腹膜后腹腔镜手术治疗右肾囊肿及右肝囊肿1例报告并文献复习

目的:探讨腹膜后腹腔镜手术治疗右肾囊肿合并右肝囊肿的可行性及安全性。方法:分析腹膜后腹腔镜手术治疗右肾囊肿合并右肝囊肿1例患者的临床资料,并结合国内外文献进行分析。结果:患者顺利完成腹膜后腹腔镜右肾囊肿去顶术及右肝囊肿开窗术,手术时间约60 min。结论:腹膜后腹腔镜右肾囊肿去顶术可同时行右肝囊肿开窗术,手术操作方便、安全、有效。     

苗勒氏管源性囊肿3例诊治报告并文献复习

目的 探讨苗勒氏管源性囊肿的诊断与治疗方法.方法 2010年3～9月收治3例盆腔囊肿患者.回顾3例患者的诊治过程,结合文献复习讨论其临床、影像表现及治疗方法.结果 1例盆腔、会阴部巨大囊肿在全麻下行会阴部囊肿切除联合盆腔囊肿切除,术中见肿块呈多房囊性,囊肿血供丰富.1例行腹腔镜下囊肿切除.2例术后病理诊断均为"苗勒氏管源性囊肿",术后随访6～11个月未见囊肿复发.另1例经影像检查诊断,予随访观察.结论 B超、CT、MRI检查均可发现盆腔苗勒氏管源性囊肿包块,确诊依赖病理学检查,手术切除安全有效.     

阴囊多发表皮样囊肿1例报告并文献复习

目的：探讨阴囊表皮样囊肿的临床特征和诊疗方案。方法：对1例阴囊多发表皮样囊肿临床资料进行分析,结合相关文献进行复习并讨论。结果：本例患者阴囊多发肿块,进行性长大,触之质软,无疼痛等不适。仔细体检,术前行活组织病理检查诊断为阴囊表皮样囊肿,术后切除病变组织块送病检证实为阴囊表皮样囊肿。随访3个月无明显不适。结论：阴囊多发表皮样囊肿是阴囊罕见的良性肿瘤,一般无明显不适,诊断主要依靠病理检查。手术切除肿瘤后患者预后良好,但易复发。     

手辅助腹腔镜腹部肿瘤切除术

目的 探讨手辅助腹腔镜腹部肿瘤切除术手术技术。方法 应用手辅助腹腔镜技术结合吻合器及超声切割止血刀完成直肠癌切除1例，乙状结肠癌切除2例，胃壁平滑肌瘤切除1例，胆囊、胆总管结石并左侧腹巨大肠系膜囊肿行胆囊切除、胆总管探查、囊肿切除1例。结果 5例患者术后恢复良好，失血量最多为100m1。结论 手辅助腹腔镜技术操作安全，损伤小，将是腹腔镜大器官切除的新方向。     

1295例盆腔混合性肿块术前良恶性评估的多因素分析与个体化腹腔镜手术的研究

目的探讨盆腔混合性肿块术前评估良恶性的相关因素以及个体化的腹腔镜手术方法。方法回顾性分析2006年1月～2010年10月1295例经过超声和妇科检查诊断为盆腔混合性肿块行腹腔镜手术治疗者的临床资料。结果 1232例（95.1%）经腹腔镜病理诊断为良性肿瘤,其中681例（52.6%）行囊肿剔除术,372例（28.7%）行附件切除术,179例（13.8%）行输卵管切除、整形、盆腔粘连松解术。63例（4.9%）术中冰冻病理为恶性或交界性肿瘤,其中3例行腹腔镜下卵巢癌根治术,16例中转开腹行根治、肿瘤细胞减灭手术,20例行患侧附件切除术,8例行肿瘤剔除术（其中6例在术后石蜡病理明确后行二次手术切除患侧附件并行化疗）,16例仅行活检术（其中8例在新辅助化疗后行开腹肿瘤细胞减灭术）。患者术前出现腹部不适,超声发现肿瘤直径〉6 cm、附壁乳头状突起、盆腔积液以及伴有肿瘤指标CA125、CEA升高者患恶性肿瘤的比例高于良性。这些单因素行Logistic回归分析,肿瘤直径〉6 cm、附壁乳头状突起、盆腔积液、CA125升高提示肿块恶性可能大。结论盆腔混合性肿块95%以上为良性肿瘤。术前认真评估肿块性质行个体化腹腔镜手术是诊治盆腔混合性肿块安全有效的方法。     

腹腔镜下腹膜后巨大假性囊肿切除术1例报告

2015年1月我科行腹腔镜下腹膜后巨大假性囊肿切除术1例,手术顺利,手术时间120 min,出血量45 ml,术后随访6个月,无并发症,无复发。我们认为只要术者具备丰富的开放腹膜后肿瘤切除经验和熟练的腹腔镜操作技能,选择合适患者,腹腔镜下囊性肿瘤切除术是一种安全、有效的术式。     

腹膜后囊性占位诊疗体会及文献复习(附3例报告)

目的:提高对腹膜后囊性占位的认识、诊治经验。方法:对收治3例腹膜后疑难囊肿的临床资料、诊治过程进行总结,并结合相关文献对其诊断及治疗进行探讨。结果:3例患者术前诊断分别为肾囊肿、2例腹膜后囊肿,2例通过腹腔镜下囊肿去顶减压术,1例通过开放性手术行去顶减压术。术后病理诊断为胰腺囊肿、淋巴管瘤性囊肿、肾上腺囊肿。术后随访6个月~2年未见复发。结论:腹膜后囊肿大多为良性疾病,早期临床症状不明显,随着囊肿体积增大压迫周围组织、器官出现相应的症状、体征,超声检查容易早期发现,在囊肿体积较小CT、磁共振检查更有利于明确囊肿来源及性质。     

原发性腹膜后巨大淋巴管瘤1例报告并文献复习

目的：提高原发性腹膜后淋巴管瘤的诊治水平。方法：报道1例原发性腹膜后淋巴管瘤患者的诊治过程,术前诊断腹膜后囊肿,行单孔腹腔镜双侧腹膜后囊肿切除术。结果：术后病理（腹膜后囊肿）检材由扩张的淋巴管组成,囊壁由内皮细胞、平滑肌及纤维组织组成,符合腹膜后淋巴管瘤。术后随访6个月未见复发。结论：原发性腹膜后淋巴瘤是一种良性病变,临床罕见,确诊需结合术后病理和影像学表现,手术切除是最佳治疗方式。     

原发性精囊癌2例诊治分析

目的探讨原发性精囊腺癌的临床表现、影像学特点及诊治方法。方法分析收治的原发性精囊腺癌患者2例,其中1例合并巨大多分隔精囊囊肿,并结合文献进行复习。结果 1例术前行前列腺穿刺活检阴性,行前列腺电切术后病理证实为偶发癌,2个月后二期行开放前列腺癌根治术后确诊为精囊癌;另一例术前经CT及经直肠超声可见盆腔巨大囊性多分隔肿物,未见正常前列腺及精囊结构,代之以多房囊肿,行腹腔镜下盆腔囊肿切除术,术中冰冻病理诊断为精囊癌,转行开放性前列腺根治术。两例术后恢复良好,分别随访10年及7个月,未见复发转移。结论原发性精囊腺癌临床罕见,术前诊断较困难,影像学表现大致可分为3类,手术为主要治疗方式,切除范围应足够广泛。     

机器人辅助腹腔镜盆腔廓清术的初步经验——附1例报告

本文报道1例54岁宫颈癌复发患者使用达芬奇机器人手术系统(da Vinci S)施行盆腔廓清术的初步经验。初次治疗行放疗外照射,随后行腹腔镜广泛全子宫切除+双侧附件切除联合盆腔淋巴结清扫术。术后6个月经阴道超声检查和盆腔CT检查均提示宫颈残端上方可见直径约2.8 cm包块,与膀胱后壁及直肠右前壁分界不清。使用达芬奇机器人手术系统共4臂进行手术,切除宫颈残端病灶及部分致密粘连的膀胱壁和病变肠管,并行耻骨联合上膀胱造瘘和结肠腹壁造瘘。手术时间480 min(自建立气腹至手术结束),出血量1200 ml。术后一般状况良好,术后第29天出院。术后病理:中分化鳞状细胞癌。术后3、6个月随访恢复好,未诉不适。我们认为达芬奇机器人系统辅助腹腔镜盆腔廓清术治疗难治性、复发性妇科肿瘤较传统手术具有操作精细灵活、创伤小、切除彻底的优势。     

后腹腔镜下右侧巨大肾上腺肿瘤切除的手术技巧

目的:探讨后腹腔镜下切除右侧巨大肾上腺肿瘤(最大径≥6cm)的可行性及手术技巧。方法:采用后腹腔镜下右侧巨大肾上腺肿瘤切除术治疗右侧巨大肾上腺肿瘤患者18例,肿瘤最大径为6~19(8.4±0.69)cm。术中按3个相对无血管平面分离,在腹侧平面游离时尽量将腔静脉与瘤体分开,并显露肾上腺中央静脉,在背侧平面分离时尽量向内侧中线分离,形成基于腔静脉与腰大肌之间的倒三角形肿瘤基底部。抬起瘤体,逐步向上离断汇入基底部的动脉血供,切除肿瘤。结果:除1例患者因粘连转为开放手术外,17例均顺利完成腹腔镜下肿瘤切除,手术时间80~210(147.9±7.6)min。术后病理检查报告为髓质脂肪瘤8例,嗜铬细胞瘤4例,节细胞神经纤维瘤3例,性索间质瘤1例,肾上腺囊肿伴囊壁钙化囊内出血1例。17例腹腔镜肿瘤切除手术均无术中术后输血。结论:后腹腔可以获得巨大的手术空间,术中妥善处理富含动脉血供的肿瘤基底部可以安全切除体积巨大的肿瘤。     

机器人辅助腹腔镜腹膜后肿瘤切除术的初步经验——附1例报告

目的探讨应用达芬奇机器人手术系统行后腹膜肿瘤切除术的安全性及手术效果。方法通过使用达芬奇机器人辅助腹腔镜手术系统行经腹人路的复杂腹膜后肿瘤切除术。患者为56岁女性,高血压病史5年,cT提示腹膜后6cm左右类圆形肿块,血供丰富,肿瘤紧邻胰腺钩突和十二指肠后方,位于腹主动脉及下腔静脉之间,并压迫下腔静脉。结果手术取得成功,无中转开腹,无重要脏器、血管损伤。手术时间240min,出血量约200ml,术中血压平稳。术后恢复顺利,无并发症,于术后11天出院。病理为腹膜后副神经节瘤。结论机器人辅助微创手术系统能安全有效地进行腹腔内深在位置或大血管旁的腹膜后肿瘤的手术治疗。     

Giant extradural epidermoid cyst of the posterior fossa

We report an unusual case of giant extradural epidermoid cyst of the posterior fossa in a 73-year-old man. The patient presented headache and gait disturbance for 3-4 months, cerebellar ataxia, left cerebellar dysmetria, and perturbed balance. The CT-scan showed a huge posterior fossa extradural lesion with a small area of peripheral contrast enhancement. Outcome was good after total resection of the lesion via a suboccipital approach. Pathology reported an epidermoid cyst. Extradural epidermoid cyst is a rare benign tumor of the skull which sometimes can reach considerable size. It is a slow growing lesion and may cause mild neurological deficits. The goal of surgical treatment is total resection of the tumor with its capsule. The long-term prognosis is excellent after successful resection.     

肾表皮样囊肿1例报告并文献复习

目的探讨肾表皮样囊肿的临床特点、诊断和治疗方法。方法回顾分析1例肾表皮样囊肿伴肾结石患者的临床资料。结果患者行根治性右肾切除,病理报告为右肾表皮样囊肿。患者术后1周痊愈出院,随访10个月未见肿物复发转移。结论肾表皮样囊肿为罕见的肾脏良性肿瘤,临床上报道极少。临床症状缺乏特异性,诊断较困难,需与肾脏肿瘤、囊性肾癌等相鉴别。     

后腹腔镜肾盂癌根治性切除术后穿刺孔种植转移1例体会

目的:探讨后腹腔镜肾盂癌根治性切除术穿刺孔肿瘤种植的诊断治疗、预防措施等。方法:分析2004年9月诊治的1例后腹腔镜肾盂癌根治性切除术后穿刺孔肿瘤种植病例的临床资料。结果:该例肾盂癌患者行后腹腔镜肾输尿管全长及膀胱袖状切除术后3月发生穿刺孔种植转移,表现为穿刺孔处质硬肿块,病理证实为移行上皮癌,但无法找到原发病灶。行肿块扩大切除后辅以局部放疗及全身化疗,随访12个月,未见肿瘤复发及转移。结论:后腹腔镜肾盂癌根治性切除术可能引起术后穿刺孔肿瘤种植转移。经过系统的治疗,预后良好。认识其临床表现与发病机制,有利于更好的指导临床工作。     

盆腔局灶型Castleman病致输尿管梗阻1例报告并文献复习

目的:探讨盆腔局灶型Castleman病(Castleman’s disease,CD)的临床特点及诊治方法。方法:对1例因盆腔占位压迫输尿管引起肾积水的患者进行实验室和影像学检查,并于全麻下行腹腔镜下盆腔肿块切除术。结果:手术时间30min,术中出血10ml。术后第3天出院,恢复良好。术后病理检查示Castleman’s病(巨大淋巴结增生症)血管滤泡型。随访6个月,未见疾病复发或转移。结论:盆腔局灶型Castleman病是一种罕见的盆腔疾病,常以无痛性淋巴组织肿大或肿块压迫症状而就诊。治疗方法首选手术。腹腔镜微创手术比传统开放手术在术中创伤、出血量、术后恢复、美观性等方面的优越性明显,对于盆腔局灶型CD,可优先考虑行经腹腔镜切除,预后良好。     

Primary cauda equina epidermoid cyst. A case report

A primary epidermoid cyst of the cauda equina was diagnosed in an eleven-year-old boy. The patient had a previous two months history of lumbar pain with unilateral L 4 radicular pain. The diagnosis of an epidermoid cyst of the cauda equina, suspected by MRI, was confirmed by histology following surgery. Wide tumor resection, as complete as possible, was performed with minimum trauma. Presence of an epidermoid cyst in the filum terminale is a rare finding, few cases have been reported in the literature. However, surgical treatment and favorable post-operative course are similar to that observed in intraspinal localizations. MRI is helpful for the preoperative and differential diagnosis and for post-operative follow-up.     

Pulmonary sequestration presenting as retroperitoneal cyst: case report

A 21-year-old woman presented with flank pain, and an abdominal and pelvic CT scan demonstrated a left 7.4-cm simple cyst superior to the left kidney. She underwent laparoscopic cyst decortication complicated by a diaphragmatic injury and pneumothorax. The final pathology report described a retroperitoneal pulmonary sequestration (RPS). Urologists need to consider RPS in the differential diagnosis of a retroperitoneal cyst because of the associated morbidity of hemorrhage during surgical excision. With the widespread use abdominal imaging techniques, more cases of RPS are likely to be identified and referred for laparoscopic management.     

Total splenectomy for a recurrent giant splenic cyst

Primary splenic cysts are a rare finding. Some are large and require surgical removal. The Authors report a case of a recurrent huge splenic cyst in a 41-year-old female patient. A marsupialization was performed at another hospital 6 years before. Ultrasonography and computed tomography imaging revealed a cystic lesion in the spleen measuring approximately 20 cm in diameter. A total open splenectomy was performed. Postoperative course was uneventful. The histologic diagnosis was an epithelial cyst of the spleen with no atypical cells in the cyst wall, as previously found at the first operation. The epidermoid cysts have an epidermal lining, and prevention of recurrence is dependent on complete resection of the cyst wall preserving, whenever possible, the splenic tissue. Recurrence can be avoided with partial splenectomy in polar localization of the cyst, or complete removal of the cyst by "peeling" it off the splenic parenchyma. Marsupialization of the cyst, either via a laparoscopic or an open approach, is often ineffective.