腹腔镜下非寄生虫性脾囊肿开窗引流术23例

目的探讨腹腔镜下开窗引流术治疗非寄生虫性脾囊肿的效果。方法回顾性分析2012年1月~2016年12月23例非寄生虫性脾囊肿的临床资料,行腹腔镜开窗引流术。结果 23例均成功完手术,无中转开腹;手术时间(52.6±14.5)min,术后住院时间(4.5±1.1)d,术后随访(12.3±7.6)月,无复发。结论腹腔镜下非寄生性脾囊肿开窗引流术操作简单,创伤小,术后恢复快,是治疗非寄生性脾囊肿的有效、微创手段。     

42例非寄生虫性肝囊肿的手术治疗体会

目的探讨非寄生虫性肝囊肿的手术治疗。方法回顾性分析我院1988～2001年期间收治的42例非寄生虫性肝囊肿的手术治疗情况。结果42例中行单纯肝部分切除术10例，囊肿切除剥离术4例，单纯开窗术12例，空肠囊肿Roux-en-Y吻合内引流术5例，外引流术2例，多发性囊肿中行肝叶切除加开窗术2例；大囊肿行肝叶切除、小囊肿抽吸囊液后注入无水酒精2例；大囊肿行囊肿切除、小囊肿开窗囊壁电灼1例，腹腔镜囊肿开窗术4例。术后出现消化道出血、膈下脓肿各1例，经保守治疗后痊愈。42例恢复良好。结论非寄生虫性肝囊肿手术治疗要根据囊肿部位、大小、形态、囊液的性状以及肝功能等情况，选择不同术式，复杂的肝囊肿需要多种方法联合应用。     

腹腔镜肝右后叶囊肿开窗引流术35例报告

目的：探讨肝右后叶肝囊肿的腹腔镜处理方法。方法：1998年1月～2005年12月对35例有症状的肝右后叶囊肿（21例主要位于Ⅵ段，14例主要位于第Ⅶ段）采用四孔法行囊肿开窗引流术。囊肿位于肝右后叶上段者采用肝上入路，胆囊牵引钳或三叶钳推压肝脏使其向前向下，暴露肝后囊肿，囊肿开窗，修剪带蒂大网膜放入囊肿。囊肿位于肝右后叶下段者采用肝下入路，超声刀切开肝结肠韧带，右三角韧带及肝肾间疏松组织，胆囊牵引钳抬起肝脏，囊肿开窗，大网膜放入囊腔引流。结果：35例肝右后叶肝囊肿均在腹腔镜下完成肝囊肿开窗引流术，无中转开腹手术。15例采用肝上入路，20例采用肝下入路。手术时间30～95min，平均46min。无手术并发症。35例病理检查结果均为先天性肝囊肿。术后症状均消失。术后住院2～5d，平均3．8d。35例随访6～36个月，平均34个月，33例无复发，2例（为肝上入路病例）囊肿未完全消失，但较术前明显缩小，无明显症状，观察半年未见增大。结论：肝下及肝上入路囊肿开窗引流是腹腔镜下处理肝右叶肝囊肿的有效方法。     

微创伤技术治疗非寄生虫性肝囊肿的评价

目的：探讨非寄生虫性肝囊肿外科治疗的最佳治疗方法。方法：回顾分析52例治疗过程及结果,穿刺注射法27例,腹腔镜囊肿开窗14例,开腹手术11例。结果：开腹手术效果确实,但创伤大,恢复慢;穿刺注射法及腹腔镜囊肿开窗14例,开腹手术11例。结果：开腹手术效果确实,但创伤大,恢复慢;穿刺注射法及腹腔镜囊肿开窗法创伤轻,痛苦小,住院时间短。直径8cm以上囊肿穿刺注射无水乙醇,囊肿于6个月内消失,囊肿越大,越适合腹腔镜开窗法治疗。结论：应用微创伤技术治疗非寄生虫性肝囊肿具有良好的临床效果,合理选择治疗方法十分重要。     

腹腔镜治疗不同肝段非寄生虫性肝囊肿78例

目的:探讨腹腔镜治疗不同肝段非寄生虫性肝囊肿(NPHC)方法,优化手术策略减少囊肿复发。方法:回顾性收集78例腹腔镜肝囊肿开窗术的病例资料,分析不同肝段NPHC的手术经验。结果:78例均完成腹腔镜手术,无中转开腹。78例手术时间平均(49.4±17.5)min,术后住院时间平均(5.8±1.1)d。无胆漏、出血及腹腔感染等并发症。随访68例(87.2%),影像复发率为8.8%(6/68),囊肿复发部位为Ⅳb+a、Ⅶ、Ⅷ段。结论:腹腔镜肝囊肿开窗术治疗NPHC安全有效,可作为首选方法。术前充分评估及术中合理处置对减少不同肝段NPHC复发十分重要。     

腹腔镜开窗引流术治疗儿童非寄生虫性脾囊肿的单中心经验

目的:探讨腹腔镜下开窗引流术治疗儿童非寄生虫性脾囊肿的应用价值。方法:回顾分析2017年5月至2020年5月为6例脾囊肿患儿行腹腔镜脾囊肿开窗引流术的临床资料,统计分析囊肿大小、患儿年龄、手术时间、术中出血量、腹腔引流管留置时间及术后住院时间等相关指标,并进行长期随访,观察复发及并发症等情况。结果:6例患儿均成功完成腹腔镜脾囊肿开窗引流术,无中转开腹。患儿4~15岁,手术时间75~150 min,术中出血量10~30 mL,术后留置腹腔引流管4~19 d,术后住院4~19 d。术后随访0.5~3年,2例复发。结论:腹腔镜下脾囊肿开窗引流术治疗儿童脾囊肿安全、可行,操作简单。     

经脐腹腔镜单纯性肝囊肿开窗术12例临床分析

目的 探讨经脐腹腔镜单纯性肝囊肿开窗术的可行性及临床应用价值。方法 回顾性分析2015年6月至2018年8月东南大学医学院附属江阴医院由同一术者采用围绕脐孔作3个5 mm切口置入3个5 mm Trocar的方法完成12例腹腔镜肝囊肿开窗术患者的临床资料,其中5例囊肿位于肝脏左外叶,5例位于中肝叶,2例位于肝脏右后叶。所有囊肿均凸出于肝脏表面,囊肿直径约6.0～12.5 cm,平均（8.6±2.2）cm。结果 所有患者均顺利完成手术,手术时间35～76 min,平均（52.1±11.8）min,无中转开腹或转为常规多孔腹腔镜手术,术后住院时间2～5 d,平均（3.5±0.9）d,术后无出血、胆漏、切口感染等近期并发症,远期随访除一例肝脏右叶膈面囊肿复发,其余病例无切口疝、囊肿复发等并发症,患者恢复良好。结论 在掌握适应证和手术技巧的情况下开展经脐腹腔镜肝囊肿开窗术安全可行,切口美观,且疗效好。     

经腹腔镜去顶开窗术治疗单纯性肝囊肿19例

目的探讨经腹腔镜去顶开窗术治疗单纯性肝囊肿的方法及效果。方法对19例单纯性肝囊肿患者采用经腹腔镜去顶开窗术,回顾性分析患者的临床资料。结果 19例患者中18例完成腹腔镜肝囊肿去顶开窗术,平均手术时间52 min,术中出血40~95 ml,引流澄清透明囊液65~340 ml,平均住院时间5.5d。患者术后24 h下床活动,进半流食,未使用镇痛药物。术后2~3 d拔除引流管,无出血、胆漏等并发症发生。随访6~11个月,B超复查未见囊肿复发。1例因胆汁外漏明显中转开腹手术治愈。结论腹腔镜肝囊肿去顶开窗术创伤小、恢复快、住院时间缩短,但应严格掌握手术适应征,正确细致操作。     

经脐单孔腹腔镜肝囊肿开窗术加肝部分切除术四例体会

非寄生虫性肝囊肿是发生在肝脏的一种常见良性病变,一般可不进行治疗,但如患者出现疼痛不适、囊肿超过5cm或迅速生长以及同时出现出血、破裂等情况时[1],通常采用肝囊肿开窗术+肝部分切除术治疗.现在腹腔镜下肝囊肿开窗术被公认为治疗非寄生虫性肝囊肿的标准方案[1-2].2010年1月至2011年12月我院采用经脐单孔腹腔镜手术(single-incision laparoscopic surgery,SILS)治疗非寄生虫性肝囊肿4例,报道如下.     

90°左侧卧位腹直肌旁视孔腹腔镜下非解剖性肝右后叶切除术的临床研究

[摘 要] 目的 比较90°左侧卧位腹直肌旁视孔腹腔镜与开腹非解剖性肝右后叶切除术的疗效。方法 回顾性分析2013年1月至2017年12月在右江民族医学院附属医院确诊并行肝右后叶肿瘤切除术的60例患者的临床资料。其中行90°左侧卧位腹直肌旁视孔腹腔镜非解剖性肝右后叶切除术（腹腔镜组）30例,开腹非解剖性肝右后叶切除术（开腹组）30 例。比较两组患者手术前后资料,评价其疗效。结果 所有患者均顺利完成非解剖性肝右后叶切除术,术后病理检查示切缘均为阴性,均无围手术期死亡。腹腔镜组在手术时间、术中出血量、术后进食时间、腹腔引流管留置时间、VAS疼痛评分、术后并发症、术后总住院时间及生活质量方面均明显优于开腹组（均P < 0.05）。结论 90°左侧卧位腹直肌旁视孔腹腔镜非解剖性肝右后叶切除术安全、有效,具有手术时间短、术中出血少、术后恢复快的优点,且腹腔镜肝脏手术可显著提高肝癌患者术后生存质量。     

Laparoscopic deroofing of non parasitic posterolateral liver cyst. Technical considerations

Laparoscopic deroofing of the solitary non parasitic cysts of the liver is a safe and effective procedure. This technique allows a wide access for surgical treatment of cysts localized in segments II, III, IVb, V, and VIII of the liver. On the contrary, the posterior segments, VI and VII, and the segment IVa, are difficult to approach laparoscopically. This report describes a laparoscopic technique used in treating 3 cases of symptomatic solitary cysts of the posterior segments of the liver. The patients were placed in the left lateral position. The fenestration treatment was easy and the mobilization of the right hepatic lobe was not required. At one year follow-up, neither postoperative complications nor recurring episodes were observed.     

后腹腔镜肾切除术(附23例报告)

目的探讨后腹腔镜肾切除术的临床应用价值.方法采用后腹腔镜技术实施肾切除23例,其中单纯肾切除12例,根治性肾切除6例,肾输尿管全切并膀胱袖套状切除5例.结果手术全部成功,无中转开放手术.手术时间35～240 min,平均135 min.术中出血量30～800 ml,平均90 ml.术后2～4 d下床活动.术后住院7～15 d,平均8.6 d.结论后腹腔镜肾切除术具有创伤小、恢复快、并发症少等优点,临床疗效可靠,具有良好的应用前景.     

腹腔镜肝脏手术治疗肝脏占位性病变

目的 :探讨腹腔镜肝脏手术的可行性、适应证及方法。方法 :分析 1998年 6月至 2 0 0 2年 8月腹腔镜下肝脏手术 2 3例的临床资料。结果 :2 3例手术均在腹腔镜下完成 ,其中肝左外叶切除术 2例 ,肝癌局部切除术 7例 ,肝局限性结节状增生局部切除术 3例 ,肝血管瘤摘除术 1例 ,肝癌射频治疗 2例 ,肝囊肿开窗引流术 +胆囊切除术 7例 ,肝脓肿引流术 1例。平均手术时间 16 5min ,平均出血 12 0ml,术后 4 8h内胃肠功能恢复 ,术后平均住院 7.6d ,痊愈出院 ,无严重并发症发生。结论 :腹腔镜下肝脏手术 ,包括肝切除术是一种安全、有效、微创的手术 ,但应严格掌握适应证     

Laparoscopic Treatment of Nonparasitic Liver Cysts: Adequate Selection of Patients and Surgical Technique

Results of laparoscopic fenestration in patients with a highly symptomatic solitary liver cyst (17 patients) or polycystic liver disease (PLD) (9 patients) were prospectively evaluated in a multicenter practice of general surgeons. Conversion to laparotomy was required in two patients because of inaccessible deep liver cyst in one and a diffuse form of PLD in the other. There was no mortality or major morbidity. Mean postoperative hospital stay was 4.6 days after successful laparoscopic procedures. During a mean follow-up of 9 months, 23% of the patients had recurrence of symptoms and 38% had radiographic reappearance of cysts. Factors predicting failure included previous surgical treatment, deep-sited cysts, incomplete deroofing technique, location in the right posterior segments of the liver, and a diffuse form of PLD with small cysts. Adequate selection of patients and type of cystic liver disease and meticulous and aggressive surgical technique are recommended.     

经脐单孔腹腔镜肝囊肿开窗术

目的总结经脐单孔腹腔镜肝囊肿开窗术的疗效。方法回顾性分析3例经脐单孔腹腔镜肝囊肿开窗术患者临床资料。结果 3例手术均获成功,平均手术时间55（50～60）min,无胆漏、出血、切口感染、切口疝等并发症发生。平均住院时间8.3（8～9）d。平均随访7（3～12）个月,囊肿无复发。结论经脐单孔腹腔镜肝囊肿开窗术是一种安全而又有效的手术,随着器械的改进和术者经验的积累,可作为常规手术方法应用于临床。     

Laparoscopic palliation of polycystic liver disease

The role of laparoscopic surgery in the management of polycystic liver disease (PCLD) is not well defined. The authors hypothesized that laparoscopic fenestration for PCLD relieves symptoms caused by polycystic liver disease. In this study, 11 patients underwent 20 laparoscopic cyst fenestration operations as treatment for symptoms of their PCLD. Symptoms leading to surgery were pain and pressure in 15 (75%) and early satiety in 12 (60%) patients. The median hospital stay was 1 day. The symptoms resolved postoperatively in all the patients. An additional laparoscopic fenestration was required in six (55%) patients for recurrent symptoms. The average time to reoperation was 22 ± 16 months. Two patients required hepatic transplantation. Initial symptom resolution occurred in all the patients undergoing redo fenestration. The authors conclude that laparoscopic fenestration for PCLD is safe, results in minimal down time and relieves the symptoms caused by PCLD. Symptomatic relief usually is temporary, and repeat surgery is required for recurring symptoms in half of the patients.No financial involvement, competing interests, or affiliations exist.     

后腹腔镜手术治疗重复肾重复输尿管畸形九例报告

目的 探讨后腹腔镜手术治疗重复肾重复输尿管畸形的疗效.方法 回顾性分析9例重复肾重复输尿管患者的资料.男6例,女3例.年龄13～58岁,平均37岁.左侧5例,右侧2例,双侧2例(其中1例左侧输尿管3条,右侧2条).重复肾重复输尿管位于肾上极7例,下极2例.9例术前彩色多普勒超声、MRU、ⅣU或CTU检查确诊为重复肾.采用后腹腔镜下重复肾重复输尿管切除术.观察手术时间、术中出血量、术后住院天数和术中术后并发症及手术效果.结果 9例手术均获成功,术中均未发生周围脏器、血管损伤.手术时间65～125 min,平均87 min.出血量30～600 ml,平均112 ml.术后肠道功能恢复时间1～3 d,平均1.6 d;术后住院天数5～12 d,平均7 d.随访6～36个月,平均18个月0.原发病症状消失,残留半肾功能良好.结论 后腹腔镜下手术治疗重复肾重复输尿管畸形创伤小、并发症少、恢复快、疗效确切,可作为重复肾重复输尿管治疗的首选术式.

Abstract：

Objective To investigate the efficacy of retroperitoneal laparoscopic heminephroureterectomy for duplex kidney anomalies.Methods Retroperitoneoscopic heminephroureterectomy was performed on nine patients, six males and three females.The average age of the study group was 37 years ( range 13 to 58).Seven cases had anomalies on the upper kidney pole, two cases had anomalies on the lower kidney pole.Five anomalies were on the left side, two were on the right side and two were in bilateral sides (one special case had three ureters on the left side and two ureters on the right side ).Three cases complained of flank pain; two cases were found hydronephrosis by physical routine examination;Three cases complained of flank pain and fever; one cases complained of hematuria and kidney atones.All the cases were preoperatively diagnosed by color doppler ultrasound, MRU, IVP or CTU.Retroperitoneal laparoscopic heminephroureterectomy was performed on all patients.The operation time, blood loss, hospital stay, intraoperative and postoperative complications and efficacy were observed.Results All the retroperitoneal laparoscopic procedures were successfully completed.No intraoperative complications were found.The average operation time was 87 min (range, 65 to 125).The average blood loss was 112 ml (range, 30 to 600).The recovery times of intestinal function was 1.6 days ( range, 1 to 3 ).The average postoperative hospital stay was 7 days (range, 5 to 12).The syndrome disappeared and kidney function was normal at a mean followup of 18 monthes.Conclusions Retroperitoneal laparoscopic surgeries for duplex kidney has the benefits of being minimally invasive, fewer complications, quick recovery and certainty of efficacy.Retroperitoneal laparoscopic surgeries can be considered as a first operation method to treat duplex kidney anomalies.     

后腹腔镜下保留肾单位手术治疗肾肿瘤16例临床分析

目的：评价后腹腔镜下保留肾单位手术治疗肾肿瘤的疗效.方法回顾性分析我院2010年10月至2015年5月施行的16例后腹腔镜下保留肾单位手术的临床病例资料.其中男11例,女5例,年龄35~76岁,平均年龄52.5岁,左肾肿瘤9例,右肾肿瘤7例.16例肾肿瘤均行后腹腔镜下保留肾单位手术.结果16例手术均获成功,无中转开放.手术时间90~180 min,平均100 min;术中出血约30~200 ml,平均约50 ml;术后住院时间5~10 d,平均7 d;术后无明显并发症,术后随访6个月~5年,未见肾功能下降及肿瘤复发.结论后腹腔镜下保留肾单位手术创伤小、并发症少、住院时间短、治愈率高,是一种简单有效的微创治疗方法.     

后腹腔镜肾部分切除术治疗T1a期肾肿瘤的临床价值

目的：探讨后腹腔镜肾部分切除术治疗T3a期肾肿瘤的手术技巧和临床价值。方法：采用后腹腔镜肾部分切除术治疗T1a期肾肿瘤患者52例,观察手术时间、术中出血量、术后住院天数和术中术后并发症及手术效果。结果：52例手术均获得成功,平均手术时间90min,平均出血量70ml,平均术后住院时间8天,围手术期无并发症,平均随访21个月,无局部复发。结论：后腹腔镜肾部分切除术具有低失血量、术后镇痛药物使用少、住院时间短、恢复快、肾功能损伤小的优点,是≤4cm的T1a期肾肿瘤的首选治疗术式。     

后腹腔镜肾囊肿去顶术(附38例报告)

目的探讨后腹腔镜技术在肾囊肿去顶术中的应用。方法回顾性分析38例后腹腔镜肾囊肿去顶术患者的临床资料,其中,右肾16例,左肾22例,肾上极12例,肾中部16例,肾下极10例。结果除1例因肾周严重粘连而改行开放手术,余37例均手术成功,手术时间45~120(平均65)min,手术出血量10~80(平均40)ml,术后住院时间3~12(平均6)天。结论后腹腔镜肾囊肿去顶术疗效确切,创伤小,是目前治疗单纯性肾囊肿的最佳选择。