经脐单孔腹腔镜肝囊肿去顶减压术8例临床分析

目的:探讨经脐单孔腹腔镜肝囊肿去顶减压术治疗单纯性肝囊肿的可行性及安全性。方法:回顾分析2009年5月至2010年5月为8例单纯性肝囊肿患者行经脐单孔腹腔镜肝囊肿去顶减压术的临床资料。结果:8例手术均获成功。手术时间30~75min,平均40.8min。术后平均住院3.7d。术后随访2~12个月,平均7个月,除1例患者原有的小囊肿增大外,无再发病例。结论:经脐单孔腹腔镜肝囊肿去顶减压术虽然较传统的多孔腹腔镜手术操作略复杂,但安全有效,腹壁无可见疤痕,患者创伤小,痛苦轻,康复快,住院时间短。     

腹腔镜治疗肝囊肿的临床体会

目的 :探讨腹腔镜手术治疗肝囊肿的效果。方法 :回顾分析 18例腹腔镜治疗肝囊肿的临床资料。结果 :18例手术均获成功。术中出血 5～ 15ml,手术时间 2 0～ 5 0min ,术后住院 2～ 5d ,无 1例发生并发症。结论 :腹腔镜手术具有创伤小 ,恢复快 ,住院时间短等优点 ,是治疗单纯性肝囊肿合理、有效的方法     

经腹腔镜去顶开窗术治疗单纯性肝囊肿19例

目的探讨经腹腔镜去顶开窗术治疗单纯性肝囊肿的方法及效果。方法对19例单纯性肝囊肿患者采用经腹腔镜去顶开窗术,回顾性分析患者的临床资料。结果 19例患者中18例完成腹腔镜肝囊肿去顶开窗术,平均手术时间52 min,术中出血40~95 ml,引流澄清透明囊液65~340 ml,平均住院时间5.5d。患者术后24 h下床活动,进半流食,未使用镇痛药物。术后2~3 d拔除引流管,无出血、胆漏等并发症发生。随访6~11个月,B超复查未见囊肿复发。1例因胆汁外漏明显中转开腹手术治愈。结论腹腔镜肝囊肿去顶开窗术创伤小、恢复快、住院时间缩短,但应严格掌握手术适应征,正确细致操作。     

完全腹腔镜手术治疗成人先天性胆总管囊肿的临床分析

目的:探讨完全腹腔镜胆总管囊肿切除并肝管空肠Roux-en-Y吻合术治疗成人先天性胆总管囊肿的可行性、安全性及疗效。方法:回顾性分析昆明医科大学第一附属医院2014年5月—2016年5月12例行腹腔镜下胆总管囊肿手术治疗患者的临床资料。结果:11例患者完全腹腔镜下完成胆总管囊肿切除+肝管空肠吻合术,1例为减少手术费用在腹腔外行手工肠肠吻合。手术时间240~310 min,平均280 min;术中出血20~150 m L,平均60 m L;术后住院时间5~7 d,平均6.5 d。术后随访2~12个月,未出现手术并发症,无死亡病例。结论:完全腹腔镜下胆总管囊肿切除+肝管空肠Roux-en-Y吻合术治疗成人先天性胆总管囊肿是安全可行的,且具有明显微创优势,可进一步推广。     

后腹腔镜手术治疗非寄生虫性肝右后叶囊肿临床分析

目的探讨后腹腔镜在非寄生虫性肝右后叶囊肿开窗术中的应用。方法采用后腹腔镜完成11例非寄生虫性肝右后叶囊肿开窗引流术。结果11例全部获得成功。术后并发气腹8例。住院时间4~10 d,平均5.3 d。结论后腹腔镜手术治疗非寄生虫性肝右后叶囊肿具有微创、恢复快、住院时间短、安全优点。后腹腔镜手术为非寄生虫性肝囊肿治疗开辟了新的手术路径。     

腹腔镜治疗肝囊肿86例报道

目的探讨肝囊肿腹腔镜治疗的临床效果及手术技巧。方法对86例肝囊肿患者临床资料进行回顾性分析。其中联合胆囊切除加肝囊肿开窗引流术23例。结果86例手术均获成功,术中出血10～100ml,手术时间20～60min,术后住院时间2～5d。随访2例复发,其余无并发症及复发。结论腹腔镜治疗肝囊肿技术上成熟,手术时间短,术后恢复好,是治疗肝囊肿的首选方法。术前准确诊断,术中精确操作及术后正常处理也同样重要。     

Clinical study on laparoscopic and open surgery in hepatic cyst with a report of 32 cases

目的 比较腹腔镜与开腹手术治疗肝囊肿的疗效与安全性.方法 回顾性分析我院2008年1月至2011年12月行手术治疗的32例肝囊肿患者临床资料,其中运用腹腔镜手术治疗(腹腔镜组)19例,开腹手术治疗(开腹组)13例.比较两组的手术时间、术中出血量、术后并发症发生率、胃肠功能恢复时间、住院时间、住院费用、术后肝功能及肝囊肿复发率差异.结果 与开腹组相比,腹腔镜组术中出血量少(P =0.014)、胃肠功能恢复时间短(P=0.002)、住院时间短(P=0.036)；而手术时间、术后并发症发生率、术后丙氨酸氨基转移酶与总胆红素以及住院费用均无明显差别.术后27例获得随访,随访率84.4％ (27/32),随访2～38个月,平均16个月,两种手术方式的肝囊肿复发率无明显差异.结论 腹腔镜手术治疗肝囊肿创伤小,术后患者恢复快,住院时间短,应成为肝囊肿的首选治疗方法.     

腹腔镜肝囊肿去顶减压术治疗肝囊肿效果分析

目的观察腹腔镜肝囊肿去顶减压术治疗单纯性肝囊肿的效果。方法随机将78例接受去顶减压术的单纯肝囊肿患者分为2组,各39例。对照组采用开腹手术,观察组采用腹腔镜手术。比较2组的疗效。结果观察组术中出血量、手术时间、肛门恢复排气时间、住院时间均明显低于对照组,差异有统计学意义(P0.05)。随访6个月,2组复发率差异无统计学意义(P0.05)。结论腹腔镜肝囊肿去顶减压术治疗单纯肝囊肿,与开腹手术同样有良好效果。但前者创伤小、患者术后恢复快。     

腹腔镜开窗引流术治疗单纯性肝囊肿的临床评价

目的:评价腹腔镜开窗引流术治疗单纯性肝囊肿的临床疗效。方法:回顾分析近5年为78例单纯性肝囊肿患者行腹腔镜开窗引流术的临床资料。其中单发囊肿41例,2枚及以上37例(96枚囊肿),共计137枚囊肿。肝后部(Ⅳa、Ⅵ、Ⅶ、Ⅷ)囊肿24枚,余113枚位于肝前部。23例囊肿最大直径<5 cm,作为腹腔镜胆囊切除等手术的附属手术行肝囊肿开窗引流术。结果:78例手术均获成功,无一例中转开腹,无手术并发症发生。手术时间平均(37.4±10.2)min,中位术中出血量10 ml(5~150 ml),术后平均住院(3.2±0.9)d。随访观察12个月,囊肿复发6例(其中3例复发囊肿位于肝后部),直径<5 cm,且无临床症状。结论:腹腔镜开窗引流术治疗单纯性肝囊肿疗效确切,患者创伤小,术后康复快,已成为治疗单纯性肝囊肿的首选方法。囊肿较小但合并胆囊结石等的患者,可适当扩大手术适应证。     

腹腔镜与开腹手术治疗肝囊肿32例临床分析

目的 比较腹腔镜与开腹手术治疗肝囊肿的疗效与安全性.方法 回顾性分析我院2008年1月至2011年12月行手术治疗的32例肝囊肿患者临床资料,其中运用腹腔镜手术治疗(腹腔镜组)19例,开腹手术治疗(开腹组)13例.比较两组的手术时间、术中出血量、术后并发症发生率、胃肠功能恢复时间、住院时间、住院费用、术后肝功能及肝囊肿...     

腹腔镜胆囊切除联合肝肾囊肿手术的应用

目的 :探讨腹腔镜胆囊切除 (LC)联合肝囊肿或肾囊肿部分切除减压术的疗效及适用性。方法 :回顾分析 15例LC联合肝囊肿或肾囊肿部分切除减压术的临床资料。结果 :15例LC联合肝、肾囊肿手术均获成功。手术时间 6 0～ 12 0min ,术后未发生严重并发症 ,康复顺利 ,平均住院 3～ 5d。随访 2～ 10月无复发。结论 :LC联合肝囊肿或肾囊肿部分切除减压术疗效肯定 ,操作方便 ,术中视野显露良好 ,患者创伤小 ,康复快 ,术后住院时间短 ,是兼患肝或肾囊肿的胆囊疾病患者最佳的手术方法     

腹腔镜治疗肝囊肿

目的探讨应用腹腔镜治疗肝囊肿的手术方法及临床疗效。方法回顾性分析42例腹腔镜治疗肝囊肿的临床资料。结果42例患者手术全部成功，3例（7．1％、3／42）行肝囊肿切除，31例（73．8％、31／42）行肝囊肿开窗引流术，8例（19．1％、8／42）合并胆囊结石行腹腔镜联合手术，无一例中转开腹。手术历时30—100min，平均48min，术中出血量5—65ml，平均20ml，术后住院6—9d，平均7．8d，术后肠功能恢复时间短，有3例使用止痛药，所有患者均痊愈出院。随访病人40例，失访2例，随访率95．2％（40／42），随访时间为6～30个月，平均22个月，术后原症状均消失，随访病人中无肝囊肿复发。结论应用腹腔镜技术治疗肝囊肿具有创伤小、病人恢复快、术后并发症少、住院时间短等优点，是治疗肝囊肿的首选方法。     

Laparoscopic surgery of hepatic hydatid cyst at the 3rd Surgical Clinic, Cluj-Napoca

In the III-rd Surgical Clinic Cluj-Napoca, during 1996-2005, there was operated laparoscopic 33 patients with hepatic hydatid cyst. The sex ratio was M10/F23, with a mean age of 34 years and with ages between 10 and 66 years. Hepatic echography was used in preoperative diagnosis. The hepatic hydatid cysts were situated in 9 cases in the left liver (II-III-IV Couinaud segments) and in 24 cases in the right liver (15 cases in the V-VI segments and 9 cases in the VII-VIII Couinaud segments). The laparoscopic treatment was performed by Lagrot pericystectomy at 31 patients and by ideal cystectomy at 2 patients. Around the cyst there were put switches impregnated with formalin 2% or hypertonic saline 20% to prevent peritoneal insemination. The cyst sterilization was done in most cases with hypertonic saline solution. The mean postoperative hospitalization was 5,6 days, with the range 1-21 days. Laparoscopic surgery with the well known advantages offers a good alternative to classic surgery in the treatment of hepatic hydatid cyst.     

腹腔镜手术治疗先天性肝囊肿28例体会

目的探讨腹腔镜手术治疗先天性肝囊肿处理方法及效果。方法回顾性分析2000年6月-2008年8月28例腹腔镜肝囊肿开窗术的临床资料。结果27例在腹腔镜下成功完成手术，1例因囊液内有胆汁中转开腹手术，全组病例无严重并发症，平均住院时间6天，术后肠功能恢复时间1—2天，术后疼痛可耐受，全组均痊愈出院。结论腹腔镜肝囊肿开窗术疗效确切，创伤小，恢复快，是治疗先天性肝囊肿目前最合理、有效的方法。     

腹腔镜治疗先天性肝囊肿48例的临床经验与分析

目的 探讨腹腔镜治疗先天性肝囊肿的手术操作要点和临床价值.方法 回顾性分析扬州大学临床医学院2006年8月-2009年4月对48例肝囊肿施行腹腔镜治疗,其中开窗术46例,左半肝切除术2例;单发肝囊肿41例,多发肝囊肿7例.结果 48例手术均获成功,无中转开腹,术后无一例胆漏、出血.除左半肝切除术,手术时间均为30～96...     

经脐单孔腹腔镜手术在肝胆外科中的应用

目的:探讨经脐单孔腹腔镜手术在肝胆疾病中的应用,总结其可行性及局限性。方法:回顾分析经脐单孔腹腔镜胆囊切除术24例、肝血管瘤2例、肝囊肿3例、脾囊肿1例共30例患者的临床资料。经脐下缘做约1.5 cm弧形切口,穿刺3个5mm Trocar,其中2例采用Tri-Port切除肝血管瘤,术中使用多角度可旋转分离钳。结果:30例均完成经脐单孔腹腔镜手术,24例胆囊患者平均住院1.2d,5例肝脏手术、1例脾囊肿患者平均住院4d,术后30例患者均未发生胆漏、出血等严重并发症。结论:经脐单孔腹腔镜手术安全、可行,患者疼痛轻,同时具有手术瘢痕小、美观的特点,但腹腔镜器械尚待进一步研发。     

Laparoscopic surgery of the liver, in 92 cases

We analyze the experience in laparoscopic hepatic surgery of the Research Center of Laparoscopic and Open Surgery from Ia?i between 1993-2006. This study includes 92 patients (0.9% from 10,367 laparoscopic operations) with liver pathology considered for laparoscopic treatment. We performed 42 Lin procedures (wide fenestration technique) for serous hepatic cysts, 32 cystectomies for hepatic hydatid disease, 10 non-anatomical hepatic resections (for 2 adenomas, 4 haemangiomas, 4 metastasis) and 8 steam water thermo-necrosis (for multiple hepatic metastasis). Conversion to open surgery rate was 8.7% (hepatic hydatid cysts--6 cases, serous hepatic cyst--1 case with associated acute cholecystitis, thermo-necrosis--1 case). We had no postoperative mortality and morbidity rate was 6.5%. The follow-up was available in all patients for a mean time of 12 months, by abdominal ultrasound exam and/or computed tomography. No evidence of disease recurrence was registered. We are at the beginning of the laparoscopic hepatic surgery and these results need to be confirmed. For the hepatic serous cysts the laparoscopic fenestration is the best treatment, but for the hepatic hydatid cyst, the laparoscopic approach is indicated only in selected cases: uni-vesicular hydatid cyst, noncomplicated, localised into the "laparoscopic" segments of the liver. Albendazole treatment is also necessary in these cases. For all types of benign liver tumours, the best indication remains small, superficial lesions, located in the anterior or the lateral segments of the liver. When performed by expert liver and laparoscopic surgeons using an adequate surgical technique, the laparoscopic approach is safe for performing minor liver resection for malignant tumours and is accompanied by the usual postoperative benefits of laparoscopic surgery.     

腹腔镜技术在腹部外科的临床应用

目的 :探讨腹腔镜在腹部外科手术中的应用价值。方法 :回顾分析腹腔镜胆囊切除、阑尾切除、肠粘连松解、肝囊肿开窗、溃疡穿孔修补、肾囊肿去顶、精索静脉结扎以及腹部联合手术等病例的临床资料。结果 :30 2例手术中因阑尾异位中转开腹 2例 ,出现气胸、皮下气肿各 1例 ,戳口感染 2例 ,全组均痊愈出院。结论 :腹腔镜探查有助于提高诊断率 ,降低阴性剖腹探查率 ,具有明显优越性 ,手术适应证随技术进步和设备改善被逐步拓宽     

Surgical Treatment of Liver Echinococcosis — the Role of Laparoscopy

Background: The surgical approach to liver echinococcosis is still a controversial issue. This study shows our results of surgical treatment of liver hydatid cysts during a 5-year period.

Methods: A prospective study of 21 patients operated on in a 5-year period (1999–2003), in Dubrava University Hospital in Zagreb, Croatia, with hepatic hydatid cyst. All patients were pre-operatively treated with albendazole. In 12 patients, total pericystectomy without opening the cyst cavity was performed, 9 open and 3 laparoscopic. In the other 9 patients, partial pericystectomy was done, 6 open and 3 laparoscopic.

Results: There was no mortality after 5–65 months follow-up, but in 1 patient, in the open partial pericystectomy group, recurrence of the disease occurred after 3 years. When a laparoscopic procedure was done, there were no complications or recurrence. The median operative duration for open surgery was 100.0 min (range 60.0-210.0), and for laparoscopic surgery 67.5 min (range 60.0-120.0). The median length of hospitalisation for open surgery was 8.0 days (range 7.014.0), and for laparoscopic surgery 5.0 days (range 4.0-7.0).

Conclusion: Total pericystectomy without opening the cyst cavity, preceded by pre-operative albendazole therapy is the method of choice for hepatic hydatid cyst treatment. Despite the small group of patients, our first results show laparo-scopic total pericystectomy without opening the cyst cavity, in the treatment of hepatic hydatid cyst, as a good alternative to open surgery in selected patients.