单孔腹腔镜在巨大卵巢囊肿剔除术中的应用

目的探讨单孔腹腔镜技术在卵巢巨大囊肿剥除术中的应用价值。 方法回顾性分析2017年3月至2018年3月在北京协和医院妇产科进行单孔腹腔镜辅助下巨大卵巢囊肿体外剥除术的9例患者的临床资料,其中2例为孕13^＋周;根据术后病理类型分类：其中5例为黏液性囊腺瘤,2例为畸胎瘤,1例为子宫内膜异位囊肿,1例为单纯囊肿。 结果9例患者均顺利在单孔腹腔镜辅助下完成巨大卵巢囊肿体外剥除,无患者中转开腹或多孔腹腔镜,围手术期无手术相关并发症发生。中位手术时间55 min(35～60 min),中位术中出血量10 ml(10～75 ml),平均术后住院时间(5.11±1.41)d。其中2例妊娠患者均顺利足月阴道分娩,1例患者术后3个月自然妊娠,6例患者术后6～12个月复查超声均无复发。 结论术前严格筛查排除恶性卵巢肿瘤可能,行单孔腹腔镜辅助下巨大卵巢囊肿体外剥除术为治疗卵巢巨大囊肿提供了一种安全可行的方法。     

经脐单孔腹腔镜手术治疗巨大卵巢囊肿

目的探讨单孔腹腔镜治疗巨大卵巢囊肿(直径≥10 cm)的安全性和有效性。方法 2016年12月～2018年12月,对27例巨大卵巢良性囊肿(囊肿直径10～15 cm)行经脐单孔腹腔镜卵巢囊肿剥除术。脐部切口1. 5～2 cm,置入单孔port和腹腔镜、器械探查,将囊肿提至切口保护套下穿刺抽出囊液,剔除囊肿。结果 27例均在单孔腹腔镜下顺利完成手术,手术时间40～65(51. 3±1. 2) min,术中出血量20～50 ml,术后肛门排气时间6～18 h,术后2～3 d出院。无切口感染、皮下血肿、创面出血、器官损伤等并发症。结论对巨大卵巢囊肿行经脐单孔腹腔镜囊肿剥除术简单易行,安全可靠,疗效确切。     

单孔腹腔镜手术治疗良性卵巢囊肿的临床体会

目的探讨单孔腹腔镜手术治疗良性卵巢囊肿的临床疗效,为患者提供临床手术指导。方法回顾性分析2016年1月至2019年6月就诊的62例卵巢良性囊肿行单孔腹腔镜手术治疗情况。观察分析患者的手术进行时间、术中出血的出血量、导尿管置管的时间、术后能进行自如活动时间,记录并发症发生情况。结果 62例卵巢良性囊肿患者的平均手术时间(61.2±1.1)分钟,术中出血量(29.2±20.1)ml,导尿管置管时间(1.8±1.5)天,术后自如活动时间(3.2±1)天,肛门平均排气时间(1.42±0.82)天,住院时间(6.2±3.1)天。对所有患者进行1～6月术后随访,患者均没有发生切口出现感染、出血或切口疝等术后并发症,并发症发生率0%。结论单孔腹腔镜手术治疗良性卵巢囊肿,具有创伤小,术中出血量少,并发症少,患者术后恢复速度快等优点,值得临床推广。     

单孔腹腔镜联合经脐小切口体外妊娠期巨大卵巢囊肿剥除术的临床应用价值

目的评估利用单孔腹腔镜联合经脐小切口体外剥除妊娠期巨大卵巢囊肿的临床意义和治疗效果。 方法回顾性分析2018年5～11月在石家庄市第四医院实施单孔腹腔镜联合经脐小切口体外妊娠期巨大卵巢囊肿(10～11 cm)剥除术的6例患者的临床资料。 结果6例患者均顺利完成单孔腹腔镜联合经脐小切口体外巨大卵巢囊肿剥除。6例患者中,1例输卵管系膜囊肿扭转,2例卵巢囊肿蒂扭转,3例患者恢复正常解剖结构后卵巢均未发生坏死,行囊肿剥除术。中位囊肿直径10 cm(10～11 cm),中位手术时间51.50 min(43.75～63.50 min),中位术中出血7.5 ml( 5～20 ml),平均住院时间( 3.50±0.43) d。随访,6例患者中,5例(83.33%)妊娠至足月分娩,1例(16.67%)早产;其中2例(33.33%)行剖宫产,4例(66.67%)顺产;中位新生儿体质量3 050 g(2 750～3 162.5 g)。6例患者的新生儿均无畸形及窒息。 结论对妊娠期巨大卵巢囊肿,应用单孔腹腔镜联合经脐小切口体外巨大卵巢囊肿剥除术是安全可行的,值得临床推广。     

经脐单孔腹腔镜与传统腹腔镜卵巢囊肿剥除术的比较

目的探讨经脐单孔腹腔镜卵巢囊肿剥除术的安全性和临床价值。方法对2017年3月~2019年8月我院87例良性卵巢囊肿剥除术进行回顾性分析,其中单孔腹腔镜卵巢囊肿剥除术43例(单孔腹腔镜组),传统腹腔镜卵巢囊肿剥除术44例(传统腹腔镜组),比较2组手术时间、术中囊肿破裂率、术后血红蛋白(hemoglobin,Hb)下降幅度、术后24 h疼痛视觉模拟评分(Visual Analogue Scale,VAS)、排气时间、住院时间。结果2组患者均无中转开腹和手术并发症发生。单孔腹腔镜组囊肿破裂率81.3%,明显高于传统腹腔镜组56.8%(χ^2=6.137,P=0.013),术后24 h疼痛VAS评分单孔腹腔镜组明显低于传统腹腔镜组[1(0~2)分vs.2(0~3)分,Z=-3.575,P=0.000],排气时间明显早于传统腹腔镜组[(26.5±11.1)h vs.(33.1±11.8)h,t=-2.654,P=0.009]。2组手术时间、术后Hb下降幅度和住院时间差异均无统计学意义(P>0.05)。结论经脐单孔腹腔镜良性卵巢囊肿剥除术是安全和可行的,但囊肿破裂率明显增高,应重视术前良恶性肿瘤的评估,交界性或恶性肿瘤慎用此术式。     

经阴道自然腔道内镜卵巢囊肿剥除术十例临床分析

目的评估经阴道自然腔道内镜(natural orifice transluminal endoscopic surgery,NOTES)卵巢囊肿剥除术的可行性、安全性及术后恢复情况。 方法回顾分析2017年9－12月在上海市第一妇婴保健院妇科行NOTES卵巢囊肿剥除术患者10例,所有患者取阴道后穹窿入路2.5 cm切口,置入硅胶密封圈后,装上Port,建立气腹后用传统腹腔镜行患侧卵巢囊肿剥除术。统计卵巢囊肿大小、手术时间、术前与术后血色素差值、术中出血量、术后24 h视觉模拟疼痛评分(visual analog scale,VAS)及术后恢复排气时间。 结果其中1例患者因双侧卵巢成熟性囊性畸胎瘤合并多囊卵巢综合征,由于卵巢门出血略活跃、缝合困难影响手术进展,中转为传统腹腔镜手术之外,其他患者均经阴道腹腔镜完成,手术均无并发症、无输血。9例患者的平均手术时间78.3 min,术前与术后血色素的平均差值18.3 g/L,平均术中出血量23.3 ml,术后24 h VAS平均0.55分,术后平均恢复排气时间17.5 h,平均住院时间4.7 d。 结论NOTES卵巢囊肿剥除术后患者的切口疼痛感较轻,具有术后恢复快、腹部无瘢痕、美观的优势,合适的病例选择加上灵活的手术技巧,NOTES卵巢良性囊肿剥除是安全可行的。     

经脐单孔腹腔镜手术治疗巨大附件良性肿瘤30例

目的探讨经脐单孔腹腔镜手术治疗巨大附件良性肿瘤可行性和安全性。方法 2017年10月～2018年11月同一术者对30例巨大附件良性肿瘤实施单孔腹腔镜手术,采用经脐入路,1. 5～2. 0 cm切口置入切口保护套及Port,用相关腹腔镜器械完成经脐单孔腹腔镜手术,手术方式包括卵巢囊肿剔除术、附件切除术、全子宫+单附件或双附件切除术。结果 30例均成功完成经脐单孔腹腔镜手术,无一例增加辅助穿刺孔或中转开腹,其中卵巢囊肿剔除术8例,单/双附件切除13例,全子宫+单附件或双附件切除9例。术中囊肿破裂2例(6. 7%)。无一例术中、术后并发症。术后病理均良性肿瘤,无一例交界瘤或恶性肿瘤,其中浆液性囊腺瘤9例,成熟囊性畸胎瘤8例,黏液性囊腺瘤7例,纤维瘤、子宫内膜异位囊肿、单纯囊肿各2例。术后住院时间中位数4 d(1～10 d)。30例中位随访时间6. 5月(1～12个月),无一例复发。结论经脐腹腔镜手术治疗巨大附件良性肿瘤安全、可行。     

应用自制单孔装置行腹腔镜卵巢囊肿手术的疗效分析

目的:探讨使用自制单孔腹腔镜装置治疗卵巢囊肿的临床疗效及经济学价值。方法:回顾分析2018年6月至2020年6月卵巢囊肿患者的临床资料,分别行自制单孔腹腔镜(单孔组,n=80)与多孔腹腔镜(多孔组,n=100)手术,对比分析两组手术中转率、手术时间、术中出血量、术后疼痛评分、术后肛门排气时间、术后住院时间、住院费用等指标。结果:两组中转率、术中出血量、术后切口疼痛评分差异无统计学意义(P>0.05);单孔组术后首次下床时间、术后肛门排气时间、术后住院时间、住院费用、耗材费用低于多孔组,手术时间长于多孔组,术后肩背痛发生率高于多孔组,差异均有统计学意义(P<0.05)。结论:使用自制单孔装置行腹腔镜手术治疗卵巢囊肿具有安全、术后康复快、住院时间短、费用低等优势。     

腹腔镜巨大卵巢囊肿手术的经验体会

目的:探讨巨大卵巢囊肿行腹腔镜手术的手术方法及临床疗效。方法:回顾分析2010年10月至2011年6月收治的10例巨大卵巢囊肿患者的临床资料。全身麻醉后经腹穿刺,缩小囊肿体积后行腹腔镜巨大卵巢囊肿剥除术或患侧附件切除术。结果:10例均顺利完成腹腔镜手术;手术时间平均(45.7±19.1)min,术中出血量平均(55.3±13.1)ml,平均吸出囊内液(2 695.7±120.5)ml。术后病理均提示为良性,其中卵巢浆液性囊腺瘤5例,卵巢成熟型畸胎瘤3例,卵巢巧克力囊肿2例。术后随访均无复发及不适。结论:腹腔镜手术治疗巨大卵巢囊肿是安全、可行的;具有患者创伤小、康复快等优点,适当选择手术病例,手术方法灵活多样、个性化,完全可达到开腹手术的效果,值得临床推广应用。     

腹腔镜下卵巢囊肿剥除术治疗良性卵巢囊肿的体会

目的总结腹腔镜卵巢囊肿剥除术治疗良性卵巢囊肿的体会。方法选取2014-03—2017-01间在信阳市中医院接受治疗的96例卵巢囊肿患者,按手术方式不同分为2组,每组48例。分别实施开腹卵巢囊肿剥除术(开腹组)和腹腔镜下卵巢囊肿剥除术(腹腔镜组)。观察2组患者手术时间、术中出血量、术后肛门排气时间、住院时间及术后12个月内的妊娠情况。结果 2组手术时间差异无统计学意义(P 0. 05)。腹腔镜组术中出血量及术后肛门排气时间、住院时间均优于开腹组,差异均有统计学意义(P 0. 05)。2组患者均获随访12个月,其间腹腔镜组有生育要求患者妊娠率高于开腹组,差异有统计学意义(P 0. 05)。结论腹腔镜下卵巢囊肿剥除术治疗良性卵巢囊肿,创伤小、术后恢复快、卵巢功能好。     

腹腔镜治疗巨大卵巢囊肿19例报告

目的:探讨腹腔镜巨大卵巢囊肿手术的可行性及安全性.方法:回顾分析2008年3月至2010年7月行腹腔镜手术治疗19例直径15～24cm巨大卵巢囊肿患者的临床资料,总结分析其病例选择、手术方式、手术时间、出血量、住院时间、术后并发症等.结果:19例术中冰冻及病理结果均为良性肿瘤,手术均获成功,无一例中转开腹.16例行卵巢...     

Management of an ovarian cyst during pregnancy

OBJECTIVE: With routine ultrasonographic examination during the first trimester, the discovery of an ovarian cyst has become relatively common in the beginning of pregnancy. Between a waiting policy and interventionism, where is the optimal management situated? The objective of this article, based on the analysis of articles published on the subject in the data base of Medline, was to reply to this question. IN GENERAL: Most of unilocular and anechoic ovarian cysts with thin borders during the first trimester are corpus luteum cysts. They are not generally present after the end of the first trimester. Except in the case of complications, abstention is advocated in their respect. After 16 weeks of amenorrhea, organic cysts are the most frequent, mainly dermoid cysts. Only ovarian cysts at risk of complication are to be considered. They are essentially ovarian cysts which, whatever their echogenic features, have a size > or =6 cm. Their prevalence is estimated between 0.5 and 2 per thousand of pregnancies. The complications of these cysts are represented mainly by torsion, intracystic bleeding and rupture. THE TIME FOR SURGERY: Emergency surgery during the first trimester, especially before 9th week of amenorrhea, for complication of an ovarian cyst is associated with a high rate of abortion. In the second part of pregnancy, foetal morbidity with prematurity provoked by emergency surgery is considerable. The ideal period for scheduled surgery is probably the beginning of the second trimester. The probability of operating on a functional cyst becomes small and the rate of abortion is minimized. Coelioscopy is then often possible and does not appear to have much impact on the pregnancy. If we are sure of the organic character of an ovarian cyst, after 9 weeks of amenorrhea, then surgery is recommended.     

Gasless laparoscopic surgery for ovarian cyst in a second trimester pregnant patient with a ventricular septal defect

BACKGROUND: Ovarian cysts are estimated to occur in 4.1% of second trimester and third trimester obstetric ultrasonographic examination. Laparoscopy has not been widely performed during pregnancy, especially after the first trimester, and laparotomy remains the standard of care. Herein, we report a use of gasless laparoscopy in the management of an ovarian cyst during second trimester of pregnancy. CASE: A 21-year-old primigravida woman initially presented for antenatal care at 6 weeks' pregnancy. She had an underlying small subaortic ventricular septal wall defect with a functional class I. A left ovarian cyst was found during ultrasound examination. Elective gasless laparoscopic surgery due to persistence ovarian cyst was performed at 14th week of gestation without complications. The subsequent antenatal course was unremarkable. The pregnancy carried to term with uneventful maternal and fetal outcomes. CONCLUSIONS: Gasless laparoscopy is an alternative procedure for the management of ovarian cyst during pregnancy. This allows laparoscopic surgery that is minimally invasive for both the mother and the fetus.     

Laparoscopic ovarian cystectomy with abdominal wall lift during pregnancy under combined spinal-epidural anesthesia

Abdominal wall lift laparoscopic surgery is often used for patients during pregnancy because it is physiologically superior to CO2 pneumoperitoneum laparoscopic surgery. Operation for adnexal cysts is performed in the 1st trimester. We report seven cases of ovarian cysts during pregnancy, resected using gassless laparoscopic method with a whole abdominal wall lift under combined spinal-epidural anesthesia (CSEA). Combined spinal-epidural anesthesia had several advantages in these cases; 1. In the 1 st trimester, general anesthesia should be avoided. We could manage these cases without general anesthesia nor sedative medications. 2. During pregnancy, it is difficult to estimate the level of sensory blockade by spinal anesthesia. Epidural top-up helped us to easily control the level of sensory blockade. 3. Differential diagnosis of pain related to uterine contraction and postoperative pain is difficult. Post-operative analgesia was established by epidural PCA, thus anti uterine contraction medicines were prophylactically administered in only one of seven cases. There was no particular trouble during the anesthesia and all the operative procedures were performed uneventfully. Based on our limited experiences, CSEA may be a safe and appropriate anesthetic technique for laparoscopic ovarian cystectomy with abdominal wall lift during pregnancy.     

����ͨ·������΢����������ֱ�������ٴ��о�

??Glove port transanal minimally invasive surgery for rectal tumor GAO Zhi-gang, YANG Yong, WANG Zhen-jun, et al. Department of General Surgery, Beijing Chaoyang Hospital, Capital University of Medicine, Beijing 100020, China
Corresponding author: WANG Zhen-jun, E-mail:Wang3zj@sohu.com
Abstract Objective To evaluate the validity of glove port transanal minimally invasive surgery for rectal benign tumor and early rectal cancer. Methods From January 2013 to March 2013?? 6 cases of transanal minimally invasive surgery (TAMIS) via a ‘glove TEM port’ were performed in Department of General Surgery, Beijing Chaoyang Hospital, Capital University of Medicine. The access device was constructed using a circular anal dilator (CAD), wound retractor and standard surgical glove, along with standard, straight laparoscopic trocars and instruments. Results Five cases underwent full thickness resection and the incisions were closed with an absorbable continuous suture. One patient underwent non-full thickness resection of rectum polyps. The median operating time was 45min. The average blood lost was 10mL. Pathological analysis proved achieving R0 resection in all cases. All cases were discharged in the second day after operation with no intraoperative morbidity. All cases were followed up for 21 days with no postoperative complication. Conclusion The glove port TAMIS using conventional laparoscopic equipments and instruments is safe, inexpensive and effective.     

单孔后腹腔镜解剖性切除治疗肾上腺囊肿

目的探讨单孔后腹腔镜解剖性切除治疗肾上腺囊肿的临床应用与疗效。 方法2010年7月至2015年5月梅州市人民医院共收治肾上腺囊肿患者12例,采用自制单孔多通道套管后腹腔镜下三个层面解剖性切除肾上腺囊肿。年龄36～67岁,平均（47±8）,平均体质量指数（25.0±3.2）kg/m²。右侧5例,左侧7例。囊肿直径平均为（5.0±0.7）cm。 结果手术均顺利完成,4例行肾上腺囊肿切除,8例行肾上腺部分切除术,手术时间（64±14） min,失血量（30±8） ml,术后肠道功能恢复时间8～12 h,术后第1天疼痛评分（1.6±0.8）,术后住院天数2～5 d,术后无肠麻痹、感染、继发出血等并发症,无输血。术后病理诊断为肾上腺囊肿。随访7～15个月,无囊肿复发。 结论单孔后腹腔镜解剖性切除肾上腺囊肿是安全、有效的,具有创伤小,恢复快等优点。     

悬吊线法经脐单孔腹腔镜在妇科手术的应用

目的探讨"悬吊线法"经脐单孔腹腔镜在妇科手术应用的可行性。 方法收集2017年1－12月大连医科大学附属大连市妇产医院收治的135例卵巢囊肿、子宫肌瘤患者的临床资料,观察组采用"悬吊线法"行单孔腹腔镜手术,其中卵巢囊肿剔除术30例,子宫肌瘤剔除术15例;对照组行多孔腹腔镜手术,其中卵巢囊肿剔除术60例,子宫肌瘤剔除术30例。观察两组的手术时间、术中出血量、术后血红蛋白下降幅度、术后24 h发热的最高体温、术后住院时间、术后并发症、术后24 h视觉模拟评分法(visual analogue scale/score, VAS)评分、体象量表(body image scale, BIS)评分、切口美观满意度CS评分等指标。 结果135例均成功完成手术。比较观察组与对照组的术中出血量[(48.44 ± 7.97)ml vs(40.07 ± 8.62)ml]、术后血红蛋白下降幅度[(13.27±6.05)g/L vs(12.44±5.91)g/L]、术后24 h发热的最高体温[(37.32 ± 0.23)℃ vs(37.29 ± 0.18)℃]、术后住院时间[(4.22 ± 1.66)d vs(4.44±1.22)d],差异均无统计学意义(P> 0.05);比较观察组与对照组的手术时间[(77.44 ± 28.10)min vs(54.00 ± 27.89)min]、术后24h VAS评分[(5.33±0.74)分vs(5.56 ± 1.31)分]、BIS评分[(5.13 ± 0.41)分vs (5.44 ± 0.91)分]、切口美观满意度CS评分[(41.23 ± 1.04)分vs(39.29±2.02)分],差异有统计学意义(P< 0.05)。 结论经脐单孔腹腔镜手术在妇科良性疾病中应用是可行的,"悬吊线法"在一定程度上降低了单孔腹腔镜手术中的手术难度。