经蓝碟(LapDisc)手助腹腔镜肝血管瘤切除术

目的探讨经蓝碟(LapDisc)手助腹腔镜下肝血管瘤切除的可行性及方法. 方法完成LapDisc手助腹腔镜下肝血管瘤切除8例,男6例,女2例,年龄30～72岁,平均47.6岁. 结果 8例手术均获成功,平均手术时间196.3 min(110～350 min),平均出血量307.5 ml(100～750 ml),平均住院时间7.9 d(6～15 d).无胆漏、腹腔出血及感染等术后并发症. 结论对有手术适应证的肝血管瘤行LapDisc手助腹腔镜下肝血管瘤切除安全可行.     

手助腹腔镜切除左肝巨大肿瘤九例

目的探讨手助腹腔镜左肝巨大肝肿瘤切除的可行性和安全性。方法本组9例患者，平均年龄45．3岁，肿瘤均位于左肝，包括肝细胞癌（4例），肝内胆管细胞癌（1例），肝转移性鳞癌（1例），肝海绵状血管瘤（2例），肝梭形细胞瘤（1例）。AFP阳性3例，CEA阳性1例，术前肝功能均为Child—Pust,A级，手术按游离左肝韧带、阻断肝门和肝实质切除的步骤进行。结果9例手助腹腔镜肝切除均获得成功，肝左外叶切除6例，左半肝切除3例，无中转开腹。平均手术时间为111．7min，平均出血量97．8ml，8例行肝门阻断，平均阻断时间为13．4min。术中未发生大出血和气体栓塞，术后均无出血、胆漏和肝衰竭等严重并发症发生。肝功能均在7～10d恢复正常。AFP和CEA阳性者均转阴，术后平均住院日为8．4d。4例肝细胞癌术后1个月行预防性肝动脉造影和化疗1次。术后随访4～11个月，所有患者均无瘤生存。结论只要病例选择得当，手助腹腔镜左肝巨大肝肿瘤切除是安全可行的微创手术方式。     

手助腹腔镜肝血管瘤切除3例

目的探讨手助腹腔镜下切除位置深在或巨大肝血管瘤的安全性及可行性。方法2012年5—12月,实施3例手助腹腔镜肝血管瘤切除术。其中2例S6段肝血管瘤位置深在,1例为S7段10．7cm×6．7cm×7．0cm巨大肝血管瘤。术者直接将左手伸入腹腔,辅助完成腹腔镜肝血管瘤切除术。结果3例均顺利完成手术。手术时间分别为150、230和220min。出血量分别为200、350和500ml。无中转开腹手术。术后住院时间分别为6、5和8d。无术后出血及感染等并发症。结论手助腹腔镜下切除位置深在或巨大肝血管瘤是安全可行的。     

手辅助腹腔镜肝切除术

目的探讨经蓝碟(Lapdisc)系统手助腹腔镜下肝切除的可行性及临床效果。方法经Lapdisc辅助腹腔镜下完成23例肝切除,男14例,女9例;年龄28~72岁,平均年龄(48·8±6·4)岁。其中肝血管瘤8例,原发性肝癌7例,肝转移癌3例,肝囊肿3例,肝内胆管结石2例。结果所有病人经Lapdisc辅助腹腔镜下均顺利切除病灶,无中转开腹手术,平均手术时间(190·3±45·7)min,平均出血量(420·5±56·8)ml,平均住院时间(8·3±2·3)d。无胆漏、腹腔出血及感染等术后并发症,平均随访(7·4±2·4)个月,未见长期并发症。结论Lapdisc辅助腹腔镜下肝切除安全可行,在肝脏外科具有广阔应用前景。     

手助腹腔镜肝切除术治疗肝内胆管结石的临床研究

目的:评价手助腹腔镜肝切除术治疗肝内胆管结石的可行性和微创性。方法:2004年7月至2008年12月天津微创外科中心共收治符合研究条件的患者68例,随机分为手助腹腔镜肝切除组(hand-assisted laparoscopic hepatectomy,HALH)和开腹肝切除组(open hepatectomy,OH),对比分析两组的手术时间、术中出血量、术后肠道功能恢复时间、止痛剂应用例次、术后住院时间及围手术期C反应蛋白的变化。结果:HALH组与OH组的手术时间、术中出血量差异无统计学意义(P>0.05),但HALH组术后肠道功能恢复较OH组快,且住院时间短,止痛剂应用次数少,术后C反应蛋白上升幅度小、下降快,差异有统计学意义(P<0.05)。结论:HALH治疗肝胆管结石比开腹手术患者创伤小,康复快。     

手助腹腔镜肝脾联合切除3例

目的探讨手助腹腔镜肝脾联合切除的可行性。方法采用手助腹腔镜（Hand—port）行肝脾联合切除术，选择剑突下正中或右肋缘下手助切口，手助下超声刀分离脾周韧带，Endo-GIA断脾蒂，采用超声刀、生物夹夹闭断肝，肝断面间断缝合闭合。结果3例手术均获得成功，手术时间分别为130、115、145min，术中出血量分别为350、50、150ml。3例术后未发生严重并发症，术后住院日分别为9、7、11d。3例分别随访6、23、5个月，肿瘤无复发。结论手助腹腔镜肝脾联合切除术安全、可行。     

手助的腹腔镜脾切除术

目的 探讨手助的腹腔镜脾切除术手术技术。方法用手助技术完成5例腹腔镜脾切除术，其中原发性血小板减少性紫癜3例，血吸虫性肝硬化、脾肿大及脾功能亢进伴胆囊结石2例。3例行手助的腹腔镜脾切除术，2例同时行腹腔镜胆囊切除术 手助腹腔镜巨脾切除。结果 2～5h完成手术，术中出血少。病人术后恢复顺利。结论 手助腹腔镜脾切除术操作安全、手术时间缩短，并使腹腔镜切除较大脾脏成为可能。     

手助腹腔镜脾切除术

目的　探讨手助腹腔镜脾切除术手术技术。　方法　用手助腹腔镜技术完成 5例腹腔镜脾切除术 ,其中原发性血小板减少性紫癜 (ITP) 3例 ,血吸虫性肝硬变、脾肿大及脾功能亢进伴胆囊结石2例。 3例行手助腹腔镜脾切除术 ;2例同时行腹腔镜胆囊切除与手助腹腔镜巨脾切除。　结果　 2h～ 5h完成手术 ,术中出血少。患者术后恢复顺利。　结论　手助腹腔镜脾切除术操作安全、手术时间短 ,并使腹腔镜切除较大脾脏成为可能。     

手助腹腔镜左肝巨大肝癌切除6例报告

目的:探讨手助腹腔镜左肝巨大肝癌切除的可行性和安全性。方法:病变位于左肝的巨大肝癌6例中肝细胞癌4例,肝内胆管细胞癌1例,肝转移性鳞癌1例。采用手助腹腔镜行左肝规则性切除术。结果:6例手助腹腔镜肝切除术均获成功,肝左外叶和左半肝切除各3例,平均手术时间109.2m in,平均出血量83.3m l,术后无严重并发症发生,术后平均住院8.3d。结论:只要病例选择得当,手助腹腔镜切除左肝巨大肝癌是安全可行的。     

手助腹腔镜肝切除28例报告

腹腔镜技术已广泛应用于腹部外科手术，但腹腔镜下 肝切除术仍是一种手术难度和风险均较高的手术，其主要 原因为术中出血的控制、气体栓塞以及潜在的恶性肿瘤种 植。随着腔镜技术和器材的发展，特别是 Handport 手助装 置的使用，使腹腔镜肝切除术推广应用成为可能。我院于 2002年12月至2005年6月对28例病人施行了手助腹腔 镜肝切除术，现报告如下。     

Hand-assisted laparoscopic colorectal surgery using GelPort

Background: An easily usable hand access device will optimize success in hand-assisted laparoscopic surgery (HALS). The authors describe their initial series of HALS colorectal resections using GelPort to evaluate their current technique and results with this new device. Methods: A retrospective study investigated 33 HALS colorectal procedures including total colectomy (n = 16) and low anterior resection (n = 10). All operative data, including intraoperative GelPort performance, were prospectively recorded and retrospectively analyzed. Results: In this study, 3 (9.1%) of 33 HALS procedures were converted to open surgery, and 4 (13.3%) of 30 HALS procedures required minimal enlargement of incisions to facilitate extracorporeal procedures. The operative time was 263 ± 85 min, and the blood loss was 282 ± 148 ml. There were no device malfunctions. Three major complications (9.1%) and 7 minor wound infections (21%) were noted postoperatively. The mean hospital stay was 7.9 ± 3.8 days. Conclusion: When performed with GelPort, HALS is safely and reliably applicable for various colorectal procedures.     

手助腹腔镜技术在大肝癌切除中的应用

目的 探讨手助腹腔镜技术在大肝癌切除中的应用价值.方法 2004年3月至2007年12月,在腹腔镜下肝内小病灶切除的基础上共对56例病变位于肝外周部位(Ⅱ～Ⅵ段)的直径大于5 cm大肝癌患者成功施行了手助腹腔镜肝切除术.其中肝细胞癌53例,肝内胆管细胞癌2例,肝转移性鳞癌1例.采用手助腹腔镜技术行规则性左肝叶切除或不规则性右肝切除术.结果 56例手助腹腔镜肝切除均获得成功,肝左外叶切除27例、左半肝切除6例,肝V、Ⅵ段不规则性切除23例.31例行肝门阻断,平均阻断时间为16.7 min,平均手术时间为105.3 min,平均出血量97 ml,瘤体平均大小8.6 cm,切除的肝组织最大径平均10.5 cm,术后无严重并发症发生,术后平均进食时间为2.1 d,术后平均住院7.3 d.结论 在严格掌握患者手术指征的前提下,手助腹腔镜大肝癌切除是安全可行的.     

手辅助腹腔镜在右半结肠癌并急性肠梗阻中的应用

目的比较手辅助腹腔镜与开腹在右半结肠癌并急性肠梗阻中的近期疗效。方法回顾性分析2012年1月至2015年6月右半结肠癌并急性肠梗阻行根治性右半结肠切除的75例病人的临床病理资料,根据其手术方式分为手辅助腹腔镜手术组(n=34)和开腹手术组(n=41),比较两组的一般资料、手术时间、出血量、切口长度、切口感染率、术后C反应蛋白(C-reactive protein,CRP)水平、淋巴结数目、肛门排气时间、术后住院时间、术后并发症。结果手辅助腹腔镜组和开腹手术组基本资料具有可比性(P均0.05),两组间出血量分别为(139.85±53.75)ml和(178.05±75.04)ml、切口长度分别为(6.07±0.64)cm和(17.00±1.78)cm、切口感染率分别为5.88%和24.39%、术后CRP水平分别为(48.82±16.29)mg/L和(87.29±25.00)mg/L、肛门排气时间分别为(5.29±1.03)d和(6.02±1.01)d、术后住院时间分别为(13.62±2.45)d和(16.49±4.79)d,差异具有统计学意义(P均0.05),两组手术时间分别为(205.29±65.02)min和(195.61±45.69)min、淋巴结数目分别为(22.50±5.75)和(20.71±5.65)及术后并发症(吻合口瘘、吻合口出血、腹腔感染)差异无统计学意义(P均0.05)。结论右半结肠癌并急性肠梗阻病人应用手辅助腹腔镜手术创伤小、安全、有效,具有可行性。     

Hand-assisted laparoscopic surgery (HALS): a report of 150 procedures

Background: This study was performed to evaluate the (long-term) morbidity associated with hand-assisted laparoscopic surgery (HALS) for various indications. Methods: HALS procedures for various indications were evaluated prospectively from 1995 to 2002. The primary outcome parameters were postsurgical complications and the development of incisional hernias. Results: Twenty-six splenectomies, 51 hand-assisted laparoscopic donor nephrectomies (HLDN), 34 segmental bowel resections, 29 proctocolectomies, and 10 emergency colectomies were evaluated. A Küstner or Pfannenstiel incision was used for handport placement. Minor complications (i.e., wound complications, urinary tract infection) occurred in 15%, 12%, 26%, 7%, and 33% of the patients after, respectively, splenectomy, HLDN, bowel resection, proctocolectomy, and emergency colectomy. Major complications (i.e., hemorrhage, anastomotic leakage) occurred in 15% and 12% of the patients after, respectively, bowel resection and proctocolectomy. Incisional hernias occurred in six patients (4%), all after a wound complication in the Küstner incision. Conclusion: HALS is fast, safe, and feasible for various indications, especially HLDN and (procto-)colectomies. Little advantage can be expected when HALS is applied in splenectomy and segmental bowel (sigmoid) resection.     

手助腹腔镜脾切除术治疗外伤性脾破裂的临床应用

目的探讨手助腹腔镜脾切除术治疗外伤性脾破裂的可行性及临床意义. 方法 2002年1月～2003年1月,采用手助腹腔镜脾切除术治疗外伤性脾破裂18例,Buntain CT分级Ⅱ型7例,Ⅲ型11例.其中12例合并其它脏器损伤.结果 16例顺利完成手术,手术时间75～115 min,平均92.5 min.2例因术中怀疑有其它大血管破裂而中转开腹手术.术后恢复正常工作时间:6例单纯脾破裂20～30 d,有合并伤10例30～100 d. 结论手助腹腔镜脾切除术治疗外伤性脾破裂切实可行,适用于Buntain CT分级Ⅱ、Ⅲ型脾脏损伤且无严重合并伤的患者.     

"蓝碟"手助技术在腹腔镜腹部手术的应用——附78例报告

目的探讨“蓝碟”（Lapdisc）手助器辅助腹腔镜手术（hand—assisted laparoscopic surgery，HALS）用于腹部手术的可行性。方法建立CO2气腹，根据病变部位和手术的要求，放置trocar和“蓝碟”手助器，对78例腹部疾病施行HALS，观察“蓝碟”手助器在腹部HALSA的实施过程，术中效果及术后临床效果。结果经Lapdisc完成70例HALS，术中出血量100—300ml，平均186ml；手术时间60—240min，平均140min；住院时间9—15d，平均10．2d。8例因腹腔镜下操作复杂危险而中转开腹。结论“蓝碟”手助器使用简单、感觉舒适，对切口提供完美保护，术中能维持良好的气腹状态。“蓝碟”简化传统腹腔镜的操作，可应用于绝大多数腹部外科疾病的HALS，安全可行。     

Hand-assisted laparoscopic restorative proctocolectomy for ulcerative colitis

AIM To evaluate the utility of hand-assisted laparoscopic restorative proctocolectomy(HALS-RP) compared with the conventional open procedure(OPEN-RP).METHODS Fifty-one patients who underwent restorative total proctocolectomy with rectal mucosectomy and ileal pouch anal anastomosis between January 2008 and July 2015 were retrospectively analyzed.Twentythree patients in the HALS-RP group and twentyfour patients in the OPEN-RP group were compared.Four patients who had purely laparoscopic surgery were excluded.Restorative total proctocolectomy was performed with mucosectomy and a hand-sewn ilealpouch-anal anastomosis.Preoperative comorbidities,intraoperative factors such as blood loss and operative time,postoperative complications,and postoperative course were compared between two groups.RESULTS Patients in both groups were matched with regards to patient age,gender,and American Society of Anesthesiologists score.There were no significant differences in extent of colitis,indications for surgery,preoperative comorbidities,and preoperative medications in the two groups.The median operative time for the HALS-RP group was 369(320-420) min,slightly longer than the OPEN-RP group at 355(318-421) min; this was not statistically significant.Blood loss was significantly less in HALS-RP [300(230-402) m L] compared to OPEN-RP [512(401-1162) m L,P = 0.003].Anastomotic leakage was noted in 3 patients in the HALS-RP group and 2 patients in the OPEN-RP group(13% vs 8.3%,NS).The rates of other postoperative complications and the length of hospital stay were not different between the two groups.CONCLUSION HALS-RP can be performed with less blood loss and smaller skin incisions.This procedure is a feasible technique for total proctocolectomy for ulcerative colitis.