groups,hospital days were(6.5±0.3)d and(12.5±0.5)d,costs were(1.22±0.17)and(1.98±0.24)ten thousand yuan,the rate of residual stone was 0 and 5.3%,the rate of biliary infection or pancreatitis was 1.4%and 15.8%,and the rate of stone recur was 1.4%and 10.5%respectively.When compared each other the difference was statistically significant(t=2.48,1.96,χ2=4.32,4.90,8.79,all P＜0.05).Conclusion In patients with gallstone and bile duct stones,laparoscopy-assisted choledochoelectroseopy presented more predominances when compared with two steps methods.
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Objective To compare the effect of postoperative intercostal nerves cryoanalgesia and patient controlled epidural analgesia (PCEA) in patients undergoing thoracic surgery. Methods From April 2006 to May 2008,89 patients undergoing thoracic surgery were randomly divided into intercostal nerves cryoanalgesia group (group A,47 cases) and PCEA group (group B,42 cases). The scores of pain, use of pain medication and time of out-of-bed activity after the operation were used to evaluate the effect of pain between two groups. Results The scores of pain in group A and group B were (1.49 ± 0.80) and (2.43 ± 1.21) scores respectively. There were significant differences in the scores of pain. The use of pain medication [(1.28 ± 0.62) times vs (2.02 ± 1.05) times]and time of out-of-bed activity after the operation [(43.15 ± 12.22) h vs (64.10 ± 14.25) hi were significant difference between the two groups(P< 0.05). Conclusions For reducing the post- thoracotomy pain,intercostal nerves cryoanalgesia is superior to PCEA. Intercostal nerves cryoanalgesia can provide satisfactory analgesia after thoracic surgery.
ABSTRACT
Colorectal cancer is one of the malignant tumors that endangers human health. Nowadays the surgery is the primary therapy for colorectal cancer. Laparescopic surgery has developped for more than ten years. It consolidates its position in the field of colorectal surgery gradually. We now make a comparison of laparoscopic surgery and open surgery about the safety, the pathophysiological influence and the effective-ness, etc, in order to discuss the value of the laparoscopic surgery in the therapy of colorectal cancer.