摘要：腹腔镜右半结肠癌根治术是腹腔镜结直肠手术中较为复杂的术式。解剖和清扫肠系膜上静脉周围的淋巴组织、戳卡位置的选择、不断变换体位、术者与助手的配合都需要较高的要求。因此，规范化实施腹腔镜右半结肠癌根治术不仅是腔镜手术的理论基础，更是手术安全实施的有利保障。本文从手术适应证的选择、手术入路选择、右半结肠切除术的外科平面、肠系膜上静脉和Henle干的解剖等方面诠释规范化腹腔镜右半结肠癌根治术的具体操作细节。为腹腔镜外科医生手术的规范化实施提供理论指导。%Radical laparoscopic right hemicolectomy is a complicated procedure in laparoscopic colorectal operations.It is characterized by dissection of local lymphoid tissue, selection of trocar position, change of body position, and cooperation of performers and assistants.Therefore, the standardization of laparoscopic right hemicolectomy not only is the theoretical basis of laparoscopic operation, but also the guarantee of operative safety.This article described the indications, operative approaches, surgical plane, Henle trunk anatomy of laparoscopic right hemicolectomy.The article might provide laparoscopic surgeons the theoretical guidance of the operation .
摘要：Objective To study the curative effect of emergency or conventional laparoscopic lithotomy in treating cholecystitis. Methods From September 2013 to March 2014, 150 patients with cholecystitis underwent lithotomy using rigid choledochoscope.These patients were divided into two groups:34 patients in an emergency surgery group and 116 patients in a conventional surgery group.Their clinical data were analyzed by using SPSS 13.0 software, including comparison of operation time, hospital stay, and hospitalization cost by using Student's t test, and comparison of the incidence of incisional infection and conversion by using the Chi-square test.P<0.05 was considered statistically significant. Results All of the 150 patients in the 2 groups were operated on successfully.Their average hospitalization days (5.86 ±1.5 d vs 17.31 ±2 d) and hospitalization expense (11 991.3 ±587.4 yuan vs 14 152.3 ±895.6 yuan) in the emergency surgery group were higher than those in the conventional surgery group (t=1.31, t=1.82 respectively, P<0.05).There was no significant difference in average operation time between the emergency surgery group (82 ±3.2 min) and the conventional surgery group (63 ±4.3 min) (t=6.02, P>6.02).There were 1 case of incisional infection and 1 case of conversion in the emergency surgery group, whereas 4 cases of incisional infection and 5 cases of conversion in the conventional surgery group (χ2 =9.75,χ2=7.65 respectively, P>0.05).During the follow up, 93%of patients showed thickening or mild edema of gallbladder wall 1 month after treatment, and recovered within 3 months, but no recurrence observed within 6 months.The follow-up rate was 95.4%. Conclusion Compared with conventional laparoscopic lithotomy, emergency treatment could alleviate clinical symptoms, reduce the length of hospital stay,and lower hospitalization expense.But there were no significant differences in clinical effects and postoperative complications between the two groups.%目的：探讨急诊腹腔镜下保胆取石手术与常规腹腔镜下保胆取石手术的临床疗效。方法回顾性分析自2013年9月至2014年3月采用硬质胆道镜完成保胆取石手术150例，根据手术时机不同，急诊手术患者34例（急诊手术组），常规手术患者116例（常规手术组），采用SPSS 13．0软件进行统计分析，两组平均手术时间、平均住院天数、平均住院费用比较采用 t 检验；术后切口感染率、中转开腹率采用χ2检验。P＜0．05为差异有统计学意义。结果两组患者手术顺利，急诊手术组在平均住院天数、平均住院费用方面优于常规手术组：（5．86±1．5） d 与（17．31±2） d，（11991．3±587．4）元与（14152．3±895．6）元，差异有统计学意义（t＝1．31、 t＝1．82， P＜0．05）。平均手术时间：急诊手术组为（82±3．2） min，常规手术组为（63±4．3） min，差异无统计学意义（t＝6．02， P＞0．05）。急诊手术组术后切口感染1例，中转开腹1例，常规手术组术后切口感染4例，中转开腹5例，两组比较差异无统计学意义（χ2＝9．75、χ2＝7．65， P＞0．05）。随访发现，术后1个月93％的胆囊壁增厚、存在轻度水肿表现，术后3个月基本正常，术后6个月无1例结石复发。随访率达到95．4％。结论急诊行腹腔镜下保胆取石手术，可缓解患者临床症状，减少住院时间，降低住院费用，与常规腹腔镜下保胆取石手术在治疗效果、术后并发症等方面无明显差异，值得推广。
摘要：This patient suffered from diaphragmatic hernia with incomplete colonic obstruction .The diaphragmatic hernia defect located at the inferior pole of the spleen , which was repaired under laparoscopy by using intraperitoneal onlay mesh procedure ( IPOM) .There are three key points of the procedure:firstly, to close the diaphragmatic hernia defect by suture before the insertion of mesh , namely “augmentation”instead of “bridging”;secondly , to cut off the splenophrenic ligament , and to mobilize the splenic flexure of the colon, which ensured enough coverage of the defect by mesh;thirdly, to fix mesh into the diagphragm by tacks should be strictly forbiddened .Fibrin glue was applied in this case .%该患者为膈疝伴不全性结肠梗阻，术中发现膈疝缺损靠近脾脏下极的后方，采用腹腔镜腹腔内补片植入术（IPOM）进行治疗。手术有三个关键点：（1）补片修补之前先用缝合的方法关闭膈疝缺损，即“加强修补（Augmentation）”代替“桥接修补（bridging）”。（2）切断脾膈韧带，游离部分结肠脾曲，使补片能够充分覆盖缺损的后方。（3）严禁用疝钉来固定覆盖在膈肌上的补片，本例患者使用的是医用胶固定。
