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 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。

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.

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.