腹腔镜肾囊肿切除术14例报告

目的探讨腹腔镜肾囊肿切除术的方法及较其他方法治疗肾囊肿的优点。方法对14例腹腔镜肾囊肿切除术病例进行临床分析。结果 14例腹腔镜肾囊肿切除术患者均治愈,随访无复发。结论腹腔镜肾囊肿切除术可以完全达到切除囊肿目的,而且创伤小,恢复快,费用低。     

肾脏的腹腔镜手术

腹腔镜应用是９０年代泌尿外科的一大进展，本文综述肾脏疾病腹腔镜诊断治疗现况，介绍腹腔镜下肾切除、肾癌根治、肾部分切除、肾囊肿切除、肾固定、肾盂成形、肾输尿管联合切除、肾穿刺活检及肾盂切开取石等９种腹腔镜手术方式及其治疗优缺点。     

电视腹腔镜泌尿外科手术36例报告

目的 :探讨腹腔镜治疗泌尿外科疾病的效果。方法 :应用电视腹腔镜治疗泌尿外科疾病 36例 ,其中肾囊肿去顶术 2 2例 ,肾上腺肿瘤切除 10例 ,肾切除 2例 ,隐睾切除 1例 ,肾错构瘤剜除 1例。结果 :一次手术成功 34例 ,1例肾错构瘤 ,1例肾囊肿术中中转开放术。术后平均住院 6± 4d。结论 :腹腔镜手术治疗泌尿外科疾病安全 ,有效 ,损伤小 ,患者术后康复快 ,疤痕少 ,值得推广 ,但须掌握适应证     

腹腔镜联合手术21例报告

目的：探讨腹腔镜联合手术的优势及其适应证。方法：自1992年5月至2002年2月开展腹腔镜手术488例中21例联合手术，其中腹腔镜胆总管切开取石与胆囊切除7例；腹腔镜肝囊肿开窗引流与胆囊切除术4例；腹腔镜胆囊切除与阑尾切除4例；腹腔镜胆囊切除与腹腔镜辅助脾切除2例；腹腔镜假性胰腺囊肿切除与胆囊切除1例；腹腔镜胆总管切开取石与胆囊切除与右肾囊肿开窗引流1例；腹腔镜右卵巢囊肿切除与胆囊切除1例；腹腔镜胆囊切除与边缘型小肝癌切除1例。结果：21例均顺利完成联合手术，无并发症。结论：腹腔镜联合手术拓宽了腹腔镜手术领域。     

腹腔镜联合手术35例诊治体会

目的 探讨腹腔镜在腹腔多发病灶手术中的作用。方法 腹腔镜胆囊切除的同时施行肝囊肿开窗术3例，肾囊肿去顶术2例，阑尾切除术16例，精索高位结扎术3例，卵巢囊肿摘除术5例，子宫肌瘤切除术4例，阑尾切除＋卵巢囊肿摘除术2例。结果 35例手术顺利完成，无一例中转开腹，无严重手术并发症。结论 腹腔多发病灶腹腔镜联合手术治疗，创伤小、恢复快。     

腹腔镜胆囊切除并肾囊肿去顶术的临床应用

目的 :观察腹腔镜Ⅰ期手术治疗胆囊炎、胆囊结石合并肾囊肿的疗效。方法 :对胆囊结石并肾囊肿 13例 ,15个囊肿行Ⅰ期腹腔镜手术 ,胆囊切除后改变术野 ,经腹腔入路 ,分离肾囊肿去顶、引流。结果 :1例暴露左上极囊肿时 ,脾门轻度撕裂伤。平均手术时间 12 0min ,术后 2 4h下床、进食 ,术后平均住院 5d ,随访 1～ 12个月无手术并发症及复发。结论 :在严格掌握适应证的前提下 ,合理应用腹腔镜Ⅰ期手术治疗胆囊结石、肾囊肿 ,比传统手术或腹腔镜分期手术治疗优势明显。     

腹腔镜与后腹腔镜治疗肾囊性疾病

目的探讨腹腔镜与后腹腔镜治疗肾囊性疾病的适应证及优缺点。方法2000年6月-2006年2月，共行手术41例，其中腹腔镜组17例，后腹腔镜组24例，单纯性肾囊肿35例，左侧17例，右侧18例，双侧多发肾囊肿2例，多囊肾3例，合并胆囊结石1例。结果40例获得成功，1例在切除囊壁时损伤肾实质出血而中转开放手术，无严重并发症，术中出血20—50ml。术后引流量：肾囊肿10—30ml，多囊肾80—150ml，3—7天出院。结论腹腔镜治疗肾囊性疾病具有创伤小、出血少、恢复快、无复发、痛苦小、易接受的优点。对于双侧或合并胆囊结石时，通过腹腔途径能够同时处理。     

腹腔镜经腹腔途径治疗肾囊肿40例报告

目的：探讨腹腔镜术治疗肾囊肿,特别是肾盂周围囊肿的方法,方法：采用腹腔镜经腹腔途径切除肾囊中40例;对于囊壁切除不全的肾盂周围囊肿,用肾周脂肪填塞囊腔,以防止复发,结果：本组40例均获成功,随访1－24个月,效果良好,技术安全可靠,术后恢复快,结论：采用腹腔镜手术治疗肾囊肿明显优于开放性手术。     

腹腔镜下去顶减压术治疗肾囊肿的护理体会

我院2004年3月～2005年2月，应用腹腔镜下行肾囊肿去顶减压治疗肾囊肿患13例，效果满意，现将护理体会报告如下。     

腹膜后腹腔镜肾囊肿去顶术20例报告

目的 探讨在肾囊肿去顶术中腹腔镜的应用.方法 对20例肾囊肿患者经腹膜后入路行腹腔镜肾囊肿去顶术.结果 18例手术成功,2例转为开放手术,术后住院3-5d,平均3.5d.结论 后腹腔镜肾囊肿去顶术具有安全、损伤小、出血少、术后恢复快等特点,是一种治疗肾囊肿疾病的安全有效的手术方式.     

Laparoscopic unroofing of peripelvic cyst

Laparoscopic unroofing of renal cyst has replaced open surgical intervention in recent years. We report our experience with this procedure on 6 patients with hydronephrosis due to peripelvic cyst. Four male and two female patients, ranging from 51 to 67 years, underwent laparoscopic unroofing of peripelvic cyst. All patients had various degrees of hydronephrosis. Two patients had lumbago and hematuria. The cause of this hematuria was probably due to the renal pelvic stone. Surgical approaches i.e., retro- or transperitoneal were selected depending on the location of cyst. The operative time ranged from 80 to 235 minutes (mean 167 minutes). The length of postoperative hospital stay ranged from 3 to 7 days (mean 4.6 days). Intraoperative blood loss ranged from 20 to 26 cc (mean 21 cc). Four weeks after the operation, all patients showed improvement of hydronephrosis. Laparoscopic unroofing of peripelvic cyst is a safe and efficacious procedure, and could be an' attractive alternative for management of peripelvic renal cysts.     

Surgical Strategy for Cystic Diseases of the Liver in a Western Hepatobiliary Center

The aim of this study was to define the indications and evaluate the results of various management options in patients with cystic liver disease. Between 1992 and 1999 we managed 60 consecutive patients with cystic liver disease. Diagnoses included a simple cyst (solitary 12, multiple 10), adult polycystic liver disease (APLD 17), Caroli’s disease (8), hydatid cysts (4), and neoplastic cysts (9). Half of the patients with simple cysts had mild or no symptoms and required no treatment. Percutaneous drainage in eight patients (simple cyst 4, APLD 4) was followed by symptomatic recurrence in three. Laparoscopic deroofing in three patients (multiple simple cysts 2, APLD 1) was followed by symptomatic enlargement of the remaining cysts that required further intervention (laparoscopic deroofing 2, transplantation 1). Laparoscopic hepatectomy was successful in three patients with solitary simple cysts. Of 18 patients who underwent open hepatic resection (neoplastic 8, Caroli’s 4, simple cysts 3, hydatid cysts 2, APLD 1), 2 patients with Caroli’s disease required liver transplantation for disease progression. Nine patients (Caroli’s 5, APLD 4) underwent liver transplantation, and three had a concomitant renal transplant. Seven patients developed complications, and three died (5%). Cholangiocarcinoma developed in three patients with bilateral Caroli’s disease, and all died. Radiologic treatment has a limited role in the management of patients with simple cysts or APLD. Laparoscopic deroofing of simple cysts may have to be repeated, whereas resection minimizes cyst recurrence. Unilobar Caroli’s disease may be resected, whereas bilateral disease requires early liver transplantation owing to the high risk of malignancy. Transplantation is a reserved option in patients with extensive APLD.     

腹膜后腹腔镜肾囊肿去顶术对机体应激反应的影响

目的 :探讨腹膜后腹腔镜肾囊肿去顶减压术对机体应激反应的影响。方法 :随机将肾囊肿 35例分成腹膜后腹腔镜组与开放手术组 ,分别于术前 2 4h和术后第 1、3天测定血白细胞总数 (WBC)、血清C 反应蛋白质 (CRP)和白细胞介素 6 (IL 6 )的浓度 ,并比较两组的平均手术时间 ,术中出血量 ,术后平均引流量 ,镇痛用药量 ,发热率 ,平均住院日和费用。结果 :开放手术组术后第 1天WBC计数比术前明显升高 (P <0 0 1) ,腹膜后腹腔镜组升高不明显 (P >0 .0 5 )。两组术后第 1、3天血清CRP和IL 6水平高于术前 (P <0 .0 5 ) ,开放手术组血清CRP和IL 6明显高于后腹腔镜组 (P <0 .0 1)。与开放手术相比 ,腹膜后腹腔镜手术具有出血少 ,引流量少 ,术后发热率低 ,用药少 ,住院日短等优点。结论 :腹膜后腹腔镜肾囊肿去顶术对机体的应激反应较开放手术低 ,有望取代传统开放手术     

腹腔镜下去顶减压术治疗肾囊肿

目的:评价腹腔镜下治疗肾囊肿的疗效。方法:在腹腔镜下经后腹膜行去顶减压术治疗肾囊肿患者9例。结果:9例患者均获得成功。结论:在腹腔镜下经后腹膜行去顶减压术治疗肾囊肿具有创伤小、恢复快、治疗彻底的特点。     

腹腔镜与开放手术行肾囊肿去顶减压术的对比研究

目的:比较腹腔镜与开放手术行肾囊肿去顶减压术的临床疗效。方法:回顾37例腹腔镜单纯性肾囊肿去顶减压术,与38例开放手术的临床资料。结果:术中平均出血量,术后住院时间,术后平均引流量,术后止痛药应用比例腹腔镜组均优于开放组,手术时间、住院费用腹腔镜组与开放组差异无显著性。结论:腹腔镜肾囊肿去顶术具有创伤小,患者康复快,术后住院时间短等优点,是肾囊肿去顶术的首选方法。     

腹腔镜与开放性肾囊肿去顶术的比较

目的 :比较开放性与腹腔镜肾囊肿去顶术的疗效和优点。方法 :采用腹腔镜经腹腔途径对 4 3例肾囊肿患者进行肾囊肿去顶术。并与 2 4例开放性肾囊肿去顶术患者进行比较。结果 :腹腔镜手术时间、术后住院时间均显著少于开放性手术 (P <0 0 1)。术后随访 3～ 12个月 ,未见复发。结论 :经腹腔途径腹腔镜肾囊肿去顶术治疗肾囊肿 ,疗效好 ,患者创伤小 ,术后康复快 ,明显优于开放性手术。     

Laparoscopic management of renal cystic disease

Laparoscopic management of renal cystic disease is a highly effective, safe, and minimally invasive alternative to open surgery and antegrade or retrograde endoscopic procedures. Simple renal cysts can be accessed either transperitoneally or retroperitoneally. Almost all studies of the laparoscopic approach have demonstrated great satisfaction in terms of efficacy, minimal complications, operative time, minimal blood loss, hospital stay, recuperation, and cosmesis over other methods of treating renal cysts. Laparoscopic unroofing of peripelvic cysts is more challenging owing to their proximity to hilar vessels and the collecting system. Such surgery should be considered an advanced laparoscopic procedure. Access may be achieved either transperitoneally or retroperitoneoscopically. The basic principle of adequate exposure is essential for effective treatment. If the cyst is not completely excised, the surgeon must fulgurate the edge and tack perirenal fat in the residual cyst cavity to prevent recurrence and facilitate drainage. Laparoscopic evaluation of complex cysts seems to be sound. The results are promising, and follow-up does not show any increase in peritoneal seeding, tract recurrence, or distant metastases in the small number of neoplasms diagnosed at laparoscopy. Nevertheless, more studies are required with long-term follow-up. Bosniak type IV renal cysts or malignancy in renal cysts can be managed by laparoscopic radical nephrectomy with either access. Laparoscopic cyst marsupialization in patients with ADPKD is the latest emerging indication for laparoscopy in renal cystic disease. This procedure not only effectively reduces pain in some patients but also improves hypertension and stabilizes renal function, delaying renal replacement therapy. Long-term follow-up and further evaluation are needed.     

腹腔镜治疗小儿胆道穿孔12例临床体会

目的:总结腹腔镜手术治疗小儿胆道穿孔的临床体会。方法:2008年12月至2015年12月收治12例胆道穿孔患儿,均经腹腔镜探查证实为胆道穿孔,根据病情分别行胆总管囊肿T管引流+腹腔引流、胆囊造瘘术+腹腔引流、单纯腹腔引流。结果:12例患儿均成功完成手术,术后未出现胆道出血、胆漏等并发症。胆汁引流及腹腔引流24~72 h后,临床症状缓解,腹痛显著减轻,体温降至正常,黄疸逐步消退。8例胆总管囊肿穿孔患者术后6个月行二期胆总管囊肿切除、肝总管空肠Roux-Y吻合术,其中5例在腹腔镜下完成二期手术,3例因胆总管周围粘连重、分离困难中转开腹。结论:腹腔镜用于小儿自发性胆道穿孔的诊断与治疗避免了盲目开腹探查的缺点,创伤小,手术视野广,对腹腔及肠管干扰小,手术时间短,胆总管囊肿穿孔不影响二次腹腔镜手术。     

Percutaneous treatment of benign renal cysts

The percutaneous treatment of benign renal cysts has been proposed in alternative to conventional surgery. It minimizes the complication rate and assures good clinical results. In our Department, 15 patients with 16 symptomatic benign renal cysts underwent either percutaneous cyst aspiration + sclerosis (10 cases) or percutaneous resection of the cyst wall (6 cases). In the first group, all patients were relieved from symptoms, and 70% had no residual cavity. Two patients presented a secondary infection of the cyst, treated with systemic antibiotics and percutaneous drainage (1 case). In the second group, we did not observe any complication, all patients were relieved from symptoms, and only 1 cyst recurred, probably due to incomplete resection.     

腹腔镜手术治疗小儿前列腺囊肿6例报告

目的腹腔镜手术治疗小儿前列腺囊肿的疗效。方法2006年7月～2012年7月，腹腔镜手术治疗小儿前列腺囊肿6例。术中直视下将膀胱悬吊于前腹壁，2例输尿管导管注水引导暴露前列腺囊肿，4例在尿道镜引导下切除前列腺囊肿，能明确囊肿开口位置，避免过度充盈膀胱影响操作。结果6例腹腔镜手术均成功完成，无中转开放手术。手术时间60—90min，平均75min；术中出血量20－40ml，无输血者。术后皮管引流3d，留置尿管12d。6例随访3～24个月，平均12个月，无排尿困难，无泌尿道感染。结论腹腔镜手术切除囊肿具有安全、显露清楚、创伤小、出血少等优点。