全内脏反位胆囊结石的腹腔镜手术体会

目的探讨全内脏反位胆囊结石的腹腔镜手术技巧。方法回顾性分析本院8例全内脏反位胆囊结石患者的腹腔镜手术资料,手术均采用与普通腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)完全相反的四孔法完成。结果 8例全内脏反位的腹腔镜胆囊切除手术顺利,无一例中转开腹。手术时间未明显提高。术后患者生命体征平稳,未出现胆漏、肠瘘、出血等并发症,术后6~7天拆线出院。结论明确诊断,完善准备,转变普通腹腔镜胆囊切除术的手术思维和改良操作技巧,对全内脏反位胆囊结石患者行腹腔镜胆囊切除是安全、可行的。     

内脏反位行腹腔镜胆囊切除术体会

目的:总结内脏反位病人腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的手术方法.方法:自2000年2月至2001年5月间,对2例内脏反位病人行腹腔镜胆囊切除,其中1例因胆囊三角粘连中转开腹.结果:2例病人术后恢复良好,随访24个月无不良反应.结论:手术时清楚解剖,适应左右完全相反的位置感,内脏反位行腹腔镜胆囊切除术还是安全的.     

全内脏反位行腹腔镜胆囊切除术1例报告

全内脏反位合并胆囊结石较少见,行腹腔镜胆囊切除仅见个案报道.我院于2009年10月行全内脏反位腹腔镜胆囊切除术1例,报道如下.     

全内脏反位腹腔镜胆囊切除术1例

正内脏反位患者其脏器左右完全相反,与正常人呈镜面像,又称"镜面人",其发生机制目前认为可能是染色体及其携带的基因异常~([1]),或者胚胎发育期间旋转不良导致~([2])。全内脏反位患者胆囊结石临床少见,行腹腔镜胆囊切除术的手术难度增加,可能会发生血管或胆管损伤,需引起警惕。我科于2016年4月行全内脏反位腹腔镜胆囊切除术1例,无并发症发生,现报道如下。     

腹腔镜切除内脏全部反位型左位胆囊2例

腹腔镜切除左位胆囊尤其是内脏全部反位型左位胆囊的报道少见,经验也较缺乏。2003年我院肝胆外科中心行腹腔镜胆囊切除术中,遇到内脏全部反位型左位胆囊2例。现将经验总结如下。     

内脏完全反位腹腔镜胆囊切除术:附2例报告

本文报道1997、2015年2例完全内脏反位的结石性胆囊炎行腹腔镜胆囊切除术。腹痛部位分别在剑突下和左上腹。血常规、肝功能检查无异常。术前常规心电图、胸片提示右位心,腹部磁共振检查进一步证实为内脏反位,并排除胆总管结石。全麻,采用四孔法行腹腔镜胆囊切除术,医生站位和trocar位置均为正常的镜像,胆囊位于左上腹。手术顺利,术后恢复好,无并发症。     

全内脏反位腹腔镜胆囊切除术1例体会

内脏反位俗称“镜面人”,是指身体内各内脏器官的解剖位置与正常人左右相反,如镜子中的影像一样。内脏反位在临床上较为罕见,而合并胆囊病变者更为罕见。2019年6月笔者在山东大学齐鲁医院进修期间收治1例全内脏反位患者并行腹腔镜胆囊切除术,总结报道如下。     

异位胆囊的腹腔镜手术对策(附21例报告)

目的 探讨异位胆囊的腹腔镜手术对策。方法 收集我院近年腹腔镜胆囊切除术（ＬＣ）所遇２１例异位胆囊患者的临床资料，分析其围手术期处理、手术原则和技巧。结果 肝右后叶胆囊１例；全内脏反位，胆囊位于左肝下２例；肝左外叶胆囊２例；肝内胆囊１６例。经必要的术前准备及术中相应处理，均在腹腔镜下顺利完成胆囊切除，术中、术后无并发症发生。结论 异位胆囊给ＬＣ带来困难，应根据胆囊位置的具体变异，采取适当措施，从而避     

内脏反位腹腔镜胆囊切除术2例报告

内脏反位是一种罕见的解剖异常,发生率为1/5 000～1/20 000[1]。本人于2003-2008年间成功对2例内脏反位患者行腹腔镜胆囊切除术（LC）。现报告如下。1临床资料1.1一般资料例1,女,48岁,因＂发现胆囊息肉     

全内脏反位后腹腔镜下根治性肾切除术一例报告

正全内脏反位(situs inversus totails,SIT)是一种罕见的先天性畸形,全内脏反位合并肾脏肿瘤病例临床上更为少见[1],异常的脏器和血管分布往往增加了此类患者的手术难度,对于采取经腹腔途径腹腔镜手术则尤为困难[2]。我们近期收治1例全内脏反位同时伴有右侧肾脏肿瘤患者,对其采用腹膜后途径成功进行了腹腔镜下根治性右肾切除术,检索文献国内尚未有类似报道。临床资料患者男性,52岁,因"外院CT检查发现右     

Lateral curvature of the erect phallus without chordee.

Three cases of lateral curvature of the penis during erection are described. In no case was there evidence of chordee. A corrective operation for this condition is described.     

Infarction of a lipoma of the lesser omentum: laparoscopic treatment of a rare condition

Infarction of the lesser omentum is an infrequent occurrence and is unfamiliar to most clinicians. Patients with this condition present with insidious epigastric pain, peritonitis on examination, and a normal white blood cell count. The computed tomographic scan reveals a focal ill-defined inflammatory mass with attendant fat stranding along the lesser curve of the stomach. In most patients, the diagnosis is secured at operation, although analgesics alone might be sufficient for management of this benign inflammatory condition. We present a case with the classic findings that was managed laparoscopically. Greater familiarity with focal infarction of lesser omental fat might lead to more nonoperative management in the future.     

Haemorrhagic cholecystitis.

Two cases of haemobilia due to haemorrhagic cholecystitis are presented; only 28 other cases have been described. As there are so many more dramatic causes and treatment for haemobilia it is important for the surgeon to recognize that a common operation will suffice for this rare condition. In both cases bacteria were grown from the bile and it is to be hoped that bile culture will be recorded more commonly in future in cases of this interesting condition.     

Fatal mediastinitis after routine laparoscopic cholecystectomy

Laparoscopic cholecystectomy is now considered a routine operation with a low complication rate. In this case study, the authors present a laparoscopic cholecystectomy patient who died of masked mediastinitis and concomitant septicemia caused by an unrecognized esophageal perforation after difficult intubation. The authors call attention to the need for early detection of perforating mediastinitis to prevent a lethal outcome from this infrequent but life-threatening condition.     

A successful operation of bilateral emphysematous giant bullae in elderly case

A 77-year-old man who had bilateral giant emphysematous bullae with chronic obstructive lung disease underwent emergent bilateral bullectomy and plication through the median sternotomy approach. He developed critical hemodynamic condition followed by severe hypoxemia (PO2 32.7 Torr) and hypercapnea (PCO2 76.2 Torr) due to the atelectasis of right middle lobe following respiratory infection, which caused the ballooning of the bullae. The operation was done applying Naclerio-Langer's procedures. The postoperative course was excellent without any complications. The patient is doing well fifteen months after the operation. The median sternotomy approach for the simultaneous bilateral pulmonary operation has advantages such as the unnecessity of changing patient's position during the operation, the easiness of operation for bilateral lesion, the possibility of shortening of operation time and reduction of postoperative wound pain compared with the other thoracotomies. In this report, the practical usefulness of this approach, especially in emergency or elderly cases is emphasized.     

Surgical treatment of Taussig-Bing malformation in an adult--a case report

With the development of pediatric cardiac surgery, the surgical treatment of Taussig-Bing malformation has been common in frequency and a majority of these cases are reported. However, because the patient's condition is so critical in the early stage of life, the importance of adequate initial operation is emphasized, and this area is restricted to the operative cases of child patient. In this clinical study, the operation for 41-year-old adult patient with Taussing-Bing malformation was successfully performed using the Kawashima's procedure, and we would like to report the detailed operative procedure as well as its clinical courses. This patient was female of 41 years of age and at surgery, this case was found to be the Taussig-Bing malformation associated with pulmonic stenosis, and the operation for intracardiac repair was carried out using intracardiac conduit (5 x 4 cm) and also extracardiac conduit (5 x 3 cm). It is reported that there are many operative procedure available in child patients but we believe that Kawashima's procedure is probably the best choice of operation for adult patients because of its simplicity.     

Pathology of the bile ducts in the elderly

After examining the literature on the subject, all admissions to the Pavia University Department of Surgical Pathology from 1-1-1974 to 31-12-1985 belonging to the IIIrd age and suffering from non-neoplastic and neoplastic bile way pathology have been reviewed. The two groups were studied on the basis of their histories and laboratory examinations, the outcome of the operation and its complications. It was found that in patients affected by non-neoplastic pathology (lithiasis of the bile ways, alithiasic cholecystitis, etc.) the operation of choice was well tolerated, unlike emergency surgery which in most cases was dangerous. In the IInd group, on the other hand, general condition is very important because on this depends whether or not resective or derivative intervention is carried out. It should be noted here that in all IIIrd age patients associated diseases have to be studied closely for these can contribute to death. It is concluded that in the Ist group of patients, operation can take place in optimal general and local conditions so that the operation can be of choice and not emergency. In the IInd group, as soon as the general condition of the patient so permits, the operation must be as extensive as possible, as age is not an impediment to surgery.     

Surgical treatment of endocarditis following heart valve prosthesis

Experience of many years in surgical treatment of prosthetic valve endocarditis (RVE) is analyzed. Patients whose condition was serious were operated on for a second time: 91.6% had preoperative functional class IV, in half of them circulatory disorders were of stage IIB--III; 62.4% were subjected to reoperation for emergency indications. Twenty-five reoperations were performed for early PVE with 52% hospital mortality, 23 reoperations-for late term PVE with mortality of 30.4%. The most frequent cause of PVE was staphylococcal infection which showed a tendency to increase in the recent years. In early PVE the severity of the condition in the recent years. In early PVE the severity of the condition was due to sepsis and intoxication, in late-term PVE it was caused by disorders of hemodynamics which were usually induced by dysfunction of the prosthesis. The results of surgical management of PVE depended on the severity of the patient's condition before the operation, timely performance of the operation, and the efficacy of antibacterial therapy.     

Surgical treatment of segmental extrahepatic portal hypertension

The authors analyse the immediate and late-term results of surgical treatment of 39 patients who underwent 50 operations for segmental extrahepatic portal hypertension (SEPH). The threat of gastric hemorrhage was the main indication for surgery. Gastrotomy with suturing of the varicose veins of the stomach is the operation of choice when gastric hemorrhage continues. This operation produces an immediate clinical effect but fails to ensure long-term prevention of bleeding. In planned treatment splenectomy is the operation of choice only in patients with signs of marked hypersplenism when there is little threat of the development of asplenic thrombocytemia in the postoperative period. Separation of the vascular gastrosplenic connections is the operation of choice in the absence of hypersplenism. Ligation of the splenic artery and transposition of the decapsulated spleen into the retroperitoneal space have no haemostatic effect and must not be conducted for the prevention of gastric hemorrhage in this pathological condition.     

Pseudostriction of hiatal hernia. Apropos of a case with incarceration of the transverse mesocolon and small intestine]

Massive hiatal hernia is a lesion at risk of incarceration, volvulus, and obstruction. The true paraesophageal type is a very rare condition and probably often mistaken with end-stage slidind hernia. Furthermore reflux and oesophagitis are always possible. In this case report a small bowel loop was incarcerated with a massive hiatal hernia. This association was only possible because of the existence of an associated transverse mesocolis hernia giving way to the small bowel. An emergency operation was necessary. The need of surgical treatment of such lesions is stressed, if possible before acute complication, even if they are asymptomatic at the time of diagnostic, which is a quite common condition.