AIM: To compare single incision laparoscopic surgery for an appendectomy (SILS-A) with conventional laparoscopic appendectomy (C-LA) when implemented by experienced surgeons. METHODS: Studies and relevant literature r...AIM: To compare single incision laparoscopic surgery for an appendectomy (SILS-A) with conventional laparoscopic appendectomy (C-LA) when implemented by experienced surgeons. METHODS: Studies and relevant literature regarding the performance of single-incision laparoscopic surgery vs conventional laparoscopic surgery for appendectomy were searched for in the Cochrane Central Register of Controlled Clinical Trials, MEDLINE, EMBASE and World Health Organization international trial register. The operation time (OR time), complications, wound infection and postoperative day using SILS-A or C-LAwere pooled and compared using a meta-analysis. The risk ratios and mean differences were calculated with 95%CIs to evaluate the effect of SILS-A. RESULTS: Sixteen recent studies including 1624 patients were included in this meta-analysis. These studies demonstrated that, compared with C-LA, SILS-A has a similar OR time in adults but needs a longer OR time in children. SILS-A has similar complications, wound infection and length of the postoperative day in adults and children, and required similar doses of narcotics in children, the pooled mean different of -0.14 [95%CI: -2.73-(-2.45), P > 0.05], the pooled mean different of 11.47 (95%CI: 10.84-12.09, P < 0.001), a pooled RR of 1.15 (95%CI: 0.72-1.83, P > 0.05), a pooled RR of 1.9 (95%CI: 0.92-3.91, P > 0.05), a pooled RR of 1.01 (95%CI: 0.51-2.0, P > 0.05) a pooled RR of 1.86 (95%CI: 0.77-4.48, P > 0.05), the pooled mean different of -0.25 (95%CI: -0.50-0, P = 0.05) the pooled mean different of -0.01 (95%CI: -0.05-0.04, P > 0.05) the pooled mean different of -0.13 (95%CI: -0.49-0.23, P > 0.05) respectively. CONCLUSION: SILS-A is a technically feasible and reliable approach with short-term results similar to those obtained with the C-LA procedure.展开更多
目的探讨经脐单一部位腹腔镜下应用9号注射针头腹膜外缝合治疗小儿斜疝的可行性。方法 2011年3～10月对51例小儿斜疝横行切开脐孔皮肤约1.0 cm,开放式置入5 mm trocar后进镜,建立气腹后于切口内5 mm trocar旁盲穿置入3 mm trocar,置抓钳...目的探讨经脐单一部位腹腔镜下应用9号注射针头腹膜外缝合治疗小儿斜疝的可行性。方法 2011年3～10月对51例小儿斜疝横行切开脐孔皮肤约1.0 cm,开放式置入5 mm trocar后进镜,建立气腹后于切口内5 mm trocar旁盲穿置入3 mm trocar,置抓钳。9号针头内穿7号丝线,刺入内环口前壁腹膜外,先内侧后外侧腹膜外环形缝合内环口,腹腔内、皮下分别打结完成疝囊高位结扎。结果 51例手术均成功,8例术中发现对侧隐匿性斜疝。手术时间:32例单侧10～20 min,平均13 min;19例双侧20～35 min,平均24 min。无腹壁皮下气肿、阴囊肿胀等并发症。51例随访2～7个月,平均5个月,无复发。结论经脐单一部位腹腔镜下应用9号注射针头腹膜外缝合治疗小儿斜疝,器械简单,操作容易,效果确切,美容效果好,值得推广。展开更多
目的:总结使用常规器械行经脐腹腔镜技术在腹部手术中的应用价值与前景。方法:回顾2012年5月至2015年1月施行的107例常规器械经脐单孔腹腔镜手术患者的临床资料,分析手术技巧及术后患者恢复情况。结果:2例胆囊切除患者局部致密粘连,胆...目的:总结使用常规器械行经脐腹腔镜技术在腹部手术中的应用价值与前景。方法:回顾2012年5月至2015年1月施行的107例常规器械经脐单孔腹腔镜手术患者的临床资料,分析手术技巧及术后患者恢复情况。结果:2例胆囊切除患者局部致密粘连,胆囊三角解剖困难,于剑突下增加5 mm Trocar,中转为两孔法腹腔镜手术;105例患者顺利完成单孔手术,无腹腔内出血、切口感染、穿刺孔疝等并发症发生,脐周切口疼痛轻微,腹壁几乎见不到疤痕。结论:严格筛选病例,使用常规器械行经脐单孔腹腔镜手术安全、可行,美容效果突出,疼痛轻微,值得临床推广应用。展开更多
Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis,biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conv...Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis,biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conventional treatments and for patients with steroid dependent disease.The reduction in hospitalization and surgical intervention for patients affected by ulcerative colitis after the introduction of biologic treatment remains to be proven.Furthermore,these agents seem to be associated with increase in cost of treatment and risk for serious postoperative complications.Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in ulcerative colitis patients.Surgery is traditionally recommended as salvage therapy when medical management fails,and,despite advances in medical therapy,colectomy rates remain unchanged between 20% and 30%.To overcome the reported increase in postoperative complications in patients on biologic therapies,several surgical strategies have been developed to maintain long-term pouch failure rate around 10%,as previously reported.Surgical staging along with the development of minimally invasive surgery are among the most promising advances in this field.展开更多
In recent years,single access laparoscopic surgery(SALS) and natural orifice translumenal endoscopic surgery(NOTES) have gained interest from both clinical and industrial point of view,with the increased development o...In recent years,single access laparoscopic surgery(SALS) and natural orifice translumenal endoscopic surgery(NOTES) have gained interest from both clinical and industrial point of view,with the increased development of different laparoscopic instruments,production of various access ports,and improvement of operative endoscopes.The main advantages stimulating these two approaches are the cosmetic result,the rapid recovery of the patient,and the reduced need for pain killers.SALS and NOTES are in part complementary and in part alternative techniques.Currently,SALS is much simpler and technically easier than NOTES.展开更多
基金Supported by National Natural Science Foundation of China,No.81201885 and No.81172279
文摘AIM: To compare single incision laparoscopic surgery for an appendectomy (SILS-A) with conventional laparoscopic appendectomy (C-LA) when implemented by experienced surgeons. METHODS: Studies and relevant literature regarding the performance of single-incision laparoscopic surgery vs conventional laparoscopic surgery for appendectomy were searched for in the Cochrane Central Register of Controlled Clinical Trials, MEDLINE, EMBASE and World Health Organization international trial register. The operation time (OR time), complications, wound infection and postoperative day using SILS-A or C-LAwere pooled and compared using a meta-analysis. The risk ratios and mean differences were calculated with 95%CIs to evaluate the effect of SILS-A. RESULTS: Sixteen recent studies including 1624 patients were included in this meta-analysis. These studies demonstrated that, compared with C-LA, SILS-A has a similar OR time in adults but needs a longer OR time in children. SILS-A has similar complications, wound infection and length of the postoperative day in adults and children, and required similar doses of narcotics in children, the pooled mean different of -0.14 [95%CI: -2.73-(-2.45), P > 0.05], the pooled mean different of 11.47 (95%CI: 10.84-12.09, P < 0.001), a pooled RR of 1.15 (95%CI: 0.72-1.83, P > 0.05), a pooled RR of 1.9 (95%CI: 0.92-3.91, P > 0.05), a pooled RR of 1.01 (95%CI: 0.51-2.0, P > 0.05) a pooled RR of 1.86 (95%CI: 0.77-4.48, P > 0.05), the pooled mean different of -0.25 (95%CI: -0.50-0, P = 0.05) the pooled mean different of -0.01 (95%CI: -0.05-0.04, P > 0.05) the pooled mean different of -0.13 (95%CI: -0.49-0.23, P > 0.05) respectively. CONCLUSION: SILS-A is a technically feasible and reliable approach with short-term results similar to those obtained with the C-LA procedure.
文摘目的探讨经脐单一部位腹腔镜下应用9号注射针头腹膜外缝合治疗小儿斜疝的可行性。方法 2011年3～10月对51例小儿斜疝横行切开脐孔皮肤约1.0 cm,开放式置入5 mm trocar后进镜,建立气腹后于切口内5 mm trocar旁盲穿置入3 mm trocar,置抓钳。9号针头内穿7号丝线,刺入内环口前壁腹膜外,先内侧后外侧腹膜外环形缝合内环口,腹腔内、皮下分别打结完成疝囊高位结扎。结果 51例手术均成功,8例术中发现对侧隐匿性斜疝。手术时间:32例单侧10～20 min,平均13 min;19例双侧20～35 min,平均24 min。无腹壁皮下气肿、阴囊肿胀等并发症。51例随访2～7个月,平均5个月,无复发。结论经脐单一部位腹腔镜下应用9号注射针头腹膜外缝合治疗小儿斜疝,器械简单,操作容易,效果确切,美容效果好,值得推广。
文摘目的:总结使用常规器械行经脐腹腔镜技术在腹部手术中的应用价值与前景。方法:回顾2012年5月至2015年1月施行的107例常规器械经脐单孔腹腔镜手术患者的临床资料,分析手术技巧及术后患者恢复情况。结果:2例胆囊切除患者局部致密粘连,胆囊三角解剖困难,于剑突下增加5 mm Trocar,中转为两孔法腹腔镜手术;105例患者顺利完成单孔手术,无腹腔内出血、切口感染、穿刺孔疝等并发症发生,脐周切口疼痛轻微,腹壁几乎见不到疤痕。结论:严格筛选病例,使用常规器械行经脐单孔腹腔镜手术安全、可行,美容效果突出,疼痛轻微,值得临床推广应用。
文摘Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis,biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conventional treatments and for patients with steroid dependent disease.The reduction in hospitalization and surgical intervention for patients affected by ulcerative colitis after the introduction of biologic treatment remains to be proven.Furthermore,these agents seem to be associated with increase in cost of treatment and risk for serious postoperative complications.Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in ulcerative colitis patients.Surgery is traditionally recommended as salvage therapy when medical management fails,and,despite advances in medical therapy,colectomy rates remain unchanged between 20% and 30%.To overcome the reported increase in postoperative complications in patients on biologic therapies,several surgical strategies have been developed to maintain long-term pouch failure rate around 10%,as previously reported.Surgical staging along with the development of minimally invasive surgery are among the most promising advances in this field.
文摘In recent years,single access laparoscopic surgery(SALS) and natural orifice translumenal endoscopic surgery(NOTES) have gained interest from both clinical and industrial point of view,with the increased development of different laparoscopic instruments,production of various access ports,and improvement of operative endoscopes.The main advantages stimulating these two approaches are the cosmetic result,the rapid recovery of the patient,and the reduced need for pain killers.SALS and NOTES are in part complementary and in part alternative techniques.Currently,SALS is much simpler and technically easier than NOTES.
