经脐单孔腹腔镜术在泌尿外科的应用(附52例报告)

目的:探讨经脐单孔腹腔镜技术在泌尿外科应用的疗效及安全性。方法:回顾性分析52例应用经脐单孔腹腔镜技术行肾上腺切除术、肾囊肿去顶减压术、无功能肾切除术、输尿管切开取石术、精索静脉高位结扎及前列腺根治性切除术,其中肾上腺切除7例,左侧4例,右侧3例;肾囊肿切除24例,左侧12例,右侧9例,双侧3例;无功能肾切除9例,左侧5例,右侧4例;输尿管切开取石7例,左侧3例,右侧4例;精索静脉曲张高位结扎3例,均为左侧;前列腺根治性切除2例。分别记录各种手术的手术时间、术中出血量、术后住院天数、术后下床活动时间、术后拔引流管时间、术后镇痛药使用情况、是否增加辅助孔及术后并发症等情况。结果:52例手术均获得成功,手术时间15~275min;估计术中出血量20~300ml,均无输血。术后24~48小时均下床活动。术后住院天数3~15d,术后拔引流管时间2~7d。4例术后24小时内应用镇痛药,5例术中增加1~2个5mm辅助孔,3例术后切口发生脂肪液化,5例术后低热,经治疗后均治愈出院。结论:经脐单孔腹腔镜术在泌尿外科中的应用安全有效,且术后脐部几乎无瘢痕,美容效果佳,术后患者恢复快。随着手术实践的增加,经脐单孔腹腔镜术必将在泌尿外科微创手术中得以进一步推广。     

Endoscopically Assisted Transumbilical Single-Incision Laparoscopic Gastric Resection for GIST Treatment

Purpose: Complete surgical resection with negative margins without lymphadenectomy is the treatment of choice for nonmetastatic Gastrointestinal Stromal Tumors (GISTs). Laparoscopic resection of gastric GISTs <5 cm is an acceptable and oncologically feasible, safe, and effective treatment. We present our experience of an endoscopically assisted minimally invasive transumbilical single-incision laparoscopic (SILS) technique for gastric GISTs resection. Methods: Four patients with small gastric GISTs ≤5 cm located on the greater curvature or the anterior wall were resected with SILS by using a lesion-lifting technique under the guidance of flexible gastroscopy. Results: The technique was feasible and safe and offered significant advantages in locating the tumor and controlling the resection margins. There were no major intraoperative or postoperative complications, conversions, or tumor ruptures. Pathology showed low-risk GISTs resected with disease-free margins without tumor rupture. No recurrences have been observed. Conclusion: The endoscopically assisted SILS wedge gastrectomy is a feasible, safe, and advantageous technique for the treatment of the greater curvature or anterior wall gastric GISTs.     

Resultados de las 100 primeras colecistectomías por puerto único en un hospital de segundo nivel

Introduction

Despite the excellent results obtained with standard laparoscopic cholecystectomy, the efforts for minimizing the ports needed to reduce postoperative pain, for a quicker recovery and to improve the patient's cosmetics continue. The aim of this study is to report the results of the first 100 cases of single port laparoscopic cholecystectomy performed in a secondary care hospital.

Material and methods

Prospective, observational and unicentric study including 100 patients between January 2010 and April 2012. Inclusion criteria: symptomatic cholelythiasis patients over 16-years of age on whom a single port laparoscopic cholecystectomy was performed. Exclusion criteria: history of acute cholecystitis, pancreatitis or suspected choledocholithiasis, Endoscopic retrograde cholangiopancreatography, BMI > 35 and previous laparotomies. We studied epidemiological, surgical and safety variables.

Results

The mean patient age was 39,89 ± 11,5 years. The mean time of the surgical procedure was 67,94 ± 25,5 min. There were 2 cases of postoperative complications. A non-infected seroma and a biliar leak. In 2 cases the use of an accessory trocar was needed. The mean hospital stay was 1,13 ± 0,8 days. A total of 35% patients were included in the major ambulatory surgery programme.The overall patient satisfaction survey rating showed a high level of cosmetic satisfaction in 100% of patients.

Conclusions

Single port laparoscopic cholecystectomy is a good technique when performed in selected cases by expert surgeons. It is feasible to include the single port laparoscopic cholecystectomy in a major ambulatory surgery programme. We have not had serious complications. There is a high cosmetic satisfaction index with this technique.     

经脐入路腹腔镜胆总管探查一期缝合术后胆漏34例分析

目的分析经脐入路腹腔镜胆总管探查一期缝合术后胆漏并发症的发生及其治疗,探讨有效的防治措施。方法回顾性分析2008年11月至2013年3月,本院34例经脐入路腹腔镜胆总管探查一期缝合术后发生胆漏并发症患者的临床资料。结果胆漏发生率为22．7％（a4／150）。34例胆漏患者中,22例在术后24h内出现,12例在术后3～7d出现,经腹腔引流34例患者均治愈。结论严格掌握手术适应证,术中操作轻柔,认真仔细缝合胆总管以及加强营养支持等,是防治经脐入路腹腔镜胆总管探查一期缝合术后胆漏的有效措施。     

经阴道与经脐单孔腹腔镜在子宫肌瘤手术中的应用比较

目的 对比分析经阴道自然腔道内镜手术（V-NOTES）与经脐单孔腹腔镜在子宫肌瘤切除术中的优缺点。方法 选取2019年1月－2019年10月因子宫前壁单发肌瘤住院行经阴道自然腔道子宫肌瘤切除术的患者23例（观察组）、经脐单孔腹腔镜子宫肌瘤切除术的患者44例（对照组）,对比分析两组患者手术时间、术中出血量、术后肛门排气时间、术后第1天疼痛情况［数字评分法（NRS）］、术后住院时间、术后平均峰值体温和住院费用。结果 观察组术后肛门排气时间（25.52±4.17）h较对照组（32.72±3.06）h短（P < 0.05）,观察组术后第1天NRS疼痛评分（2.65±0.98）分低于对照组（4.50±1.00）分（P < 0.05）;两组患者手术时间、术中出血量、住院时间、术后平均峰值体温和住院费用比较,差异均无统计学意义（P > 0.05）。结论 V-NOTES用于子宫前壁单发肌瘤切除是可行的,患者术后肛门排气时间更短、疼痛程度更轻。     

单切口经脐腹腔镜减重手术

目的近来,人们将单一切口腹腔镜胃减重手术的方法,视为除经自然腔道内镜手术之外的另一种选择。单一切口经脐腹腔镜胃减重手术的优势在于能隐藏手术瘢痕,获得较好的美容效果。然而,由于器械操作空间有限及肝脏牵引困难,此项技术一直受到很大限制,仅被认为适用于简单胃减重手术。本研究中,通过采用特殊技术和操作以期改善手术的安全及有效性,使其应用于更广泛的领域。方法自2008年12月起,我院采用LST装置（liver-suspension tape）及′Ω形脐孔成形术成功开展单一切口经脐胃减重手术。至2009年7月,共完成40例患者45例次手术,包括5例次胆囊切除术,2例胃束缚带放置,6例次胃袖状切除,32例次Roux-en-Y胃转流术（Roux-en-Y gastric bypass,RYGB）,记录术后住院天数及并发症情况。结果平均手术时间89.9min,平均术后住院1.15d。无一例发生术中或术后并发症,无死亡病例。所有病人均满意手术的美容效果。结论采用本技术施行单一切口经脐胃减重手术是安全、可行的,有进一步推广应用于更多外科手术的价值。     

腹腔镜经脐单孔三通道精索静脉高位结扎术60例

目的总结经脐单孔三通道腹腔镜手术治疗原发性精索静脉曲张手术经验。方法对60例经脐单孔三通道腹腔镜下精索静脉高位结扎术治疗患者的病例资料进行回顾分析。结果 60例手术中,成功率100%,无一例复发,仅5例存在近期并发症,且无远期并发症发生,术后随访6～12个月恢复良好。结论经脐单孔三通道腹腔镜下精索静脉高位结扎术是一种成功率高、无明显并发症的较理想的手术方式,值得临床推广应用。     

经脐单孔腹腔镜在妇科附件良性疾病中的临床应用价值#br#

Objective?To study the clinical application value of laparoendoscopic single-site surgery (LESS) in benign adnexal lesions. Methods?A retrospective case analysis of 208 patients who underwent accessory surgery in our hospital from May 2017 to March 2019, 68 of which underwent laparoendoscopic single-site surgery(LESS group) and 140 underwent general surgery laparoscopic surgery (control group), compare the perioperative period and follow-up of the two groups of patients. Results?The operation time of different diseases in LESS group was longer than that of the control group (P＜0.05) [unilateral ovarian teratoma/cystectomy (49.7±7.3) min vs (33.6±7.2) min]; bilateral ovarian teratoma resection [(68.2±7.3) min vs. (50.1±4.2) min]; the postoperative hospital stay in LESS group was shortened (P＜0.05) [(3.12±0.39) d) vs. (3.57±0.29) d],  and the 24-hour pain (VAS) score of the LESS group was lower than that of the control group (P＜0.05) [(3.23±0.12) points vs (3.45±0.20) points], the postoperative incision cosmetic satisfaction was higher (P＜0.05). There was no statistically significant difference between the two groups of patients in intraoperative blood loss, postoperative exhaust time, postoperative time to get out of bed, postoperative analgesics use, and postoperative fever (P＞0.05); There were no complications such as visceral injury and incisional hernia after the operation. Conclusion?The application of LESS in benign adnexal lesions is feasible. Although the operation time is long relatively, it has the advantages of fast postoperative recovery, postoperative pain reduction and cosmetic advantages.     

Transumbilical approach for laparo-endoscopic single-site adrenalectomy: initial experience and short-term outcome

Objectives: To report our initial experience with transumbilical laparo‐endoscopic single‐site adrenalectomy for adrenal tumors by using a single port with a multichannel cannula and bent laparoscopic instrumentation. Methods: Between December 2009 and December 2010, 30 patients underwent transumbilical laparo‐endoscopic single‐site adrenalectomy at our hospital. The procedure was carried out for adrenal cortical adenoma in 17 patients, adrenal pheochromocytoma in seven patients and other types of tumors in six patients. A multichannel port, bent laparoscopic instruments and Opti4 laparoscopic electrodes were used in all patients. The intraperitoneal space was approached through the umbilicus. The multichannel port was placed through a 2‐cm incision at the inner edge of the umbilicus. A 5‐mm flexible laparoscope was introduced to maintain an adequate laparoscopic view, and surgical specimens were extracted using an Endocatch bag. Results: All procedures were successfully completed, with only one incision through the umbilicus, and without conversion to a standard laparoscopic approach. Mean operative time was 120.1 ± 34.7 min. Tumor laterality and patient body mass index did not affect surgical morbidity. The initial 15 patients had a significantly longer mean pneumoperitoneum time (95.8 ± 37.5 min) than the last 15 patients (70.5 ± 18.7 min). Only one postoperative complication was observed (postoperative hematoma). Conclusions: A transumbilical approach for laparo‐endoscopic single‐site adrenalectomy is safe and feasible, and it results in superior cosmesis. Improvements in surgical devices might facilitate further development of this approach.     

应用改进的器械行经脐单孔腹腔镜胆囊切除术

目的 探讨应用改进的器械行经脐单孔腹腔镜胆囊切除术的应用价值.方法 回顾性分析2010年4月至6月间53例应用改进的器械行经脐单孔腹腔镜胆囊切除术患者的临床资料.结果 53例手术均获成功,无增加穿刺孔转为传统LC或中转开腹,未放置腹腔引流管.手术时间20～50min,平均30min;出血0～100ml,平均20ml.无并发症发生.术后随访2周～2个月,无继发出血、胆漏、切口感染、黄疸等并发症发生,腹壁瘢痕不明显.结论 应用改进的器械行经脐单孔腹腔镜胆囊切除术,减少了器械之间的相互干扰,提高了手术的安全性,具有应用价值.