腹腔镜下胆囊切除术96例的临床分析

目的：探讨腹腔镜胆囊切除术(LC)的临床治疗效果及其并发症的预防。方法回顾分析我院2013年3月~2014年6月96例胆囊结石患者的临床资料,全部患者均在腹腔镜下行胆囊切除术。结果本组96例均顺利完成胆囊切除,平均手术时间40min(24~70min);术后平均住院4d(3~5.5d)。术中出现并发症6例,均未采取特殊处理,对症治疗后无严重后遗症发生。结论腹腔镜胆囊切除术具有手术时间短、创伤小、粘连少、痛苦轻、恢复快、术后瘢痕小等优点,值得推广,但仍然存有并发症;因此应严格遵循手术原则,并规范手术操作以减少并发症,从而保证手术治疗效果。     

腹腔镜阑尾切除术手术技巧探讨

目的探讨腹腔镜阑尾切除术手术技巧,提高腹腔镜阑尾切除手术技能。方法回顾性分析2009年2月至2010年5月施行的161例腹腔镜阑尾切除术,总结腹腔镜阑尾切除手术处理的方法要点。结果 161例腹腔镜阑尾切除术均成功完成,无一例发生副损伤及并发症。结论随着腹腔镜技术提高和经验积累,只要掌握了腹腔镜阑尾切除术的手术技巧可以安全可靠地完成手术,并且能够最大程度地减少并发症。     

腹腔镜胆囊切除术中电凝法处理胆囊动脉的临床应用

目的总结腹腔镜胆囊切除术中用电凝处理胆囊动脉的效果。方法回顾性分析2000~2006年86例腹腔镜胆囊切除术中电凝法处理胆囊动脉的临床资料。结果电凝法85例(98.8%)术中、术后无继发出血;1例因胆囊动脉封闭不牢固需要用夹闭法。平均手术时间38min(20~70min)。术中平均出血量11ml(5~30ml)。术后平均住院时间3d(1~5d)。无手术并发症发生。结论腹腔镜胆囊切除术中合理应用电凝法处理胆囊动脉止血效果可靠,节省费用。     

腹腔镜下胆囊、阑尾联合同孔多脏器切除的临床分析

目的：观察腹腔镜下进行胆囊、阑尾联合同孔多脏器切除的临床效果。方法选取我院2010年5月~2014年5月收治的腹腔镜下行胆囊+阑尾联合同孔切除术患者38例,对他们的临床资料进行回顾性分析。结果38例患者全部顺利完成手术,没有发生中转开腹,也没有严重并发症发生。结论在腹腔镜下行胆囊+阑尾联合同孔多脏器切除术,具有微创、高效、灵活的特点,可以一次性切除两种或者多种病灶,不增加患者痛苦,减少了医疗费用。     

腹腔镜胆囊切除术治疗急性胆囊炎88例体会

目的：探讨急性胆囊炎行LC治疗的临床疗效评价。方法对2009年1月~2013年6月灌云县人民医院88例急性胆囊炎行腹腔镜胆囊切除术的患者进行回顾性分析和总结,其中胆囊周围包裹粘连42例。胆囊三角区致密粘连21例,胆囊颈部结石嵌顿18例,胆囊化脓坏疽7例,8例有腹部手术史。结果88例患者中85例成功完成腹腔镜胆囊切除术,成功率96.6%,3例中转开腹,中转率3.4%,手术时间35~160min,平均76min,术中出血量10~160ml,平均90ml,术后住院时间3~11d,平均住院6d。术后并发症5例,经对症治疗痊愈出院,术后无1例因胆管损伤、出血、胆漏及腹腔局限性感染而二次进腹手术.无残余小胆囊、胆总管残余结石及死亡等严重并发症。结论腹腔镜胆囊切除术治疗急性胆囊炎更具有恢复快、创伤小、住院时间短、并发症少,是单纯性胆囊结石、非结石性胆囊炎的首选术式。对于某些急性胆囊炎,只要术前充分准备及准确评估,早期及时的对急性胆囊炎患者进行Lc手术是一种比较安全快捷的治疗方法。     

腹腔镜多脏器手术23例分析

目的探讨腹腔镜多脏器联合手术临床应用的可能性。方法回顾性分析自2002年3月至2005年6月23例行腹腔镜多脏器联合手术的临床资料，其中腹腔镜胆囊切除术加阑尾切除术共15例，加脾切除术1例，加胃大部切除术1例，加左肾、左卵巢畸胎瘤切除术1例，加阑尾切除术后粘连松解术1例，加肝囊肿开窗术1例，加肝血管瘤切除术1例，腹腔镜胰体、尾切除加脾切除术2例。与同期同类腹腔镜单病灶手术的临床资料进行对比。结果腹腔镜胆囊切除术加肝血管瘤切除术因术中出血中转开腹，其余22例手术均顺利，未发生术后并发症。手术时间均较同期同类腹腔镜单病灶手术相加组缩短。术后患者排气时间1～5d，平均3．0d（标准差0．9d）。术后住院时间3～17d，平均6．5d（标准差3．2d）。结论腹腔镜多脏器联合手术能同时有效地处理腹腔内多个病灶。     

悬吊辅助下隐瘢痕法腹腔镜阑尾切除术临床分析

目的探讨悬吊辅助下隐瘢痕法施行腹腔镜阑尾切除术的可行性及优点。方法应用悬吊辅助下隐瘢痕法腹腔镜阑尾切除术27例。将银质探针插入腹腔内,用抓钳将其弯成鱼钩状,悬吊固定阑尾,然后行阑尾切除术。结果 27例患者均顺利完成手术,手术时间25~100 min,平均45 min,术中出血10~50 mL,平均20 mL,住院3~8 d,平均4 d。结论悬吊辅助下隐瘢痕法腹腔镜阑尾切除术安全、可行,兼具美容效果。     

腹腔镜胆囊大部分切除术在复杂型胆囊结石手术中的临床运用

目的探讨腹腔镜胆囊大部分切除术(laparoscopic subtotal cholecystectomy, LSC)的适应证、手术方法及临床应用价值。方法回顾分析总结本科自2012年7月~2013年9月28例腹腔镜胆囊大部分切除术的原因、方法和体会。结果28例手术顺利完成,手术平均时间75.8min,术中平均出血量60.5mL,肠蠕动平均恢复时间34 h,开始进食平均时间16~24 h,腹腔引流管平均留置时间为69.6 h,术后平均住院时间7.6d。术后无出血及肝外胆道损伤,随访6个月~1年,无症状复发,效果满意。结论在复杂型胆囊结石,选择行LSC是一种切实有效、并发症少、术后恢复快的手术方式,既能达切除胆囊之目的,且还能避免临近脏器之损伤(如肝外胆道、右肝管、胃肠道等),不失为复杂型胆囊手术治疗的一种较好的选择。     

对比腹腔镜和开腹阑尾切除术在治疗穿孔性阑尾炎中的手术效果

目的：探讨对比腹腔镜和开腹阑尾切除术在治疗穿孔性阑尾炎中的手术效果。方法选取我院2010年5月~2013年5月收治的60例阑尾炎患者，将患者随机分为观察组和对照组各30例，对对照组进行传统开腹阑尾切除手术治疗，对观察组给予腹腔镜下阑尾炎切除术治疗，比较两组患者手术时间、住院时间、手术中的出血量以及手术并发症的发生率。结果观察组平均手术时间比对照组更短，手术中出血量更少，两组差异具有统计学意义，P<0.05。观察组并发症发生明显少于对照组，P<0.05。两组患者手术时间差异没有统计学意义，P>0.05。结论腹腔镜下阑尾炎切除术与传统阑尾切除术的临床疗效更好，所造成的创伤更小，手术后患者恢复更快，并发症发生率更低，值得临床推广。     

腹腔镜拖出式阑尾切除术的初步经验

目的总结两孔法腹腔镜拖出式阑尾切除术的初步经验。方法 29例急性阑尾炎或慢性阑尾炎急性发作患者行腹腔镜拖出式阑尾切除术,并与腹腔镜阑尾切除术、传统开腹阑尾切除术进行比对。结果 29例均成功完成腹腔镜拖出式阑尾切除术,无中转开腹。手术时间10～20 min,平均12 min,术后恢复顺利,平均住院日4 d,术后随防3个月,无并发症发生,切口美容效果满意。结论腹腔镜拖出式阑尾切除术安全可行,操作简单易学,对腹腔的探查更具优势,美容美观效果好,设备要求不高,便于在基层医院推广。     

Laparoscopic renal cooling device

A new medical device has been designed for inducing hypothermia in kidneys, via laparoscopic deployment, without leaving residual fluid in the abdomen. It was tested in laboratory and animal trials to ascertain its suitability for achieving a target renal temperature of 15°C for tissue preservation within a 30-min period. A simple theoretical model was developed to calculate cooling rates under ideal circumstances. In the laboratory, a potato was used as the model for the kidney and an average minimum temperature of 15.8°C was reached in 30 min. The theoretical model calculated this as 9.9°C. In the animal trials, an average minimum temperature of 11.4°C was reached in 30 min, compared to the calculated temperature of 9.8°C from the theoretical model. In conclusion, the new device can cool as affectively as other techniques trialled, with the added advantage that it does not release cold fluid or ice into the abdomen.     

Laparoscopic myomectomy for large myomas

The aim of this study was to assess the feasibility and efficacy of laparoscopic myomectomy (LM) for large myomas. A subpopulation of 51 patients with myomas 8 cm or larger in diameter was selected from 155 patients who underwent LM at Kangbuk Samsung Hospital from July 2003 to November 2006. The mean age of the patients was 34.9 +/- 5.6 yr, mean parity was 0.6 +/- 0.9, and 8 patients had a previous operative history. The most common operative indication was a palpable abdominal mass (24 patients, 47%). The mean operating time was 85.6 +/- 38.9 min, and the mean diameter of the largest myoma was 9.3 +/- 1.8 cm. The mean change in hemoglobin concentration was 2.1 +/- 1.2 g/dL. Histopathological diagnosis included 49 patients of leiomyoma (96.1%) and 2 patients of leiomyoma with adenomyosis (3.9%). Postoperatively, a transfusion was done in 7 patients, and a case of subcutaneous emphysema was noted. None of the operations was switched to laparotomy. With the newly-developed screw and the port placement system that was modified from the Choi's 4-trocar method to obtain better surgical vision, LM of large myomas proved to be one of the efficient and feasible methods.     

腹腔镜手术治疗卵巢良性畸胎瘤

目的：探讨卵巢良性畸胎瘤腹腔镜手术的适应症、方法和临床应用价值。方法：对26例卵巢良性畸胎瘤患者行腹腔镜下肿瘤剥除术或附件切除术，分析其手术适应症、术中、术后情况及近期和远期并发症。结果：26例卵巢畸胎瘤均在腹腔镜下完成手术，单侧的23例，双侧的3例，囊肿直径3－9cm，20例行囊肿剥除术，6例行附件切除。平均手术时间110分钟，术中出血量20－100ml，病理报告全部为卵巢良性囊性畸胎瘤。术后体温2－3天恢复正常的23例，术后住院平均5．2天，随访1－40个月，症状、妇科检查和B超检查等均未发现异常。结论：腹腔镜下手术治疗卵巢成熟畸胎瘤是一种安全、有效且可进行早期治疗的方法，具有损伤小、恢复快，并发症少等优点。     

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,术后无继发性出务、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。     

Single-Fulcrum Laparoscopic Cholecystectomy in Uncomplicated Gallbladder Diseases: A Retrospective Comparative Analysis with Conventional Laparoscopic Cholecystectomy

Purpose

Single-fulcrum laparoscopic cholecystectomy (SFLC) is a variant type of single incision and multi-port technique that does not use specialized one-port devices or articulating instruments. We retrospectively compared perioperative outcomes of SFLC with those of conventional laparoscopic cholecystectomy (CLC).

Materials and Methods

Between March 2009 and December 2010, SFLC was performed in 130 patients. Among them, 105 patients with uncomplicated gallbladder disease (no inflammation or no clinical symptoms) and another 105 patients who underwent CLC were selected for this study.

Results

There was no open conversion. In comparison with CLC, SFLC was performed more often in young (46.4±12.2 years vs. 52.5±13.6 years, p=0.001) female patients (80/25 vs. 62/43, p=0.008). The total operation time was longer in SFLC (56.7±14.1 min vs. 47.5±17.1 min, p<0.001), but pain scores immediately after operation and at discharge time were lower for SFLC than for CLC (3.1±1.3 vs. 4.0±1.9, p<0.001, 2.0±0.9 vs. 2.4±0.8, p=0.002). Total cost was lower for SFLC than for CLC (US $ 1801±289.9 vs. US $ 2003±617.4, p=0.004). There were no differences in hospital stay or complication rates.

Conclusion

SFLC showed greater technical feasibility and cost benefits in treating uncomplicated benign gallbladder disease than CLC.     

超声诊断在腹腔镜胆囊切除术前的应用价值

目的：探讨超声在腹腔镜胆囊切除术（LC）术前的应用价值。并与内窥镜逆行性胆管造影（ERC）对比研究。方法：对56例可疑肝外胆管病变患者，应用超声观察胆管脂肪餐前后变化情况，同时行ERC检查。结果：与手术对照，56例可疑肝外胆管病变者脂餐后胆总管增宽的有38例，其中29例为胆管疾病，而脂餐后胆总管明显缩小的病例，未见胆管疾病。结论：超声检查中的脂肪餐试验对筛选胆管病变有较高的特异性和敏感性，可避免部分患者不必要的ERC检查。     

Single-Port Laparoscopic Salpingectomy for Surgical Treatment of Tubal Pregnancy: Comparison with Multi-Port Laparoscopic Salpingectomy

BackgroundThis study investigates the safety and feasibility of transumbilical single-port laparoscopic salpingectomy (SPLS) using conventional laparoscopic instruments compared to conventional multi-port laparoscopic salpingectomy (MPLS) for surgical treatment of tubal pregnancy.Material and methods We conducted a retrospective analysis of 63 patients with tubal pregnancy who underwent SPLS and 71 patients who underwent conventional MPLS between January 2008 and December 2010. All patients in the SPLS group had a drainage tube placed through the umbilicus, and, in the MPLS group, through a 5-mm trocar site in one side of the lower abdomen.Results No significance difference was discovered between the groups with regard to adjusted hemoglobin values (SPLS, 1.9 ± 1.0 g/dL versus MPLS, 1.7 ± 1.0 g/dL, P = 0.335). Additionally, there was also no significant difference in clinical characteristics, intraoperative findings, or operative outcomes.Conclusions Our study demonstrated that transumbilical SPLS using conventional laparoscopic instruments has operative outcomes comparable to MPLS for the surgical treatment of tubal pregnancy. Transumbilical SPLS may therefore be offered as a feasible alternative to MPLS.     

腹腔镜手术治疗胃癌的现状与进展

胃癌是临床常见恶性肿瘤,发病率、死亡率高,外科手术是胃癌主要治疗方法。腹腔镜手术是一种微创性的外科术式,在减少手术创伤,促进患者恢复中具有重要价值。随着腹腔镜技术的发展,腹腔镜胃癌手术已经成为早期、进展期胃癌外科治疗的主要术式,本文就腹腔镜类型、手术方式及其在胃癌治疗中的应用效果及发展前景进行综述。     

Pain Characteristics after Total Laparoscopic Hysterectomy

Background. Total laparoscopic hysterectomy (TLH) causes various types of postoperative pain, and the pain pattern has not been evaluated in detail to date. This prospective observational study investigated the types of postoperative pain, intensity in the course of time, and pain characteristics during the first postoperative 72 hr after TLH.Methods. Sixty four female patients undergoing TLH were enrolled, which finally 50 patients were included for the data analyses. The locations of pain included overall pain, abdominal visceral and incisional pains, shoulder pain, and perineal pain. Assessments were made at rest and in motion, and pain level was scored with the use of the 100 mm visual analog scale. The pain was assessed at baseline, and at postoperative 30 min, 1 hr, 3 hr, 6 hr, 24 hr, 48 hr, and 72 hr.Results. Overall, visceral, and incisional pains were most intense on the day of operation and then decreased following surgery. In contrast, shoulder pain gradually increased, peaking at postoperative 24 hr. Shoulder pain developed in 90% of all patients (44/50). It was not more aggravated in motion than at rest, in comparison with other pains, and right shoulder pain was more severe than left shoulder pain (p=0.006). In addition, the preoperative exercise habit of patients increased the threshold of shoulder pain. Most patients (46/50) had perineal pain, which was more severe than abdominal pain in approximately 30% of patients (17/50).Conclusion. Pain after TLH showed considerably different duration, severity, and characteristics, compared with other laparoscopic procedures. Shoulder pain was most intense at postoperative 24 hr, and the intensity was associated with the prior exercise habit of patients and the high level of analgesic request.     

腹腔镜手术治疗急性腹膜炎的临床效果分析

目的分析腹腔镜手术应用于急性腹膜炎的效果遥方法选择我院在2014 年2 月耀2016 年1 月收治的100 例急性腹膜 炎患者为研究对象,按照数字随机原则分为对照组和观察组各50 例,对照组采用传统开腹手术治疗,观察组采用腹腔镜手术治 疗,观察两组患者的手术情况和并发症发生情况遥结果观察组患者手术时间尧下床时间尧排气时间尧拔管时间等各项手术指标 均显著优于对照组患者,差异有统计学意义（约0.05）曰对照组（8.00%）术后并发症发生率高于观察组（4.00%）,差异无统计学意 义（跃0.05）遥结论与传统开腹手术相比,腹腔镜手术治疗急性腹膜炎的效果更加理想,且安全性较高遥