腹腔镜脑室-腹腔分流术治疗脑积水156例报告

目的探讨腹腔镜在脑室腹腔分流术（ventriculope ritoneal shunt,V-P分流术）中的应用价值。方法2000年8月～2008年8月,对156例脑积水行腹腔镜脑室-腹腔分流术,将引流管通过腹腔镜手术置于右膈下,并结扎、固定于肝圆韧带。结果手术均获成功,133例随访14～24个月,平均17个月,无脑室分流管远端梗阻、消化道症状、腹内脏器损伤以及感染等腹腔镜手术相关并发症,仅有7例脑室端堵塞。结论腹腔镜V-P分流术具有腹部创伤小、效果好、并发症少等优点。     

A Laparoscopic Technique for Retrieval and Prevention of Migration of Ventriculoperitoneal Shunt Tubing

A 31-year-old female with a history of pseudotumor cerebri presented with headache and abdominal discomfort after placement of a ventriculoperitoneal (VP) shunt. The VP shunt was placed after prior failure and revision of a lumbar peritoneal shunt. Computed tomography demonstrated shunt migration into the subcutaneous tissue. Laparoscopy was used to reposition the VP shunt, directing the shunt toward the pelvis. The patient presented for further evaluation one month later, at which point the shunt was shown to have migrated into the subcutaneous tissue once again. Laparoscopy was again used to reposition the shunt and affix it to the abdominal wall by using polytetrafluoroethylene (PTFE) mesh.     

Ventriculoperitoneal shunt migration into the pulmonary artery

Background  Ventriculoperitoneal (VP) shunting is the most common form of treatment for hydrocephalus. Complications of VP shunts may occur anywhere along their course from the cerebral ventricle to the peritoneal cavity. Rare complications such as migration of the peritoneal catheter into the stomach, gallbladder, urinary bladder, vagina, liver, bowel, colon, and diaphragm have been described in the literature. Methods  In this review of the literature we discuss the rare but serious event of migration of the distal catheter of a ventriculoperitoneal shunt (VP shunt) into the pulmonary artery. We present an additional patient with a special emphasis on minimally invasive treatment. Results  The patient’s postoperative course was uneventful, and a postoperative plain X-ray of the chest and abdomen confirmed appropriate placement of the new distal catheter intraperitoneally. Conclusion  It is useful to consider alternative nonsurgical techniques for percutaneous intravascular foreign body retrieval. Many different percutaneous techniques have been described. Rare complications of percutaneous intravascular foreign body retrieval may include transient cardiac arrhythmia, fragmentation of the foreign body, or migration of the foreign body to a different location. A multidisciplinary discussion and approach is pivotal to treating this extraordinarily rare complication.     

Migration of Abdominal Catheter of Ventriculoperitoneal Shunt into the Scrotum

Summary Four cases of migration of the ventriculoperitoneal (V-P) shunt tip through patent processes vaginalis resulting in scrotal hydrocele are presented. These cases are considered a rare complication of V-P shunts and causal mechanisms are discussed with a review of the literature.     

Ventriculoperitoneal Shunt Failure as a Complication of Laparoscopic Surgery

Objective:

The authors report the first documented case of laparoscopically induced Ventriculoperitoneal (VP) shunt failure.

Summary Background Data:

Laparoscopic surgery has become a preferred method of accessing and treating a variety of intraperitoneal pathology.Surgeons can expect to encounter patients who have previously under-gone placement of cerebrospinal fluid (CSF) shunts who present as candidates for laparoscopic procedures. Currently, the presence of a CSF shunt is not considered to be a contraindication to laparoscopy. We report the first documented case of laparoscopically induced VP shunt failure.

Clinical History:

A patient with shunt-dependent hydrocephalus underwent laparoscopic placement of a feeding jejunostomy. Postoperatively, clinical and radiographic evidence of shunt failure was noted. The patient under-went emergent shunt revision. Intraoperatively, an isolated distal shunt obstruction was encountered. Gentle irrigation cleared the occlusion. We believe that this shunt dysfunction was secondary to impaction of either soft tissue or air within the distal catheter as a consequence of peritoneal insufflation.

Conclusions:

It is concluded that laparoscopic surgery may represent a potential danger in patients with pre-existing CSF shunts. The risk of neurological injury faced by this patient population during laparoscopy is derived from peritoneal insufflation and relates to two primary concerns. The first is impaired CSF drainage due to a sustained elevated distal pressure gradient or, as in our case, an acute distal catheter obstruction. The second concern relates to the potential for retrograde insufflation of the CSF spaces through an incompetent shunt valve mechanism. Distal shunt catheter externalization performed in conjunction with a neurosurgeon during the laparoscopic procedure would prevent these complications. Internalization of the distal shunt catheter would then be performed at the completion of the laparoscopic procedure.     

脑室腹腔分流术治疗脑积水83例临床分析

目的探讨脑室腹腔分流术治疗脑积水的手术技巧和并发症的防治,以提高手术疗效。方法回顾性分析83例脑积水患者的临床资料,均行脑室腹腔分流术治疗。结果 83例均获随访,平均18月(9月~6年)。术后症状明显改善57例,好转21例,症状无明显改善5例。11例发生术后并发症,其中分流管阻塞4例,术后感染3例,硬膜下血肿1例,硬膜下积液1例,裂隙脑室1例,癫痫1例。结论正确选择分流装置的置放路径,采用规范的手术操作和严格的无菌技术可有效降低脑室腹腔分流术后并发症的发生,提高临床疗效。     

Laparoscopy as a prognostic factor in curative resection for node positive colorectal cancer: Results for a single-institution nonrandomized prospective trial

Background Several studies reporting preliminary long-term survival data after laparoscopic resections for colonic adenocarcinoma did not show any detrimental effect in comparison with historic studies of laparotomies. A previous randomized study has reported an unforeseen better long-term survival for node-positive patients treated by laparoscopic colectomy.Methods A single-institution prospective nonrandomized trial compared short- and long-term results of laparoscopic and open curative resection for adenocarcinoma of the left colon or rectum in 255 consecutive patients from January 1996 to December 2000.Results In this study, 34 left hemicolectomy, 202 anterior resections, and 19 abdominoperineal resections were performed. A total of 74 patients underwent a laparoscopic resection (LR), and 181, an open resection (OR). The tumor site was the descending colon in 32 cases, the sigmoid colon in 98 cases, and the rectum in 125 cases, including 87 mid–low rectal cancers. Ten LR procedures (13.5%) were converted to open surgery. The hospital mortality was 0.08%, and in hospital morbidity was 16.2% for LR and 13.3% for OR (p = 0.56). The median postoperative stay was 1 day shorter for LR (9 days) than for OR (10 days) (p = 0.09). The mean number of lymph nodes retrieved were 13.8 ± 5.7 for OR and 12.7 ± 5; for LR (p = 0.23). Age exceeding 70 years, T stage, N stage, grading, mid–low rectal site, and laparoscopy were found by multivariate analysis to be significant prognostic factors for disease-free and cancer-related survival. When patients were stratified by stage, a trend toward a better disease-free and cancer-related survival was identifyed in stage III patients undergoing LR.Conclusions Laparoscopic colonic resection is a safe procedure in terms of postoperative outcome and long-term survival. Multivariate analysis showed that laparoscopy is a positive prognostic factor for disease-free and cancer-related survival. The current data agrees with the data for the only randomized study reported so far. Both suggest a better outcome for node-positive patients treated by laparoscopy.     

腹腔镜脑室腹膜分流术治疗脑积水并发症的临床体会

目的:探讨腹腔镜脑室腹膜分流术治疗脑积水的临床应用价值,总结并发症发生的原因及预防措施.方法:回顾分析60例患者行腹腔镜脑室腹膜分流术的临床资料.结果:60例患者无一例手术死亡,40例术后临床症状较术前明显改善,14例发生并发症,发生率约23.3%,其中分流管梗阻6例,感染4例,硬膜下积液4例.结论:严格掌握手术指征,...     

Laparoscopic hysteropexy in a patient with spina bifida and ventriculoperitoneal shunt

Laparoscopic repair of pelvic organ prolapse in patients with ventriculoperitoneal shunts has not been previously described. The optimum management of patients with ventriculoperitoneal shunts undergoing laparoscopy is uncertain. We describe the case of a 21-year-old female patient with spina bifida and ventriculoperitoneal shunt who underwent laparoscopic hysteropexy for severe pelvic organ prolapse. The implications of performing laparoscopy on patients with ventriculoperitoneal shunts are reviewed along with strategies to reduce potential intraoperative complications.     

Removal of an intraperitoneal foreign body using a single port laparoscopic procedure

Background and Objectives:

To remove a foreign body from the peritoneal cavity in laparoscopic surgery, 2 or 3 ports are usually used. We have recently performed such a removal using a single 10-mm transumbilical port, a 0-degree laparoscope, a Farabeuf retractor, and a laparoscopic grasping forceps.

Methods:

Two patients with ventriculoperitoneal shunt catheter (V-P shunt) were admitted to our unit during the last year. They previously had a shunt catheter implanted for hydrocephalus of unknown cause. The complete migration of the ventriculoperitoneal shunt catheter into the peritoneal cavity was observed in these patients 12 and 7 years after the implantation. The laparoscopic removal of the migrated catheter was decided on. Its presence and location were confirmed by the use of a 0-degree laparoscope, through a 10-mm trocar port. The catheter was held and pulled out using a grasping forceps that was pushed in just beside the trocar port.

Conclusion:

The laparoscopic approach enables safe removal of a foreign body in the peritoneal cavity. The procedure can be performed using a single port.     

腹腔镜结直肠癌切除术(附16例报告)

目的 :探讨腹腔镜结直肠癌切除术的可行性与适应证。方法 :回顾分析腹腔镜下 16例结直肠癌切除术的临床资料。结果 :按Dukes分期 :A期 3例 ,B期 9例 ,C期 4例 ;管状腺癌 9例 (中分化 5例、低分化 4例 ) ,粘液腺癌 7例 (中分化 1例、低分化 6例 )。成功 15例 ,其中腹腔镜辅助下经腹会阴联合切除术(Miles) 8例 ,1例中转剖腹行Miles术 ;全腹腔镜下直肠前切除术 (Dixon) 7例。手术时间 2 5～ 4 5h ,平均3 2h。全组无手术死亡病例 ,未发生脏器损伤。随访 5个月～ 2 5年 ,死亡 2例。结论 :腹腔镜结直肠癌手术可行 ,具有视野清 ,患者创伤小、康复快等优点 ,对全直肠系膜切除 (TME)和保肛手术更为有利 ,但应掌握手术适应证     

Appendicitis in the child with a ventriculo-peritoneal shunt: a 30-year review

Purpose

Each year, about 270 children are treated at our hospital for appendicitis, and there are 200 ventriculo-peritoneal (VP) shunt procedures. The incidence of primary peritonitis after a VP shunt is 8% to 12%. The purpose of this article is to try and differentiate these 2 entities.

Methods

From 1973 to 2003 inclusive, appendicitis was diagnosed in 8 children with a VP shunt at our hospital; there were 7 boys and 1 girl with 5 acute appendicitis and 3 ruptured appendices. The first case was diagnosed on purely clinical grounds, whereas the last 7 were confirmed by ultrasonography and/or computed tomography.

Results

All 8 had appendectomy and the shunt was exteriorized in the 3 children with a ruptured appendix. There were no postoperative problems, and the 8 children remained well.

Conclusion

Acute appendicitis can and does rarely occur in children with VP shunts; however, in such situations, the correct diagnosis can be confirmed by imaging. The shunt must be temporarily exteriorized if the appendix is ruptured.     

腹腔镜结直肠肿瘤切除术的难点及对策(附83例报告)

目的:探讨腹腔镜结直肠肿瘤切除的常见难点及对策。方法:回顾分析2005年2月至2007年6月83例腹腔镜结直肠肿瘤切除术患者的临床资料。结果:74例手术成功,9例中转开腹。手术并发症是皮下气肿5例(6.0%)、不完全性肠梗阻5例(6.0%)、术后大出血1例(1.2%)、肠管损伤3例(3.6%)、吻合口漏1例(1.2%)等。结论:腹腔镜结直肠肿瘤切除术的常见难点为血管的识别及处理、脏器损伤特别是输尿管及肠管损伤的预防及手术操作面的显露等。正确的解剖入路、开腹手术经验丰富及良好的腹腔镜培训可减少手术并发症的发生。     

Laparoscopy in the diagnosis and treatment of malfunctioning ventriculo-peritoneal shunts in children.

Abdominal complications following ventriculo-peritoneal shunting for hydrocephalus are not uncommon. One of the complications that has heretofore required abandonment of the peritoneal shunt has been entrapment or encystation of the peritoneal limb of the catheter system. Four infants have been identified with malfunction of the peritoneal limb of the system by characteristic physical findings of increasing head size and dissection of fluid along the shunt track. Abdominal radiographs in multiple views revealed the tip of the peritoneal catheter to be fixed in position in each patient and sonography aided in identification of encysted catheters. These infants underwent six laparoscopic procedures to define the cause of shunt malfunction and to reposition the catheter. Cerebrospinal fluid cysts were encountered in three infants and entrapment by the falciform ligament in the fourth. All catheters were easily repositioned within the abdominal cavity with laparoscopy forceps and three of the infants presently have normally functioning shunt systems.     

腹腔镜结直肠癌手术的临床分析(附45例报告)

目的：总结行腹腔镜结直肠癌根治术的临床经验。方法：回顾分析2003年5月至2007年5月45例行腹腔镜结直肠癌根治术患者的临床资料。其中右半结肠癌8例,左半结肠癌5例,乙状结肠癌20例,直肠癌12例。按传统根治术的要求术中使用超声刀或同时用结扎束游离结肠或直肠及其相应的肠系膜和淋巴、脂肪等组织。结肠癌根治术：在腹部左侧或右侧做5cm的辅助切口,腹腔外行肠切除和肠吻合。低位直肠癌行Miles手术者在充分游离乙状结肠和直肠后,在左下腹做辅助性小切口（乙状结肠造口处）,切断乙状结肠后,腹部手术组行乙状结肠造口,会阴手术组经会阴行直肠切除术。结果：手助腹腔镜右半结肠癌根治术6例,左半结肠癌根治术3例,乙状结肠癌、直肠中上段癌根治术20例,腹会阴联合直肠切除术6例。腹腔镜手术35例,中转开腹10例,中转率22．2％。无死亡病例。手术时间120～280min,平均180min;出血50～100ml,平均80ml。术后随访6～36个月,平均18个月。8例肿瘤复发、转移死亡,复发率22．9％。未发现腹壁小切口和穿刺孔转移。结论：依据结直肠肿瘤分期和部位选择合适的病例,用腹腔镜完成微创手术安全可行,可以达到根治目的。     

腹腔镜保守手术治疗异位妊娠

目的探讨腹腔镜在异位妊娠保守手术中的应用价值。方法回顾性分析我院2000年1月～2005年12月76例有生育要求的异位妊娠腹腔镜保守手术的临床资料。结果输卵管开窗术42例，输卵管切开缝合术21例，伞端挤出术8例，患侧输卵管节段切除联合端端吻合术5例。输卵管造影76例双侧输卵管均可见美蓝生理盐水溢出。手术时间为35—105min，（58．5±19．4）min。血β—hCG均于术后3周内降至正常。61例随访1年，术后1年内35例（57．4％，35／61）获得宫内妊娠，2例（3．3％，2／61）自然流产，2例（3．3％，2／61）再次异位妊娠，余22例（36．1％，22／61）未获得妊娠。结论腹腔镜手术是异位妊娠保守手术治疗中安全、有效的方法之一，术后密切监测血中β-hCC水平，预防持续性异位妊娠发生。     

腹腔镜辅助结直肠癌根治术的临床应用

目的：探讨腹腔镜辅助结直肠癌根治术的可行性、安全性及近期疗效。方法：回顾分析2007年8月至2009年6月施行的32例腹腔镜辅助结直肠癌根治术的临床资料。其中右半结肠切除术5例,横结肠切除术1例,左半结肠切除术7例,乙状结肠切除术5例,结肠次全切除术1例,直肠癌行Dixon手术7例,Miles手术6例。结果：除2例中转开腹外,余30例均在腹腔镜辅助下顺利完成手术,无手术死亡病例;结肠癌切除包括肿块在内的12~23cm肠管;直肠癌行Dixon术或Miles术时,下端切缘距肿瘤下缘3~5cm,术后病理证实所有标本残端均无肿瘤细胞残留、浸润。手术时间130~248min,平均152min;术中出血90~320ml,平均160ml;术后肠蠕动恢复时间36~72h,平均48h;淋巴结清扫4~22枚,平均12.6枚。术后无出血、吻合口瘘和狭窄等并发症发生,术后仅1例切口感染,2个月后再次清创缝合后痊愈;术后住院5~9d,平均7.2d;术后电话随访至2010年2月,死亡1例,局部复发1例,余患者随访期内均未发现转移、复发及切口种植。结论：腹腔镜辅助结直肠癌手术具有患者创伤小、操作安全、术后康复快等优点,不仅技术上可行,而且完全可取得与传统开腹手术同样的治疗效果。     

腹腔镜辅助与开腹结直肠癌根治术临床对比研究

目的对比研究腹腔镜辅助与开腹结直肠癌根治术的安全性及根治疗效。方法选取2010年2月至2012年2月结直肠的患者252例,前瞻性非随机(根据患者意愿)将入选病例分为腹腔镜组(143例)及开腹组109例。将所得数据采用SPSS 19.0软件检验分析。术前、术后指标、肿瘤大小、结肠标本的大小、直肠标本的大小、直肠下切端距离及淋巴结清扫枚数采用x珋±s表示并用t检验,近期并发症、复发率、转移率及远期并发症采用率表示并用χ~2检验,检验标准α=0.05,P0.05则具有统计学意义。结果腹腔镜的手术时间长于开腹组[(156.8±52.3)min比(143.5±41.9)min,t=2.187,P0.05]。腹腔组的术中失血、术后排气时间、术后下床时间、术后进食流食时间及术后住院时间的指标优于开腹组[(83.8±26.7)ml比(173.2±39.5)ml,(2.2±0.7)d比(3.9±0.9)d,(2.4±0.6)d比(3.2±1.1)d,(3.0±0.8)d比(4.3±0.9)d,(6.8±1.3)d比(8.9±1.6)d,t=21.368,t=16.867,t=7.349,t=12.123,t=11.496,P0.05]。两组术后近期并发症、切除的肿瘤大小、结肠标本的大小、直肠标本的大小、直肠下切端距离及淋巴结清扫枚数、局部复发率、远处转移率、术后远期并发症发生率及3年生存率差异无统计学意义(P0.05)。结论本研究腹腔镜结直肠癌手术具有开腹手术相同的手术安全性及肿瘤根治效果,近期疗效优于开腹手术,远期疗效与开腹手术无显著差异。     

基层医院开展腹腔镜结直肠手术的体会(附10例报告)

目的:探讨基层医院开展腹腔镜结直肠癌手术的可行性和安全性。方法:2006年6月至11月我院为10例患者行腹腔镜结直肠癌手术,其中乙状结肠切除术3例,Dixon手术5例,Miles手术2例。结果:10例均顺利完成手术,平均手术时间210min,术中平均出血180ml,术后肠道功能恢复时间平均28h,术后平均住院9d,淋巴结清扫数5~16枚。无手术死亡、中转开腹及并发症发生。结论:腹腔镜治疗结直肠癌具有创伤小,出血少,肠功能恢复快,住院时间短,术后并发症少等优点。只要能熟练掌握结直肠解剖特性,开展腹腔镜结直肠癌手术是安全可行的。     

36例直肠、乙状结肠癌腹腔镜手术的临床经验总结

目的：总结腹腔镜直肠、乙状结肠癌手术的临床经验。方法：回顾分析2009年2月至2009年12月为36例患者行腹腔镜直肠、乙状结肠癌手术的临床资料。结果：34例顺利完成腹腔镜手术,2例因肿瘤较大、侵犯周围脏器（膀胱或子宫）而中转开腹行Hartman手术。平均手术时间145min;术中平均出血105ml;术后2~3d胃肠功能恢复;所有标本残端均无癌细胞浸润或残留,清扫淋巴结12~29枚,平均（16.2±4.7）枚;术后发生2例吻合口瘘,1例术后早期炎性肠梗阻,无术后出血、输尿管损伤等并发症发生。术后随访所有患者均恢复良好。结论：腹腔镜结直肠手术安全可行,短期效果理想。