经腹膜外入路腹腔镜前列腺癌根治术（附16例报告）

目的总结经腹膜外入路腹腔镜前列腺癌根治术的临床体会。方法回顾性分析2010年10月至2011年12月,采用四孔经腹膜外入路行腹腔镜前列腺癌根治术治疗局限性前列腺癌患者16例的临床资料。结果本组16例手术全部顺利完成,9例同期行盆腔淋巴结清扫术,无一例中转开放。手术时间150～420min,平均270min。术中出血量50～2000ml,平均534ml,4例术中输血400～800ml,输血率25%。术后病理报告切缘阳性1例（6.2%）。术后4～15d出院,平均8d。所有患者留置尿管2周,拔除尿管后无真性尿失禁。随访3～17个月,8例昼夜控尿良好,8例白天偶有压力性尿失禁,其中1例术后4个月出现吻合口狭窄。9例患者术后可勃起,其中1例行保留神经的前列腺癌根治术患者术后1个月可正常进行性生活。结论经腹膜外入路腹腔镜前列腺癌根治术具有创伤小、出血少、操作容易、并发症少等优点,是开展腹腔镜前列腺癌根治术的较好选择。     

经腹腔入路腹腔镜前列腺癌根治术（附10例报告）

目的探讨经腹腔入路腹腔镜前列腺癌根治术的临床疗效。方法 2006年7月至2010年11月,采用五孔经腹腔入路对10例T1、T2期前列腺癌进行根治性切除,其中T1期1例,T2期9例,平均年龄67岁。结果平均手术时间186min,平均出血量约150ml,1例中转开放。均未输血,无并发症发生。随访2～52个月,所有患者排尿通畅,8例昼夜排尿完全控尿,2例夜间有轻微遗尿。无局部及远处转移。结论经腹腔入路腹腔镜前列腺癌根治术具有创伤小、出血少、操作容易、并发症少等优点,是初开展腹腔镜前列腺癌根治术的较好选择。     

机器人辅助腹腔镜前列腺癌根治术患者体位的安全管理

目的 探讨机器人辅助腹腔镜前列腺癌根治术患者体位安置的安全护理方法.方法 对100例机器人辅助腹腔镜前列腺癌根治术患者设计专项护理方案,包括患者评估、体位安置方法、皮肤预警及加强护理措施、术后评估与回访.结果 100例患者实施机器人辅助腹腔镜前列腺癌根治术,无因体位安置不当而造成皮肤损伤.术中手术体位得当稳固,未发生皮肤和神经损伤,术后回访无不适,无下肢静脉血栓等并发症发生.结论 机器人辅助腹腔镜前列腺癌根治术患者体位有其特殊性,采取有计划的护理措施是安全护理的关键.     

Transanal total pelvic exenteration in the prone jackknife position for rectal cancer invading the bladder,seminal vesicles,and small intestine

A 58-year-old man had rectal cancer directly invading the urinary bladder and small intestine, without distant metastasis. We successfully performed complete resection using a hybrid approach, including laparoscopic surgery and transanal total pelvic exenteration (TaTPE) with the patient in the prone jackknife (PJK) position. In the PJK position, gravity and pelvic morphology lead to a clear and wide surgical field. This case demonstrates that total pelvic exenteration using laparoscopic surgery and TaTPE in the PJK position provides a better surgical field than either TaTPE or laparoscopic surgery in the supine position. TaTPE in the PJK position may also be useful for curative surgery in locally advanced rectal cancer.     

探讨麻醉选择与手术体位对妇科腔镜手术的干预

目的探讨麻醉选择与手术体位对妇科腔镜手术的干预。方法回顾性分析我院2008年10月-2009年8月腹腔镜手术220例,宫腔镜手术200例,手术中采用适合手术的体位及麻醉。结果均能顺利完成手术,避免因麻醉及体位不当而造成的相关并发症。结论适当手术体位的设置及适合的麻醉选择,不仅有利于手术的操作又能确保患者的安全。     

两种手术体位在胃肠外科腹腔镜手术中安全性的随机对照研究

目的探讨截石位和剪刀位在胃肠外科腹腔镜手术中的安全性。方法选择胃肠外科腹腔镜手术患者258例为研究对象,随机分为截石位组和剪刀位组,每组各129例。观察两组安置手术体位所耗时间、术毕体位恢复水平卧位时间、术后体位相关并发症(下肢深静脉血栓、肌力下降等),以及术后患者主观感受(下肢麻木、腿痛等)。结果截石位组安置体位所耗时间为(427±61)s,术毕体位恢复水平卧位时间为(252±57)s,剪刀位组安置体位所耗时间为(185±43)s,术毕体位恢复水平卧位时间为(144±47)s。与截石位组比较,剪刀位组体位安置时间和体位恢复水平卧位时间均明显缩短,差异有统计学意义(P0.05);截石位组发生1例下肢深静脉血栓,剪刀位组0例,差异无统计学意义(P0.05);截石位组肌力小于Ⅴ级7例,剪刀位组肌力小于Ⅴ级2例,差异有统计学意义(P0.05);术后第一天截石位组患者自述下肢麻木有23例,腿痛12例(疼痛评分3分3例、2分9例),剪刀位组患者自述下肢麻木6例,腿痛1例(疼痛评分3分0例、2分1例),差异有统计学意义(P0.05)。结论剪刀位较截石位应用于胃肠外科腹腔镜手术中,更加安全有效。     

解剖性耻骨后根治性前列腺切除术

虽然近年来腹腔镜手术及机器人辅助腹腔镜手术发展迅速,但解剖性耻骨后根治性前列腺切除术仍是治疗局限性前列腺癌的金标准。经过20多年的不断改进与创新,这项手术技术无论在安全性还是从有效性上都得到了很大的提高,同时也存在一定的并发症,如术中出血、直肠损伤、术后尿失禁、勃起功能障碍等。本文结合临床经验体会,对解剖性耻骨后前列腺癌根治术的要点进行详尽探讨,并对近年来手术技巧方面的改进作一简要阐述。     

A case of esophageal cancer with an aberrant right subclavian artery treated with mediastinoscopic esophagectomy

An aberrant right subclavian artery (ARSA) is one of the famous anatomical abnormalities with a prevalence of 0.16–4.4%. In esophagectomy, anatomical abnormalities of the ARSA could cause complications with some surgical procedures. An 85-year old man was referred to our department for esophageal adenocarcinoma that was at a slightly high position for esophagectomy with the abdominal approach. However, he had a significant past medical history. This risk factor made it difficult to perform thoracoscopic esophagectomy. He underwent mediastinoscopic esophagectomy (ME) with the left cervical and laparoscopic approach. The ARSA presented no difficulties with the ME surgical technique including the dissection of the left recurrent laryngeal nerve lymph node. Although this patient had a respiratory dysfunction and some difficulties in a prone position, ME enabled a safe esophagectomy with lymph node dissection.     

Massive subcutaneous emphysema and hypercarbia: complications of carbon dioxide absorption during extraperitoneal and intraperitoneal laparoscopic surgery--case studies

The laparoscopic approach to surgery is being used with greater frequency as our healthcare system continues to strive for shorter hospital stays and improved postoperative patient recovery times. However, laparoscopy is not without potential complications. This article presents 2 patient case studies. The cases differ in surgical technique. One patient's laparoscopic surgery involved an extraperitoneal approach. The second patient's surgery involved an intraperitoneal approach. Massive subcutaneous emphysema developed in both patients. The phenomenon of subcutaneous emphysema associated with laparoscopic surgery will be defined and discussed.     

Application of a modified surgical position in anterior approach for total cervical artificial disc replacement

BACKGROUND Total cervical artificial disc replacement(TDR)has been considered a safe and effective alternative surgical treatment for cervical spondylosis and degenerative disc disease that have failed to improve with conservative methods.Positioning the surgical patient is a critical part of the procedure.Appropriate patient positioning is crucial not only for the safety of the patient but also for optimizing surgical exposure,ensuring adequate and safe anesthesia,and allowing the surgeon to operate comfortably during lengthy procedures.The surgical posture is the traditional position used in anterior cervical approach;in general,patients are in a supine position with a pad under their shoulders and a ring-shaped pillow under their head.AIM To investigate the clinical outcomes of the use of a modified surgical position versus the traditional surgical position in anterior approach for TDR.METHODS In the modified position group,the patients had a soft pillow under their neck,and their jaw and both shoulders were fixed with wide tape.The analyzed data included intraoperative blood loss,position setting time,total operation time,and perioperative blood pressure and heart rate.RESULTS Blood pressure and heart rate were not significantly different before and after body positioning in both groups(P>0.05).Compared with the traditional position group,the modified position group showed a statistically significantly longer position setting time(P<0.05).However,the total operation time and intraoperative blood loss were significantly reduced in the modified position group compared with the traditional position group(P<0.05).CONCLUSION The clinical outcomes indicated that total operation time and intraoperative blood loss were relatively lower in the modified position group than in the traditional position group,thus reducing the risks of surgery while increasing the position setting time.The modified surgical position is a safe and effective method to be used in anterior approach for TDR surgery.     

Minimizing Patient Risk During Laparoscopic Electrosurgery

By the year 2000, many surgical procedures will be performed laparoscopically. When used appropriately, this technique is less disruptive to tissues than open surgery. It results in faster patient recovery time with less pain, fewer wound complications, and less scarring. As this technology is increasing, it is important to develop and implement perioperative safety precautions to reduce the risks associated with laparoscopic electrosurgery. Using the safety precautions outlined in this article may substantially reduce iatrogenic complications that can occur with these surgeries and result in better patient outcomes. AORN J 67 (June 1998) 1194–1205.     

改良经腹入路全腹腔镜下上尿路 上皮癌根治术的临床研究

目的评价改良的经腹入路腹腔镜下上尿路上皮癌根治术的手术技巧及临床效果。方法对郑州大学附属洛阳中心医院2013年9月-2018年4月收治的104例上尿路上皮癌患者随机分为两组。51例侧卧位行经腹入路腹腔镜下切肾后,改平卧位下腹部切口处理输尿管膀胱连接部并取出标本(标准组);53例行改良经腹入路全腹腔镜下上尿路上皮癌根治术(改良组)。比较两组患者的手术时间、术中出血量、术后疼痛程度、住院时间,术后引流量和术后短期并发症发生率等临床指标。术后疼痛程度评估采用疼痛数字评定量表(NRS)。结果改良组手术时间及住院时间明显少于标准组,差异均有统计学意义(P<0.05),改良组术后疼痛程度较标准组轻,术后引流量少,差异均有统计学意义(P<0.05)。改良组术中出血量虽较标准组少,但两组比较,差异无统计学意义(P>0.05)。标准组术后出现短期并发症11例(21.6%),改良组4例(7.5%),改良组明显少于标准组(P<0.05)。结论改良经腹入路全腹腔镜下上尿路上皮癌根治术是一种安全有效的手术方法,值得临床推广。     

腹腔镜在上消化道穿孔修补术中的应用技术探讨

目的探讨腹腔镜在上消化道穿孔修补术中的应用可行性和技术探讨。方法对近几年使用腹腔镜和开腹手术修补治疗上消化道溃疡穿孔各37例和52例的临床资料进行回顾性分析和讨论。结果两组无围手术期死亡病例和严重并发症；两组的手术时间和溃疡愈合方面无明显差异；但在肛门恢复排气、住院时间、并发症和病员满意度调查方面，腹腔镜组明显优于开腹组。结论腹腔镜技术在上消化道穿孔修补术中的应用是确切可行的，只要精心操作、合理治疗，腹腔镜具有操作简便、安全有效、创伤较小、恢复较快等优点，是一个理想的治疗方式。     

Laparoscopic splenectomy with a vessel sealing device

When compared with open splenectomy, laparoscopic splenectomy was associated with fewer complications, however, with more hemorrhagic complications. Furthermore, the mean operative time for laparoscopy was significantly longer than for the open procedure. Vessel sealing systems are represented as decreasing operative time and blood loss in several surgical procedures. The aim of this study is to evaluate the blood loss and operating time of laparoscopic splenectomy with a vessel sealing system. We evaluated 19 laparoscopic splenectomies with a vessel sealing device, particularly focusing on operative blood loss and operating time. Patients were operated in the right lateral decubitus position usually with three ports. In all cases, dissection of the spleen and sealing of hilar vessels and short gastric vessels were performed with a vessel sealing system. No clips, sutures, or monopolar–bipolar diathermy were used. Mean operative blood loss was 88ml (range 20–400?ml) and mean operative time was 107 minutes (range 45–230?minutes). Both results were better than those of most series of laparoscopic splenectomy performed with endostaplers or endoclips. Laparoscopic splenectomy with a vessel sealing system is safe for all vascular controls in laparoscopic splenectomy and can lead to less blood loss. This technique removes the disadvantage of longer operating times for laparoscopic as compared to open splenectomy.     

Incarcerated obturator hernia treated using a hybrid laparoscopic and anterior preperitoneal approach: A case report

Obturator hernia (OH) is a rare cause of bowel obstruction. Although several surgical approaches, including the laparoscopic approach, have been reported to date, a standard approach for treating OH has not been established. A 101‐year‐old woman who presented with constipation and vomiting was admitted to our hospital. CT revealed an incarcerated small bowel within the left obturator foramen, and a diagnosis of left‐sided incarcerated OH with small bowel ileus was made. With the patient under general anesthesia, exploratory laparoscopy was performed; we identified an OH with an incarcerated small bowel, which was judged viable after hernia reduction. We repaired the hernia using an anterior preperitoneal approach under laparoscopic assistance and placed a prosthetic mesh over the obturator foramen. The patient recovered with no postoperative complications and was discharged on postoperative day 4. A hybrid laparoscopic and anterior preperitoneal approach is safe and effective for treating an incarcerated OH in an elderly patient.     

图片式体位解释法对手术室患者体位配合程度及并发症的影响

目的 探讨图片式体位解释法对手术室患者体位配合程度及相关并发症的影响.方法 选取医院2018年1—10月收治的外科手术患者180例为研究对象,按照患者性别、年龄、体重、科室来源、手术体位及文化程度组间均衡可比的原则,分为对照组和观察组,每组90例.对照组单纯以语言方式解释手术体位,观察组结合图片式体位解释法,比较两种不...     

Combined laparoscopic and perineal approach for the management of recurrent tailgut cyst

Tailgut cyst is an uncommon developmental anomaly arising from the embryonic hindgut in the retrorectal space. The patient frequently is asymptomatic or has vague perineal complaints that pose a diagnostic dilemma. Moreover, the patient is often misdiagnosed and therefore mismanaged. MRI is the investigation of choice for diagnosis. After the diagnosis is established, complete surgical excision is required to alleviate patient discomfort and to prevent complications such as infection, malignant transformation, and recurrence. Proper clinical examination and imaging not only establish the accurate diagnosis but also help in determining the best surgical approach for the patient (anterior abdominal, posterior sacral perineal, or combined approach). We hereby report a case of recurrent tailgut cyst managed with a combined anterior laparoscopic and perineal approach.     

The Rottinger approach for total hip arthroplasty: technique and review of the literature

The surgical approach utilized in total hip arthroplasty has been identified as a factor that may affect surgical outcomes. There have been many different approaches and modifications used since the procedure was popularized by Sir John Charnley. The popular approaches today can be grouped by their relationship to the trochanter (anterior or posterior), patient position, leg position for dislocation/femoral preparation, and treatment of the abductors and short external rotators. The Rottinger approach is an anterior approach which utilizes the muscle interval between the tensor fascia lata and abductor musculature. The abductor attachments are preserved and the femur is prepared in extension, adduction, and external rotation. This approach has been shown in literature to be safe with some studies showing improved outcomes both in terms of reduced complications and better function than other standard approaches.     

混合现实技术辅助全腹腔镜下胰十二指肠切除术*

目的 探讨应用混合现实技术辅助全腹腔镜下胰十二指肠切除术(LPD)的可行性。方法选取中南大学湘雅医院肝胆胰外科收治的十二指肠肿瘤患者1例,术前检查完善,无绝对手术禁忌,拟行LPD。术前利用患者腹部CT对患者体表及靶病变进行三维重建及手术规划,术中应用混合现实(MR)技术导航手术入路、明辨重要解剖结构、辅助进行LPD,顺利完成手术。结果患者恢复顺利,无明显并发症,术后2周顺利出院。结论 MR技术对手术部位解剖结构重建及定位精确,有望为普外科手术带来更多的发展和进步,应用前景良好。     

腹膜后腹腔镜肾囊肿去顶术治疗肾囊肿30例报告

目的总结腹膜后腹腔镜去顶术治疗肾囊肿的临床体会并探讨其应用价值。方法对30例行腹膜后腹腔镜肾囊肿去顶术治疗的肾囊肿患者的临床资料进行回顾性分析。结果 30例患者均顺利完成腹膜后腹腔镜肾囊肿去顶术,无一例中转开放手术。手术时间20～60 min,平均30 min。术后住院3～7 d,切口一期愈合,随访3～24个月,无复发及并发症发生。结论腹膜后腹腔镜肾囊肿去顶术安全有效,其有出血少,创伤小,恢复快,不复发,对腹腔脏器无干扰,住院时间短等优点,是肾囊肿的较佳手术方法。