脐部单切口三孔腹腔镜在泌尿外科手术中的应用

目的 总结脐部单切口三孔腹腔镜在泌尿外科手术中的应用经验. 方法脐部单切口三孔腹腔镜手术32例.男10例,女22例.平均年龄22(16～35)岁.其中精索静脉曲张7例、单纯性肾囊肿12例、双侧肾囊肿1例、多囊肾1例、左侧肾上腺肿瘤3例、右侧肾上腺肿瘤1例、左侧输尿管上段结石1例、重度肾积水2例、萎缩无功能肾4例.在脐部作1.0～3.0 cm切口,置入3只10 mm或5 mm套管作为视孔及操作孔,腹腔镜下常规操作,完成泌尿外科手术. 结果精索静脉曲张手术时间平均15(10～20)min,术中无明显出血;肾囊肿手术时间平均40(30～53)min,术中无明显出血;肾上腺肿瘤手术时间平均68(57～120)min,术中出血量平均30(20～60)ml;输尿管切开取石86 min,术中出血50 ml,肾切除手术时间平均65(45～135)min,术中出血量平均110(90～150)ml.术后排气时间平均8.5(4～12)h.住院时间平均5.5(3～8)d.32例平均随访时间2(1～3)个月,脐部切口愈合好,腹部无可见瘢痕,无脐疝等并发症. 结论脐部单切口三孔腹腔镜治疗泌尿外科疾病安全有效,可使泌尿外科手术成为一种无瘢痕的美容手术.     

腹腔镜肾上腺切除术

腹腔镜肾上腺切除术首都医科大学宣武医院普外科（北京，１０００５３）徐大华１９９２年加拿大医生ＭｉｃｈｅｌＧａｇｎｅｒ和他的小组经侧腹膜入路成功地进行了腹腔镜肾上腺切除术（ｌａｐａｒｏｓｃｏｐｉｃａｄｒｅｎａｌｅｃｔｏｍｙ）。此后，日本、欧美国家及我...     

腹腔镜肾上腺切除术

目的：探讨腹腔镜肾上腺切除术的适应证和临床价值。方法：2005年1月～2008年3月对125例患者行腹腔镜下肾上腺切除术,其中经后腹腔途径110例（肿瘤直径〈5cm）,经腹途径15例（肿瘤直径5～8cm）。结果：124例手术成功,1例因术中出血中转开放。手术时间35～150min,平均50min,术中出血20～800ml,平均50ml,住院时间3～10天,平均5天。患者术前症状约于术后3个月内缓解,均无复发。结论：腹腔镜肾上腺手术具有创伤小、出血少、并发症少、恢复快、患者住院时间短的优点,是肾上腺肿瘤手术治疗的首选方法。     

腹腔镜肾上腺切除术

1992年Gagner等[1]报告了采用腹腔镜作肾上腺切除术的初步经验。随着腹腔镜技术的迅速发展及临床经验的积累，该技术的临床应用也越来越多，具有较好的应用前景[2]。现将该技术的现状和发展要点介绍如下。1设备器械[3]基本设备有CO2气腹机、腹腔镜、摄像机和监视器，以及高频电切电征器、冲洗吸引器。基本手术器械有气腹外、套管针、有西和无齿抓钳、剥离钩、微型剪、冲洗吸引管、钦夹和置夹钳。2手术适应证与禁忌证[4]适应证有原发性醛固配增多症、皮质醇症、较小的嗜铬细胞癌、非功能性腺癌、血管脂肪瘤、肾上腺髓质囊肿。禁忌证有：①…     

腹腔镜肾上腺部分切除与全切除治疗醛固酮腺瘤的比较

近年来，腹腔镜手术已成为治疗肾上腺疾病的标准方法。原发性醛固酮增多症是一种常见的肾上腺疾病。腹腔镜部分和全部肾上腺切除治疗醛固酮腺瘤3（APA）的手术指征目前仍存在争论。作者采用这两种手术方式，比较各自的临床治疗效果。1995-2004年，共92例原发性醛固酮增多症患者采用腹腔镜手术治疗，     

腹腔镜在肾上腺手术中的应用

目的探讨腹腔镜技术在肾上腺手术中的临床应用价值。方法2000年12月-2006年5月,对86例肾上腺占位性病变行腹腔镜肾上腺切除术,其中经腹腔途径1例,经腹膜后途径81例,经腹手助腹腔镜4例。结果86例手术全部成功,无中转开放手术,无严重并发症发生。手术时间50-175 min,平均72 min。术中出血量15-120 ml,平均54 ml。术后住院时间5-8 d,平均6.3 d。86例术后随访2-65个月,平均26.5月,影像学检查未见肿瘤复发或转移,功能性肿瘤病人的症状减轻或消失。结论腹腔镜肾上腺切除术创伤小,术中出血少,术后恢复快,是治疗大多数肾上腺占位性病变的首选术式。     

后腹腔镜及手助腹腔镜肾上腺切除术治疗肾上腺肿瘤(附21例报告)

目的 :探讨腹腔镜微创手术治疗肾上腺肿瘤的适应证及手术方法。方法 :对 18例直径小于 6cm的肾上腺肿瘤患者行后腹腔镜肾上腺切除术 (后腹腔镜组 ) ;对 3例最大直径为 10～ 17cm的肾上腺肿瘤患者行手助腹腔镜肾上腺切除术 (手助腹腔镜组 ) ,并观察手术时间、术中出血量、胃肠功能恢复时间和住院时间。结果 :2 1例患者中 ,2 0例成功。其中后腹腔镜组手术时间 2 5～ 135min ,平均 (82 .8± 31.1)min ,术中出血量 6 5～ 16 0ml,平均 (113.4± 31.8)ml,均未输血。手助腹腔镜组手术时间 180～ 2 10min ,术中出血量 80～ 6 0 0ml。两组患者均于术后 2天排气 ,1～ 3天下床活动 ,术后住院 3～ 7天。结论 :与开放手术相比 ,后腹腔镜肾上腺手术具有创伤小、出血少、恢复快等优点 ;手助腹腔镜为巨大肾上腺肿瘤切除提供了微创手术的新方式。     

腹腔镜肾上腺切除术的现状与展望

腹腔镜上腺切除术（LA）近年来在临床上应用广泛，已经成为肾上腺切除新的金标准，本文就其现状及研究进展作一综述。     

A Modified Umbilical Incision for Specimen Extraction After Laparoscopic Abdominal Surgery

Background One advantage of laparoscopic surgery over open surgery is the absence of laparotomic incisions. This advantage is reduced when an auxiliary incision is performed to remove surgical specimens larger than the trocar. Methods A special incision was performed at umbilical trocar level that enabled removal of a large surgical specimen as in right hemicolectomy (colic), gastric resection, and splenic surgery. Results The authors have used this method routinely for 10 years for all cases requiring removal of a surgical specimen too large for the normal incision of a 10-mm trocar. Conclusion The authors maintain that this method avoids the use of auxiliary incisions, which undo the many benefits of laparoscopic surgery.     

经脐单孔腹腔镜胆囊切除46例体会

目的 探讨经脐单孔腹腔镜胆囊切除术(LC)的方法和可行性.方法 回顾性分析我院2008年12月至2009年2月期间46例经脐单孔LC患者的临床资料.结果 本组46例均通过普通腹腔镜器械经脐行单孔LC取得成功,均未放置引流.手术时间40～130 min,平均52.3 min;出血10～150 ml,平均40.6 ml.无漏胆、出血、脐疝、切口感染等并发症发生,住院1～4 d,切口不拆线,术后随访2周～3个月,平均1.8个月,腹壁疤痕不明显.结论 经脐单孔LC安全、可行,术后腹壁疤痕不明显,但操作困难,在有条件的医院可作为LC的改进术式推广.     

三孔法腹腔镜脾脏切除术

目的：总结三孔法腹腔镜脾脏切除术的手术经验及治疗效果。方法；对5例原发性血小板减少性紫癜、2例脾脏占位性病变的患采用三孔法腹腔镜脾切除术。结果：本组7例手术过程均顺利，术中出血少、创伤小、术后6例恢复快，无并发症发生，1例术后出血，再次行剖腹探查止血。7例患均痊愈出院。结论：腹腔镜脾切除对于某些病例是可行的，防止术中和术后出血是手术的关键。     

单孔腹腔镜结直肠肿瘤手术操作技巧

目的总结笔者单孔腹腔镜结直肠手术的经验,对该方法的手术操作技巧进行讨论。方法回顾性分析2010年1月至2011年6月期间于笔者所在医院行单孔腹腔镜手术的21例结直肠恶性肿瘤患者的病例资料,总结手术体会。结果 21例患者中,行右半结肠切除者5例,行乙状结肠切除者2例,行经骶前直肠癌切除术者9例,行经腹会阴直肠癌切除术者2例,行全结肠切除者1例,行结肠造瘘术者2例。其中20例患者顺利完成单孔腹腔镜手术,另1例在离断低位直肠时增加了一处12 mm的穿刺切口。手术操作时间40～335 min,(189±75)min;术后住院时间7～16 d,(11.5±3.4)d。术后无出血、吻合口漏、肠梗阻等并发症发生,手术切口无感染、裂口、疝等并发症发生;术后随访6个月未见肿瘤复发。结论在合理掌握适应证条件下,单孔腹腔镜手术对结直肠肿瘤的治疗是安全可行的,其具有更好的微创与美容效果。     

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.     

Choroid Plexus Tumors: Experience of 10 Cases with Special References to Adult Cases

Choroid plexus tumors (CPTs) are rare intraventricular neoplasms accounting for about 0.3–0.6% of all intracranial tumors. This retrospective study on CPTs presents clinico-pathological features and management strategies based on a 20-year single-institutional experience. This series included 10 consecutive patients with pathologically proven CPTs; 5 choroid plexus papillomas (CPPs), 3 atypical CPPs (ACPPs), and 2 choroid plexus carcinomas (CPCs). Their clinical, radiological, and histopathological features as well as management including follow-up studies were reviewed. The patients included five males and five females, aging from 0 years to 61 years with median of 28 years. The affected site was lateral ventricle in two adults and fourth ventricle in eight patients; four children and four adults. The most common symptoms were gait disturbance and memory disturbance. All the patients underwent craniotomy with total, subtotal, and partial removals achieved in 50%, 40%, and 10% of the patients, respectively. The occurrence of the high grade subtypes was 50% in both the adult and pediatric groups. The Ki-67/MIB-1 index increased across the three histological subtypes, from CPP to ACPP and then to CPC. Adjuvant therapy was administered in three patients. The two patients (one adult and one child) with CPC died of whole central nervous system dissemination. At a median of 62-month follow-up, the other eight patients were alive, with only one patient having recurrence and reoperation. The results demonstrate that gross total resection is usually curative for CPP and ACPP, and adjuvant chemoradiotherapy would be required for CPC and incompletely resected ACPP.     

26例臂丛神经鞘瘤的显微手术治疗

目的探讨臂丛神经鞘瘤显微手术的治疗要点。方法回顾性总结2000年1月～2009年10月我院收治的26例臂丛神经鞘瘤患者的临床资料,其中臂丛上干11例,中干10例,内侧束2例,外侧束1例,C5-71例,C6-71例,均实行显微镜下手术切除。结果 26例患者臂丛神经鞘瘤均完整切除,术后无臂丛神经受损表现。病理提示Antoni A型18例,Antoni B型8例。随访6个月到10年,无一例复发。结论臂丛神经鞘瘤的显微外科手术治疗应尽量避开神经纤维,保护好神经干,逐层剥离包膜,将瘤体完整切除,多能获得较满意的疗效。