腹腔镜下幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄50例报告

目的总结腹腔镜下幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄的成功经验.方法2001年4月～2004年4月,应用腹腔镜下幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄50例,年龄12～90 d,平均35 d.分别在左、右上腹各置入3 mm trocar,左侧trocar置入无损伤抓钳夹近幽门处胃壁,右侧trocar先后置入伸缩式幽门肌切开刀、剥离器和幽门分离钳,完成幽门环肌切开术.结果腹腔镜下完成手术48例,中转开腹2例,其中1例为术中发现幽门前瓣膜症,1例为幽门黏膜损伤,经开腹修补痊愈.手术时间15～45 min,平均25 min.术后6 h拔胃管,开始喂奶.3～5 d出院.42例术后随访3～6个月,平均4.5月,生长发育均恢复正常.结论丰富的开腹手术经验、熟练的腹腔镜操作技术、术中良好的麻醉和合适的手术器械是完成腹腔镜下幽门环肌切开术的保障.     

微型腹腔镜幽门环肌切开术182例报告

目的:总结微型腹腔镜幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄(congenital hypertrophic pyloric stenosis,CHPS)的临床经验,探讨手术成功因素及并发症的防治。方法:回顾分析2001年3月至2009年5月应用微型腹腔镜技术治疗182例CHPS患儿的临床资料,术中分别于左、右、上腹部各穿刺3mm Trocar。结果:180例顺利完成腹腔镜手术,术中2例幽门粘膜损伤中转开腹,术后2例并发脐部戳孔疝经修补治愈;随访至今,无呕吐及肠粘连、肠梗阻等并发症发生。结论:丰富的开腹手术经验、娴熟的腹腔镜技术、专用的腹腔镜器械及固定的手术团队是保障腹腔镜幽门环肌切开术顺利完成的基础。     

腹腔镜幽门环肌切开术治疗先天性肥厚性幽门狭窄的效果评价

目的探讨腹腔镜幽门环肌切开术治疗先天性肥厚性幽门狭窄(CHPS)的效果。方法选取2015-06—2018-06间在西峡县人民医院接受幽门环肌切开术的71例CHPS患儿,依照术式不同分为2组,各35例。观察组采取腹腔镜手术,对照组行开腹手术。结果 2组手术时间差异无统计学意义(P0.05)。观察组术后恢复喂养时间、住院时间短于对照组,并发症发生率低于对照组,差异均有统计学意义(P0.05)。结论腹腔镜下幽门环肌切开术治疗CHPS,可缩短手术时间,并发症少,术后恢复快。     

经脐单一部位腹腔镜手术治疗小儿先天性肥厚性幽门狭窄30例

目的探讨经脐单一部位腹腔镜下幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄(congenital hypertrophic pyloric stenosis,CHPS)的临床疗效。方法 2012年8月~2013年12月,我科应用腹腔镜经脐单一部位行幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄30例。术中在脐部置入5 mm trocar,放置腹腔镜,在脐环皱褶旁右侧放置2个3 mm trocar,先后置入电钩、抓钳和幽门分离器,完成幽门环肌切开术。结果 30例手术顺利完成,无中转开腹。手术时间25~55 min,(35.9±12.1)min。无并发症发生。术后6 h拔除胃管,从喂糖水逐渐过渡至喂奶。术后住院3~6 d,(3.8±1.1)d。切口隐蔽且美观。30例术后随访3~6个月,生长发育均恢复正常,脐部外观美观,几乎无法观察到手术瘢痕。结论经脐一单部位腹腔镜下幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄安全可靠,疗效满意,切口隐蔽且美观。     

开腹和腹腔镜手术治疗小儿肠旋转不良的临床对比研究

【摘要】〓目的〓比较开腹手术和腹腔镜手术治疗小儿肠旋转不良的治疗效果。方法〓收集2012年至2014年的肠旋转不良患儿资料,传统开腹手术68例,腹腔镜手术30例,分别比较两组间的手术时间、术后进食时间和术后并发症等的差别。结果〓开腹手术时间较腹腔镜手术时间短,但术后开始进食时间及全量进食时间较腹腔镜手术组的时间长,两组之间比较有统计学意义;开腹手术术后并发症8例,腹腔镜手术术后并发症4例,两组间比较无统计学意义。结论〓腹腔镜Ladd?蒺s手术术后肠功能恢复快,可早期恢复进食,术后并发症无增加,用于治疗小儿肠旋转不良是安全而有效的。     

腹腔镜手术治疗新生儿先天肥厚性幽门狭窄156例临床分析

目的探讨腹腔镜手术治疗新生儿先天肥厚性幽门狭窄(CHPS)的效果。方法选取156例于郑州儿童医院出生的CHPS新生儿。按照出生顺序分为2组,各78例。对照组实施传统开腹幽门肌切开术,观察组予以腹腔镜下幽门肌切开术。比较2组的疗效。结果观察组手术时间、完全恢复哺乳时间、手术至出院时间、切口愈合不良率、术后3 d呕吐发生率均明显优于对照组,差异有统计学意义(P0.05)。术后3 d内,2组患儿幽门黏膜穿孔发生率差异无统计学意义(P0.05)。结论腹腔镜手术治疗新生儿CHPS,效果好且安全,有利于改善患儿预后。     

腹腔镜在6月龄以内新生儿和婴儿疾病诊断和治疗中的应用(附297例报告)

目的 探讨腹腔镜技术在新生儿和小婴儿疾病诊断和治疗中的安全性及可行性. 方法 2001年1月～2007年5月,我们对297例新生儿及小婴儿进行腹腔镜手术治疗.年龄生后2小时～6个月,其中先天性肥厚性幽门狭窄80例,梗阻性黄疸67例,腹股沟斜疝35例,胆道闭锁31例,中高位肛门闭锁21例,胆汁黏稠21例,先天性膈疝7例,空肠闭锁7例,胆总管囊肿6例,先天性巨结肠5例,十二指肠膜式狭窄5例,肾积水3例,食管裂孔疝2例,食管闭锁2例,肠旋转不良2例,小肠梗阻1例,肠套叠1例,先天性肌性斜颈1例. 结果 诊断性手术胆道造影术67例;操作简单的中小手术如幽门环肌切开术80例,疝囊高位结扎术35例,胆道冲洗术21例,十二指肠膜式狭窄手术5例,肠旋转不良Ladd手术2例,肠套叠复位术1例,肠粘连松解术1例,胸锁乳突肌松解术1例;复杂性大手术如肝门空肠吻合术31例,肛门成形术21例,膈疝修补术7例,肠闭锁肠切除吻合术7例,肝管空肠吻合术6例,长段型巨结肠根治术5例,肾盂成形术3例,食管闭锁2例,食管裂孔疝胃底折叠术2例.无术中大出血、无术中及术后需要输血者、意外损伤及围手术期死亡病例.腹腔镜下完成手术294例,3例胆道闭锁因术中肝门渗血中转开腹手术.术后随访2个月～6年,无明显远近期并发症发生. 结论 腹腔镜技术是诊断、治疗新生儿和小婴儿疾病的安全、可靠的方法,具有创伤小,恢复快,美容效果满意等优势.     

腹腔镜手术治疗婴儿肥厚性幽门狭窄合并腹股沟斜疝

目的总结婴儿肥厚性幽门狭窄腹腔镜下幽门环肌切开术,同时探查双侧内环口,若合并腹股沟斜疝则同时行腹腔镜下疝囊高位结扎术的经验。方法腹腔镜下先行幽门环肌切开术,然后腹腔镜转向盆腔探查双侧内环口,若未闭合（直径≥0.3 cm）则行疝囊高位缝扎术。结果86例中合并腹股沟斜疝32例（37.2%）,其中单侧13例,双侧19例。手术时间较单纯行幽门环肌切开术增加5~20 min,平均15 min。均于术后6 h开始喂养,术后2~6 d,平均3.5 d出院。86例术后随访3~24个月,平均13个月,无并发症发生。结论腹腔镜下幽门环肌切开术同时行疝囊高位结扎术避免了二次行嵌顿疝复位或疝囊高位结扎手术的可能性,同时因疝囊小,没有因疝内容反复进出或嵌顿形成的瘢痕而易于操作,较传统手术更不易损伤精索。     

腹腔镜下幽门肌切开术治疗 CHPS 的临床分析

目的：探讨腹腔镜下幽门肌切开术治疗先天性肥厚性幽门狭窄（CHPS）的临床疗效。方法选取2012年5月－2014年3月期间我院共收治的采用腹腔镜下幽门肌切开术治疗36例CHPS 患儿,经脐轮上缘偏右侧的弧形切口,直视下置入一次性利用的5 rnm Trocar,建立气腹,置入30°视镜。在左右上腹部利用11号刀片各戳出一个3 mm 腹壁戳孔,经左侧戳孔直接置入肠钳固定幽门管,右侧戳孔先后直接置入幽门肌切开刀和幽门肌分离钳,完成幽门肌切开术。结果本组36例CHPS 患儿均在腹腔镜下完成手术,无中转开腹,手术时间25～61 min,平均36 min,术后3～6 d 出院。随访3～6个月,生长发育均恢复正常。结论初学腹腔镜下幽门肌切开术,需要一定的知识储备和腹腔镜的手术操作经验,并牢记手术注意事项和技巧。     

腹腔镜手术治疗肠旋转不良的Meta 分析

目的：比较腹腔镜与传统开腹Ladd术治疗肠旋转不良的临床效果。 方法：收集已公开发表的关于腹腔镜与开腹Ladd术治疗肠旋转不良的文献,对两种方法的手术时间,术后进食时间,住院时间及术后并发症情况行Meta分析。 结果：经筛选共4篇文献纳入Meta分析,共454例患者,其中腹腔镜Ladd术89例（腹腔镜组）,开腹Ladd术365例（开腹组）。与开腹组比较,腹腔镜组时间并无延长（P>0.05）,但术后进食时间早,住院时间短,术后发生肠梗阻率低（均P<0.05）,术后肠扭转发生率亦无增加（P>0.05）。 结论：腹腔镜Ladd术较开腹Ladd术治疗肠旋转不良术后恢复快,并发症少。     

Laparoscopic treatment of intestinal malrotation in neonates and infants: retrospective study

Background  

Intestinal malrotation in neonates or infants may require urgent surgical treatment, especially when volvulus and vascular compromise of the midgut are suspected. Successful laparoscopic management of malrotation has been described in a number of case reports. It remains unclear, however, whether laparoscopy for the treatment of malrotation has a success rate equal to that of open surgery and what relative risks exist in terms of conversion and redo surgery in larger numbers of patients. This report describes a retrospective analysis of the clinical outcome for 45 children who underwent laparoscopic treatment of intestinal malrotation at the authors’ institution.     

腹腔镜经腹入路泌尿系手术的并发症及预防处理

目的：分析腹腔镜经腹入路泌尿系手术并发症的原因及预防和处理方法。方法：回顾分析1156例腹腔镜经腹入路泌尿系手术的资料，总结出现的并发症和处理方法。结果：1156例手术出现严重并发症22例，其中皮下气肿6例；肾上腺手术过程中肾静脉损伤转开放1例，肾上腺中央静脉损伤2例；肾囊肿去顶减压周围肾实质出血2例；根治性肾切出血转开放3例；1例肾切除术后出血再次急诊开放手术发现肾蒂周围一分支小动脉出血。膈肌损伤腔镜下修补2例；胰腺损伤转开放1例；脾脏损伤出血再手术开放脾切除1例；结肠损伤1例；术后肺动脉栓塞2例。本组手术的并发症发生率为1．9％（22／1156），转开放率0．43％（5／1156），再手术率0．35％（4／1156），无死亡病例。22例患者积极正确处理后均痊愈出院。结论：充分认识腹腔镜经腹入路泌尿系手术的常见并发症，提高手术操作技巧，正确预防和处理并发症，可以避免严重后果的发生。     

Laparoscopic surgery for colon cancer with intestinal malrotation in adults: Two case reports and review of literatures in Japan

IntroductionIntestinal malrotation is a congenital anomaly, and its occurrence in adults is rare. Colon cancer with intestinal malrotation is far more rare. We herein report two cases of colon cancer with intestinal malrotation treated with laparoscopic surgery and reviewed the literatures in Japan.Presentation of casesCase 1 involved a 78-year-old man. Abdominal enhanced computed tomography (CT) showed that the tumor was located in the sigmoid colon. Intraoperatively, the cecum and ascending colon were located along the midline and the small intestine occupied the right side of the abdomen. The tumor was located in the cecum, and the patient was diagnosed with cecal cancer with intestinal malrotation. We performed laparoscopy-assisted ileocecal resection. Case 2 involved a 81-year-old man. Colonoscopy revealed a laterally spreading tumor in the cecum. Intraoperatively, the position of the small intestine and the ascending colon was similar to case 1, and Ladd’s band was found in front of the duodenum. Thus, we diagnosed the patient with a laterally spreading cecal tumor with intestinal malrotation and performed laparoscopy-assisted ileocecal resection.DiscussionA review of the literature revealed 49 cases of colon cancer with intestinal malrotation and laparoscopic surgery performed at 30.6%. If laparoscopic mesenteric excision for colon cancer with intestinal malrotation is unsafe because of the abnormalities of the artery, mesenteric excision should be performed outside the body.ConclusionIf the intestinal malrotation is diagnosed preoperatively, 3D-CT angiography should be used to reveal the vascular anatomic anomalies for safe performance of laparoscopic surgery.     

腹腔镜下腹股沟疝手术失败后再手术原因分析

目的：分析腹股沟疝患者行腹腔镜手术失败的原因,探讨腹腔镜腹股沟疝手术中应注意的事项。方法回顾性分析2003年8月至2013年1月间收治的17例腹股沟疝行腹腔镜手术后失败再手术患者的临床资料。结果再手术原因：复发9例,补片感染1例,小肠漏1例,肠壁疝1例,线结反应2例,膀胱损伤1例,脐部切口裂开1例,阴囊血肿1例,髂血管损伤1例。6例再次行腹腔镜探查手术,11例行开腹手术,所有患者均手术成功,术后2～15 d痊愈出院。结论腹腔镜技术应用于腹股沟疝时,在严格掌握腔镜手术指征和遵循手术操作规范。对于病情特殊,手术有难度者应及时中转开腹。术后应密切注意并发症的发生,及时处理并发症。     

腹腔镜在异位妊娠诊治中的价值

目的 探讨腹腔镜手术在异位妊娠诊断和治疗中的价值。方法 2003年1月～2005年1月,我院对342例临床拟诊异位妊娠行腹腔镜检查。诊断明确335例,行单侧输卵管切除术、输卵管开窗术、部分卵巢切除术或宫角切除术等：诊断不明确7例,进一步行诊断性刮宫术。结果 335例腹腔镜确诊异位妊娠,333例成功行腹腔镜手术（包括3例卵巢妊娠、3例输卵管间质部妊娠）,2例中转开腹。7例腹腔镜未见明显妊娠部位行诊断性刮宫术,其中1例子宫畸形（残角子宫）合并宫内妊娠行残角子宫及同侧输卵管切除术,1例卵巢黄体囊肿破裂合并宫内妊娠行黄体囊肿剥出术,5例宫内外均未发现妊娠部位,MTX治疗成功。340例腹腔镜术后8～24h肛门排气,除5例MTX保守治疗外,335例术后2～4d出院;2例中转开腹术后24～36h肛门排气,术后6d出院。结论 腹腔镜检查有利于异位妊娠的早期诊断;腹腔镜手术治疗异位妊娠安全有效、恢复快。     

Laparoscopic treatment of intestinal malrotation in adults.

BACKGROUND: Congenital midgut malrotation is rarely encountered outside the pediatric population. The Ladd's procedure is the standard corrective measure for intestinal malrotation in children and consists of division of peritoneal bands (Ladd's bands) traversing the posterior abdomen, reduction of volvulus, appendectomy, and functional postioning of the intestine with or without fixation. Clinical manifestations of malrotation and results of Ladd's procedure have been described in adults, but laparoscopic treatment remains to be established as adequate treatment. METHODS: Records were reviewed of 7 patients, ages 17 to 45, all with a history of abdominal discomfort dating from childhood or early adolescence. The diagnosis of malrotation was made by barium small bowel examination in all cases. Symptoms consisted of recurrent bouts of abdominal pain that were most often postprandial, with bloating and, less frequently, constipation. Surgical treatment consisted of laparoscopic exploration via 4 ports. Peritoneal bands were completely divided, and an appendectomy performed in all patients. Three patients required reduction of nonstrangulated chronic midgut volvulus. RESULTS: No early complications occurred, and all patients were discharged on postoperative days 1 through 3. At 2 months to 48 months after surgery, 1 patient had been lost to follow-up. Five patients (71%) reported substantial improvement in abdominal discomfort, with only occasional mild symptoms. Constipation continued in 1 patient, but required less aggressive treatment. One patient reported only slight improvement in postprandial abdominal pain. CONCLUSIONS: Although rarely encountered, intestinal malrotation after childhood can produce significant clinical symptoms that respond to surgical treatment. The results of the present series indicate that laparoscopic Ladd's procedure is an acceptable alternative to the open technique in treating symptoms of intestinal malrotation in adults.     

6个月以内婴儿腹腔镜手术的特点

目的 探讨6个月以内婴儿腹腔镜手术的特点。方法 回顾性分析98例6个月以内婴儿腹腔镜手术情况及其术后并发症。结果 47例探查性手术中46例在腹腔镜下明确诊断，1例中转开腹。51例治疗性手术中2例中转开腹。术后合并呼吸道感染11例，高碳酸血症14例，心肌酶异常1例。无围手术期死亡，无伤口感染及切口疝。结论 在婴儿外科手术中应用腹腔镜技术创伤小、术后合并症少，具有临床应用前景。