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find Keyword "开腹" 68 results
  • Analysis of therapeutic effects of 22 cases of mesenteric venous thrombosis

    ObjectiveTo analyze the therapeutic effects of open surgery and endovascular treatment for mesenteric venous thrombosis.MethodsThe clinical data of 22 patients with mesenteric venous thrombosis from March 2005 to January 2014 were analyzed retrospectively. One patient underwent open surgery including removal of necrotic small intestine and thrombectomy of superior mesenteric vein immediately admission to the hospital. Five cases were treated with simple anticoagulation and cured. Sixteen cases received thrombolytic therapy after primary anticoagulant therapy.ResultsOne case who underwent open surgery died of multiple organ failure at 72 h after the surgery. Five cases who received simple anticoagulant reached clinical relief finally. Sixteen patients who received thrombolytic therapy achieved recanalization totally or partially. Three cases died during follow-up (3 months to 7 years, average) of which 1 died of recurrence of acute superior mesenteric venous thrombosis, 1 died of myocardial infarction, and 1 died of stroke.ConclusionsFor patients with symptomatic mesenteric venous thrombosis, if there is no intestinal necrosis, there will be encouraging results by interventional thrombolytic therapy. And the treatment effect needs further experience accumulation in more cases.

    Release date:2020-10-21 03:05 Export PDF Favorites Scan
  • Clinical comparative study of different kinds of primary lesion resection combined with D2 lymph node dissection in treatment of elderly patients with advanced gastric cancer

    Objective To investigate the clinical effects and safety differences of open surgery and laparoscopy primary lesion resection combined with D2 lymph node dissection in the treatment of elderly patients with advanced gastric cancer. Methods One hundred and forty elderly patients with advanced gastric cancer were chosen and randomly divided into two group including open operative group (70 patients) with primary lesion resection combined with D2 lymph node dissection by open operation and laparoscopic surgery group (70 patients) with primary lesion resection combined with D2 lymph node dissection by laparoscopy; and the operative time, intraoperative bleeding amount, the levels of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of haemoglobin (Hb) after operation, the hospitalization time, the number of lymph node dissection, the survival rate with followed-up and postoperative complication incidence of both groups were compared. Results There was no significant difference in the operative time between 2 groups (P>0.05). The intraoperative bleeding amount, the level of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of Hb after operation and the hospitalization time of laparoscopic surgery group were significantly better than open operative group (P<0.05). The level of PaCO2 in operation of laparoscopic surgery group was significantly higher than open operative group (P<0.05). There were no significant difference in the gastric lymph node dissection number and the peripheral lymph node dissection number of gastric artery between 2 groups (P>0.05). There were no significant difference in the survival rates between the 2 groups after 3-year followed-up (P>0.05). The complication incidence after operation of laparoscopic surgery group was significantly lower than open operative group (P<0.05). The quality of life scores of patients in laparoscopic surgery group were significantly higher than those in open operative group on 7 days and in 3 months after operation, and the difference were statistically significant (P<0.05). Conclusion Compared with open operation, primary lesion resection combined with D2 lymph node dissection by laparoscopy in the treatment of elderly patients with advanced gastric cancer can efficiently possess the advantages including minimally invasive, shorter recovery time and less postoperative complications.

    Release date:2017-07-12 02:01 Export PDF Favorites Scan
  • 腹腔镜与开腹手术治疗 Mirizzi 综合征的临床疗效比较

    目的 比较腹腔镜和开腹手术治疗 Mirizzi 综合征的临床疗效。 方法 回顾性收集解放军第 451 医院全军腹腔镜中心于 2010 年 1 月至 2014 年 12 月期间收治的 69 例 Mirizzi 综合征患者的临床资料,根据接受的手术类型分为腹腔镜组(n=36)和开腹组(n=33),比较腹腔镜组和开腹组患者的手术疗效。 结果 腹腔镜组患者的手术时间〔(56.2±19.4)min比(86.2±22.1)min〕、术中出血量〔(47.5±25.4)mL比(104.9±41.6)mL〕、术后进食时间〔(12.4±5.6)h比(29.2±10.4)h〕、术后排气时间〔(11.4±5.7)h比(25.4±6.6)h〕和住院时间〔(5.4±2.4)d比(8.9±3.1)d〕均短于开腹组,差异均有统计学意义(P<0.05)。术后腹腔镜组发生胆瘘 2 例,并发症发生率为 5.56%;开腹组发生胆瘘 1 例,肺部感染 1 例,并发症发生率为 6.06%,2 组患者的近期并发症发生率比较差异无统计学意义(P>0.05)。术后所有患者均获访,随访时间为 10~35 个月,中位数为 19 个月。随访期间,腹腔镜组和开腹组各有 1 例患者新发胆瘘,远期并发症发生率分别为 2.78% 和 3.03%,2 组患者的远期并发症发生率比较差异也无统计学意义(P>0.05)。所有患者随访期间均无胆管狭窄和结石残留发生。 结论 腹腔镜治疗Ⅰ型和Ⅱ型 Mirizzi 综合征安全有效,可减轻对患者的创伤并加快恢复,对于术前明确诊断的患者可首选腹腔镜治疗。

    Release date:2017-07-12 02:01 Export PDF Favorites Scan
  • Application of Ultrasonic Harmonic Scalpel in The Open Surgical Treatment of Gastrointestinal Cancer

    目的 探讨超声刀(ultrasonic harmonic scalpel,UHS)在消化道恶性肿瘤开腹手术中的应用价值。方法 回顾性分析2009年10月至2011年10月期间广西壮族自治区人民医院普通外科-小儿外科收治并由同一手术者进行消化道恶性肿瘤开腹手术的186例患者的临床资料,根据接受手术的种类(UHS开腹手术或传统电刀开腹手术)将其分为UHS组(86例)和传统电刀组(100例),比较2组患者的手术切口长度、手术时间、术中出血量、术后3d引流量、术后住院时间以及住院总费用。结果 UHS组手术切口长度、手术时间、术中出血量以及术后住院时间均短于(少于)传统电刀组(P<0.05);术后3d引流量和住院总费用2组间比较差异均无统计学意义(P>0.05)。结论 将UHS应用于消化道恶性肿瘤开腹手术可获得较好的效果,能提高手术操作的效率,具有很好的应用前景。

    Release date:2016-09-08 10:36 Export PDF Favorites Scan
  • 腹腔镜胆囊切除术中转开腹相关因素分析

    目的探讨腹腔镜胆囊切除术(LC)中转开腹的相关因素。 方法回顾性分析2002年12月至2012年12月期间笔者所在医院6 038例LC中168例中转开腹患者的临床资料。 结果本组中转开腹率为2.8%,其中主动中转开腹120例,主要原因为胆囊三角及胆囊与周围组织严重粘连、胆总管及胆囊管变异等;被动中转开腹48例,主要原因为术中出血镜下难以处理(胆囊床、胆囊动脉损伤等)、肝外胆管损伤等。168例均成功完成相应手术,术后恢复顺利,治愈出院。 结论LC术中转开腹的发生与多种因素有关,其常见原因有手术区严重粘连、肝外胆管损伤等。提高技术水平、严格掌握LC的适应证,可降低中转开腹率,及时中转开腹可减少严重并发症的发生。

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  • Clinical analysis of laparoscopic common bile duct reexploration in treatment of bile duct stones

    Objective To evaluate safety, efficacy, and indications of laparoscopic bile duct reexploration in treatment of bile duct stones. Methods Fifty-seven patients with bile duct stones who underwent laparoscopic common bile duct reexploration (laparoscope group) and 62 patients with bile duct stones who underwent open common bile duct reexploration (laparotomy group) were included into this study from February 2013 to February 2017 in the Renmin Hospital of Wuhan University. The intraoperative and postoperative data of the patients were documented and analyzed. Results All the operations were performed successfully and all the patients had no extra-damage during the operation. One case was converted to the laparotomy due to the intraabdominal serious adhesion in the laparoscope group. Compared with the laparotomy group, the amount of intraoperative blood loss was less, the first time of anal exhaust was earlier, the rates of postoperative analgesia and incision infection were lower, and the length of hospital stay was shorter in the laparoscope group, there were significant differences (P<0.05). There were no significant differences in the operative time, the hospitalization expense, primary suture rate of common bile duct, and the rates of postoperative complications such as the bile leakage, bile duct stricture, and residual stone between the laparoscope group and the laparotomy group (P>0.05). Conclusion With experienced skills and strict surgical indications, laparoscopic common bile duct reexploration is safe and effective in treatment of bile duct stones, and it has some advantages including less bleeding, rapid recovery, and shorter hospitalization time.

    Release date:2018-01-16 09:17 Export PDF Favorites Scan
  • Laparoscopic Hepatectomy Compared with Conventional Open Hepatectomy for Hepatocellular Carcinoma: A Systematic Review

    Objective To evaluate the efficiency and safety of laparoscopic hepatectomy (LH) and conventional open hepatectomy (OH) in patients with hepatocellular carcinoma (HCC). Methods We searched The Cochrane Library, MEDLINE (1966~2008.3), EMBASE (1966~2008.3), CBM (1979~2008.3), we also handsearched some Chinese journals. Using a defined search strategy, randomized controlled trails and controlled clinical trials of comparing OH with LH for hepatocellular carcinoma were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trails was evaluated by Deeks JJ’s evaluation criterion. Meta–analysis was done using the Cochrane collaboration’s Revman 4.2.10. Results Seven controlled clinical trials (309 patients) were included, The meta–analysis showed that: (1) Four studies (n=198) reported mortality, the mortality rate of the LH group was not significantly different from that of the OH group [OR=1.14, 95%Cl (0.15, 8.65), P=0.90]; (2) Two studies (n=91) reported blood transfusion. There were no significant differences between the two treatment groups in terms of the blood transfusion [OR=0.20, 95%Cl (0.03, 1.19), P=0.08]; (3) Four studies (n=165) reported operation time. There were significant differences in operating time between the two groups [SMD=1.05, 95%CI (0.72, 1.38), Plt;0.000 01]; (4) Four studies (n=165) reported intraoperative blood loss. There were significant differences in intraoperative blood loss between the two groups [SMD= – 1.56, 95%Cl (– 2.39, – 0.73), P=0.000 2]; (5) Five studies (n=210) reported the duration of hospital stay. There were significant differences in duration of hospital stay between the two groups [WMD= – 3.89, 95%CI (– 5.54, – 2.23), Plt;0.000 01]; (6) Two studies (n=248) reported complications. There were significant differences in complications between the two groups [OR=0.31, 95%Cl (0.13, 0.72), P=0.006]; (7) Two studies (n=97) reported ALT. There were significant differences in ALT between the two groups [SMD= – 1.54, 95%Cl (– 207, – 1.01), Plt;0.000 01]. Conclusion LH is associated with less postoperative complications, operative blood loss, duration of hospital stay and lower ALT, but longer operation time. However, the trails available for this systematic review are limited, so a prospective randomized controlled trial is warranted to fully investigate these and other outcome measures.

    Release date:2016-08-25 02:51 Export PDF Favorites Scan
  • 十二指肠乳头肿瘤局部切除术应用

    【摘要】 目的 探讨十二指肠乳头肿瘤局部切除术在基层医院的应用。 方法 2006年4月-2009年10月,对5例十二指肠乳头肿瘤患者开腹行局部切除术。 结果 5例十二指肠乳头肿瘤局部切除术均成功完成,无手术死亡和并发症。 结论 严格掌握适应证,局部切除术对十二指肠乳头肿瘤是一种适于基层开展、安全有效的可选择术式。

    Release date:2016-09-08 09:51 Export PDF Favorites Scan
  • The clinical effect of laparoscopic and open surgery in treatment of gastric cancer and their effect on the blood coagulation state

    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.

    Release date:2017-06-19 11:08 Export PDF Favorites Scan
  • COMPARISON OF ENDOVASCULAR REPAIR AND OPEN REPAIR FOR RUPTURED ABDOMINAL AORTIC ANEURYSM

    Objective To compare the effectiveness between conventional open repair (OR) and endovascular repair (EVRAR) for ruptured abdominal aortic aneurysm. Methods Between March 2000 and July 2011, 48 cases of ruptured abdominal aortic aneurysm were treated by conventional OR in 40 cases (OR group) or by EVRAR in 8 cases (EVRAR group). There was no significant difference in age, sex, the neck length (less than 2 cm), the neck angulation of aneurysm (more than60°), il iac severe tortuosity, preoperative systol ic pressure, and preoperative comorbidity between 2 groups (P gt; 0.05). The blood transfusion volume, operation time, intensive care unit (ICU) stay, postoperative complications, reinterventions, and mortality were analyzed. Results There was no significant difference in 24-hour and 30-day mortality rates and non graft-related complications between 2 groups (P gt; 0.05). EVRAR group was significantly better than OR group in blood transfusion volume, operation time, and ICU stay (P lt; 0.05), but OR group was significantly better than EVRAR group in reinterventions and graftrelated complications (P lt; 0.05). Conclusion EVRAR has obvious advantages in blood transfusion volume, operation time, and ICU stay, so it is feasible for ruptured abdominal aortic aneurysm in patients with precise anatomical suitability.

    Release date:2016-08-31 04:23 Export PDF Favorites Scan
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