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Objective To evaluate of safety and feasibility of thoracoscopic and laparoscopic esophagec -tomy for the treatment of esophageal carcinoma .Methods Retrospective analyses were performed on chest com-bined with laparoscopy in the treatment of 20 patients with esophageal cancer information from september 2013 to July 2014 .The patients were placed at a left lateral decubitus position ,with the thoracoscopic mobilization of the intrathoracic esophagus and lymph node dissection;then in the lithotomy position .Laparoscopic mobilization of the stomach and lymph node dissection were cleared .Finally we pulled out the gastric tube from the esophageal bed to the neck and made stapled esophagogastrostomy in the left neck .Results All patients were not to be opened tho-racic surgery and abdominal surgery .The mean operation time for thoracoscopy was (90 ±30)minutes,The mean operation time for laparoscopic was(65 ±20)minutes,The total operation time was(210 ±40)minutes.The tho-racic blood loss ranged from 60 to 200 mL( mean,110 mL) ,The abdominal blood loss ranged from 30 to 100 mL (mean,60 mL).mean number of mediastinal lymph nodes resected was ranged from 8 to 15(11.2 per ease), mean number of abdominal lymph nodes resected was ranged from 6 to 12(8.4 per ease).Postoperative thoracic drainage was ranged from 200 to 650 mL( mean,350 mL) .mean time to resume oral intake was ranged from 6 to 8 days(mean,7 days),mean postoperative hospital stay was ranged from 11 to 14 days(mean,12 days),All the patients were diagnosis for esophageal squamous cell cancer after operation .Postoperative pathologicalcat staging identified stage T 1~3 N0~1 M0 .There was not tumor at the upper rejection margin and the lower margin .There was not anastomotic leak in postoperative .Postoperative lung infection in1 case.Postoperative recurrent laryngeal nerve injury in 1case.It was successfully followed up with durations 6 months.anastomotie stricture in 1 case after post-operative 3 months,And in endoscopic probe dilatation for patients with anastomotie stricture was successful in three times.20 cases were successfully followed up with durations ranged from 2 to 10 months.There was not spreaded and died in cases .Conclusion Combined thoracoscopic and laparoscopic esophagectomy can reduce trauma and postoperative complications ,which is safe and feasible therapeutic method .
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Objective To evaluate the effect of fast track surgery nursing in perioperative nursing of patients undergoing laparoscopic resection of colorectal cancer. Methods 60 cases undergoing laparoscopic resection of colorectal cancer were divided into the control group and the obserevation group with 30 patients in each group.The control group was given routine nursing,the observation group accepted fast track surgery nursing.The operation situation,clinical effect and the rate of postoperative complications were compared between two groups. Results There was no significant difference of anesthesia duration,operation time and intraoperative blood loss in two groups.Time of getting out of bed,exhaust time and hospital stay in the observation group were much shorter than those in the control group.The rate of postoperative complications were 26.7％ and 46.7％ in the observation group and the control group respectively,the difference was significant. Conclusions Application of fast track surgery nursing in perioperative nursing of patients undergoing laparoscopic resection of colorectal cancer can promote the quick recovery of patients and reduce the hospital stay and postoperative complications.
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Objective To investigate the efficacy of transorally inserted anvil system(OrVilTM)in esophagogastrostomy and esophagojejunostomy after laparoscopic gastrectomy.Methods The clinical data of 34 patients with gastric neoplasms who were installed OrVilTM for esophagogastrostomy or esophagojejunostomy at the Changhai Hospital from July 2009 to February 2011 were retrospectively analyzed.After radical dissection of lymph nodes and full mobilization of esophagus,the esophagus was transected and the anvil was then transorally inserted into the esophagus by using the OrVilTB system.Double-stapling esophagogastrustomy or esophagojejunostomy with a circular stapler Was performed intracorporeally under direct laparuscopic view.Results The surgery was success fully completed in all the 34 patients with no conversion to open surgery.Two patients had difficulty in placing OrVilTM system.and the condition Was alleviated by reducing tension in the cuff and tilting the head back.The mean operation time,volume of blood loss,duration of postoperative hospital stay and time to gastrointestinal function recovery were 175 minutes(range,90-240 minutes),196 ml(range,50-800 ml),7.6 days(range,5-14 days)and 3 days(range,2-6 days).No postoperative anastomotic leakage Was detected.Thirty-three patients were followed up for 2-20 months with a mean time of(10±6)months,and no tumor recurrence or metastasis occurred.Conclusion OrVilTM system changes insert direction of the anvil,which significantly reduces the difficulty of laparoscopic operation,shortens the operation time and avoids the thoracotomy.
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Objective To explore the safety and clinical effects of laparosepie splenectomy.Methods Clinical data of 24 cages of laparoscopic splenectomy in our hospital from 2002 to 2008 were retrospectively analvzed.Among these 24 cases,there were 6 cases with liver cirrhosis,10 cases with ITP,2 cases with hemolytic anemia(Evens syndmm),2 cases with spelenic rupture,and 4 cases optimum spleen ambuty.Results All the 24 cases were successfully underwent laparoscopic splenectomy.The mean operation time wag 146 minute.the mean volume of blood loss was 220 ml.the postoperative gastrointestinal peristalsis time Was from 24 to 48 hours.The mean hospitalization time was 9 days after operation.Conclusions Provided mastering operation indication and technique,Laparoscopie spleneetomy is a safe and minimally invasive surgery.
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Objective In order to know the operative key points of combined endoscopic nephroureterectomy. Methods Retrospective analyzed 16 patients with combined endoscopic nephroureterec-tomy, and then summarized perioperative nursing points. Results All the patients had successful operation without any complications. Conclusions Careful perioperative nursing are the guarantee for successful oper-ation, which can effective promote the rehabilitation for patients.
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Objective To assess the clinical analysis of trans laparoscope hysterectomy(TLH).Methods Retrospectively analyzed the TLH in 62 patients Which were compared with the trans alxtominal hysterectomy(TAH)in 64 patients.Results Blood loss during operation,analgesic use after operation,time to first passing flatus,hospital stay in TVH group were significantly lower than those in TAH group(P＜0.05),and mean operating time has no significant difference in TVH group and TAH group(P＞0.05).Conclusion TVH has been shown to be an effective modus operandi of mini-invasive and safe.
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To observe the hemodynamics changes of patients undergoing laparoscopic cholecystectomy under epidural or general anesthesia. Method: 25 patients were divided into two groups: general(GA, n=11)and epidural (EA, n=14) anesthesia groups. Hemodynamic parameters (HR, MAP, CVP, PCWP, PAP, CO, CI, SVR, PVR) were measured with Swan-Ganz technique after the patients being placed to rT position,CO2 being insufflated into peritoneal cavity, and at the end of operation. Result: 1. In the EA group, CVP reduced significantly after rT position placed, SV, CO, MAP and HR reduced significanty after peritoneal insufflation,but still within normal range. 2. In the GA group, CVP, SV, CO were significant ly reduced after rT position placed; After peritoneal insufflation, all parametere were significantly increased except SV had no significant change. Conclusion:Epidural anesthesia can be safely applied to the ASA Ⅰ-Ⅱ grade patients undergoing laparoscopic cbolecystectomy.