Objective To compare the effects between laparoscopic and conventional open abdominal approaches on perineal wound healing for patients with rectal cancer. Methods The clinical data of 54 patients undergoing laparoscopic abdominal perineal resection (laparoscopy group) and 48 patients undergoing open abdominal perineal resection (open group) between January 2008 and December 2009 in this hospital were collected. Parameters including class A healing rate of perineal wound, duration of surgery, duration of perineal resection, blood loss during operation, anterosacral drainage, and serum albumin level on day 3 after surgery were compared between two groups. Results There was no significant difference of gender, age, tumor Dukes stage, preoperative albumin, or preoperative complications between two groups (Pgt;0.05). The class A healing rate of perineal wound (χ2=5.54, Plt;0.05) and serum albumin level on the third day after surgery （t＝3.92, Plt;0.01） in the laparoscopy group was significantly higher than those in the open group. In the laparoscopy group, duration of perineal resection （t＝6.64, Plt;0.01）, blood loss during operation （t＝6.05, Plt;0.01）, and anterosacral drainage （t＝12.86, Plt;0.01） were less than those in the open group. Conclusion The higher class A healing rate of laparoscopic approach for the patients with rectal cancer might be associated with the minimal invasiveness, less blood loss, and shorter duration.
目的 探討腹腔鏡胃腸道手術常見戳孔并發癥的特點及防治對策。方法 回顧性分析我院78例行腹腔鏡胃腸道手術后9例發生戳孔并發癥患者的臨床資料。結果 9例中戳孔感染4例，戳孔周圍皮下瘀血和血腫2例，戳孔疝1例，皮下氣腫2例，經采取拆除戳孔處縫線、通暢引流、換藥、局部壓迫、藥物止血等相應處置，患者均痊愈出院。結論 戳孔并發癥重在預防，其危害不容忽視。
目的 探討腹腔鏡下修補醫源性結腸穿孔的可行性和手術技巧。方法 回顧性分析我院2007年 10月至2009年12月期間腹腔鏡下修補醫源性結腸穿孔手術6例患者的臨床資料，其中診斷性腸鏡檢查結腸穿孔2例，治療性腸鏡結腸穿孔4例。結果 6例患者均順利完成腹腔鏡下手術, 無中轉開腹。3例患者全腹腔鏡下完成結腸穿孔修補，2例因破口較大在腹腔鏡輔助下完成結腸穿孔修補，1例乙狀結腸癌患者腸鏡檢查結腸穿孔后同時行腹腔鏡下乙狀結腸癌根治手術，術后未發生吻合口漏、殘余感染等并發癥。結論 腹腔鏡下修補醫源性結腸穿孔安全、可靠，臨床效果肯定。
目的 探討腹腔鏡胃腸道手術中醫源性脾損傷的發生原因和處理方法。方法 回顧性分析我院2007年12月至2009年2月期間125例行腹腔鏡胃腸手術中出現的5例醫源性脾損傷的臨床資料。結果 5例脾損傷患者中腹腔鏡胃手術4例，腹腔鏡結腸手術1例； 按Pachter脾損傷分級，Ⅰ級3例，Ⅱ級2例。所有患者均經腹腔鏡手術治療治愈，電凝止血1例,小紗布壓迫加電凝加止血紗布壓迫止血4例。結論 腹腔鏡胃腸手術中發生的脾損傷多為表淺的Ⅰ、Ⅱ級損傷,及時發現及正確處理十分重要。