Hem-o-lok结扎锁在后腹腔镜肾切除术肾蒂血管处理中的应用及注意事项

目的探讨后腹腔镜肾切除术中用Hem-o-lok结扎锁处理肾蒂的应用价值及注意事项。方珐应用后腹腔镜技术行肾切除30例,均用Hem-o-lok结扎锁处理肾蒂血管,其中肾动脉近端用L号（13mm）Hem-o-lok结扎锁2枚结扎,远端用1枚结扎后剪断,肾静脉用XL号（16mm）Hem—o—lok结扎锁近端2枚、远端1枚结扎后剪断。结果30例手术均获成功,无1例转为开放手术。术中术后无肾血管出血及其他严重并发症。手术时间90-240min,平均130min;出血量30-300mL,平均85mL;术后住院7～10d,平均8d。结论后腹腔镜肾切除术中应用Hem-o—lok结扎肾蒂血管安全可行,疗效可靠,值得临床推广应用。     

腹腔镜阑尾切除术中Hem-o-lok夹闭阑尾根部与荷包缝合包埋阑尾残端的临床对比研究

目的 探讨腹腔镜阑尾切除术(LA)中Hem-o-lok夹闭阑尾根部与荷包缝合包埋阑尾残端的临床效果。方法 前瞻性纳入2019-12—2021-09在三门峡市陕州区人民医院普外科行LA治疗的急性阑尾炎患者,根据术中阑尾根部处理方法分为Hem-o-lok夹闭阑尾根部组(Hem-o-lok夹闭组)和荷包缝合包埋阑尾残端组(荷包包埋组)。比较2组患者的基线资料、手术时间、术中出血量和术后并发症发生率、疼痛药物使用率,以及住院时间和住院费用。结果 共纳入68例患者,每组34例。2组患者的基线资料差异无统计学意义(P>0.05)。2组患者均成功完成手术,无中转开腹病例。荷包包埋组的手术时间长于Hem-o-lok夹闭组,术后住院费用低于Hem-o-lok夹闭组,差异均有统计学意义(P<0.05)。2组患者的术中出血量、术后镇痛药物使用率和住院时间差异均无统计学意义(P>0.05)。结论 在LA术中,采用Hem-o-lok夹闭阑尾根部与荷包缝合包埋阑尾残端均可有效预防术后切口感染、阑尾残端瘘、阑尾残株炎、腹盆腔脓肿等并发症。其中Hem-o-lok夹闭阑尾根部的操作简便,可有效缩短手时...     

Hem-o-lok结扎夹在腹腔镜肾切除肾蒂处理中的应用

目的:探讨腹腔镜肾切除术中用Hem-o-lok结扎夹处理肾蒂的方法、优势及其应用价值.方法:2004年1月～2006年9月行腹腔镜肾切除术56例,其中38例术中应用Hem-o-lok夹处理肾蒂血管,包括腹腔镜单纯肾切除9例,腹腔镜.肾癌根治术18例,腹腔镜肾输尿管全长切除术11例.观察手术时间、术中出血量、是否中转开放、术后胃肠功能恢复时间、术后住院时间以及术后并发症等情况.结果:应用Hem-o-lok夹处理肾蒂的38例腹腔镜肾切除手术均获成功,无一例转为开放手术,术中术后无肾血管出血及其他严重并发症.手术时间35～270 min,平均165 min;术中出血量50～600 ml,平均187 ml;术后胃肠道功能恢复时间18～72 h,平均32h;术后住院时间7～16天,平均11天.结论:在腹腔镜.肾切除术中,Hem-o-lok结扎夹可以安全快速可靠的处理肾蒂血管,是一种新型有效的血管控制系统,具有广阔的应用前景.     

Hem-o-lok结扎锁在后腹腔镜肾切除术肾蒂血管处理中的应用

目的:探讨后腹腔镜肾切除术中应用Hem-o-lok结扎锁处理肾蒂血管的价值。方法:我们为63例患者行后腹腔镜肾切除术并采用Hem-o-lok结扎锁处理肾蒂血管,其中肾动脉近端用大号Hem-o-lok2枚结扎,远端用2枚钛夹夹闭后剪断,肾静脉用加大号Hem-o-lok近端2枚、远端1枚结扎后剪断。结果:本组手术时间90~255min,平均135min;出血量20~180ml,平均45ml;术后住院时间5~8d;术中肾蒂血管处理满意,术中、术后未发生严重并发症。结论:腹腔镜肾切除术中用Hem-o-lok结扎锁分别处理肾动静脉,安全可靠,经济实用,值得临床推广应用。     

Hem-o-lok结扎夹在腹腔镜肾部分切除术中的应用

目的：探讨腹腔镜肾部分切除术中减少打结的方法。方法：2005年3月～2008年3月,对22例肾肿瘤患者行腹腔镜肾部分切除术。其中肾细胞癌15洌．为临床分期T。期;良性肿瘤7例。术前放置F5输尿管导管．阻断肾蒂或肾动脉,锐性切除肿瘤,用线尾带Hem-o-lok结扎央的20可吸收线缝合肾实质及集合系统,术后注射美蓝检查是否漏尿。结果：本组患者肿瘤平均大小为3．2（1．4～4．6）cm,平均手术时间为110（85～270）min,平均热缺血时间为33．2（111～55）min,估计出血量平均为197（30～1000）ml。1例中转开放手术,行肾切除术。无术后出血及漏尿发生。结论：腹腔镜肾部分切除术中应用Hem-o-lok结扎夹简化了缝合过程,是一种安全、有效的打结替代方法。     

腹腔镜阑尾切除术阑尾根部的处理体会

<正>阑尾炎是外科常见急腹症,手术是阑尾炎唯一的根治方法。在保证安全的前提下,减少手术创伤,并兼顾美容,是广大患者及外科医生追求的目标。腹腔镜阑尾切除术(laparoscopic appendectomy,LA)由Semm教授于1983年首先报道。由于LA具有损伤轻、住院时间短、康复快、术后肠粘连可能性小、手术切口感染率低等优点,近年逐渐得到重视与认     

超声刀和结扎夹在腹腔镜阑尾切除术中的应用(附254例报告)

本文报道使用超声刀和Hem-o-lok结扎夹完成254例腹腔镜阑尾切除（laparoscopic appendectomy，LA）的效果。手术均顺利完成，无中转开腹手术，手术时间25～60min，平均40min，住院3～5d。2例左下腹trocar感染。我们认为LA术中使用超声刀和结扎夹安全，损伤轻，可提高手术可靠性。     

Hem-o-lok结扎夹在腹腔镜肾切除肾动脉处理失败（附4例报告）

目的：报告Hem—o—lok结扎夹在腹腔镜肾切除术中肾动脉处理失败的体会。方法：报告我院4例经后腹腔途径行腹腔镜肾切除术时Hem—o—lok结扎夹结扎肾动脉时动脉断裂出血的临床资料。男3例,女1例。平均年龄76岁（58～84岁）。肾透明细胞癌2级2例,。肾透明细胞癌1～2级1例,肾盂移行细胞癌1例。行腹腔镜肾癌根治术3例,腹腔镜肾输尿管全长切除术1例。4例均经后腹腔途径行腹腔镜肾切除术,采用Hem—o—lok结扎夹结扎肾动脉和肾静脉。结果：3例Hem—o—lok结扎夹结扎。肾动脉后,肾动脉结扎处近心端发生部分断裂出血,1例肾动静脉结扎切断后肾脏已完全游离在取肾脏标本时肾动脉完全断裂引起大出血。4例均改行开放手术,血管阻断钳部分阻断腹主动脉,可吸收线缝合血管断端。平均手术时间80min（65～110min）,术中平均出血量450ml（200～1000m1）,1例术中输血800ml。结论：腹腔镜肾切除时Hem-o-lok结扎夹结扎肾动脉具有一定的潜在危险,肾动脉一旦断裂需及时改行开放手术。     

腹腔镜阑尾切除术阑尾残端荷包缝合包埋与Hem-o-lok的比较

目的探讨荷包缝合包埋阑尾残端在腹腔镜阑尾切除术中的应用价值。方法2010年6月-2013年6月因急慢性阑尾炎行腹腔镜阑尾切除术101例,采用2种不同方法处理阑尾残端：50例阑尾根部行丝线结扎后,荷包缝合包埋残端（包埋组）;5l例用Hem-o-lok夹闭阑尾根部后,不再进一步处理阑尾残端（Hem-o-lok组）,比较2组手术时间和术后患者恢复情况。结果2组术后并发症、术后住院时间无显著性差异（P〉0．05）。包埋组手术时间（55．8±5．8）min,明显长于Hem-o-lok组（44．8±5．7）min（t=9．613,P=0．000）;包埋组手术费用（5086±58）元,显著少于Hem-o-lok组（5430±50）元（t=-31．945,P=0．000）。结论2种处理阑尾残端的方法都是安全、有效的,但荷包缝合包埋阑尾残端更符合传统阑尾切除术的手术操作要求,对术者腹腔镜操作水平要求较高,但节省手术费用。Hem-o-lok夹闭阑尾根部节省手术时间,操作简单,更适合于初学者。     

Tissue reaction to absorbable endoloop, nonabsorbable titanium staples, and polymer Hem-o-lok clip after laparoscopic appendectomy

Background and Objectives:

The standard technique for securing the base of the appendix during laparoscopic appendectomy is by absorbable endoloop ligature, although clinical reports favor the use of the stapler. Nonabsorbable Hem-o-lok clips have been shown to be an alternative technique to this. However, it is currently not clear whether nonabsorbable clips have any effects on the intestine or promote infection in the surgical area.

Materials and Methods:

Sixty Wistar albino rats were randomized into 3 treatment groups: group I (n=20) the base of the appendix was secured by endoloop 2-0 ligature; group II (n=20) dissection of the appendix was performed by a 45-mm thick stapler; and group III (n=20) the base of the appendix was secured by a Hem-o-lok plastic clip. The animals were sacrificed on the 14th and 28th days after surgery. The secured stump was used for histopathological examination.

Results:

There were no significant differences in histopathological changes observed on the 14th postoperative day between the groups. On the 28th postoperative day, it was proved that mild and moderate inflammation is more frequent in the endoloop and Hem-o-lok groups than in the stapler group. Reaction to a foreign body is more frequent in the endoloop than in stapler and Hem-o-lok groups.

Conclusion:

The mildest postoperative inflammatory changes were seen in the stapler group, followed by the Hem-o-lok group. However, because of the price of the plastic clip and the simplicity of its application, its use is still favored during laparoscopic appendectomy.     

Laparoscopic appendectomy using a polymeric clip to close the appendicular stump.

BACKGROUND: The objectives of this study were to establish whether the occlusion of the appendicular stump by using nonabsorbable polymeric clips is technically feasible and whether differences exist in the postoperative course of patients to whom polymeric clips are applied compared with patients whose appendicular stump is closed with a surgical stapler. METHODS: This was a prospective study in 2 stages. In phase 1, 28 patients operated on for resection of the appendix between March 2002 and September 2003 were assigned to 1 of 2 groups. In 14 patients, the appendicular base was occluded by using an endoscopic linear cutting stapler. In the remaining 14, the appendicular base was ligated by using nonabsorbable polymeric clips (Hem-o-lock). We compared the surgical time, hospital stay, hospital costs, and complications. In phase 2, 250 patients were analyzed who underwent laparoscopic appendectomies performed between March 2002 and 2006 using a Harmonic scalpel for the section and hemostasis of the appendicular mesentery. Ligation of the appendicular stump was performed with Hem-o-lock clips. RESULTS: We found a significant difference in procedure costs, with the endoscopic staplers being more expensive. CONCLUSION: The use of polymeric clips is feasible, safe, and an economic alternative for ligation of the appendicular stump during laparoscopic appendectomies.     

用Hem-o-Lok结扎夹行腹腔镜胆囊切除

目的探讨使用Hem-o-Lok结扎夹行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的方法及优势.方法用Hem-o-Lok结扎夹对288例胆囊结石及胆囊息肉样病变施行LC,均采用三孔法. 结果手术均获成功,无中转开腹,264例(92%)用中大号(ML)结扎夹,剑突下切口几乎无痛感,术后平均住院时间2.7 d(1～3 d).另24例因手术困难改用大号(L)结扎夹,均成功.无出血、胆漏、胆管损伤等并发症. 结论使用中大号(ML)Hem-o-Lok结扎夹行LC,可使剑突下切口仅5 mm,使用常规的腹腔镜手术设备即可.     

Laparoscopic Appendectomy Using Endoloops: A Prospective,Randomized Clinical Trial

Background Inadequate closure of the appendix stump can lead to abscess formation or peritonitis. This prospective randomized clinical trial was performed to evaluate the number of endoloops needed in laparoscopic appendectomy.Methods A total of 208 patients were randomized in two groups: 109 in group 1 using one and 99 in group 2 using two proximal endoloops. The groups were compared in terms of intra- and postoperative complications.Results Postoperative complications were found in five patients (4.6%) in group 1, consisting of intraabdominal abscesses (three patients), pulmonary embolism (one patient), and persisting port-site pain (one patient). In group 2, postoperative complications were found in five patients (5.1%), consisting of intraabdominal abscesses (four patients) and prolonged percutaneous drainage (one patient). There was no significant difference between the two groups.Discussion In acute appendicitis, a minimal inflamed appendix base can be safely divided using one endoloop.Presented at the 9th EAES annual congress in Maastricht, 13–16 June 2001     

Hem-o-lok结扎夹行动脉导管夹闭术84例临床分析

目的探讨直视下采用Hem—o-10k结扎夹行动脉导管夹闭术的临床价值。方法2001年5月-2007年5月，对84例管型动脉导管采用左腋下小切口直视下释放1—2枚Hem—o—lok结扎夹夹闭。结果手术时间30～60min，平均42min。84例术中无出血，术后杂音消失，无手术死亡。84例随访2～50个月，平均28个月，无残余分流及再通。结论Hem—o—lok结扎夹治疗管型动脉导管未闭是一种创伤小、安全可靠的方法。     

Laparoscopic Appendectomy Versus Open Appendectomy: A Single Institution Study

Purpose:

The purpose of this study was to compare the safety and efficacy of laparoscopic appendectomy versus open appendectomy at Baptist Hospital in Miami, Florida.

Methods:

A retrospective review was performed on all appendectomies performed at Baptist Hospital from October 1, 1994 to September 30, 1995. There were a total of 244 cases; 137 open appendectomies and 107 laparoscopic appendectomies. The cases were reviewed with regard to pathology, operating time, length of hospital stay and complications.

Results:

The pathologic findings at surgery were similar for the two groups. Concomitant pathology was more likely to be found laparoscopically than in open surgery. There was a greater percentage of ruptured appendices in surgery done via the open method. Operative time was slightly longer, but complications were less in the laparoscopic group. Length of stay was lower in the laparoscopic appendectomy group.

Conclusions:

Although very similar, our method of appendectomy favors the laparoscopic technique.     

可吸收夹在改良式两孔腹腔镜阑尾切除术中的应用

目的 探讨Lapro-Clip可吸收生物夹在改良式两孔腹腔镜阑尾切除术中的应用价值.方法 2012年3月~2013年6月,对112例急、慢性阑尾炎行两孔腹腔镜阑尾切除术,均用Lapro-Clip可吸收生物夹（12 mm）处理阑尾及其系膜.结果 手术均顺利完成,手术时间18～44 min,（25.6±7.8）min,术中出血〈15 ml,术后仅6例应用镇痛药,无腹腔残余感染、肠漏及肠梗阻等.术后住院2～5 d,（3.9±0.9）d.结论 两孔腹腔镜阑尾切除术中用Lapro-Clip可吸收生物夹处理阑尾及其系膜,操作方便,出血少,创伤小,疼痛轻,恢复快.     

腹腔镜阑尾切除术阑尾根部3种处理方法的比较

目的比较腹腔镜阑尾切除手术中分别应用3种不同方法处理阑尾根部：丝线结扎、塑料夹（Hem—O—lok）夹闭、圈套器（Endoloop）套扎的效果。方法2010年2月～2011年8月168例因急性阑尾炎接受急诊腹腔镜阑尾切除术,采用3种不同方法处理根部：阑尾根部用丝线结扎50例（丝线组）,用Hem—O—lok夹闭65例（Hem—O—lok组）,用Endoloop套扎53例（Endoloop组）,比较3组术中、术后情况。结果3组术后并发症、术后住院时间无显著性差异（P〉0．05）。丝线组手术时间（54．7±5．6）min,显著长于Hem—O-lok组（44．7±5．5）min（q=13．903,P〈0．05）和Endoloop组（49．1±5．1）min（q=7．428,P〈0．05）。丝线组手术费用（3285．2±55．4）元,显著多于Hem．O—lok组（3083．3±80．0）元（q=23．402,P〈0．05）,但显著少于Endoloop组（3646．5±50．8）元（q=39．957,P〈0．05）。结论3种处理阑尾根部的方法都是安全、有效的,但Hem—O—lok夹闭比丝线结扎和Endoloop套扎,更省手术时间和手术费用,并且更适合于初学者。     

非气腹单孔拖出式腹腔镜阑尾切除术与常规腹腔镜阑尾切除术的比较

目的 探讨非气腹单孔拖出式腹腔镜阑尾切除术的疗效.方法 2010年1月~2012年1月对93例慢性阑尾炎、急性单纯性阑尾炎分别施行非气腹单孔拖出式腹腔镜阑尾切除手术（单孔组,n=42）和常规腹腔镜阑尾切除术（常规组,n=51）,比较2组手术时间、术后排气时间、术后住院时间及费用.结果 单孔组8例为后位阑尾,无法单钳局部分离,改行传统腹腔镜下阑尾切除;常规组51例行传统腹腔镜下三孔阑尾切除术,无中转开腹.单孔组手术时间（26.1±3.2）min,显著短于常规组（47.1±4.4）min（t=-23.912,P=0.000）;单孔组术后恢复排气时间（12.1±2.1）h,显著短于常规组（20.1±1.9）h（t=-18.231,P=0.000）;单孔组术后住院时间（2.1±0.7）d,明显短于常规组（3.1±0.6）d（t=-7.039,P=0.000）;单孔组住院费用（5066.7±99.6）元明显少于常规组（5996.7±119.3）元（t=-37.543,P=0.000）.93例术后随访3～6个月,平均5.3月,均无并发症发生.结论 非气腹单孔拖出式腹腔镜阑尾切除术手术安全可行,与常规三孔法腹腔阑尾切除术相比,恢复快、费用少,切口瘢痕藏于脐部,美容效果更好.