腹腔镜在诊断不明确的急腹症和腹部外伤诊治中的应用

目的 探讨和分析腹腔镜诊断和治疗急腹症及腹部外伤的价值.方法 对具有开腹探查指征的61例不明确诊断的急腹症及腹部外伤患者进行腹腔镜探查,根据探查情况决定具体术式.结果 61例均行腹腔镜探查,60例明确诊断,50例避免开腹手术,手术并发症3例,无死亡病例.结论 腹腔镜技术不仅对外科急腹症和腹部外伤能明确诊断,避免不必要的开腹探查,同时又能进行腹腔镜下手术治疗,具有良好的临床应用价值.     

腹腔镜探查术在非创伤性急腹症中的临床应用(附101例报告)

目的:探讨腹腔镜探查术在非创伤性急腹症中的临床应用价值。方法:回顾分析2011年8月至2014年7月为101例非创伤性急腹症患者行腹腔镜探查术的临床资料,其中男69例,女32例,11~78岁,平均(44.6±11.5)岁。结果:101例非创伤性急腹症患者通过腹腔镜探查术均明确诊断,其中9例中转开腹;92例患者直接在腹腔镜下完成确定性手术,术中出血量平均(28.0±7.0)ml,手术时间平均(80.0±11.3)min,平均住院(5.0±1.0)d,术后1~2 d下床活动,术后无并发症发生,患者均痊愈出院。结论:腹腔镜探查术具有诊断与治疗非创伤性急腹症的双重作用,具有微创、直观、安全、康复快等优点,在治疗急腹症方面具有显著的优越性及临床应用价值。     

急诊腹腔镜探查术的价值探讨

目的：探讨急诊腹腔镜探查术的临床应用价值。方法：总结29例急腹症和腹部损伤的急诊腹腔镜探查术的经验。结果：全部病例明确诊断。4例(13．8％)避免了不必要的剖腹探查术，20例(68．9％)经腹腔镜下完成治疗，5例(17．3％)中转开腹。结论：急诊腹腔镜探查术适用于：①一般辅助检查不能明确而临床又有可疑证据的急腹症和腹部外伤。②已经明确诊断且能利用腹腔镜完成治疗的急腹症和腹部外伤。     

腹腔镜在腹部外伤中的应用体会

目的:分析腹腔镜诊断与治疗腹部外伤的临床价值。方法:2002年7月~2006年7月,我院对具有剖腹探查指征的68例腹部外伤患者使用腹腔镜诊断,并根据镜检结果决定镜下治疗或中转开腹手术。结果:51例腹部外伤于镜下作出正确诊断,19例于镜下手术,18例可免治疗性处理;31例中转开腹手术,其中9例为腹腔镜辅助开腹或手助腹腔镜手术,术后并发症5例,全组均治愈出院。结论:腹腔镜诊治腹部外伤具有创伤小、安全可靠、诊断率高,并有效降低阴性剖腹探查率等优点,适用于大部分腹部外伤的病例。     

腹腔镜技术在胃肠外科急腹症中的应用

目的探讨腹腔镜技术在腹部外科急腹症诊断和治疗中的应用。方法回顾性分析2008年10月至2011年10月问解放军总医院普通外科收治的因诊断不明确而接受腹腔镜探查术44例急腹症患者的临床资料。并与同期行急诊剖腹探查术的65例患者资料进行比较分析。结果经腹腔镜探查的44例患者中,有42例患者（95．5％,42／44）在腹腔镜下明确诊断,其中34例（77．3％）患者在明确诊断的同时于腹腔镜下完成手术治疗,全腔镜下处理20例,小切口辅助14例。与传统剖腹探查术患者相比,腹腔镜探查术手术切口长度明显缩短[（6．7±2．2）cm比（15．8±3．4）cm]、术中出血明显减少[（51．4±303）ml比（117．9±49．5）m1]、术后胃肠功能恢复明显加快[术后进食时间（15．0±6．1）d比（30．5±8.4）d]和术后住院时间明显缩短[（5．6±4．2）d比（8．4±4．8）d],差异均具有统计学意义（均P〈O．05）,而且手术费用也并未见明显增加[（1．2±0．8）万元比（1．4±0．5）万元,P〉O．05]。结论腹腔镜探杏技术在腹部外科急腹症患者中的应用安全、有效．可在明确病因的同时实施治疗。     

腹腔镜技术在普通外科急腹症及腹部外伤诊治中的应用体会

目的:探讨腹腔镜技术在普通外科急腹症及腹部外伤诊治中的临床效果及应用价值。方法:回顾分析2008年10月至2013年10月应用腹腔镜技术诊治248例普通外科急腹症及腹部外伤患者的临床资料。结果:248例均在腹腔镜探查下明确诊断,211例成功完成腹腔镜手术,37例(14.92%)中转开腹;发现术前误诊11例、腹腔无明显病变及脏器损伤5例,共16例(占6.45%)。死亡2例。结论:腹腔镜技术诊治急腹症及腹部外伤具有独特优点,在快速明确诊断减少误诊的同时可一并于镜下进行治疗;镜下不能处理的患者也可为开腹手术提供合理方案及路径,是积极、微创、安全的诊治方法,患者创伤小、痛苦轻、康复快,值得推广应用尤其基层医院。     

腹腔镜腹腔探查在急腹症诊治中的应用

目的:探讨腹腔镜技术在急腹症诊治过程中的应用价值。方法:回顾性分析2008年10月—2010年10月间72例急腹症患者行腹腔镜探查诊治的临床资料。结果:全组患者经腹腔镜探查均获明确诊断,69例行腹腔镜下手术治疗,2例因术中发现回盲部肿瘤,1例被证实为中肠旋转不良中转开腹手术。结论:腹腔镜技术在急腹症的诊治过程中有准确、及时、微创、安全、术后恢复快等特点。尤其在临床表现不典型的急性阑尾炎、消化性溃疡穿孔、粘连性肠梗阻、闭孔疝嵌顿等急腹症诊治疗方面,具有重要临床价值。在明确诊断的同时,能够一并完成腔镜下治疗,疗效安全可靠。对于一些腹部疑难病症的诊断如节段性小肠炎、中肠旋转不良等,有决定性作用。     

腹腔镜在腹部闭合性损伤中的应用

目的探讨腹腔镜在腹部闭合性损伤中的应用. 方法 2000年7月～2003年12月我院对21例血流动力学稳定的腹部闭合性损伤急诊行腹腔镜探查及治疗. 结果 21例均在腹腔镜下明确诊断.开腹肝修补术4例,腹腔镜肝修补术2例,开腹脾切除术5例,手助腹腔镜脾切除术3例,腹腔镜辅助下小切口小肠修补术2例,小肠部分切除术4例,腹腔镜大网膜血管缝扎止血1例. 结论腹腔镜诊治腹部闭合性外伤准确、安全、有效.     

腹腔镜在腹部外伤治疗中的应用

目的:分析应用腹腔镜经原创口诊断与治疗腹部外伤的临床价值。方法:2003年7月至2006年12月,对具有剖腹探查指征的14例腹部外伤患者使用腹腔镜经原创口诊断,并根据镜检结果决定镜下治疗或中转开腹手术。结果:14例腹部外伤患者均于镜下作出正确诊断,5例镜下手术,2例可免治疗性处理;7例中转开腹手术,其中5例于腹腔镜辅助下手术,全组均治愈出院。结论:腹腔镜诊治腹部外伤具有创伤小、安全可靠、诊断率高,并有效降低阴性剖腹探查率等优点,适用于大部分腹部外伤的病例。     

腹部创伤应用腹腔镜探查的临床意义(附65例报道)

目的探讨腹腔镜探查在腹部创伤中的应用价值及其临床意义。方法 2010年1月至2014年12月期间泰山医学院附属莱钢医院对65例腹部创伤患者行腹腔镜探查术,并根据腹腔镜探查结果行腹腔镜下修复手术或中转开腹手术。回顾性分析该65例患者的临床资料。结果 65例患者中,有60例于腹腔镜探查后即刻作出诊断,其中23例未见明显损伤而未进行治疗性处理,27例行腹腔镜下手术(其中3例行手助腹腔镜下手术),10例中转开腹手术;余5例行腹腔镜探查而未作出诊断者中转剖腹探查。术后发生伤口感染1例,膈下脓肿1例,余无并发症发生。术后65例患者均获访,随访时间2~48个月,中位数为10个月。随访期间所有患者均无明显并发症发生,无再次手术病例。结论对血流动力学稳定的腹部创伤患者,腹腔镜探查具有创伤小、安全、有效、可靠、诊断率高及有效降低阴性剖腹探查率的优点,适用于大部分轻中度腹部创伤病例;对血流动力学不稳定、腹腔内广泛出血患者应尽早行开腹探查以实施确定性手术。     

Non-operative management of abdominal stab wounds--an analysis of 186 patients

BACKGROUND: The modern management of abdominal stab wounds remains controversial and subject to continued reappraisal. In the present study we reviewed patients with abdominal stab wounds to examine and validate a policy of selective non-operative management with serial physical abdominal examination in a busy urban trauma centre with a high incidence of penetrating trauma. METHODS: Over a 12-month period (2005), the records of all patients with abdominal stab wounds were reviewed. Patients with abdominal stab wounds presenting with peritonitis, haemodynamic instability, organ evisceration and high spinal cord injury underwent emergency laparotomy. No local wound exploration, diagnostic peritoneal lavage or ultrasound was used. Haematuria in patients without an indication for emergency surgery was investigated with a contrasted computed tomography (CT) scan. Patients selected for non-operative management were admitted for serial clinical abdominal examination for 24 hours. Patients in whom abdominal findings were negative were given a test feed. If food was tolerated, they were discharged with an abdominal injury form. RESULTS: One hundred and eighty-six patients with abdominal stab wounds were admitted. There were 171 (91.9%) males, with a mean age of 29.5 years. Seventy-four patients (39.8%) underwent emergency laparotomy. There were 5 negative laparotomies (6.8%). The remaining 112 patients (60.2%) were assigned for abdominal observation. One hundred (89.3%) of these patients were successfully managed non-operatively. The remaining 12 patients underwent delayed laparotomy, which was negative in 2 cases (16.7%). Non-operative management was successful in 53.8% of patients overall. The overall sensitivity and specificity of serial abdominal examination was 87.3% and 93.5%, respectively. CONCLUSION: Serial physical examination alone for asymptomatic or mildly symptomatic patients with abdominal stab wounds enables a significant reduction in unnecessary laparotomies.     

腹腔开放所致复杂腹壁缺损的确定性修复

目的探讨联合应用多种腹壁缺损修复技术治疗腹腔开放所致复杂腹壁缺损的效果。 方法收集2013年1月至2018年1月,东南大学医学院附属江阴医院9例因腹腔间室综合征或严重腹腔感染导致腹腔开放进而引起的复杂腹壁缺损行腹壁缺损修复患者的临床资料,分析其治疗方法和临床效果。 结果本组9例患者中,手术时间（4.5±3.2）h,术后住院时间（9.0±4.2）d。术后腹壁缺损完全修复,且腹壁功能恢复良好患者7例;再发腹壁缺损患者2例。 结论联合应用多种腹壁缺损修复技术可以有效修复腹腔开放导致的复杂腹壁缺损,为这一困难临床结局提供了可行的解决途径。     

Acute surgical diseases and injuries of the abdominal organs in mentally ill patients

The work analyses the results of treatment of acute surgical diseases and traumas of the abdominal organs in 84 patients 18 to 81 years of age suffering from various mental disorders. Schizophrenia was encountered in 47 patients, the manic-depressive syndrome in 16, epilepsy in 8, reactive psychosis in 8, and senile psychosis in 5 patients. Among 66 patients who were admitted for suspected acute surgical disease of the abdominal organs, in 54 the diagnosis was confirmed. Operation was conducted on 59 of them. Eighteen patients had an abdominal trauma. Fourteen patients were operated on for closed (2) and open (12) abdominal injury. All in all 73 patients were treated by operation. Eight patients died. The causes of death were peritonitis and intoxication (4), thromboembolism of the pulmonary artery (1), acute cardiovascular insufficiency (2), and pulmonary edema (1). The peculiarities of the diagnosis and postoperative management of these patients are discussed.     

胸中段食管鳞状细胞癌伴腹腔淋巴结转移及其预后的临床研究

目的 了解胸中段食管鳞状细胞癌伴腹腔淋巴结转移的方式,分析预后的影响因素.方法 对1998年1月至2003年1月接受手术治疗的368例胸中段食管鳞状细胞癌患者进行回顾性研究.本组男性289例,女性79例,年龄38～79岁,平均56岁.术前临床分期I～Ⅲ期.全部患者采用Ivor-Lewis手术(右胸及上腹部两切口)行食管大部切除加胸腹二野淋巴结清扫.全组患者平均随访时间68个月.结果 腹腔淋巴结转移58例(15.8%),其中T1-2患者占36.2%(21/58);有13.8%(8/58)的患者为跳跃性腹腔淋巴结转移,均发生在T1-2患者中.腹腔淋巴结转移患者5年生存率为10.3%,低于胸腔淋巴结转移患者的18.3%.远处腹腔淋巴结转移患者预后极差,无1例达到5年生存(0/16).COX多因素分析结果 显示,淋巴结转移数目≥5枚和远处腹腔淋巴结转移是腹腔淋巴结转移患者的独立预后因素.结论 胸中段食管癌腹腔淋巴结转移的发生率较高,应该选择有利于腹腔淋巴结广泛清扫的手术方式.腹腔淋巴结转移患者的预后不良,尤其淋巴结转移数目较多和远处淋巴结转移的患者预后更差.     

Abdominal Lymph Node Metastasis in Patients with Mid Thoracic Esophageal Squamous Cell Carcinoma

Background  There are few reports about abdominal lymph node metastasis of mid thoracic esophageal carcinoma. This study was designed to explore the pattern of abdominal lymph node metastasis in patients with mid thoracic esophageal squamous cell carcinoma and to evaluate the prognostic factors. Methods  The complete data of 368 patients with mid thoracic esophageal squamous cell carcinoma, who underwent modified Ivor-Lewis esophagectomy with two-field lymphadenectomy from January 1998 to January 2003, were reviewed. Survival rate was calculated by Kaplan-Meier method. Cox regression analysis was performed to identify risk prognostic factors. Results  Abdominal lymph node metastasis occurred in 58 (15.8%) patients: 34.5% (20/58) of them were stage T1 and T2. Skipping abdominal node metastasis was recognized in 13.8% (8/58) patients: all were stage T1 and T2. The overall 5-year survival rate of patients with abdominal lymph node metastasis (10.3%) was lower than that of those with thoracic node metastasis (18.3%). The prognosis of patients with distant abdominal lymph node metastasis was poor, and no one could survive more than 5 years. Cox regression analysis showed that five or more positive nodes and distant abdominal node metastasis were independent risk factors of patients with abdominal lymph node metastasis. Conclusions  Abdominal lymph node metastasis in patients with mid thoracic esophageal squamous cell carcinoma occurred frequently, and the surgery favorable for extensive abdominal lymph node dissection should be selected. The prognosis of patients with abdominal lymph node metastasis was poor, especially those with more positive nodes and distant abdominal node metastasis.     

三维可视化技术在腹壁肿瘤外科中的应用

目的探讨三维可视化技术在腹壁肿瘤术前评估中的应用价值。 方法回顾性分析2017年11月至2019年4月,上海交通大学医学院附属第九人民医院收治的23例腹壁肿瘤患者的临床资料。患者术前行腹部增强CT检查获取影像学信息,以医学数字成像和通信格式储存,并应用Medraw软件进行三维重建及数据分析,精准计算腹壁肿瘤体积和腹壁缺损面积,精准评估腹壁缺损分型及分区并制定个性化手术方案。 结果23例患者均进行三维重建并进行精准分型及分区及制定个性化手术方案,其中原发性腹壁肿瘤患者15例,继发性腹壁肿瘤患者7例。腹壁肿瘤平均体积为（355.18±820.13）cm³,腹壁缺损平均面积为（216.2±145.49）cm²;术中平均出血量（334.78±271.54）ml,平均住院时间（21.22±8.65）d;平均随访时间为（12.1±6.87）个月。患者的存活率为86.96%（20/23）,原发性腹壁肿瘤复发率为13.33%（2/15）,继发性腹壁肿瘤复发率28.57%（2/7）;术后并发症的发生率为34.78%（8/23）。 结论三维可视化技术能够对腹壁肿瘤患者进行精准评估及制定个性化手术方案。     

局部腹腔内冲洗在腹腔镜阑尾手术中的应用

目的:探讨局部腹腔内冲洗在腹腔镜阑尾手术中的应用价值。方法:在腹腔镜阑尾手术中,将合并有腹腔内脓液的患者分为两组,A组为未冲洗组,B组为冲洗组。比较两组患者术后发热程度、并发寒战人数、抗生素应用天数及住院时间有无差异。结果:B组在术后发热程度、并发寒战的人数、抗生素应用天数及住院天数等均明显优于A组。结论:局部腹腔内冲洗在合并有腹腔脓液的阑尾手术中应用较未冲洗组效果优越。     

Abdominal wall endometriomas

BACKGROUND: The diagnosis of abdominal wall endometriomas is often confused with other surgical conditions. METHODS: A retrospective study was made of 12 patients presenting with an abdominal wall mass, which proved to be endometrioma. RESULTS: Of a total of 297 patients of endometriosis treated in our hospital over a 7-year period, 12 (4%) had isolated abdominal wall endometriomas. Their mean age was 29.4 years. The presenting symptoms were abdominal mass (n = 12), cyclical (n = 5) or noncyclic pain (n = 7), dyspareunia and dysmenorrhea (n = 1). All patients had a history of gynecologic operations and presented, after an average of 1.9 years, with a tender mass (average 4 cm) at the previous incision site. Preoperative diagnosis was correct in 4 patients (33%) who presented with a cyclically painful abdominal mass. The others were diagnosed as incisional hernia (n = 4), "abdominal wall tumor" (n = 2), and inguinal hernia (n = 2). All patients underwent wide excision of their endometrioma; 2 required polytetrafluoroethylene patch grafting for the resulting fascial defect. The diagnosis was confirmed at frozen section or conventional histological examination in all patients. At follow-up, ranging from 4 months to 3 years, there was no recurrence of endometrioma. CONCLUSIONS: Scar endometrioma commonly presents as an abdominal mass with noncyclical symptoms. Imaging techniques are nonspecific and needle biopsy may confirm the diagnosis. Wide excision is the treatment of choice for abdominal wall endometrioma as well as for recurrent lesions.     

Probability of rupture of an abdominal aortic aneurysm after an unrelated operative procedure: a prospective study

It has been assumed by some authors that patients with abdominal aortic aneurysms may be at increased risk of rupture after unrelated operations. From July 1986 to December 1989, 33 patients (29 men, 4 women) with a known abdominal aortic aneurysm underwent 45 operations. Twenty-eight patients had an infrarenal abdominal aortic aneurysm, and five patients had a thoracoabdominal aneurysm. The abdominal aortic aneurysm ranged in transverse diameter from 3.0 to 8.5 cm (average 5.6 cm). Twenty-seven patients underwent a single operation, and six patients had two or more (range of 1 to 6). Operations performed were abdominal (13); cardiothoracic (9); head/neck (2); other vascular (11); urologic (7); amputation (2); breast (1). General anesthesia was used in 29 procedures, spinal/epidural in 6, and regional/local in 10. One postoperative death occurred from cardiopulmonary failure. One patient died of a ruptured abdominal aortic aneurysm at 20 days after coronary artery bypass (1/33 patients [3%]; 1/45 operations [2%]). Fourteen patients had repair of their abdominal aortic aneurysm at a later date, an average of 18 weeks after operation. Four patients had abdominal aortic aneurysm considered too small to warrant resection (average 3.6 cm). Four patients were considered at excessive risk for elective repair. The five thoracoabdominal aneurysm were not repaired. Four patients are awaiting repair. During this same 40-month period, two other patients, not known to have an abdominal aortic aneurysm, died of a ruptured abdominal aortic aneurysm after another operative procedure, at 21 days and 77 days. All three ruptured abdominal aortic aneurysms were 5.0 cm or greater in transverse diameter.(ABSTRACT TRUNCATED AT 250 WORDS)     

腹茧症16例诊治体会

目的 探讨腹茧症的诊断及治疗方法。方法 回顾性分析l6例腹茧症的临床资料及随访结果。结果 16例腹茧症均经手术治疗并确诊。术前11例误诊为机械性肠梗阻2～l0年，4例为误诊慢性阑尾炎，l例误诊为腹部肿块。术后并发症2例，全部患者均临床治愈。并获随访1～l0年，2例分别因反复发作肠梗阻于1年和5年死亡，2例反复发作不完全性肠梗阻合并营养不良，12例情况良好。结论 腹茧症术前诊断困难，上消化道造影和B超及CT对诊断可能有帮助；包膜切除，肠粘连松解是治疗本病的有效方法。