腹腔镜下超声刀小儿肾输尿管切除术

目的探讨腹腔镜下超声刀小儿肾输尿管切除手术的操作特点及疗效. 方法对5例肾发育不全、多房性肾囊性变和重复肾合并输尿管异位开口的病孩,使用微型腹腔镜及超声刀技术施行肾输尿管切除术或部分肾及输尿管切除术. 结果 5例手术均获成功.手术耗时105～268分钟,平均152分钟.术中出血不少15ml,术后无继发性出血、无手术合并症. 结论腹腔镜超声刀技术能安全、有效地应用于肾或部分肾输尿管切除术,有利于病孩术后的恢复.     

小儿重复肾的治疗（附38例报告）

目的探讨各种方法治疗重复肾的疗效，寻找影响预后的有关因素。方法38例重复肾患儿，男8例，女30例，左侧20例，右侧12例，双侧6例。 VCU检查28例，3例发现中-重度返流，38例均行超声和IVU及CT检查。结果术后随访6个月~3年。38例重肾中，有3例经膀胱行输尿管囊肿切除输尿管膀胱再植术，2例行输尿管囊肿切除输尿管膀胱再植术加上半肾切除术；其余33例均行上半肾切除术，术后2例因严重尿路感染行输尿管残端切除术。结论重复肾的治疗应根据是否合并输尿管囊肿及囊肿的类型、肾功能、有无返流决定手术方式，对于大多数重肾，单纯上半肾切除预后良好，若术前 VCU检查有-重度返流，应行完全重建术。     

腹腔镜肾部分切除术的手术配合

目的探讨腹腔镜治疗右重复肾双输尿管畸形的手术配合。方法根据腹腔镜肾部分切除术的手术特点,周密地做好术前准备工作。熟悉手术所用器械仪器的性能,掌握手术步骤,重视术前准备和术中密切配合;保证手术顺利完成,有利于新手术的开展。结果手术顺利完成,取得满意的临床效果。结论腹腔镜右重复肾双输尿管畸形肾部分切除术安全有效。     

腹腔镜下肾前筋膜间平面的临床解剖学研究

目的　探讨腹腔镜下肾前筋膜间平面的活体形态解剖分层,寻找安全正确的外科解剖层面。 方法　经腹腔入路3例,经腹膜后腔入路25例,其中肾上腺肿瘤切除术11例、肾切除术8例、肾癌根治术2例、肾部分切除术2例、肾盂输尿管成形术3例、输尿管上段结石2例。术前进行320排CT影像解剖分析肾筋膜结构。术中及术后对镜下肾前筋膜间层面解剖结构及毗邻关系分析辨别。 结果　肾前筋膜间平面包括结肠融合筋膜肾前融合筋膜间平面、肾前融合筋膜肾筋膜前叶间平面、肾筋膜前叶肾脂肪囊外平面,是多层次的无血管筋膜结构。腹腔镜下可见层面间充满蜘蛛丝网格状白色纤维组织。 结论肾前筋膜间平面是肾脏和肾上腺外科手术时前入路的安全层面。沿这些平面可实施无血化解剖性腹膜后脏器微创手术。     

经后腹腔镜肾切除23例体会

目的 探讨经后腹腔镜下肾切除术治疗肾脏疾病的疗效及临床价值.方法 经后腹腔镜肾切除术治疗肾脏疾病23例,其中肾肿瘤8例,重度肾积水致肾功能丧失6例,肾萎缩4例,肾结核5例.结果 23例手术均获成功,无术中及术后严重并发症发生,无中转开放手术病例.平均手术时间200.2min.结论 经后腹腔镜肾切除术具有损伤小、出血少,成功率高,并发症少、恢复快等优点,适用于多种病因引起的肾脏疾病的肾切除,值得推广运用.     

评价肾部分切除术治疗肾肿瘤的安全性及有效性

目的：研究探讨肾部分切除术治疗肾肿瘤的安全性以及有效性。方法分析我院66例肾肿瘤行肾部分切除术患者的病例资料,随机进行分组：肾动脉阻断缺血时间小于等于30min的为观察组,有33例;肾动脉阻断缺血时间大于30min的为对照组,有33例。治疗后,观察两组患者治疗的有效率及手术中的出血量、住院时间、并发症等情况。结果比较观察组和对照组的手术时间、术后住院时间、术中出血量、术后血清尿酸肌酐升高幅度及术后并发症,两组差异无统计学意义(P>0.05)。比较两组的术前术后肾小球滤过率(GFR),有统计学差异(P<0.05)。结论肾部分切除术治疗肾肿瘤时,将肾缺血时间控制在小于等于30分钟,对术后肾功能的恢复影响较小,安全有效。     

双J导管在肾、输尿管手术中的应用

目的探讨双J导管在基层医院肾、输尿管手术中的应用价值.方法在69例肾、输尿管手术中使用双J导管作内引流,术后2～6周通过膀胱镜拔管.结果术后引流通畅,无导管移位,无吻合口狭窄,无切口感染、漏尿、腰痛、发热等现象,肾积水减少或消失,肾功能明显改善.结论肾、输尿管手术中应用双J导管作内引流,可充分引流肾盂尿液,预防吻合口狭窄,防止尿瘘,有利于肾功能的恢复.术后恢复快,住院时间缩短.     

双J导管在肾、输尿管手术中的应用

目的　探讨双J导管在基层医院肾、输尿管手术中的应用价值 .方法　在 69例肾、输尿管手术中使用双J导管作内引流 ,术后 2～ 6周通过膀胱镜拔管 .结果　术后引流通畅 ,无导管移位 ,无吻合口狭窄 ,无切口感染、漏尿、腰痛、发热等现象 ,肾积水减少或消失 ,肾功能明显改善 .结论　肾、输尿管手术中应用双J导管作内引流 ,可充分引流肾盂尿液 ,预防吻合口狭窄 ,防止尿瘘 ,有利于肾功能的恢复 .术后恢复快 ,住院时间缩短     

后腹腔镜下肾切除术中肾血管的处理方法探讨

目的 探讨后腹腔镜下肾切除术中左右肾血管不同的处理方法及临床价值.方法 回顾性分析2005年3月至2011年12月行后腹腔镜下肾切除术的64例患者的病例资料及手术视频,总结术中处理肾血管的经验.术中以腰肌前间隙内侧弓状韧带为解剖标志寻找右肾蒂,小心处理右肾静脉防止撕裂下腔静脉;在腰肌前间隙腹主动脉旁脂肪前内寻找左肾蒂,避免损伤或漏扎左肾血管属支.结果 64例手术均获成功,无中转开放手术及输血病例,术后未出现严重并发症.结论 熟悉肾血管的解剖特征,采用不同的方法分别处理左右肾血管,有利于提高后腹腔镜下肾切除术的安全性.     

侧卧位经腹腹腔镜肾-输尿管全段-膀胱部分袖状切除术效果分析

目的探讨侧卧位经腹腹腔镜肾-输尿管全段-膀胱部分袖状切除术的临床效果。方法回顾性分析云南省第三人民医院2017年6月至2019年6月收治的14例侧卧位下行经腹腹腔镜肾-输尿管全段-膀胱部分袖状切除术患者的临床资料,记录患者手术时间、术中出血量、术后住院时间及并发症情况。结果本研究中14例患者手术均获成功,均未出现手术并发症,手术时间为(4.5±1.3) h,术中失血量(112.5±42.2) m L,术后住院时间(9.2±5.4) d。术后病理证实肾盂癌8例,输尿管癌4例,无功能肾2例。所有患者均行膀胱造影,确认无漏尿后拔除尿管。结论经腹腹腔镜下侧卧位肾-输尿管全段-膀胱部分袖状切除术安全有效,操作方便,经腹腔路径暴露充分,标本完整。     

Laparoscopy-assisted urologic surgery through minilaparotomy

Minimally invasive surgery has gained wide acceptance as a method of reducing postoperative pain and curtailing the convalescence period. We have devised a modified surgical technique of laparoscopy-assisted surgery through minilaparotomy. It is a hybridized form of conventional open and laparoscopic surgery and it combines the benefits of both techniques by reducing postoperative pain and scarring as in laparoscopy, but at the same time maintaining the safety of conventional open surgery. From January 1992 to September 1999, we performed laparoscopy-assisted surgery through minilaparotomy in 167 patients. The operative time for laparoscopy-assisted surgery through minilaparotomy ranged from 79 to 290 minutes (mean 125). There was no conversion to open surgery, no peri- or postoperative complications, and only 3 patients needed a blood transfusion at any stage. Pain was significant on the first day but resolved quickly. All patients resumed consistent oral intake on the second day. All patients commenced ambulation by the second postoperative day and were able to resume full ambulatory activity by the fourth postoperative day. The final would size did not exceed 10 cm in size and all patients expressed satisfaction with their wounds. In conclusion, we believe that laparoscopy-assisted minilaparotomy surgery is a truly minimally invasive technique maintaining the advantages of conventional surgery. Our method could become a first-line approach for simple nephrectomy, living donor nephrectomy and radical nephrectomy, as well as surgery for kidney and ureter stones.     

Hand-assisted retroperitoneoscopic nephroureterectomy without hand-assisted device

Various laparoscopic nephroureterectomy techniques for urothelial carcinoma of the upper urinary tract have been developed to minimize postoperative discomfort and the necessity for a lengthy convalescence. We performed hand-assisted retroperitoneoscopic nephroureterectomy without hand-assisted device in 3 male patients with urothelial carcinoma of the distal ureter. Average operative time and estimated blood loss were 251 min (range 235 to 280) and 250 mL (range 200 to 300), respectively. Complication did not occur and conversion to open surgery was not necessary in all cases. Postoperative analgesic requirements were moderate and the time to regular diet intake averaged 3 days (range 2 to 4). None of the patients had a positive margin on the final pathologic specimen. At the average follow-up of 8.1 months, no regional recurrence, port-site metastasis, bladder recurrence, or distant metastasis were noted in any patient. We described our initial experience with the described technique, which obviates the need for midprocedural patient repositioning.     

The value of routine preoperative medical testing before cataract surgery. Study of Medical Testing for Cataract Surgery

BACKGROUND: Routine preoperative medical testing is commonly performed in patients scheduled to undergo cataract surgery, although the value of such testing is uncertain. We performed a study to determine whether routine testing helps reduce the incidence of intraoperative and postoperative medical complications. METHODS: We randomly assigned 19,557 elective cataract operations in 18,189 patients at nine centers to be preceded or not preceded by a standard battery of medical tests (electrocardiography, complete blood count, and measurement of serum levels of electrolytes, urea nitrogen, creatinine, and glucose), in addition to a history taking and physical examination. Adverse medical events and interventions on the day of surgery and during the seven days after surgery were recorded. RESULTS: Medical outcomes were assessed in 9408 patients who underwent 9626 cataract operations that were not preceded by routine testing and in 9411 patients who underwent 9624 operations that were preceded by routine testing. The most frequent medical events in both groups were treatment for hypertension and arrhythmia (principally bradycardia). The overall rate of complications (intraoperative and postoperative events combined) was the same in the two groups (31.3 events per 1000 operations). There were also no significant differences between the no-testing group and the testing group in the rates of intraoperative events (19.2 and 19.7, respectively, per 1000 operations) and postoperative events (12.6 and 12.1 per 1000 operations). Analyses stratified according to age, sex, race, physical status (according to the American Society of Anesthesiologists classification), and medical history revealed no benefit of routine testing. CONCLUSIONS: Routine medical testing before cataract surgery does not measurably increase the safety of the surgery.     

Laparoscopic bilateral nephroureterectomy and bladder cuff excision for native renal pelvic and ureteral transitional cell carcinoma after renal transplantation

A 37-years-old female who was suffering from end-stage renal disease for about 6 years received allograft renal transplantation 4 years ago. She has been receiving 50mg of Cyclosporin A orally daily for immuno-suppression since then. Gross haematuria was noted and computerised tomography showed native left renal pelvic and ureteral multi-focal transitional cell carcinoma with severe hydronephrosis. Laparoscopic bilateral nephroureterectomy and bladder cuff excision were performed. In the past, history of previous operation was considered a relative contraindication for laparoscopic surgery. To our knowledge, we present the first case of laparoscopic treatment for native renal pelvic and ureteral transitional cell carcinoma after renal allograft transplantation without a hand-assisted device. This case shows the feasibility of laparoscopic bilateral nephroureterectomy in patients with transplanted kidneys.     

The prevalence of postoperative pain in the first 48 hours following day surgery at a tertiary hospital in Nairobi

Background

Day case surgery services are increasing all over the world. The prevalence of postoperative pain after day surgery is found to be high. Little is known about the prevalence of postoperative pain, in Kenya, after day case surgeries.

Objective

To investigate the prevalence of postoperative pain after day surgery at Aga Khan University Hospital (AKUH), Nairobi, to determine the severity/intensity of postoperative pain following day case surgery

Methods

Consecutive sampling was carried out until sample size of one hundred and fifty patients was achieved. The purpose and nature of the study was explained to patients before informed consent was obtained. They were shown how to score their pain using a visual analogue scale prior to the surgical procedure. A questionnaire was used to collect data from the patients. Follow up information was obtained through telephone interviews at 24 and 48 hours, after discharge from the day surgery unit.

Results

The prevalence of postoperative pain after day care surgery was found to be 58% within 30minutes postoperatively, 55.3% after 24 hours, and 34.7% after 48 hours following surgery. The prevalence of moderate to severe postoperative pain was 13% after 24 hours, and 11.7% after 48 hours.

Conclusion

The overall prevalence of postoperative pain after day surgery at the Aga Khan University Hospital, Nairobi was noted to be different from what has been reported in the literature. The prevalence of moderate and severe pain however, is less than reported in the literature.     

The influence of hospital volume on survival after resection for lung cancer.

BACKGROUND: Among patients who have undergone high-risk operations for cancer, postoperative mortality rates are often lower at hospitals where more of these procedures are performed. We undertook a population-based study to estimate the extent to which the number of procedures performed at a hospital (hospital volume) is associated with survival after resection for lung cancer. METHODS: We studied patients 65 years old or older who received a diagnosis of stage I, II, or IIIA non-small-cell lung cancer between 1985 and 1996, resided in 1 of the 10 study areas covered by the Surveillance, Epidemiology, and End Results Program, and underwent surgery at a hospital that participates in the Nationwide Inpatient Sample (2118 patients and 76 hospitals). RESULTS: The volume of procedures at the hospital was positively associated with the survival of patients (P<0.001). Five years after surgery, 44 percent of patients who underwent operations at the hospitals with the highest volume were alive, as compared with 33 percent of those who underwent operations at the hospitals with the lowest volume. Patients at the highest-volume hospitals also had lower rates of postoperative complications (20 percent vs. 44 percent) and lower 30-day mortality (3 percent vs. 6 percent) than those at the lowest-volume hospitals. CONCLUSIONS: Patients who undergo resection for lung cancer at hospitals that perform large numbers of such procedures are likely to survive longer than patients who have such surgery at hospitals with a low volume of lung-resection procedures.     

Experiences of Single Incision Cholecystectomy

Purpose: Single incision laparoscopic surgery in suitable cases is preferred today because it results in less postoperative pain, a more rapid recovery period, more comfort, and a better cosmetic appearance from smaller incisions. This study aims to present our experiences with single incision laparoscopic cholecystectomy to evaluate the safety and feasibility of this procedure.Methods: A total of 150 patients who underwent single incision laparoscopic cholecystectomy between January 2009 and December 2011 were evaluated retrospectively. In this serial, two different access techniques were used for single incision laparoscopy.Results: Single incision laparoscopic cholecystectomy was performed successfully on 150 patients. Median operative time was 29 (minimum-maximum=5-66) minutes. Median duration of hospital stay was found to be 1.33 (minimum-maximum=1-8) days. Patients were controlled on the seventh postoperative day. Bilier complication was not seen in the early period. Five patients showed port site hernia complications. Other major complications were not seen in the 36-month follow-up period.Conclusion: Operation time of single incision laparoscopic cholecystectomy is significantly shortened with the learning curve. Single incision laparoscopic cholecystectomy seems a safe method.     

腹腔镜胆总管切开取石术后引流与非引流的临床探讨

目的总结腹腔镜联合纤维胆道镜胆总管切开取石行内引流、“T”管外引流与I期缝合的临床适应证。方法应用腹腔镜及纤维胆道镜技术治疗胆总管结石患者,行胆总管切开取石。胆总管内置入“内引流管”,“T”管以及一期缝合并观察疗效。结果131例腹腔镜手术全部成功,手术时间90—210min．其中行“T”管外引流41例,一期缝合90例。全组发生胆漏3例,8例术后残留肝内胆管结石,均带“T”管出院,于术后6周回院行胆道镜取净结石治愈。全组均无胆道狭窄、大出血、腹腔感染。术后第2天进流质饮食并下床活动．平均住院7．5d。结论只要严格掌握适应证和熟练的腹腔镜操作技术,胆总管切开取石术后一期缝合是值得推广的。     

七氟醚对老年冠心病患者非心脏手术血流动力学及心肌缺血事件的影响

 目的 探讨七氟醚对老年冠心病患者非心脏手术心肌保护作用。方法 选取4家医院择期行非心脏手术的老年冠心病患者165例,随机分两组：七氟醚持续吸入维持全身麻醉（S组,）和丙泊酚持续静脉输注维持全身麻醉（P组）。记录术中不同时点血压、心率,检测术前、术后即刻、术后第1天、第2天12导联心电图ST段和T波改变。术后随访30d,记录术后不稳定心绞痛、心梗、心衰及心源性死亡发生情况。结果 心电图提示的心肌缺血发生率：S组患者在术后各时点均低于P组,其中术后第1天(16.9% VS 30.5%)和第2天(16.9% VS 30.5%)的差异显著（p<0.05）。结论 七氟醚对老年冠心病患者接受非心脏手术具有一定的心肌保护作用,但并不改变患者心脏事件发生率。