腹腔镜手术与开放手术治疗精索静脉曲张的对比性研究(附273例分析)

目的:对比研究腹腔镜和开放手术精索静脉高位结扎术治疗精索静脉曲张的疗效。方法:回顾分析121例腹腔镜和152例开放手术精索静脉高位结扎术的临床资料,比较两种方法在手术时间、术后住院天数及综合治疗费用及术后止痛药应用等的差异。结果:两组在手术时间、术后住院天数及止痛药应用等方面差异均有高度显著性(P<0.01),腹腔镜组均优于开放手术组;综合治疗费用两组差异无显著性(P>0.05)。结论:腹腔镜治疗精索静脉曲张较开放手术具有创伤小、康复快,术后住院时间短及美容效果好等优点。     

腹腔镜下不同术式子宫切除术151例分析

目的探讨腹腔镜下不同术式子宫切除术适应证及临床应用价值. 方法回顾分析2003年1月～2004年3月151例不同术式腹腔镜子宫切除术.其中腹腔镜筋膜内子宫切除术(classic interfascial supracervical hysterectomy, CISH)19例,腹腔镜辅助下阴式子宫切除术(laparoscopic assisted vaginal hysterectomy, LAVH)60例,腹腔镜次全子宫切除术(laparoscopic supracervical hysterectomy, LSH)67例,腹腔镜下全子宫切除术(laparoscopic total hysterecotomy, LTH)5例,对40例＞孕12周子宫的手术方法进行改进. 结果无一例中转开腹,无并发症发生.各术式手术时间、术中出血、术后排气及住院时间为CISH(109.2±14.4) min,(80.5±14.3) ml, (21.1±3.2) h, (4.2±0.4) d;LAVH(108.7±14.8) min, (79.8±10.0) ml,(20.6±2.7) h,(4.2±0.4) d;LSH(107.6±24.2) min, (80.8±17.2) ml, (20.4±2.0) h,(4.1±0.5) d;LTH(110.0±12.3) min, (80.0±18.7) ml, (20.8±1.9) h, (4.2±0.5) d.40例较大子宫技术性改进手术方法均获成功. 结论腹腔镜下各种子宫切除术各有其适应证及优缺点,应根据病人的具体情况选择具体的手术方式.     

后腹腔镜下离断式肾盂成形术

目的探讨后腹腔镜下肾盂成形术的临床疗效. 方法腹腔镜下通过后腹腔途径对9例肾盂输尿管连接部狭窄行离断式肾盂成形术并对技术进行改进. 结果 9例手术均获成功,手术时间110～240 min,平均160 min.术中出血量30～80 ml,平均50 ml.术后住院8～18 d,平均11.2 d.术后并发症:皮下气肿(合并阴囊气肿)1例,漏尿2例.术后1～10个月B超示术侧肾盂无积水5例,轻度积水2例,中度积水2例.3例术后5个月IVU显示吻合口通畅. 结论后腹腔镜肾盂成形术微创、效果好,值得推广.     

Factors leading to long-term hospitalization after laparoscopic appendectomy.

BACKGROUND: Randomized studies demonstrate that laparoscopic appendectomy yields better results compared with open techniques. We sought to identify factors that determine an extended hospital stay among patients undergoing laparoscopic appendectomy. METHODS: This was a prospective study including 669 patients undergoing laparoscopic appendectomy. We analyzed variables that can predict the length of hospital stay. RESULTS: Of 669 patients undergoing laparoscopic appendectomy, 141 stayed in the hospital for > or = 5 days (Group 1), and 97 stayed in the hospital for < or = 1 day after surgery (Group 2). The univariate analysis demonstrated that fever (P<0.0001), nausea and vomiting (P=0.060), leukocytosis (P<0.0001), gangrened or perforated intraoperative appearance of the appendix (P<0.0001), and appendix position behind the ileocecal junction (P<0.001) were related to a longer hospital stay. The multivariate analysis through logistical regression showed that the factors independently and significantly associated with an extended hospital stay were presurgical fever, appendix position behind the ileocecal junction, and intraoperative gangrened or perforated appearance of the appendix. CONCLUSION: Fever, appearance, and position of the appendix are factors related to an extended hospital stay.     

Experimental laparoscopic aortobifemoral bypass

The goal of the present study is to develop a technique for laparoscopic aortobifemoral bypass.Piglets weighing between 60 and 78 kg were anesthetized with halothane. The lateral retroperitoneal approach was preferred to the more familiar anterior transperitoneal approach and was successfully completed in 19 piglets. The piglets were placed in the right lateral decubitus position. The first port (2 cm) was inserted halfway between the tip of the 12th rib and the iliac crest. Four other trocars were placed in the retroperitoneum after balloon inflation had allowed creation of a space which permitted visualization of the aorta from the left renal artery down to the aorto-iliac junction. After evacuation of the retropneumoperitoneum, the cavity was maintained using an abdominal lift device and a retractor.Using this approach, we performed four aortobifemoral bypasses (end-to-end aortic anastomosis) after conventional intravenous heparinization (100 IU/kg) in less than 4 h. Blood loss did not exceed 250 ml and the hematocrit remained stable. Postmortem evaluation of the grafts revealed they were positioned as in a conventional bypass, their limbs having followed in the created retroperitoneal tunnels along the path of the native arteries. No mortality occurred before sacrifice of the animals. We believe that this first performed series of totally retroperitoneal laparoscopic aortobifemoral bypasses in the porcine model is useful in preparation for human application due to the anatomical similarities in the periaortic region.     

腹腔镜卵巢穿刺内凝治疗多囊卵巢不孕症的临床研究

目的探讨腹腔镜卵巢穿刺内凝对多囊卵巢不孕症的治疗价值。方法１５１例腹腔镜卵巢穿刺内凝术（实验组）和１５１例开腹卵巢楔切术（对照组）治疗多囊卵巢不孕症配对对比研究。结果实验组的手术时间３３．１±７．２ｍｉｎ，术中失血１５．６±４．７ｍｌ，总排卵率９２．０５％，总妊娠率４９．６７％，均优于对照组（Ｐ＜０．０１）；术后雄激素、ＬＨ／ＦＳＨ下降幅度小于对照组（Ｐ＜０．０１）。随时间推移，两组术后排卵巢、妊娠率均有下降倾向，而术后雄激素、ＬＨ／ＦＳＨ则有逐渐回升的倾向。结论腹腔镜卵巢穿刺内凝术对多囊卵巢不孕症有较好的治疗效果     

Laparoscopic repair/peritoneal toilet of perforated duodenal ulcer

Summary Laparoscopic techniques have been refined to the point where exposure, haemostasis and tissue approximation by suture approach those obtained at open access surgery. We report a patient with acute perforation of an ulcer in the first part of the duodenum who was successfully treated by laparoscopic oversewing and omental patching. The clinical indications for contemplating use of laparoscopic surgery for acute ulcer perforation, techniques employed and the areas for potential improvement of instruments, needles and sutures are discussed.     

Results of the routine use of a modified endoprosthesis to drain the common bile duct after laparoscopic choledochotomy

Background: One hundred eighty-one patients were submitted to laparoscopic common bile duct exploration. Methods: A transcystic approach was used in 147 patients, choledochotomy in 14, and both in 20. The indications to perform a choledochotomy included stones larger than 20 mm, stones proximal to the cystic duct entrance, and cases in which the transcystic duct approach proved impossible or unsuccessful. Results: The common bile duct was drained by a T-tube in four patients, by laparoscopic sphincterotomy in one, by laparoscopic choledochoduodenostomy in one, and by a 10 Fr endoprosthesis in 28. The stent placement was technically feasible in all patients but one. The biliary drainage was adequate. Mean hospital stay was 2.1 days. Complication was limited to one umbilical infection and one self-limited biliary leak. Conclusions: The procedure proved to be technically simple, safe, and efficient, and resulted in a low morbidity rate and short hospital stay. Received: 29 March 1996/Accepted: 12 June 1996     

腹腔镜与开放手术治疗上尿路移行细胞癌的对比研究

目的　评价联合尿道电切镜、腹膜后镜行肾输尿管切除术的临床效果。　方法　肾盂输尿管癌患者 4 4例 ,采用联合尿道电切镜、腹腔后镜行肾输尿管切除术 15例 (A组 ) ,开放性肾输尿管切除术 2 9例 (B组 )。对两组的临床疗效、术后恢复、费用及并发症等进行对比研究。　结果　A组术中出血量 (75 .1± 2 9.5 )ml、术后 (2 4 .1± 12 .6 )h肠功能恢复、(2 4 .3± 10 .5 )h下床活动、应用止痛药(3.0± 0 .8)d、静脉应用抗生素 (7.2± 3.1)d、术后住院 (6 .3± 1.2 )d、(2 8.0± 7.8)d恢复正常工作 ,明显优于B组 ,差异有显著性意义 (P <0 .0 1或P <0 .0 5 )。B组手术时间、手术治疗费用、住院总费用优于A组 ,差异有显著性意义 (P均 <0 .0 1)。A组并发症明显少于B组。两组随访 14～ 36个月 ,均未见肿瘤复发。　结论　联合尿道电切镜、腹膜后镜肾输尿管切除术与开放手术相比 ,疗效相当 ,创伤小、痛苦少、术后恢复快、并发症少 ,费用较高。     

腹腔镜下处理腹腔镜胆囊切除术胆道和胃肠道损伤

目的评价腹腔镜下处理腹腔镜胆囊切除术后胆道和胃肠道损伤. 方法 1991年10月～2002年12月,完成连续无选择腹腔镜胆囊切除术和腹腔镜胆囊切除联合胆道探查9 016例,其中发生胆道损伤14例(0.15%),胃肠道损伤3例(0.03%).其中1例胆管横断伤、10例胆管部分损伤、1例胃损伤、2例十二指肠损伤均在腹腔镜下修补. 结果 1例胆道损伤腹腔镜下修补术后胆漏,1年后发生胆道狭窄,其余均痊愈出院. 结论胆道部分损伤及胃肠道损伤可在腹腔镜下处理,对于胆道横断伤的腹腔镜处理,需进一步探讨.