单孔与传统腹腔镜在治疗粘连性肠梗阻中的效果对比研究

探讨单孔腹腔镜在粘连性肠梗阻中的应用价值与优势。回顾性分析2013年~2017年大连医科大学附属第二医院粘连性肠梗阻住院患者44例,其中行传统腹腔镜手术患者28例,经脐单孔腹腔镜手术患者16例,比较两组手术治疗的疗效及术后恢复情况。研究组经脐单孔腹腔镜治疗患者在手术时长、出血量,与对照组传统腹腔镜手术患者并无明显差异,而术后离床活动、排气、进食时间、术后引流管留置时间、住院时长及费用、术后并发症及半年内再梗阻发生方面有明显优势。经脐单孔腹腔镜治疗粘连性肠梗阻既具有传统腹腔镜的手术时间短,创伤小等特点,更加体现了术后并发症少、恢复快及再梗阻发生率低等优点,如果掌握合理的手术适应证,值得临床推广应用,具有广阔前景。     

经后腹腔单孔腹腔镜肾切术应用体会

总结经后腹腔单孔腹腔镜单纯及根治性肾切除术的初步临床经验,探讨其临床应用价值.在2010年～2011年,我科应用经后腹腔入路单孔腹腔镜下进行单纯肾切除及根活性肾切除病例8例.其中肾积水合并无功能肾5例,肾癌2例,萎缩无功能肾1例.结果8例手术均获成功,手术时间110min～170min,平均138min;术中出血50ml～200ml,平均88ml ;术后均无并发症发生.我们在应用后腹腔单孔腹腔镜行单纯及根治肾切除术初步总结,该手术方式安全有效,可行性高.其手术优势需更多病例进一步评估.     

原发性阑尾肿瘤30例临床诊治分析

为探讨原发性阑尾肿瘤的临床特点,提高阑尾肿瘤的诊治水平,本文回顾性分析本院2009年1月~2016年7月经手术治疗的原发性阑尾肿瘤30例患者临床资料。本组30例患者临床表现主要为阑尾炎和腹部包块,均经手术和病理确诊,包括黏液性肿瘤19例,阑尾腺癌8例,阑尾类癌2例,恶性淋巴瘤1例。行右半结肠切除术3例,行回盲部切除术8例,15例行单纯阑尾切除,其他手术方式4例。随访25例,2例腺癌术后死于其他疾病,1例粘液性肿瘤死于白血病,1例腺癌于术后10个月复发,余均无复发和转移。阑尾肿瘤临床少见,缺乏特异临床表现,术前诊断困难,主要依靠术中快速冰冻切片和术后病理确诊。手术为主要的治疗方法,术式选择是影响预后的关键因素。     

单孔腹腔镜技术在胆囊疾病治疗中的应用

探讨单孔腹腔镜技术在胆囊切除术中的应用价值。总结52例单孔腹腔镜胆囊切除临床资料。结果单孔腹腔镜胆囊切除术与“金标准”的多孔腹腔镜胆囊切除术各项指标基本一致。因此,单孔腹腔镜胆囊切除术安全、可靠,无瘢痕,代表了当前胆囊疾病治疗的主流。     

老年胆石症患者经腹腔镜微创取石的诊疗体会

分析老年胆石症患者经腹腔镜联合胆道镜保胆取石的效果。选择在我院经手术治疗的221例胆石症患者作为研究对象。其中162例经腹腔镜联合胆道镜下保胆取石(观察组),另59例经腹腔镜下胆囊切除手术(对照组)。考察平均手术时间、术中出血量、术后肛门排气时间、下床活动时间、平均住院时间、术后并发症。观察组平均术中出血量,显著少于对照组;平均下床活动和平均住院时间均较对照组更短(P0.05)。2个组术后并发症的差异有统计学意义(P0.05)。腹腔镜联合胆道镜微创术保胆取石安全性高,临床效果显著,尤其不影响老年患者术后胆囊正常的生理功能。     

“三位一体”认识和处理单孔腹腔镜的“筷子效应”

单孔腹腔镜手术中,由于腹腔镜镜头及各手术器械均经脐部单一切口进入腹腔,易造成器械之间在腹腔内外的相互干扰,无法充分展开而形成"筷子效应",进而影响操作,降低手术安全性。细分来看,单孔腹腔镜的"筷子效应"发生在三个水平,即腹腔外,腹腔内以及肚脐水平。每个水平的"筷子效应"有各自不同的成因及对策,但并不孤立存在。任一水平的干扰均影响整体的手术操作和患者安全,是为"三位一体"。在改进器械的基础上,解决"筷子效应"主要在于提高手术技能,熟练掌握每一个操作器械。采用"三位一体"的思路,做到内外兼修才是做好单孔腹腔镜手术的关键。     

定压呼吸模式机械通气在新生儿腹腔镜麻醉中的应用

评价定压呼吸模式机械通气用于新生儿腹腔镜麻醉的安全性和有效性。31例新生儿腹腔镜手术,全麻下定压呼吸模式机械通气,术中于各时点取动脉血样并记录各数据。结果发现在气腹5min、10min、20min时HR、MAP、PaCO2和PET CO2均升高;在气腹20min和放气腹后10min时pH降低。定压呼吸模式机械通气能安全有效的应用于新生儿腹腔镜麻醉。     

腹腔镜胆囊切除术中不同麻醉方式对眼内压的影响

探讨全麻喉罩复合硬膜外阻滞麻醉对腹腔镜胆囊切除患者眼内压（IOP）的影响,60例患者行腹腔镜胆囊切除患者根据麻醉方式的不同随机分为全麻喉罩复合硬膜外阻滞组（A 组）与气管插管全麻组（B 组）,每组各30例。记录麻醉前（T0）、气管插管（置入喉罩）前（T1）、气管插管（置入喉罩）后即刻（T2）、CO2气腹后10min（T3）、术毕患者清醒拔除气管导管（喉罩）前（T4）时的 IOP 。结果显示：喉罩全麻复合硬膜外阻滞用于腹腔镜胆囊切除,与单纯气管插管全麻比较,可有效降低患者在诱导插管、CO2气腹与患者清醒吸痰、拔管所引起的 IOP 升高反应（P＜0．05）。     

持续性闭式吸引技术在腹腔镜中低位直肠癌手术烟雾消除中的临床应用

探讨持续性闭式吸引技术在腹腔镜中低位直肠癌手术过程中能量器械使用而产生的烟雾消除效果。选取2015年1月~2017年6月笔者所在医院收治的100例中低位直肠癌患者,根据入院顺序分为对照组和研究组各50例,两组均实施腹腔镜直肠癌根治术,对照组经戳卡侧孔排烟法,研究组在术中应用持续性闭式引流技术,比较两组患者手术疗效及术后近期并发症情况。手术疗效的观察指标中,发现研究组与对照组相比术中出血量少、手术时间短、手术耗材成本低、术后住院时间短,差异有统计学意义(P0.05)。术后近期并发症指标观察中,发现研究组术后出血或术后吻合口瘘发生率明显少于对照组,差异有统计学意义(P0.05)。持续性闭式吸引技术能快速消除腹腔镜中低位直肠癌手术过程中产生的烟雾,不会影响腹腔内恒定的气腹压,保持清晰的手术视野,从而确保手术能安全、顺利地进行,还能减轻高额微创手术费用的负担,值得临床推广应用。     

如何看待腹腔镜阑尾切除术

随着微创技术的发展,腹腔镜阑尾切除术（1aparoscopic appendectomy,LA）正逐渐被广大医务工作者所接受,但现在仍然有很多人认为LA与传统开腹阑尾切除术（open appendectomy,OA）相比没有优势,而且LA价格昂贵,不适合推广。但是作为正在发展完善的新技术,很多证据表明LA与OA相比优势正在逐步增强。     

腹腔镜与开腹肝包虫内囊摘除术的临床对照研究

对腹腔镜和开腹肝包虫内囊摘除术的治疗效果进行比较。选择腹腔镜肝包虫内囊摘除术病例26例及行开腹肝包虫内囊摘除术病例50例,比较其手术时间、术中出血量、胃肠功能恢复时间、术后禁食时间、镇痛药物使用例数、镇痛药物使用时间、并发症发生率及术后住院时间的比较。腹腔镜和开腹组均无手术死亡病例;腹腔镜组术中出血量明显少于开腹组;术后胃肠功能恢复时间、术后禁食时间、镇痛药使用例数及时间、住院天数显著短于开腹组;两组并发症发生率差异无统计学意义。腹腔镜下肝包虫内囊摘除术可以达到与开腹肝包虫内囊摘除术同样的效果,且手术创伤小,恢复快。     

A method for utilizing a single port for multiple functions on the IBM PC or compatible system

Psychological experiments often require the control of a large number of output lines; unfortunately, the IBM PC provides only 32 8-bit ports through which communication may be implemented without risk of conflict with other software/hardware. A single 8-bit port may be used to control a large number of devices by adding appropriate decoder logic between the computer’s port and the devices that are to be controlled. Software and hardware are presented that illustrate this technique by controlling an 8-digit light-emitting diode display with a single IBM PC output port.     

Domestic cats (Felis catus) do not show causal understanding in a string-pulling task

This study explored how domestic cats perform in a horizontal string-pulling task to determine whether they understand this case of physical causality. Fifteen cats were tested on their ability to retrieve an unreachable food treat in three different set-ups: (a) a single baited string, (b) two parallel strings where only one was baited and (c) two crossed strings where only one was baited. All cats succeeded at pulling a single string to obtain a treat, but none consistently chose the correct string when two strings were parallel. When tested with two crossed strings one cat chose the wrong string consistently and all others performed at chance level. There was no evidence that cats understand the function of the strings or their physical causality.     

七氟醚预处理对腹腔镜胃肠手术肝功能的影响

了解七氟醚预处理对腹腔镜胃肠手术术后肝功能变化的影响。选取80例择期行腹腔镜胃癌、结肠癌、直肠癌根治术者,随机分为2组。七氟醚组（S组）于麻醉诱导后CO2气腹建立前吸入0．8％～1．5％七氟醚30min ,对照组（C组）吸入氧气。检测2组患者术前,术后1d、2d、3d及7d肝功能（ALT、AST、TB、DB、TP、ALB）。结果七氟醚组术后1d、2d、3d的ALT及AST 水平低于对照组,且七氟醚组内气腹时间＞2．5h者术后1d、2d的 ALT 增长率（4％）低于≤2．5h者（10％）,术后2d、3d的ALT降低率,气腹时间＞2．5h者（25％）高于≤2．5h者（23％）。七氟醚预处理对腹腔镜胃肠手术术后肝功能有一定保护作用,且气腹时间越长,保护作用越明显。     

微创与开腹手术治疗胆管结石患者生存质量的比较

采用消化病生存质量指数（gastrointestinal quality of life index,GIQLI）前瞻性测定45例微创内引流一期缝合术与42例开腹胆总管探查术治疗肝外胆管结石在术前、术后2,4,8,12周的生存质量值。结果显示微创组较开腹组治疗肝外胆管结石更有利于患者术后恢复和生存质量提高,微创手术患者术后生存质量更好。     

Low diversity and low frequency of participation in leisure activities compromise working memory efficiency in young adults

People perform leisure activities (LA) every day; pursuits that entail applying cognitive, physical and social abilities. As in old age, doing LA during early and middle adulthood is related to a reduced risk of dementias, probably by generating a cognitive reserve. As it is possible that a relation between doing LA and working memory (WM) efficiency exists in young adults, we assessed whether the diversity and frequency of LA are related to WM efficiency in this population. Ninety-three healthy young subjects solved the n-back task at two levels of difficulty (2, 3), and answered an LA questionnaire on the activities in which they had participated in the month prior to the experiment. Subjects were classified separately on their scores for (1) diversity (high/low) and (2) frequency (high/low) in order to test the relation between each variable and WM efficiency. Though no differences were found, a subsequent analysis of the average of diversity and frequency ratios of LA performance taken together-the diversity/frequency index-showed that low diversity plus low frequency was significantly associated with reduced WM efficiency at this age; results that suggest that frequent participation in diverse LA during youth is related to WM efficiency.     

自适应背景焦点显示技术在遥操作中的应用

遥操作界面中可视信息的有效呈现是提高操作绩效的重要途径。本研究提出自适应背景焦点显示技术原型,构建新型遥操作显示平台,并通过比较不同显示条件下遥操作绩效,考察其应用有效性及特点。结果显示：1）相比其他显示（单一纠正信息、单一指导信息、恒定背景信息和无背景信息）,自适应背景焦点显示可有效提高操作绩效;2）在降低主观负荷方面,单一纠正信息显示显著优于其他显示。本研究结果为遥操作显示界面的优化提供了新思路。     

An interface for controlling external devices via the IBM PC/XT/AT parallel port

This article describes the construction and operation of a simple interface to control external devices via the IBM PC/XT/AT’s parallel printer port. The interface is relatively inexpensive and easy to build. It is potentially useful for controlling behavioral experiments.     

Exercise-produced arousal, film-induced arousal and attribution of internal state.

Respiration rates were monitored on 20 high-anxious and 20 low-anxious female Ss while they were watching an anxiety-provoking film on industrial accidents. Half of the Ss exercised on a bicycle while half remained seated throughout their viewing of the film. Exercised Ss reported feeling less anxious while viewing the accidents compared with the inactive controls. All groups recalled similiar amounts of the film content, and respiration rates did not increase while viewing the accidents. Results of self-report of anxiety are consistent with a recently advanced theory of objective self-awareness.