腹腔镜腹股沟疝修补术(附38例报告)

目的:探讨腹腔镜经腹膜腹股沟斜疝无张力修补术(transabdominal preperitoneal prosthesis,TAPP)的安全性和有效性。方法:38例腹股沟疝患者均采用TAPP治疗,其中直疝9例,斜疝21例,股疝1例,双侧疝2例,复发疝5例。结果:所有患者均手术成功,平均手术时间(40.3±15.8)min,平均住院时间(5.4±1.6)d,随访0.5~3年,均未复发。结论:TAPP是治疗腹股沟疝安全有效的方法。     

手助腹腔镜与开腹肝切除术的临床对照研究

目的：探讨手助腹腔镜肝切除术的可行性及微创性。方法：随机将60例肝切除患者分为两组,30例行手助腹腔镜肝切除术,30例行开腹肝切除术,比较两组的手术时间、术中出血量、切口长度、术后肛门排气时间、术后住院时间、术后并发症、术前及术后第1、4、7天C反应蛋白（CRP）及中性粒细胞的动态变化。结果：手助腹腔镜组与开腹组的平均手术时间（114.3minvs.105.8min）和切缘距肿瘤边缘（3.22cmvs.3.33cm）差异无统计学意义（P〉0.05）。手助腹腔镜组术中平均出血量明显少于开腹组（212mlvs.376.5ml,P〈0.05）,切口长度差异有统计学意义（6.95cmvs.22cm,P〈0.01）。手助腹腔镜组术后胃肠功能恢复时间明显早于开腹组（术后肛门排气时间2.34dvs.3.48d,P〈0.05）。手助腹腔镜组住院时间明显短于开腹组（8.35dvs.10.8d,P〈0.01）。手助腹腔镜组与开腹组均无严重并发症发生。两组术后第7天CRP值比较有显著差异（23.23vs.63.35,P〈0.05）。两组于术后第4天中性粒细胞值比较有显著差异（6.45vs.9.51,P〈0.05）。结论：手助腹腔镜肝切除安全可行,并且具有创伤小、术后康复快等特点,是值得选择的微创肝切除方式。     

Laparoscopic cholecystectomy for left-sided gallbladder (sinistroposition).

Transposition of the gallbladder to the left side without situs inversus viscerum is rare. These gallbladders are situated under the left lobe of the liver between Segment III and IV or on Segment III to the left of the falciform ligament. Because routine preoperative studies may not detect the anomaly, it may provide the surgeons with an unusual surprise during laparoscopy. Awareness of the unpredictable confluence of the cystic duct into the common bile duct and selective use of intraoperative cholangiography aid in the safe laparoscopic management of this unusual problem.     

宫腔镜联合腹腔镜检查不孕症168例分析

目的探讨宫、腹腔镜联合检查不孕症的诊断价值.方法回顾性分析1999年6月～2003年10月宫、腹腔镜联合检查168例不孕症的临床资料.结果宫腔镜检查发现异常宫腔79例（79/168,47.0%）,其中子宫内膜增生、内膜息肉46例（46/79,58.2%）.腹腔镜检查发现盆腔器质性病变99例,其中慢性盆腔炎、子宫内膜异位症和多囊卵巢共85例（85/99,85.9%）;宫、腹腔镜检均正常15例,均异常39例.宫腔镜下行输卵管通畅检查,输卵管单侧或双侧不通90例（90/168,53.6% ）;腹腔镜检查输卵管单侧或双侧不通78例（78/168,46.4%）.结论宫腔镜联合腹腔镜检查不孕症能够提供准确的诊断依据.     

金属夹定位结肠病变在腹腔镜手术中的应用

目的：探讨腹腔镜结肠手术术前病灶定位的方法。方法：22例腹腔镜结肠手术术前行纤维结肠镜检查，并用金属夹标记结肠病变部位，并摄平卧位腹平片确定体表投影部位。结果：22例腹腔镜结肠手术均顺利找到病变部位。结论：术前用金属夹定位病变，有助于腹腔镜结肠手术时顺利找到病灶。     

腹腔镜治疗小儿腹股沟斜疝的器械改进与应用研究

目的：探讨自行改进的手术器械应用于腹腔镜小儿腹股沟斜疝内环口关闭术的应用价值。方法：回顾分析60例11个月～12岁的小儿腹股沟斜疝患儿应用自行改进的手术器械实施经腹腔镜腹股沟斜疝内环口关闭术的临床资料。结果：60例手术时间5～8min,治愈59例,复发1例,平均住院3～5d。结论：应用该技术治疗小儿腹股沟斜疝,具有创伤小、手术时间短、副损伤小、恢复快、住院时间短、手术疤痕小等优越性。     

Routine postoperative chest x-ray following laparoscopic nephrectomy.

PURPOSE: To determine whether a routine postoperative chest x-ray is required following uneventful laparoscopic nephrectomy to rule out pneumothorax. METHODS: From June 1999 to May 2003, 308 laparoscopic nephrectomy cases were performed by 5 different surgeons. This consisted of 121 radical nephrectomies, 106 donor nephrectomies, 29 simple nephrectomies, 29 partial nephrectomies, and 23 nephroureterectomies. Of the 308 procedures, 186 postoperative chest x-ray s were obtained in the recovery room: 183 routinely and 3 for known intraoperative diaphragmatic injuries. Routine chest x-rays were not obtained in 122 cases due to the individual surgeon's preference. Of these 122 patients, 15 underwent chest x-ray performed while hospitalized secondary to pulmonary issues or fever. RESULTS: Of the 308 cases, 4 pneumothoraces were identified on chest x-ray. Three were identified in the patients who had intraoperative identification of diaphragmatic injury. The fourth pneumothorax was identified in a patient who did not have a routine postoperative chest x-ray but did have a chest x-ray obtained due to postoperative shoulder pain. The pneumothorax in this patient resolved spontaneously. No incidental findings existed of pneumothorax in any patient who underwent routine postoperative chest x-ray. CONCLUSION: In our series, a pneumothorax was identified either intraoperatively or based on postoperative clinical findings. None of the 183 routine postoperative chest x-rays changed patient management. Routine postoperative chest x-ray is not necessary in uncomplicated laparoscopic nephrectomy.     

Larger urethral catheter size leads to fossa navicularis stricture formation in robotic radical prostatectomy

Fossa navicularis strictures following radical prostatectomy are reported infrequently. We recently experienced a series of fossa strictures following robotic-assisted laparoscopic prostatectomy (RLP). We describe herein our experience to prevent fossa strictures and to determine its etiologic factors. From June 2002 to May 2006, 424 patients underwent robotic-assisted laparoscopic prostatectomy with the da Vinci surgical system. Fossa strictures were diagnosed based on the acute onset of obstructive voiding symptoms and bougie calibration. During our series, we switched from the intra-operative use of an 18 French (F) catheter to that of a 22 F one to avoid inadvertent stapling of the urethra when dividing the dorsal venous complex. After we observed a high incidence of fossa strictures, we reverted back to 18 F catheters during surgery. All patients had an 18 F catheter indwelling for 1 week after surgery. Parameters were evaluated using Fisher’s exact test and Student’s t-test for means. The 18 F catheter group of patients (n = 293) developed one fossa stricture, whereas the 22 F catheter group (n = 131) developed nine fossa strictures (P < 0.01). The fossa stricture rate in the 18 F group was 0.3% versus 6.9% in the 22 F group. The two groups had no differences in age, body mass index, cardiovascular disease, American Urological Association symptom score, urinary bother score, preoperative prostate-specific antigen, operative time, estimated blood loss, cautery use, prostate size, or catheterization time. Based on these results, a larger urethral catheter size – 20 F versus 18 F – during the intra-operative dissection would appear to increase the risk for fossa stricture by more than 20-fold. Statement of disclosure Dr. Thomas Ahlering is a meeting participant and lecturer for Intuitive Surgical Corp. The other authors have no direct or indirect commercial financial incentives associated with publishing the article. No research or project support funding was received.     

改良式腹腔镜腹膜外补片植入法疝修补术

目的探讨改进式腹腔镜腹膜外补片植入法腹股沟疝修补术的可行性及临床意义.方法回顾性分析我院2002年6月～2004年10月13例腹股沟疝进行的腹腔镜下经腹腔腹膜外补片植入法联合腹膜缝合覆盖修补术的临床资料.其中腹股沟斜疝9例,直疝4例;其中复发疝1例;右侧8例,左侧4例,双侧1例.结果手术均获成功,单侧手术时间35～85 min,平均50 min,无一例中转开腹,无术后并发症,术后平均住院时间2 d,13例随访1～28个月,平均12个月,无一例复发.结论腹腔镜下经腹腔途径腹膜外补片植入法联合腹膜缝合覆盖术是一种安全、可靠、疗效显著的腹股沟疝修补方法,具有手术操作简单、创伤小、术后疼痛轻、恢复快等优点,可以代替开放手术,值得推广应用.     

Role and value of laparoscopic training devices in assessing nondominant and two-handed dexterity

Background and objectives: To determine improvement in hand dexterity with targeted laparoscopic skill exercises desirable for use in the operating rooms among in-training laparoscopic gynaecological surgeons and medical students. Design: Cross-sectional study with paired analysis. Setting: Kiel School of Gynaecological Endoscopy and Reproductive Medicine, Germany, between February and April 2005. Subjects: Twenty third-year medical students and 20 in-training gynaecological endoscopic surgeons from various parts of the world. Interventions: Demonstration and explanation of a set of five laparoscopic skill exercises desirable for use in the operating rooms before administering a pretest. This was followed by voluntary practice of these exercises for at least 10 times over 1 day. The posttest was performed the next day once the participant was comfortable performing the skill. Pre- and posttest assessments were conducted by independent supervisors. Main outcome measures: Time to completion of tasks with minimal errors. Results: There was significant reduction in mean time for all the laparoscopic skill exercises performed with dominant, nondominant, and both hands, before and after the training and practice (p-value <0.01; paired t-test). Moderate to high correlation (0.617–0.901) was seen with the intermediate and complex/difficult tasks, whereas low correlation was seen with the simple/easy task (0.200–0.336). Medical students and gynaecologists both showed improvement in performance from pretest to posttest in terms of reduction in mean time taken to perform all the tasks with minimal errors. Conclusions: Simple laparoscopic training devices can substantially help an individual hand’s improvement and acquisition of laparoscopic skills. Simple laparoscopic training devices along with animal models will continue to provide an efficient and effective environment for learning and teaching laparoscopic surgical skills. With this training, performance improves progressively with practice.