手术治疗肺部子宫内膜异位症3例分析

目的总结肺部子宫内膜异位症患者的诊断与手术治疗经验，提高早期诊断率和治疗方法。方法对手术治疗的3例肺部子宫内膜异位症患者的临床资料进行回顾性分析与总结。结果全组病例均治愈出院。结论肺部子宫内膜异位症是一种极少见且容易延误诊断的疾病，因其缺乏特有的症状和体征，影像学表现也无特异性，加之医务人员对此病警惕性不高，易耽误治疗。     

腹壁子宫内膜异位症相关因素分析

目的探讨腹壁切口子宫内膜异位症的临床特点及治疗方法。方法对2012-01—2014-04间收治的21例腹壁子宫内膜异位症患者的临床资料进行回顾性分析。结果 21例内异症患者均有下腹部手术史,其中20例继发于剖宫产术后,1例继发于子宫肌瘤剔除术后。发病潜伏期与发病年龄呈正相关(P0.001)。21例患者均手术切除腹壁异位病灶,术后病理结果诊断为腹壁切口子宫内膜异位症。术后随访7~24个月,均无复发。结论腹壁子宫内膜异位症往往根据患者病史、症状及体征即可初步确诊。手术是首选治疗方法,对于较大而深的病灶,适当扩大切除范围,彻底切除病灶防止复发是治疗本病的关键。     

腹腔镜下治疗子宫内膜异位症的临床观察

目的评价腹腔镜手术治疗子宫内膜异位症的临床疗效. 方法回顾性分析1998年1月～2003年1月经腹腔镜治疗的102例子宫内膜异位症的临床资料. 结果所有病例无中转开腹和并发症发生.手术时间(80.5±28.3)min,术中出血量(25.2±23.2) ml,术后住院时间(3.0±1.2) d.83例术后随访6～66个月,21例复发;53例内异症合并不孕症中23例正常妊娠. 结论腹腔镜手术治疗子宫内膜异位症效果明显,但仍有术后复发.     

被低估的输尿管子宫内膜异位症

输尿管子宫内膜异位症虽然整体发病率不高,但在深部浸润型子宫内膜异位症中是较常见的类型.由于病变位于后腹膜,轻度的、外在型病变存在被忽略和低估的可能.而本例所呈现的严重输尿管子宫内膜异位症已造成明显的临床症状和显著的影像学改变,其重点则在于全面评估肾脏功能受损的程度,并选择最合理的手术路径.本例存在术前低估输尿管受累程度...     

输尿管子宫内膜异位症12例报告

目的 提高输尿管子宫内膜异位症的诊治水平。方法 输尿管子宫内膜异位症患者12例，年龄29～59岁。临床表现为腰痛或下腹部疼痛不适9例，月经紊乱1例，有痛经史8例。B超均提示单侧上尿路扩张并积水，肾盂分离26～52mm。IVU检查示显影不佳5例，发现单侧上尿路扩张并积水7例。7例术前行放射性核素肾动态显像，患肾肾小球滤过率（GFR）均低于正常，其中1例GFR〈10ml／min，1例巨大肾积水无功能。结果 11例行手术治疗，1例行内分泌治疗。术后病理检查均证实为输尿管子宫内膜异位症，异位病灶均位于输尿管下段。12例随访3～110个月。1例术后19个月肾积水复发，予以内置输尿管支架，配合注射戈舍瑞林治疗后痊愈。余11例定期复查B超，积水未复发。结论 输尿管子宫内膜异位症多引起隐匿性尿路梗阻，确诊有赖于影像学检查及输尿管镜检，治疗的主要原则是解除梗阻、消除症状、保护肾功能。本病治疗主要有激素治疗和手术治疗，预后良好。     

子宫内膜异位症伴不育治疗进展

子宫内膜异位症(EMT)导致不育的治疗方法主要有药物、手术、手术药物联合、辅助生殖技术(ART)等。近年提倡先行腹腔镜手术以解除解剖方面的因素,ART也逐渐成为EMT伴不育患者的一线治疗方案。另外免疫调节剂和细胞因子调节剂的动物实验结果也提供了非激素药物治疗的新方向。     

肛周子宫内膜异位症二例

例 1　患者女 ,2 6岁。肛周包块伴间断性疼痛 4个月余 ,经前 2d加重。孕 2产 1,自然分娩 ,3年前人工流产 1次 ,避孕环避孕。肛门检查 :肛缘平整 ,截石位 2点距肛缘2cm处有一 3cm× 2cm包块 ,界限清 ,质硬 ,活动 ,轻压痛 ,未触及明显条索状物通向肛内。肛门指诊、镜检无异常。彩超示 :2点位见一 3 5cm× 1 5cm管道样结构 ,由肛管连于皮下 ,周边回声较低。提示肛周管状异常回声 (肛瘘 )。经毕第 16天 ,手术中见肛周皮下一约 3cm× 2cm硬结 ,中间有黑褐色血液样物 ,质硬 ,周围无管腔。病理诊断 :子宫内膜异位症。术后 8个月随访未复发。例 2　…     

中药治疗子宫内膜异位症患者的护理

目的探讨中药治疗内膜异位症(内异症)的给药方法及临床护理对策。方法对32例内异症患者采取口服给药、中药灌肠及药渣外敷的给药方法,并给予针对性的给药护理、情志护理、饮食护理及疼痛护理等。结果妇科检查均未发现新的病灶。2个疗程治疗与护理后,有效率93.6%。结论在中药治疗的基础上配合针对性的护理能显著提高临床治疗效果,改善患者的生活质量。     

微创外科时代胆道外科的前程与归宿

Bile duct has great attraction to surgeons due to its special anatomical location,unique biological features and origin of complicate diseases. Minimally invasive surgery,represented by laparoscopic ch...     

Mirror glasses for minimally invasive surgery

Introduction The operator performing minimally invasive surgery is prevented from seeing the whole field with both eyes by the restricted small thoracotomy incision. To overcome this problem, we developed mirror glasses. Methods Use of these glasses was evaluated in terms of the time required for threading of sutures with endoscopic forceps. Three surgeon ligated thread a suture five times with and without use of the glasses in the box, and the mean time was calculated for each surgeon. Results The time required for ligation (mean ± SD) was 24.2 ± 2.9 s with mirror glasses and 27.0 ± 2.5 s without the glasses (p = 0.01). Conclusion The mirror glasses may be found useful for fine manipulation for minimally invasive surgery.     

贲门失弛缓症微创手术治疗体会

目的探讨贲门失弛缓症治疗的理想方法。方法总结12例贲门失弛缓症经胸小切口微创手术配合食管内水囊扩张的经验。结果治愈12例,术后反流性食管炎0例,无明显并发症。结论经胸微创手术加食管内水囊扩张术治疗贲门失弛缓症疗效确切、手术简单、创伤小、恢复快、不良反应小、近期疗效较好,值得推荐。但远期疗效仍需随访观察。     

Complications during minimally invasive knee surgery

Since their advent, minimally invasive surgical techniques have achieved good results in knee arthroplasty, earning the approval of many orthopaedic surgeons. The advantages offered by this type of surgery are the respect of the extensor system, early functional recovery and reduced pain. As always in surgery, in order to obtain such results, various problems have been tackled, some of which have now been overcome thanks to the new instruments that are better suited to restricted incisions, whereas others still cause significant complications. The excessive forces exercised on the soft tissues and patella can damage the tissues despite the less invasive incision. All the statistics provided by surgeons who most frequently use these techniques show complications due to the use of a minimally invasive technique that can be avoided with the standard techniques, which have given outstanding results for a long time. Above all, implantation accuracy appears to be reduced through a small incision. The highest complication rates are reported in the quadriceps-sparing technique, which does not allow a perfect view of the joint. In this review, we highlight the possible complications associated with this “new” surgical approach, which still requires further evolution in order to achieve the same results as the standard technique.     

Long-term results of minimally invasive surgery for symptomatic epiphrenic diverticulum

Background

The real incidence of epiphrenic diverticulum is unknown, and only 15% to 20% of cases are symptomatic.

Methods

From January 1994 to May 2009, 20 patients were treated laparoscopically for this condition.

Results

The most common operation performed was transhiatal diverticulectomy with myotomy and partial fundoplication. No case was converted to open surgery. Esophageal leak occurred in 1 patient (5%). The postoperative courses were uneventful in the remaining 19 patients. After a median follow-up period of 52 months (range, 1–141 months), 1 patient had died of squamous cell carcinoma, 1 had mild solid-food dysphagia, 1 had chest pain, and 1 had heartburn. Manometry was performed postoperatively in 7 patients; all had normal lower esophageal sphincter pressure. In 5 patients who underwent 24-hour postoperative pH monitoring, pathologic reflux was absent.

Conclusions

In patients with symptomatic epiphrenic diverticulum, laparoscopic surgery is feasible, providing good access to the distal esophagus and inferior mediastinum. Long-term outcomes are satisfactory.     

微创手术平台与微创手术方式的未来走向

近30年来,随着能量平台、器械平台、显像平台三大手术平台的发展,微创外科有了突飞猛进的提升。以结直肠癌手术为例,手术方式的五要素都有着不同程度的发展：手术入路经历了"从大到小"的过程;切除范围从单纯肠段切除到根治术或扩大根治术,再到注重保留器官功能的手术;随着对正常淋巴引流方向和肿瘤淋巴转移特点的认知,淋巴结清扫愈趋规...     

Minimally invasive spinal surgery

Recent advances in endoscopy, imaging and retractor technology have led to major developments in minimal access surgery of the spine. Their place in practice probably awaits the results of prospective trials.     

质量赢未来:我国微创外科的发展路径

医疗质量始终是医疗技术得到发展的首要条件.要提高一项医疗技术乃至一个学科的水平和质量,首先需有正确的规范在质量控制上加以管理和约束以保障医疗质量;其次,需要有多中心协作、设计合理的临床研究以保障研究质量,为其进一步发展推广提供坚实可信的数据基础;再次,需要有完善的人才培养和培训体系以保障人才质量,为其发展提供源源不断的新生力量;最后,尚需有创新思维和理念,推动其在未来竞争中不断获得更高层次的发展.     

机器人微创心脏手术的应用现状

微创是心脏外科的发展方向之一.随着自动机械和计算机技术的进步,机器人微创外科手术已成为现实.机器人微创心脏手术具有创伤小、操作精细等优点,是微创心脏外科的前沿技术之一.作为一种革新的手术方式,机器人辅助下微创心脏手术得到了极大的关注,本文就机器人心脏手术的临床应用及手术效果作一综述.     

胸腰椎微创手术体表定位器的研制及临床应用

目的评估胸腰椎微创定位器在胸腰椎手术术前定位中的应用价值。方法将自2013-01—2014-01诊治的94例胸腰椎疾患拟行手术治疗,均采用微创定位器法、脊柱定位尺法、解剖定位法（髂嵴定位法或肋骨定位法）和克氏针定位法进行术前体表定位,并对4种不同定位方法的定位时间、透视次数及定位准确率进行比较分析。结果应用微创定位器法、脊柱定位尺法、解剖定位法和克氏针定位法的准确率分别为100.00%、79.79%、45.74%、41.49%;定位时间分别为（1.50±0.35）min、（1.90±0.28）min、（1.20±0.13）min、（2.60±0.24）min;透视次数分别为1.00次、（1.90±0.26）次、0次、（3.00±0.31）次。结论定位器定位后的手术靶点穿刺偏差率小,提高定位穿刺的准确性以及穿刺的成功率,并且减少手术操作者和患者的X线接触量。