腹腔镜探查术诊治不明原因腹水的价值(附35例报告)

目的:探讨腹腔镜技术诊治不明原因腹水的应用价值。方法:回顾分析2005年1月至2010年12月为35例不明原因腹水患者行腹腔镜探查活检术的临床资料。结果:35例手术均顺利完成,无手术并发症发生。中位手术时间23 min,平均出血10 ml。经病理、免疫组化检查,确诊34例(确诊率97.1%)。结核性腹膜炎20例(57.1%);腹腔恶性肿瘤12例(34.3%),其中腹膜间皮瘤4例,转移性腺癌4例,卵巢癌2例,淋巴瘤2例;其他3例(8.6%),其中肝硬化2例,未确诊1例。结论:对于不明原因腹水的病因诊断,腹腔镜探查术具有安全、高效、创伤小、确诊率高等优点,应果断行腹腔镜探查术,但腹腔镜探查术并不能代替常规检查。     

腹腔镜探查在不明原因腹水诊断中的应用

目的:探讨腹腔镜探查在不明原因腹水诊断中的应用价值。方法:回顾性分析63例不明原因腹水患者行腹腔镜探查术,并取可疑组织送病理检查的临床资料。结果:腹腔镜探查明确诊断61例,其中结核性腹膜炎31例,转移性腺癌20例,腹膜间质瘤8例,淋巴瘤2例,均未发生并发症。结论:腹腔镜探查对于不明原因腹水的诊断安全有效,确诊率高,值得临床推广。     

急腹症腹腔镜探查38例分析

目的:探讨腹腔镜用于急腹症腹腔探查的价值。方法:回顾分析应用腹腔镜探查治疗急腹症38例的临床资料。结果:手术及病理检查证实诊断,确诊率97.37%,成功率94.74%。结论:腹腔镜技术用于诊断及治疗急腹症具有独特的优势,既可明确诊断又能同时进行治疗,疗效可靠。但仍有局限性,必要时剖腹探查是避免漏诊的保证。     

腹腔镜对不明原因腹水诊断价值研究

目的探讨腹腔镜探查对不明原因腹水的诊断价值及总结手术操作经验。方法回顾性分析1999年9月至2006年10月,第二军医大学附属长海医院普外科在全麻下对72例不明原因腹水病人进行腹腔镜探查,并取可疑组织送病理检查的病例资料。结果腹腔镜手术探查阳性68例(阳性率94.5%),其中结核性腹膜炎44例(61.1%),转移性腺癌12例(占16.7%),腹膜间皮瘤5例(占7.0%),卵巢外腹膜浆液性乳头状癌4例(占5.5%),淋巴瘤、血吸虫病、结肠癌各1例,未明确诊断4例(阴性率为5.5%)。行腹腔镜探查术的病人均未出现并发症。结论腹腔镜腹水探查是一种安全有效的诊断方法,通过镜下观察及活检组织的病理检查基本可以确定产生腹水的病因。腹腔镜在不明原因腹水探查的应用,对操作有其特别要求。     

腹腔镜在胰腺肿瘤诊断和分期中的价值

目的:总结胰腺肿瘤剖腹手术前先行腹腔镜探查的价值。方法:对12例经B超和CT诊断或怀疑为胰腺肿瘤的病人,在剖腹手术前先行腹腔镜探查,其中2例联合使用腹腔镜超声检查(LUS)。结果:1例CT诊断疑为胰头肿瘤伴少量腹水者,腹腔镜明确为原发性腹膜炎,作冲洗引流而愈。2例影像学检查见胰体尾增厚,怀疑胰腺肿瘤者,腹腔镜检查未见明显异常,再作LUS检查,1例为胰腺囊肿,另1例未见异常。9例腹腔镜检查确诊为胰腺恶性肿瘤病人中,3例明确已有远处转移,从而避免了开腹;另6例腹腔镜探查提示可以切除,结果其中1例由于肠系膜血管被肿瘤包绕而无法切除,余5例(5/9=55.6%)进行了根治性切除。腹腔镜探查在评估胰腺癌不可切除性的敏感性为75%,特异性为100%,阳性预测值为100%,阴性预测值为83.3%。结论:腹腔镜探查可发现影像学检查不能发现的腹膜转移,结合腹腔镜超声检查可提高胰腺肿瘤诊断、分期的准确性,使部分病人避免了不必要的剖腹手术。     

腹腔镜在小儿不明原因下消化道出血诊治中的应用体会

目的总结双孔法腹腔镜手术在小儿不明原因下消化道出血诊治中的应用体会。方法小儿不明原因下消化道出血54例,采用双孔法腹腔镜行诊断与治疗。结果腹部超声组检查确诊率15.09%(8/53),腹部CT检查组确诊率11.54%(3/26),放射性核素组检查确诊率76.47%(39/51),腹腔镜探查组确诊率98.15%(53/54),53例发现小肠畸形,1例未发现异常。腹腔镜组探查确诊率高于其他3组。53例行腹腔镜手术均获得成功,无中转开腹手术;手术时间56~75分钟,平均67分钟,出血量3~10 ml。术后病理检查证实为美克尔憩室45例、小肠重复畸形7例、小肠血管畸形1例。结论双孔法腹腔镜手术用于小儿不明原因下消化道出血疾病具有诊断及治疗的双重价值,降低了腹腔镜手术的难度,适用于婴儿期甚至新生儿期患儿。     

腹腔镜在诊断女性不明原因腹水中的应用

目的 探讨腹腔镜对女性不明原因腹水的诊断价值. 方法 2001年6月～2005年6月在全麻或局麻下对23例女性不明原因腹水进行腹腔镜探查,取可疑组织送病理检查.结果 腹腔镜探查阳性20例,阳性率87.0%(20/23),其中结核性腹膜炎9例,转移性腺癌4例(胃癌2例,结肠癌1例,胰腺癌1例),卵巢恶性肿瘤3例(卵巢浆液性上皮癌2例,卵巢黏液性上皮癌1例),卵巢外腹膜浆液性乳头状癌2例,腹膜间皮瘤1例,肝硬化1例;不明原因3例.腹腔镜肉眼诊断与病理检查诊断的符合率为65.0%(13/20).结论 腹腔镜探查腹水病因是一种安全有效的方法,通过镜下观察及活检可以确定产生腹水的原因.     

腹腔镜技术在急腹症诊治中的应用体会

目的探讨腹腔镜技术在急腹症诊治中的作用。方法回顾性分析笔者所在医院2008年10月至2011年12月期间收治的128例急腹症患者应用腹腔镜技术进行诊治的临床资料。结果 127例均明确诊断,1例十二指肠迟发性破裂腹腔镜探查漏诊,患者2 d后因腹痛剧烈而行剖腹探查术,发现为十二指肠破裂,确诊率为99.2%。103例(80.5%)于腹腔镜下完成手术,11例(8.6%)中转开腹手术,14例经腹腔镜检查明确诊断后行保守治疗。所有手术患者术后无严重并发症发生,全部患者均痊愈出院。平均手术时间为72 min(32～166 min);平均出血量为125 ml(20～230 ml);平均住院时间为5 d(3～12 d)。结论急腹症应用腹腔镜技术是一种十分安全有效的方法,具有诊断治疗一体化、创伤小、恢复快,住院时间短等优点。     

腹腔镜在腹部外科诊治中的应用价值

目的探讨腹腔镜在腹部外科病人诊断和治疗中的应用价值。方法回顾性分析自2013年3月至2014年5月共1 15例腹部外科病人行腹腔镜探查的临床资料。结果所有病人经腹腔镜探查及术后病理得以明确诊断,其中94例(81.7%)在腹腔镜下完成手术,44例肿瘤性病变在腹腔镜探查下明确,其中4例(9.1%)发现肿瘤已广泛转移或无法切除则选择关腹,所有病人术后都恢复良好。结论腹腔镜在腹部外科病人诊治中具有重要作用,值得在临床上推广应用。     

结核性腹膜炎腹腔镜探查直视下诊断价值研究

目的探讨腹腔镜腹腔探查直视下诊断结核性腹膜炎的价值和意义。方法对新疆维吾尔自治区人民医院自2005年1月至2009年12月收治的65例怀疑结核性腹膜炎患者行全麻腹腔镜腹腔探查活检术。其中34例患者确诊为结核性腹膜炎。将本组患者腹腔镜探查直视下诊断结果与病检结果进行比较。结果本组手术均成功,腹腔镜直视诊断结核性腹膜炎敏感度88.2%,特异度90.3%。Youden指数(YI)=0.78。结论腹腔镜直视下诊断结核性腹膜炎确诊率高,安全可行。结合病理检查可做为金标准。     

腹腔镜腹腔探查用于诊断不明原因腹水的临床研究

目的:探讨腹腔镜探查用于诊断不明原因腹水的价值。方法:回顾分析1993年3月至2009年12月为102例不明原因腹水患者行腹腔镜腹腔探查活检术的临床资料。结果:97例经腹腔镜腹腔探查活检术明确病因,其中结核性腹膜炎41例(40.2%)。发生肠管损伤2例,切口二期缝合1例,术后一过性发热7例。不同常规影像学检查诊断符合率差异无统计学意义(P0.05)。常规检查费用之和较腹腔镜探查费用多(P0.05),花费时间之和明显长于腹腔镜检查(P0.01)。发病入院时结核性腹膜炎与腹腔内广泛转移癌患者血清糖类抗原125(carbohydrate antigen 125,CA125)值差异无统计学意义(P0.05);结核性腹膜炎患者入院时血清CA125值与正规抗痨治疗3个月后相比差异有统计学意义(P0.01)。结论:腹腔镜探查诊断不明原因腹水效率高,安全可行,经济,省时。血清肿瘤标记物CA125值的变化可作为评判结核性腹膜炎治疗效果的一种指标。     

腹腔镜检查用以诊断不明原因腹水的价值

目的:探讨腹腔镜技术诊断不明原因腹水的价值。方法:对65例经影像学检查难以明确原因的腹水患者行腹腔镜检查。结果:手术探查58例明确了原因,阳性率89.2%,7例病因不明,阴性率10.8%。患者术后均恢复顺利,无并发症发生。结论:诊断性腹腔镜技术对不明原因的腹水患者安全有效。     

腹腔镜诊治不明原因下腹痛的体会

目的 :探讨不明原因下腹痛的腹腔镜探查及治疗方法 ,提高不明原因下腹痛的确诊率及治疗成功率。方法 :回顾分析 38例不明原因下腹痛患者行腹腔镜探查治疗的临床资料。结果 :全部病例均获确诊 ,腹腔镜下完成手术 33例 (86 8% ) ,中转开腹 5例 (1 3 2 % ) ,发现并处理伴发病 7例 ,本组病例全部治愈 ,无并发症发生。结论 :腹腔镜探查治疗不明原因下腹痛简便 ,创伤小 ,确诊率高 ,探查范围广 ,手术安全 ,治愈率高     

不明原因腹水的腹腔镜探查(附32例报告)

目的:探讨腹腔镜用于探查不明原因腹水的价值。方法:回顾分析1999年6月至2009年6月我院为32例不明原因腹水患者行腹腔镜探查术的临床资料。结果:31例(96.9%)明确了腹水原因,其中肿瘤性腹水17例,结核性腹水12例,出血坏死性肠炎1例,盆腔炎1例;1例未查明病因。结论:不明原因腹水患者病因以恶性肿瘤及结核性腹膜炎为主;腹腔镜探查对诊断腹水病因有较高的实用价值。     

腹腔镜诊治急慢性腹痛37例分析

目的 :探讨腹腔镜在诊断和治疗不明原因急慢性腹痛中的作用。方法 :回顾分析不明原因急慢性腹痛 37例的临床资料。结果 :急性腹痛 15例中 ,11例行腹腔镜治疗 ,2例未行外科处理 ,2例开腹手术。无误诊及漏诊。治疗患者术后腹痛均明显好转或治愈 ,有效率为 10 0 %。慢性腹痛 2 2例 ,镜下诊断 2 1例 ,其中 1例误诊。 12例行腹腔镜治疗 ,3例行开腹手术 ,6例未进一步手术治疗。 1例腹腔镜下未见异常。手术治疗者近期效果均良好 ,有效率为 93%(14 / 15 )。所有急慢性腹痛患者腹腔镜探查或治疗均无严重并发症。腹腔镜术后 3～ 6d出院。结论 :腹腔镜诊断急慢性腹痛准确率较高 ,腹腔镜治疗减少了患者痛苦 ,缩短了住院时间。腹腔镜应作为外科诊治不明原因急慢性腹痛患者的首选方法。     

Laparoscopy for chronic abdominal pain

Background: This purpose of this investigation was to evaluate the utility of laparoscopy in patients with chronic abdominal pain. Methods: A retrospective review was performed of 34 patients who underwent laparoscopy for chronic abdominal pain. Average patient age was 39 years. The majority were women. Most had undergone abdominal surgery in the past. Results: All procedures were performed laparoscopically. A positive finding was made in 65% of patients. Fifty-six percent of patients underwent adhesiolysis, but 26% required no operative intervention other than laparoscopic exploration. Notably, 73% of patients reported improvement in pain postoperatively, whether or not a positive finding had been made on laparoscopy. Conclusions: This retrospective study suggests laparoscopy can identify abnormal findings and improve outcome in a majority of selected cases. Recommendations are provided for patient selection. Prior abdominal surgery is not an absolute contraindication to laparoscopic exploration for chronic abdominal pain. Received: 16 April 1996/Accepted: 30 May 1996     

Management of common bile duct stones in a rural area of the United States

BACKGROUND: Laparoscopic common bile duct exploration has been reported to be highly successful and cost-effective. It remains unknown to what extent the procedure is used in routine surgical practice. METHODS: We conducted a survey of general surgeons practicing in a rural area of the United States. The type of practice, laparoscopic training, performance of cholangiography, and preferred approach to choledocholithiasis were elicited. RESULTS: Sixty-eight of 207 surveys (33%) were returned. Thirty respondents (45%) indicated that they perform laparoscopic common bile duct explorations. The likelihood of laparoscopic common bile duct exploration increased with a higher number of cholecystectomies per year (p < 0.05, chi-square) but was independent of training or routine cholangiography. The preferred approach to a patient with choledocholithiasis was endoscopic retrograde cholangiopancreatography (75%), followed by laparoscopic (21%) and open exploration (4%). Reasons for not performing laparoscopic exploration were time (58%), equipment (24%), good gastrointestinal backup (6%), reimbursement (3%), increased morbidity (1.5%), lack of skill (1.5%), and other/no reason (18%). CONCLUSION: Although 45% of practicing surgeons indicated that they perform laparoscopic common bile duct explorations, only 21% practiced it as their preferred approach. Time constraints and lack of equipment are the main factors preventing the application of the laparoscopic technique toward choledocholithiasis.     

Choledocholithiasis: overdiagnosed endoscopically and undertreated laparoscopically

Background: Two recent meta‐analyses suggest that operative common bile duct (CBD) exploration (laparoscopic or open) may be superior to endoscopic retrograde cholangiopancreatography (ERCP) for the management of choledocholithiasis when the gall bladder is in situ. Much of the published work regarding laparoscopic exploration comes from enthusiasts of the technique and may not be transferable to other institutions. In our institution, both hepatobiliary and general surgeons carry out cholecystectomy, with differing levels of expertise in laparoscopic bile duct exploration. ERCP and laparoscopic antegrade transampullary endobiliary stents are available. We reviewed the management of choledocholithiasis in this setting. Methods: A retrospective review of all patients undergoing cholecystectomy during 2004 and 2005 at John Hunter and Belmont Hospitals (Newcastle, Australia) was conducted. Results: The overall incidence of choledocholithiasis was 10.3% (70 of 681). Fifty patients underwent preoperative ERCP, with choledocholithiasis confirmed in only 24 patients (therapeutic rate 30%). Thirty‐one patients underwent CBD exploration with 100% clearance through an open approach (12 patients) and 58% clearance through a laparoscopic approach (11 of 19 patients). Hepatobiliary surgeons carried out 22 of 31 CBD explorations (clearance rate 82%) and placed 13 transampullary antegrade endobiliary stents. In comparison, general surgeons carried out nine CBD explorations (clearance rate 56%) and placed only four antegrade stents. Conclusion: This series suggests that preoperative ERCP is significantly overutilized, laparoscopic CBD exploration is less successful than open CBD exploration and that antegrade transampullary intraoperative endobiliary stenting is underutilized by non‐hepatobiliary surgeons.