单切口双侧睾丸单纯切除术的手术入路

双侧睾丸单纯切除术适用于进展期前列腺癌的去势治疗 ,通常是行双侧阴囊切口或双侧腹股沟管切口。为减少切口数目 ,降低患者痛苦 ,我们设计并成功地实施了经单一皮肤切口行双侧睾丸单纯切除的两种手术入路 ,现报告如下。1　资料与方法1 .1 　 临床资料前列腺癌患者 2 0例 ,年龄 71～ 80岁 ,平均 75岁。因排尿困难而收入院 ,其中 1 3例经直肠前列腺B超检查发现前列腺有大小不等的低回声占位性病变 ,停止直肠指检 1周后检查血 PSA呈阳性 ,因全身情况较差或因经济困难不能接受前列腺癌根治术 ,决定行单纯双侧睾丸切除术 ;另 7例为前列腺电切…     

腹横纹切口保留睾丸引带阴囊皮下睾丸固定术治疗隐睾症的研究

为了研究治疗先天性隐睾症的最佳术式，以提高隐睾症的治疗水平，采用腹横纹切口保留睾丸引带明囊皮下睾丸固定术（研究组）治疗隐睾症96例110枚，获得随访者94例108枚，同时采用患倒下腹斜切口肉膜囊睾丸固定术（对照组）治疗隐睾症50例62枚。结果研究组睾丸大小及硬度化94枚，占87．0％，良9枚，占8．3％，差5枚，占4．6％；睾丸位置优93枚，占86．1％，良9枚，占8．3％，差6枚，占5．6％；无睾丸萎缩及回缩，外表美观。对照组睾丸大小及硬度优41枚，占66．1％，良7枚，占11．3％，差14枚，占22．6％；睾丸位置优43枚，占69．4％，良8枚，占12．9％，差11枚，占17．7％。经统计学处理，两组睾丸大小及硬度方面比较有极显著性差异（P＜0．01），睾丸位置比较也有显著性差异（P＜0．05）。认为腹横纹切口保留睾丸引带阴囊皮下睾丸固定术损伤小，外表美观，明显降低了睾丸萎缩及回缩等并发症，符合生理要求，疗效满意。     

经阴囊单切口与腹股沟阴囊双切口睾丸下降固定术的对比研究

目的 比较经阴囊皮纹单切口(Bianchi术)与传统经腹股沟及阴囊双切口睾丸固定术治疗儿童低位隐睾的临床疗效、微创优势及适应证选择. 方法 回顾性研究2006年3月至2011年5月72例(78侧)行睾丸下降固定术的隐睾患儿资料,患儿均能在麻醉状态下将睾丸推出外环口及以下.以年龄相差不超过3个月、术前睾丸位置相同、术者相同、隐睾侧别相同为配对条件,采用1:1配对分组的方法将患者分为Bianchi术(A组)和经传统腹股沟及阴囊双切口睾丸下降固定术(B组),两组均为36例39侧.平均年龄为5.4岁(A组)、5.5岁(B组).比较两组平均手术时间、平均恢复站立活动时间、术后并发症、手术成功率. 结果 72例手术均顺利完成.两组平均手术时间分别为33、41 min,差异有统计学意义(P =0.0022).平均恢复站立活动时间分别为1.2、5.4d,差异有统计学意义(P=0.0003).随访3～ 65个月,两组均未发生睾丸萎缩、睾丸回缩、腹股沟斜疝、鞘膜积液等并发症. 结论 Bianchi术具有手术时间短、创伤小、术后痛苦小、恢复快、美容等优势,可用于治疗麻醉状态下能将睾丸推出外环口及以下的隐睾.     

阴囊镜辅助小切口睾丸鞘膜切除术在睾丸鞘膜积液治疗中的应用

目的 探讨阴囊镜技术在睾丸鞘膜积液治疗中的应用价值。方法 回顾性分析比较南京医科大学附属江宁医院2017年12月1日—2021年12月31日间成功施行阴囊镜辅助小切口睾丸鞘膜切除术27例(MHS组)和传统开放手术32例(TH组)患者的临床资料。结果 MHS组和TH组在手术时间[(32.22±5.25) min vs.(57.34±8.71) min]、切口长度[(0.95±0.15) cm vs.(5.09±0.55) cm]和住院时间[(3.63±0.97) d vs.(4.72±0.89) d]上比较，MHS组明显短于TH组(P<0.01);术后切口疼痛评分MHS组显著低于TH组(P<0.01);术后第3、7天MSH组阴囊水肿程度均明显轻于TH组(P<0.05);术后24周MHS组与TH组复发率分别为14.81%、3.13%,差异无统计学意义(P=0.256)。结论 阴囊镜技术治疗睾丸鞘膜积液是安全的，具有手术时间短、切口小、术后疼痛轻、阴囊水肿程度轻和住院时间短等优点，但其复发率可能高于开放手术。     

腹横纹切口保留睾丸引带阴囊皮下睾丸固定术治疗隐睾症的 …

为了研究治疗先天性隐睾症的最佳术式，以提高隐睾症的治疗水平，采用腹横纹切口保留睾丸引带阴囊皮下睾丸固定术（研究组）治疗隐睾症９６例１１０枚，获得随访者９４例１０８枚，同时采用患侧下腹斜切口肉膜囊睾丸固定术（对照组）治疗隐睾症５０例６２枚。结果研究组睾丸大小及硬度优９４枚，占８７．０％，良９枚，占８．３％，差５枚，占４．６％；睾丸位置优９３枚，占８６．１％，良９枚，占８．３％，差６枚，占５．６％；无     

耻骨联合上方切口睾丸去势术

我院自1995．4～2000．4，采用耻骨联合上方切口行双侧睾丸切除术90例，取得良好效果，现报告如下：     

轮廓线切口入路行唇裂术后畸形整复术

目的 探寻一种功能和外观满意，要后上唇不再遗留或减少手术瘢痕的唇裂术后畸形整复方法。方法 采用复唇沟、唇红缘等轮廓线切口入路，于皮下进行唇裂术后畸形功能性整复。结果 应用该法行手术15例，其中双侧唇裂术后畸形4例，单侧唇裂术后11例，经6个月至2年随访，功能、外观均达到满意的效果。结论 该法一改传统的唇裂术后畸形整复方法，彩和轮廓线切口入路，术后手术瘢痕不明显；皮下充分松解，使原手术瘢痕明显淡化、平整；口轮匝肌从其不正常的附着处分离，恢复肌肉正常走向和功能，重建口轮匝肌环；调整鼻翼软骨、重塑鼻翼软骨，使唇裂鼻恢复正常。从而使患者的诸多畸形在功能和外观上均获得满意的效果。     

经腹股沟与阴囊切口治疗睾丸鞘膜积液体会

目的 探讨睾丸鞘膜积液治疗方式.方法 对63例睾丸鞘膜积液病人行手术治疗,其中33例行经腹股沟切口治疗睾丸鞘膜积液;30例行经阴囊手术治疗睾丸鞘膜积液.结果 两组手术时间、出血量无明显差异,经腹股沟切口组术后复发、阴囊水肿、感染等方面优于经阴囊切口手术组,差异有统计学意义(P＜0.05).结论经腹股沟切口可替代传统的阴囊切口治疗睾丸鞘膜积液.     

睾丸扭转9例治疗教训与体会

睾丸扭转在临床上并不多见，诊断及治疗是否及时直接影响预后。我科自1998年4月～2000年3月，收治晚期睾丸扭转病人9例，皆因院外误诊而造成9例患侧睾丸全部坏死结果，其教训深刻。现报告如下。     

锁骨上侧入路行甲状腺手术30例

传统甲状腺手术因切口较大,术后出现颈部不适、咽部疼痛较多,切口瘢痕长期存在,影响美观,近年来临床上出现了一些新的手术方式。我院2010年9月—2011年10月对30例良性甲状腺疾病患者行甲状腺次全切除术治疗,总结报道如下。     

耻骨上单一小切口手术治疗小儿双侧腹股沟斜疝

目的总结耻骨上单一小横切口手术治疗小儿双侧腹股沟斜疝的疗效。方法对35例双侧腹股沟斜疝(双侧鞘膜积液)的患儿采用耻骨上单一小横切口行疝囊高位结扎术,观察手术时间、切口愈合情况、复发率、近期及远期并发症。结果手术时间平均24.5(15~45)min,切口均为甲级愈合。6例术后阴囊出现不同程度的血肿,经对症处理治愈。35例均获随访,时间3月~3年,无一例复发。结论耻骨上单一小横切口治疗小儿双侧腹股沟斜疝,可简化手术步骤,创伤小,并发症少,外观疤痕小、美观,符合美容、微创理念。     

Testicular lesions other than germ cell tumours: feasibility of testis-sparing surgery

OBJECTIVE

To review all non‐germ‐cell testicular lesions presenting at our institution and to determine the feasibility of testis‐sparing surgery for these patients.

PATIENTS AND METHODS

All surgery for testicular masses between June 1995 and June 2005 were reviewed retrospectively. Patients with atrophy, germ cell tumours, infection or torsion were excluded. The study comprised men who had radical orchidectomy for suspected germ‐cell tumour but had other final pathology, and those where testis‐sparing surgery was attempted for a presumed benign lesion.

RESULTS

Thirteen patients with lesions appropriate for the study were identified; all but one had a palpable lesion. The lesions could be categorized as inflammatory (three hyalinized fibrosis, two sarcoidosis, one chronic inflammation), cystic (one epidermoid cyst, one unilocular cyst), benign neoplasms (two adenomatoid tumours, one Leydig cell tumour, one capillary haemangioma) or malignant neoplasms (one lymphoma). Based on the preoperative impression, testis‐sparing surgery was attempted in eight of the lesions and was successful in six where it was attempted. In the other five, testis‐sparing surgery was not attempted because the preoperative impression was that of a germ cell tumour. Testis‐sparing surgery was successful in only six of the 13 patients with these lesions.

CONCLUSION

Testis‐sparing surgery might be possible if there is significant suspicion of a benign lesion. If frozen‐section analysis is equivocal, a radical orchidectomy is required. Testis‐sparing surgery was feasible in highly selected cases.     

Testicular migration: remodeling of connective tissue and muscle cells in human gubernaculum testis

PURPOSE: We present the main morphological modifications in the human gubernaculum during testicular migration in humans. MATERIALS AND METHODS: We obtained 12 gubernacula from fresh, macroscopically normal human fetuses at 15 to 29 weeks of gestation. Collagen was evidenced using trichrome and Sirius red staining procedures, while Weigert's resorcinol-fuchsin and anti-human elastin antibody were used to reveal elastic system fibers. Smooth muscle cells were detected by anti-human smooth muscle alpha-actin antibody. RESULTS: When the testes were still located in the abdomen at 15 to 16 weeks of gestation, collagen fibers were sparse and embedded in a loose extracellular matrix. The amount of fibers then gradually increased with age and at 28 weeks of gestation the gubernaculum was mostly collagenous in composition. Elastic fibers had a similar growth pattern, although they were located mainly at the distal end of the gubernaculum. Fibroblasts largely predominated over other cell types and decreased in number with gestational age, whereas smooth muscle cells were restricted to the walls of blood vessels. Striated muscle cells were detected at the scrotal end of the gubernaculum, where they were disposed as isolated and scattered bundles running in various directions. Like fibroblasts, their number also decreased with age. CONCLUSIONS: During testicular migration gubernacular connective tissue undergoes extensive remodeling and ultimately becomes an essentially fibrous structure rich in collagen and elastic fibers. Such changes should decrease the size of the gubernaculum and, thus, contribute to other forces that cause the testes to move toward the scrotum. In fact, because of the lack of smooth muscle cells, and the amount and organization of striated muscle cells, active contraction of the gubernaculum is less likely to be an important factor in testicular descent.     

Single Incision Laparoscopic Pancreas Resection for Pancreatic Metastasis of Renal Cell Carcinoma

Background:

Transumbilical single incision laparoscopic surgery (SILS) offers excellent cosmetic results and may be associated with decreased postoperative pain, reduced need for analgesia, and thus accelerated recovery. Herein, we report the first transumbilical single incision laparoscopic pancreatectomy case in a patient who had renal cell cancer metastasis on her pancreatic corpus and tail.

Methods:

A 59-year-old female who had metastatic lesions on her pancreas underwent laparoscopic subtotal pancreatectomy through a 2-cm umbilical incision.

Results:

Single incision pancreatectomy was performed with a special port (SILS port) and articulated equipment. The procedure lasted 330 minutes. Estimated blood loss was 100mL. No perioperative complications occurred. The patient was discharged on the seventh postoperative day with a low-volume (20mL/day) pancreatic fistula that ceased spontaneously. Pathology result of the specimen was renal cell cancer metastases.

Conclusion:

This is the first reported SILS pancreatectomy case, demonstrating that even advanced surgical procedures can be performed using the SILS technique in well-experienced centers. Transumbilical single incision laparoscopic pancreatectomy is feasible and can be performed safely in experienced centers. SILS may improve cosmetic results and allow accelerated recovery for patients even with malignancy requiring advanced laparoscopic interventions.     

单一前外侧切口治疗伴有腓骨骨折的Pilon骨折

目的:探讨经小腿前外侧单一切口治疗伴有腓骨骨折的Pilon骨折的可行性。方法:选择收治的33例伴腓骨下端骨折的Pilon骨折患者,均需行骨折切开复位钢板内固定。采用单盲试验随机分成两组,其中A组17例予以传统前内加后外侧切口行切开复位内固定,B组16例应用单一前外侧切口行切开复位内固定治疗,记录手术时间,观察创面愈合情况,按Mazur评定标准评估疗效。结果:所有患者均未出现钢板外露、感染等严重的手术并发症。其中A组17例患者有4例术后出现局部皮肤小面积坏死,3例2周内自行愈合,1例3周后愈合;按照Mazur评分标准评估疗效,其中优11例,良5例,可1例。B组行16例患者手术有2例患者出现局部皮肤小面积坏死,1周内自行愈合;按照Mazur评分标准评估疗效,其中优10例,良4例,可2例。评价两组临床疗效及软组织恢复情况,均获良好,且应用单一前外侧切口较传统入路并未增加手术时间,统计学分析二组手术时间和疗效无差异。结论:小腿前外侧改良单一切口治疗伴有腓骨骨折的Pilon骨折,可避免局部软组织进一步损伤。     

Bile Duct Injury After Single Incision Laparoscopic Cholecystectomy

Background:

The advancement and development of laparoscopic cholecystectomy revolutionized surgery and case management. Many procedures are routinely performed laparoscopically. Single incision laparoscopic surgery has been introduced with the hope of further reduction of scarring and possibly procedural pain. With no established technique for this procedure, the safety of single incision laparoscopic cholecystectomy has not been determined.

Methods and Results:

A 30-year-old man underwent single incision laparoscopic cholecystectomy for symptomatic cholelithiasis at an outside hospital. The operation was uneventful, and the patient was discharged home. The patient returned to the Emergency Department 4 days postoperatively, and a bile duct injury was diagnosed. A percutaneous drain was placed, and the patient was transferred to the Hepato-Pancreato-Biliary (HPB) service of a tertiary care center for definitive care. A delayed repair approach was used to allow the inflammation around the porta to decrease. Six weeks after injury, the patient underwent Roux-en-Y hepaticojejunostomy. The patient did well postoperatively.

Conclusion:

Although single incision laparoscopic surgery will play a prominent role in the future, its development and application are not without risks as demonstrated from this case. It is imperative that surgeons better define the surgical approach to achieve the critical view and select appropriate patients for single incision laparoscopic cholecystectomy.