ABSTRACT
Objective-To-discuss-the-value-of-fast-track-surgery-(-FTS-)-in-perioperative-period-of-laparoscopic-cholecystectomy-.-Methods-We-selected-200-cases-of-laparoscopic-cholecystectomy-in-our-hospital-from-January-2012-to-December-2012.The-cases-were-randomly-divided-into-either-traditional-group-(control-group)-or-fast-track-surgery-group-(FTS-group),-with-100-cases-in-each-group-.The-operation-time-,-intraoperative-blood-loss-,-time-to-get-out-of-bed-after-operation-,-time-to-intake-semi-liquid-diet,-time-to-flatus,-time-to-defecation,-and-length-of-hospital-stay-were-compared-.-Results-Compared-with-the-control-group-,-the-FTS-group-had-shorter-time-to-semi-liquid-diet-[(11.3-±2.0)-h-vs.(50.2-±8.7)-h,-t=-43.976,-P=0.000],-shorter-ambulation-time-[(6.2-±1.5)-h-vs.(14.3-±1.7)-h,-t=-35.728,-P=0.000],-shorter-flatus-time-[(12.0-±4.4)-h-vs.(24.9-±5.4)-h,-t=-18.519,-P=0.000],-shorter-defecation-time-[(15.8-±5.3)-h-vs.(25.2-±4.3)-h,-t=-13.773,-P=0.000],-and-shorter-postoperative-hospital-stay-[(3.2-±1.3)-d-vs.(4.2-±2.1)-d,-t-=-4.048,-P=0.000].-Conclusion-Fast-track-surgery-is-feasible-and-safe-,being-helpful-for-patient-’-s-postoperative-recovery-.
ABSTRACT
Objective To explore the application value of hand-assisted laparoscopic splenectomy and pericardial devascularization in the treatment of liver cirrhosis and portal hypertension. Methods Hand-assisted laparoscopic operations of splenectomy in 10 patients and pericardial devascularization in 13 patients were completed by using the LigaSure device and harmonic scalpel. Results All the operations were completed successfully under laparoscope. Of splenectomy, the operative time was 63?15.5 min and the estimated blood loss was 32.4?21.2 ml. Of pericardial devascularization, the operative time was 115.3?25.5 min and the estimated blood loss was 52.4?24.2 ml. All the patients got out of bed and moved around at 12.2?3.8 h after operation. Conclusions [WTBZ]Hand-assisted laparoscopic splenectomy and pericardial devascularization using the LigaSure device and harmonic scalpel has advantages of high reliability, little blood loss, and quick postoperative recovery. The procedure can be used in the management of portal hypertension and hypersplenism.
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Objective To evaluate the feasibility and clinical efficacy of laparoscopic biliary reoperation. Methods From May 2000 to May 2007, 105 patients received laparoscopic biliary reoperation, including choledocholithotomy and T-tube drainage in 96 cases, Roux-en-Y anastomosis of the gallstone/hepatic-duct in 5, and liver resection in 4. Results The operations were completed in all the 105 patients without severe complications. The operation time was 60-185 min [mean, (125.3?23.2) min]. Intraoperative blood loss was 15-310 ml [mean, (21.1?8.6) ml]. The patients stayed at hospital for 5-9 days after the operation. The 5 patients, who underwent Roux-en-Y anastomosis of the gallstone/hepatic-duct, were followed up for 6 to 65 months [mean, (13.2?8.6)months]. Partial liver resection was performed in 2 cases (resection of the left hepatic lobe in 2, and the right lobe in 2); they were followed up for 8-25 months [mean, (10.2?3.6)months]. In the 96 patients, who received laparoscopic choledocholithotomy and T-tube drainage, the follow-up were lasted for 3-72 months [mean, (13.2?9.6)months]. None of the patients who were followed up had recurrence of gallbladder stone. Conclusions Laparoscopic biliary reoperation is feasible and safe with minimal trauma to patients.
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Objective To sum up the experience of laparoscopic assisted radical resection for colorectal cancer. Methods Radical resection was operated on 40 patients with colorectal cancer under laparoscope. According to the Dukes’ classification, 21 patients were classified as stage A, 16 patients as stage B and 3 patients, stage C.There were 2 cases of cecum cancer, 4 cases of ascending colon cancer, 13 cases of sigmoid colon cancer, and 21 cases of rectum cancer. Results Laparoscopic assisted operations were accomplished in all the 40 patients. The operation time was 110.8?23.5 min and the intraoperative blood loss was 150.4?23.2 ml. The patients began to ambulate 12.2?3.8 hours after the surgery and the time to first passing flatus was 39.3?4.2 hours. Follow- up for 2～72 months (mean, 38.5 months) found no metastasis, local recurrence, and port or incision implantation in all the patients but one,who refused chemotherapy and had a cancer recurrence one year after surgery. Conclusions Laparoscopic radical resection is applicable to colorectal cancer at Dukes’ stage A, B, or C, in which the lymph nodes can be removed as thoroughly as open radical surgery.
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Objective To summarize the experience on the prevention of severe complications of endoscopic thyroidectomy.Methods Twelve cases of bilateral lesions underwent endoscopic thyroidectomy via precordial approach and 41 cases of unilateral lesions, via subaxillary approach. A subcutaneous channel, with a width of about 5 cm from the incision site to the thyroid, was made by using self-made instruments. The CO 2 pressure was set at 4 mm Hg. By ultrasonic scalpel the lesions were divided and removed. Results There were 41 cases of thyroid adenoma (unilateral, 34 cases; bilateral, 7 cases) and 12 cases of nodular goiter (unilateral, 7 cases; bilateral, 5 cases). Postoperative subcutaneous hematoma occurred in 1 case and was cured by conservative management. No nerve damage or parathyroid complications were observed. Conclusions Application of ultrasonic scalpel and continued low cavity pressure are effective means for preventing complications in endoscopic thyroidectomy.
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Objective To study the feasibility of the ultrasonic scalpel in the management of cystic blood vessels during laparoscopic cholecystectomy(LC). Methods Abdominal blood vessels of two dogs were managed by ultrasonic scalpel under the conditions of two step output power,low tension,low holding force and blunt scalpel head.The blood vessels were sealed and arteries and veins of (1～11)mm were cut.On this basis,the technique was applied to the management of cystic vessels during laparoscopic cystic and biliary operation. Results The sealing and cutting effect was good for the blood vessels of less than 9mm 140/150(93 3%).No blood oozing was found at the cutting ends of blood vessels during and after operation.In all 706 cases of laparoscopic gallbladder and biliary duct operations,no bleeding was found at the cutting ends of blood vessels during and after operation. Conclusions Ultrasonic scalpel can be directly used to seal and cut cystic artery during laparoscopic cholecystectomy.
