目的 探讨腹腔镜脾切除术（LS）在治疗与脾脏有关疾病中的应用、手术方法及临床效果。方法利用腹腔镜技术在CO2气腹情况下对43例需行脾切除术的患者进行手术，并对手术前后患者一般状况的改善、血小板计数的变化、并发症的出现与否及术后恢复情况等进行总结性分析。结果43例患者全部采用LS方法完成手术，术后无并发症出现；对特发性血小板减少性紫癜（ITP）患者的有效率为89.3%；体外B超脾脏长径>15cm者手术难度明显增加，手术时间延长。结论只要掌握好脾切除术的手术指征及腹腔镜下的操作技巧，LS是脾脏手术的最佳方法之一。

目的 探讨不同的手术体住在腹腔镜脾切除术时对操作的影响。方法利用腹腔镜对43倒病人进行脾切除术，并对术中出现的情况、手术体住与脾脏的大小、解剖关系及手术难易程度等进行总结性分析。结果43例病人无术中及术后并发症出现。不论何种体位，体外B超脾脏长径>15cm者手术难度明显增加，手术时间延长，结论 大多数腹腔镜脾切除术可以采用右斜卧位完成，对于长径>15cm的脾脏，采用右侧卧位可能更为有利。腹腔镜脾切除术是脾脏手术的最佳方法之一。

目的探讨电视辅助胸腔镜手术（VATS）在治疗食管癌中的应用、手术方法及临床效果。方法 利用胸腔镜技术对38例食管癌病人进行手术，并对手术操作、并发症及术后恢复等情况进行总结性分析。结果 38例病人全部采用VATS方法完成手术，1例发生支气管胸膜瘘，5例术后发生吻合口瘘，经简单对症治疗全部治愈，无死亡病例。术后1年、3年、5年生存者，分别为10、8、4例，术后因肿瘤转移死亡3例，其它原因死亡2例，失访7例，余4例为术后不足1年的病人，尚未见肿瘤复发、转移情况。结论 只要掌握好胸腔镜的操作技巧及食管癌切除的手术指征，VATS治疗食管癌不但是可行的，而且具有广阔的前景。

目的探讨电视腹腔镜手术在治疗结肠直肠癌中的应用、手术方法及临床效果。方法利用腹腔镜技术对78例结肠直肠癌的患者进行手术，并对手术操作、并发症的出现及术后恢复等情况进行总结性分析。结果78例患者采用电视腹腔镜方法完成手术，无因术后并发症而死亡的病例。经随访，1、3、5 年生存者分别为21、17、8例；术后因肿瘤转移死亡11例，其他原因死亡2例；失访10例；余9例为术后不足1年时间的患者，除1例术后11个月发生肿瘤肝转移需行手术切除外，其他8例尚未见肿瘤的复发及转移。结论只要掌握好腹腔镜的操作技巧及结肠直肠癌切除的手术指征，用腹腔镜的方法治疗结肠直肠癌不但是可行的，而且具有广阔的前景。

目的 了解腹腔镜手术对肝功能变化的影响以及探讨其可能的发生机制。方法 286例腹镜胆囊切除术（LC）患者被随机分为a，b 2组，在术前及手术后第1、2、7天接受肝功能检测。把40例开腹胆囊切除术（OC）患者的手术前、后肝功能与LC进行对照。另外，18例腹腔镜结、直肠癌手术（LCR）患者与23例开腹结、直肠癌（OCR）手术的患者也参与了研究。结果LC与LCR患者的血清谷丙转氨酶（ALT）与谷草转氨酶（AST）与术前比较，都有显著性差异（P<0.05）。LC与OC、LCR与OCR相比，ALT术后24h与48h均有显著性差异（P<0.05）。同样，LC与OC、LCR与OCR相比，AST术后24h与48h也均有显著性差异（P<0.05）。同时也对其他的肝功能指标进行了检测与数据处理，未发现有意义的改变。结论 腹腔镜手术可导致血清肝转移酶有统计学意义的短暂性增高。CO2气腹是造成血清肝转移酶变化的主要原因。这种血清肝脏酶学的短暂性改变对大多数接受腹腔镜手术的患者不会造成不良影响，无临床意义。

AIM: The purpose of this study was to investigate the effect of laparoscopic surgery on liver function in humans and the possible mechanisms behind such effect. METHODS: Blood samples from 286 patients who underwent laparoscopic cholecystectomy (LC) and 40 patients who underwent open cholecystectomy (OC) were tested for liver function by measuring the level of serum alanine aminotrasferase (ALT) and aspartate aminotrasferase (AST) before and after the operations. The same tests were also applied to 18 laparoscopic colorectal cancer resection (LCR) patients and 23 open colorectal cancer resection (OCR) patients to determine whether CO2 pneumoperitoneum could alter the serum liver enzymes. RESULTS: The level of serum ALT and AST increased significantly during the first 48 hours post operations in both LC and LCR patients. However, no significant change of the serum liver enzymes was detected in both OC and OCR patients. As a result, there was statistically significant difference in change of both ALT and AST levels between LC and OC patients and LCR and OCR patients, respectively. By the 7th day post operation, the level of both enzymes returned to normal values in LC, OC and OCR patients except LCR patients whose enzymes remained at a higher level. CONCLUSION: Transient elevation of hepatic transaminases occurred after laparoscopic surgery. The major causative factor seemed to be the CO2 pneumoperitoneum. In most of the laparoscopic surgery patients, the transient elevation of serum liver enzymes showed no apparent clinical implications. However, if preoperative liver function was very poor, laparoscopic surgery may not be the best choice for the treatment of patients with certain abdominal diseases.

AIM: To introduce our latest innovation on technical manipulation of laparoscopic splenectomy. METHODS: Under general anesthesia and carbon dioxide (CO2) pneumoperitoneum, 86 cases of laparoscopic splenectomy (LS) were performed. The patients were placed in three different operative positions: 7 cases in the lithotomic position, 31 cases in the right recumbent position and 48 cases in the right lateral position. An ultrasonic scissors was used to dissect the pancreaticosplenic ligament, the splenocolicum ligament, lienorenal ligament and the lienophrenic ligament, respectively. Lastly, the gastrosplenic ligament and short gastric vessels were dissected. The splenic artery and vein were resected at splenic hilum with Endo-GIA. The impact of different operative positions, spleen size and other events during the operation were studied. RESULTS: The laparoscopic splenectomy was successfully performed on all 86 patients from August 1997 to August 2002. No operative complications, such as peritoneal cavity infection, massive bleeding after operation and adjacent organs injured were observed. There was no death related to the operation. The study showed that different operative positions could significantly influence the manipulation of LS. The right lateral position had more advantages than the lithotomic position and the right recumbent position in LS. CONCLUSION: Most cases of LS could be accomplished successfully when patients are placed in the right lateral position. The right lateral position has more advantages than the conventional supine approach by providing a more direct view of the splenic hilum as well as other important anatomies. Regardless of operation positions, the major axis of spleen exceeding 15 cm by B-ultrasound in vitro will surely increase the difficulties of LS and therefore prolong the duration of operation. LS is a safe and feasible modality for splenectomy.

目的：探讨超声刀在腔镜手术中的使用方法及其临康应用价值。方法：收集并分析采用起声刀在腔镜下完成各类外科手术448剜的临床资料。结果：全组病人没有因为使用超声手木刀止血不彻底而导致手术中转开腹及术后出血，也没有因为使用超声手木刀而导致的脏器损伤及空空腔脏器延迟性穿孔等并发症的出现，结论：尽管所有型号的超产刀目前仍存在一些技术上的缺陷，但其无烟、操作简便安奎、切割止血可靠等优点使原来许多传统开放的复杂手术在腔镜下施行成为现实。由于腹腔境及其器械均呈长杆形，对于深部小血管的离断及组织分离优于开放手术，是现代腔境外科必不可少的设备。

目的：探讨腹腔镜下行大肠癌手术的要点与并发症的防治。方法：对应用腹腔镜技术进行手术的82例大肠癌患者的临床资料进行总结性分析。结果及结论：全组病人均采用腹腔镜完成手术，术中及术后未发生重走并发症。术后无因并发症而死亡的病倒。除1例术后11个月发生肿瘤肝转移须行手术切除和1例穿刺孔及辅助切口肿瘤种植复发外，其他病人未见肿瘤的复发厦转移。只要掌握好腹腔镜的操作技巧及大肠癌切除的手术指征，重视关键部位的操作，用腹腔镜治疗大肠癌是可行的，其并发症会随着操作技巧的提高而降低。