腹腔镜保留肾单位肾肿瘤切除术对肾细胞癌患者肾功能和预后的影响

目的：分析肾细胞癌患者接受腹腔镜保留肾单位肾肿瘤切除术治疗对其肾功能及预后的影响。方法：收集2017年1月至2022年3月重庆医科大学附属第一医院泌尿外科接诊的肾细胞癌患者182例作为研究对象,采取随机法将患者进行分组,一组应用腹腔镜根治性肾切除术进行治疗,共91例为对照组,另一组应用腹腔镜保留肾单位肾肿瘤切除术进行治疗,共91例为研究组,对比两组患者术后肾功能及预后效果差异性。结果：研究组患者术后住院时间（P=0.011）优于对照组,对照组患者手术期间出血量（P<0.001）及手术时间（P=0.019）优于研究组,差异均有统计学意义;研究组患者手术后24 h血清肌酐水平（P=0.013）低于对照组,差异有统计学意义;研究组患者术后认知功能（P=0.018）、躯体功能（P=0.021）、社会功能（P=0.025）、情绪功能（P=0.032）及总体生活质量（P=0.033）等各维度评分高于对照组,差异有统计学意义。结论：临床中为肾细胞癌患者提供腹腔镜保留肾单位肾肿瘤切除术进行治疗可以缓解对患者肾功能造成的影响,提升患者手术治疗后的生活质量水平。     

造瘘口切口辅助技术在腹腔镜膀胱根治性切除及回肠通道术中的应用

目的：探讨造瘘口切口辅助技术（通过造瘘口切口取标本,行肠吻合及输尿管吻合）在腹腔镜膀胱根治性切除及回肠通道术中的安全性、实用性。方法：将60例需行膀胱根治性切除及回肠通道术的患者随机分为造瘘口切口辅助技术组（试验组）及传统下腹正中切口辅助技术组（对照组）,比较2组患者尿流改道手术时间、术中出血量、并发症发生率、术后住院日、术后疼痛评分的差异。结果：试验组尿流改道手术时间少于对照组[（105.0±18.9） min vs.(117.0±17.7) min,P<0.05];术后疼痛评分低于对照组（4.03±1.50 vs. 5.40±1.69,P<0.05）;术后住院时间少于对照组[（8.27±1.86） d vs.(9.70±1.87) d,P<0.05];术中出血量2组间差异无统计学意义[试验组：（260±155） mL,对照组：（271±154） mL,P=0.784]。试验组并发症发生4例,其中2例为肠梗阻,1例造瘘口旁疝,1例尿路感染;对照组并发症发生6例,其中肠梗阻3例,切口感染2例,尿路感染1例。组间总体并发症发生率无明显统计学差异。结论：造瘘口切口辅助技术...     

Laparoscopic resection for a left adrenal black adenoma

Ａｄｒｅｎａｌｂｌａｃｋａｄｅｎｏｍａ (ｐｉｇｍｅｎｔｅｄａｄｅｎｏｍａ)ｉｓｑｕｉｔｅｒａｒｅ Ｒｅｃｅｎｔｌｙ,ｗｅｐｅｒｆｏｒｍｅｄａｌａｐａｒｏｓｃｏｐｉｃｒｅｓｅｃｔｉｏｎｆｏｒａｆｕｎｃｔｉｏｎｉｎｇａｄｒｅｎａｌｂｌａｃｋａｄｅｎｏｍａ Ｗｅｒｅｐｏｒｔｔｈｅｃａｓｅｈｅｒｅ ＣＡＳＥＲＥＰＯＲＴＡ 2 1 ｙｅａｒ ｏｌｄｆｅｍａｌｅｗａｓａｄｍｉｔｔｅｄｔｏｏｕｒｈｏｓｐｉｔａｌｂｅｃａｕｓｅｏｆａｍｅｎｏｒｒｈｅａａｎｄｏｂｅｓｉｔｙ ＳｈｅｐｒｅｓｅｎｔｅｄｗｉｔｈｔｙｐｉｃａｌＣｕｓ…     

Laparoscopic resection for a left adrenal black adenoma

Adrenal black adenoma (pigmented adenoma) is quite rare. Recently, we performed a laparoscopic resection for a functioning adrenal black adenoma. We report the case here.     

腹腔镜下妇科手术硬膜外阻滞和全麻的比较

目的:比较硬膜外阻滞和气管内全麻腹腔镜下妇科手术CO2 气腹对患者呼吸循环的影响。方法 :60例妇科腹腔镜 (GL)病人随机分成硬外和全麻两组 ,监测两组各时点的血压、心率、SPO2(血氧饱和度 )、VT(潮气量 )、f(呼吸频率) ,PETCO2(呼气末CO2 分压 )、血气分析等。结果 :全麻组各项指标平稳 ,PETCO2、PaCO2 值均在正常范围 ;硬外组气腹后15min变化最大 ,表现在SBP(收缩压 )、DBP(缩张压 )、HR、f、PaCO2、PETCO2 升高 ,P<0.01 ,气腹后30min各值基本恢复到气腹前水平。结论 :GL下妇科手术 ,气管内全麻优于硬膜外麻 ,但可选择性地采用硬膜外阻滞 ,而对有心肺疾病 ,年老体弱或肥胖病人以及手术难度大 ,估计气腹时间长者宜选择全麻     

腹腔镜剥离卵巢子宫内膜异位囊肿92例分析

目的探讨腹腔镜下卵巢子宫内膜异位囊肿剥出术的可行性及技术要点。方法回顾性分析1995年5月～1999年5月施行的92例腹腔镜下卵巢巧克力囊肿剥出术的手术情况。结果92例患者按RAFS分期,Ⅲ期61％、Ⅳ期39％。手术均顺利完成,无中转开腹手术,平均手术时间62min,平均术中出血50ml,术后平均住院2．6d。病理均证实为卵巢子宫内膜异位囊肿。无术时术后并发症。结论对属于中、重度(Ⅲ、Ⅳ期)的卵巢子宫内膜异位囊肿进行腹腔镜下囊肿剥出术是安全可行的,应作为治疗的首选术式。在进行囊肿剥出前必须先分离卵巢与周围脏器的粘连,游离卵巢,为减少术后复发,应完全剥除囊壁,不缝合卵巢有利于减少术后粘连。     

COMPLICATIONS IN LAPAROSCOPIC GYNECOLOGIC SURGERY

Objective. To investigate retrospectively the complications and associated factors of gynecological laparescopies.Methods. 1769 laparoscopic surgeries were carried out from January 1994 to October 1999 at our department. The procedures included 1421 surgeries of ovary and tube, 52 myomectomies and 296 cases of laproscopic-assisted vaginal hysterectomy (LAVH). A total of 312 patients had a history of prior laparotomy (17.6%). Results. Complications occured in 34 cases, the overall complication rate was 1.92%. Unintended laparotomies occured in 6 cases(0.34% ). 12 complications were associated with insertion of Veress needle or trocar and creation of pneumoperitoneum, including 5 severe emphysema and 7 vascular injuries, this figure represents 35.3% of all complications of this series. Five intraopemtive complications (14.7 % ) occured during the laparescopic surgery (3 severe bleedings, one bladder injury and one skin bum of leg caused by damaged electrode plate), laparotomy was re-quired in four of these cases. Seventeen complications occured during postoperative stage: 2 intraperitoneal hemor-rhages needing laparotomy, 2 bowel injuries, 4 nerve paresis and 9 febrile morbidities. Cordusions. Operative gynecologic laparoscopy is associated with acceptable morbidity rate, but can not be over-looked. Complication rate seems to be higher in advanced procedures such as LAVH.     

Gastric Banding: Advantages and Complications. A 5- and 10-Year Follow-up

Background: Gastric banding is one of the simplest surgical procedures for the treatment of morbid obesity. We performed more than 150 ‘laparotomy’ (open) gastric bandings and more than 50 ‘laparoscopic’ bandings in the last 10 years. Methods: In most procedures we used non-adjustable bands, but since the beginning of 1995 we have used adjustable silicone banding. Results: The 5- and 10-year follow-up weight loss results are encouraging. The average long-term weight loss was 35.5 kg. Since 1993, we performed all the procedures laparoscopically, and the postoperative complications decreased from 18.5% in the ‘laparotomy’ group to 9.5% in the ‘laparoscopic’ group, with the majority being esophagitis and outlet area irritation. Conclusion: Gastric banding itself and especially the minimally invasive laparoscopic approach is an easy technical procedure. The long-term weight loss results and the reoperation rate are acceptable for bariatric surgery criteria.     

Laparoscopically assisted full thickness skin graft for reconstruction in congenital agenesis of vagina and uterine cervix

In patients with agenesis of the vagina and cervix but with a functional endometrium, the traditional treatment is hysterectomy with construction of a neovagina. We report successful treatment by laparoscopically assisted full thickness skin graft for reconstruction in a patient with congenital agenesis of the vagina and uterine cervix concomitant with haematometra and ovarian endometrioma in a 12 year old girl. Postoperatively, the vaginal skin graft healed well, and menstruation first appeared 4 weeks later. In our opinion, a combined laparoscopic and vaginal procedure with full thickness skin graft is an efficacious alternative in managing such genital defects.     

258例不孕症患者腹腔镜诊断分析

对２５８例不孕症患者利用腹腔镜检查诊断不孕原因,明确病因后进行针对性治疗,并追踪随访术后妊娠率,妊娠结局。结果２５８例中９５例为输卵管炎,术后妊娠４２例,妊娠率４４２１％,８４例子宫内膜异位症,术后妊娠６２例,妊娠率７３８１％,６１例多囊卵巢综合征,术后妊娠２７例,妊娠率４４３６％。结果表明：腹腔镜检查能迅速,正确地诊断不孕原因,术后针对病因治疗,提高了不孕症患者的妊娠率。