Aims: Ergonomics and proper planning of surgical procedures are the basis of success for laparoscopy in children. The successful execution of a laparoscopic procedure requires a great familiarity with the equipment an...Aims: Ergonomics and proper planning of surgical procedures are the basis of success for laparoscopy in children. The successful execution of a laparoscopic procedure requires a great familiarity with the equipment and the positioning of the operators. This is to avoid unnecessary surgical team fatigue that affects the duration and effectiveness of the intervention. We conducted a study on our laparoscopic procedures to determine the effectiveness and usefulness of the application of ergonomics and a regular use of a preoperative checklist. Materials and Methods: We studied the laparoscopic operations performed by a single operator between January 2008 and July 2011. These factors were considered: the position and orientation of equipment, crew and patient discomfort, and the problems encountered by the operators. We used as evaluation criteria the diagrams proposed by Lenoir and Steinbrecher and an appropriate preoperative checklist. Results: Of the 49 measures considered, only 22 procedures were useful and met the evaluation criteria. No correlation, referring to the physical measures, were detected in operations lasting <60 minutes. The fatigue of the operating team grew, even if non-exponentially, after the first hour of operation. In the 22 procedures considered, there were 71 “adverse” episodes that delayed or complicated the procedure;most of these were related to inadequate preparation of the operating room, instruments, or operators (malfunction of synthesis equipment, unavailability of instruments, insufficient number of principals, malposition of trocars, or unavailability of image intensifier). After the adoption of checklist, verified in the subsequent 18 procedures, only 10 adverse episodes occurred. Conclusions: Our study seems to confirm that simple steps related to proper planning of laparoscopic procedures were directly linked to the effectiveness of surgical performance and duration of the intervention. The preoperative checklist we set, in our experience, resulted as very useful in preventing intra-operative problems.展开更多
Objective:To analyze the therapeutic effect of laparoscopy combined with choledochoscopy in the treatment of difficult cholelithiasis.Methods:A total of 60 patients with difficult cholelithiasis admitted for treatment...Objective:To analyze the therapeutic effect of laparoscopy combined with choledochoscopy in the treatment of difficult cholelithiasis.Methods:A total of 60 patients with difficult cholelithiasis admitted for treatment from January 2022 to December 2024 were selected and evenly divided into two groups using a random number table.The combined group received laparoscopy combined with choledochoscopy treatment,while the single group received laparoscopy treatment alone.The total treatment efficacy,perioperative indicators,angiotensin(Ang)levels,quality of life scores,and complication rates were compared between the two groups.Results:The total treatment efficacy in the combined group was higher than that in the single group;except for operative time,the perioperative indicators in the combined group were superior to those in the single group;the Ang levels after treatment in the combined group were lower than those in the single group,and the quality of life scores were higher(P<0.05).The complication rate in the combined group was lower than that in the single group(P<0.05).Conclusion:Laparoscopy combined with choedochoscopy can enhance the treatment effectiveness for patients with difficult cholelithiasis,improve perioperative indicators,regulate their Ang levels,elevate quality of life,and demonstrate high surgical safety.展开更多
BACKGROUND Diagnostic laparoscopy is a minimally invasive surgical method to diagnose intra-abdominal diseases.AIM To evaluate patients with unexplained ascites who could not be definitively diagnosed via advanced rad...BACKGROUND Diagnostic laparoscopy is a minimally invasive surgical method to diagnose intra-abdominal diseases.AIM To evaluate patients with unexplained ascites who could not be definitively diagnosed via advanced radiological and endoscopic methods and serological,cytological,and microbiological examinations and,therefore,underwent diag-nostic laparoscopy.METHODS This retrospective analysis evaluated 82 patients who underwent diagnostic laparoscopy due to unexplained ascites.Patients’medical records were obtained from the hospital database.Their age,sex,complaints at admission,laboratory results,radiological imaging results,diagnostic laparoscopy reports,and pa-thology reports were analyzed.RESULTS The serum-ascites albumin gradient was<1.1 in 96.3%of the patients(n=79).Among patients,22(26.8%)had benign diagnoses and 60(73.2%)had malignant diagnoses.In addition,55(67.1%)were deceased,and the median follow-up time from diagnosis to death was four months.The overall follow-up time ranged from 1 to 142 months,with a median of 14 months.Patients’diagnoses were significantly associated with their survival(P<0.05,χ2 test).The mortality rate was 86.7%among patients with malignant diagnoses and 13.6%among patients with benign diagnoses.CONCLUSION Diagnostic laparoscopy is minimally invasive,has a low complication rate,and requires a short hospital stay.It can be safely performed to diagnose and treat ascites that remain unexplained after advanced radiological and endoscopic examinations.展开更多
BACKGROUND Ganglioneuroma is a rare,well-differentiated,slow-growing benign tumor of the peripheral nerves,with surgical resection being the only curative treatment.Surgical resection of ganglioneuromas encasing major...BACKGROUND Ganglioneuroma is a rare,well-differentiated,slow-growing benign tumor of the peripheral nerves,with surgical resection being the only curative treatment.Surgical resection of ganglioneuromas encasing major blood vessels remains a substantial clinical challenge.Traditionally,these cases often require open abdominal surgery or combined organ resections,and in some instances,the tumors are considered unresectable.Currently,no reports have described the resection of such tumors via laparoscopy.CASE SUMMARY A 35-year-old woman was admitted to our hospital after the incidental discovery of a retroperitoneal space-occupying lesion.Imaging revealed a mass with the celiac axis and superior mesenteric artery passing through it.A neurogenic tumor was suspected,with ganglioneuroma being the most likely diagnosis.Following comprehensive preoperative preparation,the retroperitoneal tumor was resected using a three-dimensional laparoscopy combined with an organ suspension technique.The surgical approach involved incising the tumor along the vascular axis and conducting meticulous,vascular-preserving tumor excision.The operation lasted approximately 458 minutes,with an estimated blood loss of 50 mL.The patient was discharged on the 8th postoperative day.A transient liver injury occurred after surgery but improved rapidly.After 11 months of postoperative follow-up,no complications or tumor recurrence were observed.CONCLUSION This case illustrates the feasibility of minimally invasive laparoscopic resection for retroperitoneal ganglioneuromas encasing major blood vessels.展开更多
Objective:To explore the effects of high-quality nursing intervention on negative emotions and quality of life in gynecological patients after laparoscopy.Methods:A total of 132 gynecological patients after laparoscop...Objective:To explore the effects of high-quality nursing intervention on negative emotions and quality of life in gynecological patients after laparoscopy.Methods:A total of 132 gynecological patients after laparoscopy were randomly divided into an observation group(n=66)and a control group(n=66)in a prospective study.The con-trol group received routine nursing care,while the observation group received high-quality nursing intervention.Anxiety,depression,quality of life,postoperative pain,self-care ability,and patient satisfaction were compared between the two groups.Results:The Self-Rating Anxiety Scale and Self-Rating Depression Scale scores were sig-nificantly lower in the observation group compared to the control group(both P<0.001).Pain scores at 6,24,48,and 72 hours post-surgery were also lower in the observation group(all P<0.001).The observation group showed significantly higher scores in physical function,general health,social function,emotional role,and mental health(all P<0.001).Furthermore,the observation group demonstrated better self-care skills,self-concept,self-care responsibility,and health knowledge(all P<0.001).Nursing satisfaction during hospitalization was significantly higher in the observation group than in the control group(P<0.05).Conclusion:High-quality nursing intervention is effective in improving depression,anxiety,postoperative pain,and quality of life in gynecological patients after laparoscopy.It also enhances self-care ability and patient satisfaction,making it worthy of clinical promotion and application.展开更多
目的:比较完全腹腔镜远端胃癌根治术与腹腔镜辅助远端胃癌根治术对胃癌患者术后恢复情况、疼痛应激反应及外周血T细胞亚群变化的影响。方法:回顾性选取2023年3月—2024年3月在句容市人民医院行远端胃癌根治术治疗的97例患者。根据治疗...目的:比较完全腹腔镜远端胃癌根治术与腹腔镜辅助远端胃癌根治术对胃癌患者术后恢复情况、疼痛应激反应及外周血T细胞亚群变化的影响。方法:回顾性选取2023年3月—2024年3月在句容市人民医院行远端胃癌根治术治疗的97例患者。根据治疗方式不同分为腹腔镜辅助组(49例)和完全腹腔镜组(48例)。观察两组的术后恢复指标、前列腺素E2(PGE2)、β-内啡肽、P物质、CD3^(+)、CD4^(+)、CD8^(+)水平及并发症发生情况。结果:完全腹腔镜组术后下床时间、术后排便时间早于腹腔镜辅助组,术后引流管留置时间、住院时间均短于腹腔镜辅助组(P<0.05)。与术前比较,两组术后1 d血清PGE2、β-内啡肽、P物质水平均升高,但完全腹腔镜组上述指标均较腹腔镜辅助组低(P<0.05)。与术前比较,两组术后1 d CD3^(+)、CD4^(+)均降低,CD8^(+)升高,但完全腹腔镜组CD3^(+)、CD4^(+)较腹腔镜辅助组高,CD8^(+)较腹腔镜辅助组低(P<0.05)。完全腹腔镜组的术后并发症总发生率低于腹腔镜辅助组(P<0.05)。结论:相较于腹腔镜辅助远端胃癌根治术,完全腹腔镜远端胃癌根治术能加速患者恢复,减轻疼痛应激,并优化外周血T细胞亚群比例,安全性更高。展开更多
文摘Aims: Ergonomics and proper planning of surgical procedures are the basis of success for laparoscopy in children. The successful execution of a laparoscopic procedure requires a great familiarity with the equipment and the positioning of the operators. This is to avoid unnecessary surgical team fatigue that affects the duration and effectiveness of the intervention. We conducted a study on our laparoscopic procedures to determine the effectiveness and usefulness of the application of ergonomics and a regular use of a preoperative checklist. Materials and Methods: We studied the laparoscopic operations performed by a single operator between January 2008 and July 2011. These factors were considered: the position and orientation of equipment, crew and patient discomfort, and the problems encountered by the operators. We used as evaluation criteria the diagrams proposed by Lenoir and Steinbrecher and an appropriate preoperative checklist. Results: Of the 49 measures considered, only 22 procedures were useful and met the evaluation criteria. No correlation, referring to the physical measures, were detected in operations lasting <60 minutes. The fatigue of the operating team grew, even if non-exponentially, after the first hour of operation. In the 22 procedures considered, there were 71 “adverse” episodes that delayed or complicated the procedure;most of these were related to inadequate preparation of the operating room, instruments, or operators (malfunction of synthesis equipment, unavailability of instruments, insufficient number of principals, malposition of trocars, or unavailability of image intensifier). After the adoption of checklist, verified in the subsequent 18 procedures, only 10 adverse episodes occurred. Conclusions: Our study seems to confirm that simple steps related to proper planning of laparoscopic procedures were directly linked to the effectiveness of surgical performance and duration of the intervention. The preoperative checklist we set, in our experience, resulted as very useful in preventing intra-operative problems.
文摘Objective:To analyze the therapeutic effect of laparoscopy combined with choledochoscopy in the treatment of difficult cholelithiasis.Methods:A total of 60 patients with difficult cholelithiasis admitted for treatment from January 2022 to December 2024 were selected and evenly divided into two groups using a random number table.The combined group received laparoscopy combined with choledochoscopy treatment,while the single group received laparoscopy treatment alone.The total treatment efficacy,perioperative indicators,angiotensin(Ang)levels,quality of life scores,and complication rates were compared between the two groups.Results:The total treatment efficacy in the combined group was higher than that in the single group;except for operative time,the perioperative indicators in the combined group were superior to those in the single group;the Ang levels after treatment in the combined group were lower than those in the single group,and the quality of life scores were higher(P<0.05).The complication rate in the combined group was lower than that in the single group(P<0.05).Conclusion:Laparoscopy combined with choedochoscopy can enhance the treatment effectiveness for patients with difficult cholelithiasis,improve perioperative indicators,regulate their Ang levels,elevate quality of life,and demonstrate high surgical safety.
文摘BACKGROUND Diagnostic laparoscopy is a minimally invasive surgical method to diagnose intra-abdominal diseases.AIM To evaluate patients with unexplained ascites who could not be definitively diagnosed via advanced radiological and endoscopic methods and serological,cytological,and microbiological examinations and,therefore,underwent diag-nostic laparoscopy.METHODS This retrospective analysis evaluated 82 patients who underwent diagnostic laparoscopy due to unexplained ascites.Patients’medical records were obtained from the hospital database.Their age,sex,complaints at admission,laboratory results,radiological imaging results,diagnostic laparoscopy reports,and pa-thology reports were analyzed.RESULTS The serum-ascites albumin gradient was<1.1 in 96.3%of the patients(n=79).Among patients,22(26.8%)had benign diagnoses and 60(73.2%)had malignant diagnoses.In addition,55(67.1%)were deceased,and the median follow-up time from diagnosis to death was four months.The overall follow-up time ranged from 1 to 142 months,with a median of 14 months.Patients’diagnoses were significantly associated with their survival(P<0.05,χ2 test).The mortality rate was 86.7%among patients with malignant diagnoses and 13.6%among patients with benign diagnoses.CONCLUSION Diagnostic laparoscopy is minimally invasive,has a low complication rate,and requires a short hospital stay.It can be safely performed to diagnose and treat ascites that remain unexplained after advanced radiological and endoscopic examinations.
基金Supported by the Zhejiang Medical Science and Technology Project,No.2022KY1325 and No.2023KY381Public Welfare Project of Jinhua Science and Technology Plan,No.2023-4-084Major Project of Jinhua Science and Technology Plan,No.2023-3-066.
文摘BACKGROUND Ganglioneuroma is a rare,well-differentiated,slow-growing benign tumor of the peripheral nerves,with surgical resection being the only curative treatment.Surgical resection of ganglioneuromas encasing major blood vessels remains a substantial clinical challenge.Traditionally,these cases often require open abdominal surgery or combined organ resections,and in some instances,the tumors are considered unresectable.Currently,no reports have described the resection of such tumors via laparoscopy.CASE SUMMARY A 35-year-old woman was admitted to our hospital after the incidental discovery of a retroperitoneal space-occupying lesion.Imaging revealed a mass with the celiac axis and superior mesenteric artery passing through it.A neurogenic tumor was suspected,with ganglioneuroma being the most likely diagnosis.Following comprehensive preoperative preparation,the retroperitoneal tumor was resected using a three-dimensional laparoscopy combined with an organ suspension technique.The surgical approach involved incising the tumor along the vascular axis and conducting meticulous,vascular-preserving tumor excision.The operation lasted approximately 458 minutes,with an estimated blood loss of 50 mL.The patient was discharged on the 8th postoperative day.A transient liver injury occurred after surgery but improved rapidly.After 11 months of postoperative follow-up,no complications or tumor recurrence were observed.CONCLUSION This case illustrates the feasibility of minimally invasive laparoscopic resection for retroperitoneal ganglioneuromas encasing major blood vessels.
文摘Objective:To explore the effects of high-quality nursing intervention on negative emotions and quality of life in gynecological patients after laparoscopy.Methods:A total of 132 gynecological patients after laparoscopy were randomly divided into an observation group(n=66)and a control group(n=66)in a prospective study.The con-trol group received routine nursing care,while the observation group received high-quality nursing intervention.Anxiety,depression,quality of life,postoperative pain,self-care ability,and patient satisfaction were compared between the two groups.Results:The Self-Rating Anxiety Scale and Self-Rating Depression Scale scores were sig-nificantly lower in the observation group compared to the control group(both P<0.001).Pain scores at 6,24,48,and 72 hours post-surgery were also lower in the observation group(all P<0.001).The observation group showed significantly higher scores in physical function,general health,social function,emotional role,and mental health(all P<0.001).Furthermore,the observation group demonstrated better self-care skills,self-concept,self-care responsibility,and health knowledge(all P<0.001).Nursing satisfaction during hospitalization was significantly higher in the observation group than in the control group(P<0.05).Conclusion:High-quality nursing intervention is effective in improving depression,anxiety,postoperative pain,and quality of life in gynecological patients after laparoscopy.It also enhances self-care ability and patient satisfaction,making it worthy of clinical promotion and application.
文摘目的:比较完全腹腔镜远端胃癌根治术与腹腔镜辅助远端胃癌根治术对胃癌患者术后恢复情况、疼痛应激反应及外周血T细胞亚群变化的影响。方法:回顾性选取2023年3月—2024年3月在句容市人民医院行远端胃癌根治术治疗的97例患者。根据治疗方式不同分为腹腔镜辅助组(49例)和完全腹腔镜组(48例)。观察两组的术后恢复指标、前列腺素E2(PGE2)、β-内啡肽、P物质、CD3^(+)、CD4^(+)、CD8^(+)水平及并发症发生情况。结果:完全腹腔镜组术后下床时间、术后排便时间早于腹腔镜辅助组,术后引流管留置时间、住院时间均短于腹腔镜辅助组(P<0.05)。与术前比较,两组术后1 d血清PGE2、β-内啡肽、P物质水平均升高,但完全腹腔镜组上述指标均较腹腔镜辅助组低(P<0.05)。与术前比较,两组术后1 d CD3^(+)、CD4^(+)均降低,CD8^(+)升高,但完全腹腔镜组CD3^(+)、CD4^(+)较腹腔镜辅助组高,CD8^(+)较腹腔镜辅助组低(P<0.05)。完全腹腔镜组的术后并发症总发生率低于腹腔镜辅助组(P<0.05)。结论:相较于腹腔镜辅助远端胃癌根治术,完全腹腔镜远端胃癌根治术能加速患者恢复,减轻疼痛应激,并优化外周血T细胞亚群比例,安全性更高。
