妇科腹腔镜手术271例临床分析

目的:探讨腹腔镜手术用于治疗妇科疾病的临床价值。方法:回顾分析为271例患者行腹腔镜妇科手术的临床资料,评价平均手术时间、术中出血量等指标。结果:271例均在腹腔镜下完成手术,包括腹腔镜全子宫切除术83例,次全切除术80例,子宫肌瘤切除术42例,附件切除术33例,附件囊肿剥除术28例,输卵管妊娠取胚术5例。2例(0.74%)发生并发症。结论:腹腔镜妇科手术患者创伤小,康复快,只要严格掌握手术适应证,大部分妇科良性疾病可用腹腔镜手术治疗。     

腹腔镜妇科手术并发症的防治体会

目的探讨腹腔镜妇科手术并发症的原因和防治措施,降低并发症的发生率。方法 2010-01—2014-01,实施腹腔镜妇科手术436例,发生并发症13例,占2.9%。对发生并发症患者的临床资料进行回顾性分析。结果 13例并发症中,腹腔镜下子宫切除术8例,其他类手术5例。7例(1.6%)为出血、感染及副损伤等严重并发症。6例为皮下气肿、皮下瘀癍和肩痛。结论随着腹腔镜手术例数增加及手术范围的扩大,手术并发症也随着手术难度增大而增加。术中及术后严密观察,针对并发症发生原因,及时诊断并采取有效防治措施,可以降低并发症的发生率。     

腹腔镜子宫切除56例临床分析

目的:探讨腹腔镜筋膜鞘内子宫切除术的临床价值。方法:回顾分析56例腹腔镜子宫切除术和50例剖腹子宫切除术的临床资料,比较两组术中、术后情况。结果:腹腔镜子宫切除术手术时间短,出血量少,术后恢复快,并发症率低,住院天数少。结论:腹腔镜筋膜鞘内子宫切除术优于传统的开腹手术,适于临床推广运用。     

老年患者腹腔镜全子宫切除手术体会

目的:探讨妇科腹腔镜对于老年患者全子宫切除术的可行性。方法:回顾分析2003年5月至2005年4月老年患者妇科腹腔镜全子宫切除手术32例;选择同期开腹子宫全切术54例老年患者为对照组。结果:腹腔镜组18例患者合并内外科疾病(占56%),32例手术均获成功,无1例出现术中及术后并发症,无1例转开腹手术。结论:腹腔镜全子宫切除术对于老年患者安全有效,但应加强围术期处理。     

腹腔镜淋巴结清扫术在早期妇科肿瘤肥胖患者中的应用

目的:评价腹腔镜广泛子宫切除术加双侧盆腔、腹主动脉旁淋巴结清扫术治疗妇科恶性肿瘤患者的应用价值。方法:回顾分析2009年6月至2013年9月为20例子宫内膜癌、宫颈癌患者行腹腔镜手术的临床资料,观察手术时间、术中出血量、切除淋巴结数量、术后肛门排气时间及术后并发症等指标,并与同期开腹手术进行对比分析。结果:20例腹腔镜手术均顺利完成,无一例中转开腹。两组手术时间、术中失血量、术后肛门排气时间、术后下床活动时间、切口感染或脂肪液化率差异均有统计学意义(P<0.01),清扫淋巴结数量、宫旁或阴道切除范围差异无统计学意义(P>0.01)。术后随访2~3年,两组患者均无复发。结论:相较传统开腹手术,腹腔镜手术具有患者创伤小、并发症少、术后康复快等优点,腹腔镜广泛子宫切除术加盆腔淋巴结切除术治疗肥胖早期妇科恶性肿瘤患者是安全、可行的。     

妇科腹腔镜手术并发症15例分析

目的探讨妇科腹腔镜手术发生并发症的原因。方法我院妇科2005～2009年共完成各种妇科腹腔镜手术1128例,发生感染、出血、器官损伤、异物残留等明显并发症15例,回顾性分析这15例的临床资料。结果术后感染5例,其中3例盆腔感染,均经加强抗感染治疗体温正常(肌瘤剔除1例术后10个月因一直下腹痛行子宫次全切除,病理示子宫伤口处与大网膜粘连并钙化);2例切口感染,引流、换药1周治愈。术后腹腔内出血7例,2例(腹腔镜子宫肌瘤剔除术1例,次全子宫切除术1例)出血快术后当天开腹手术止血,其余5例保守治疗治愈。输尿管损伤1例,腹腔镜下右附件切除术中电凝钳损伤输尿管,放置双J管2个月治愈。异物残留2例,负压引流管折断滞留腹壁筋膜下1例局麻下取出,滞留盆腔1例腹腔镜下取出。结论并发症的发生和手术相关人员对相关知识的掌握程度、术者技术的娴熟度、镜下解剖识别度及各环节工作是否仔细有关。     

腹腔镜下大子宫切除术86例报告

目的 探讨腹腔镜下巨大子宫切除术的手术技巧. 方法 回顾性分析1998年2月～2005年12月86例子宫超过12孕周行腹腔镜子宫切除手术的临床资料,其中12例腹腔镜下全子宫切除术（total laparoscopic hysterectomy,TLH））,59例腹腔镜子宫次全切除术（laparoscopic supracervical hysterectomy, LSH）和15例腹腔镜辅助阴式子宫全切除术（laparoscopic-assisted vaginal hysterectomy, LAVH）.手术中置镜位置采取在宫底上至少3～5 cm.手术关键步骤是处理附件及子宫血管,其中TLH和LAVH在阻断子宫血管后先旋切大部分宫体. 结果 86例全部在腹腔镜下完成手术,无一例中转开腹.1例术中出现皮下气肿,余无严重并发症发生.手术时间（92.3±33.5） min,术中出血量（113±31） ml,术后住院时间（4.1±0.3） d.86例随访6个月,无一例出现术后并发症. 结论 选择合适的置镜孔,处理好附件及子宫血管,腹腔镜下巨大子宫切除术安全、可行,不会增加手术危险性和手术并发症.     

妇科电视腹腔镜手术并发症的防治体会

<正> 1996年2月至12月我院共进行妇科电视腹腔镜手术33例,出现轻度皮下气肿1例,未发生严重并发症,现对腹腔镜手术并发症的预防及治疗探讨如下。 1 临床资料 本组33例,18～51岁,平均29岁,未产16例,经产17例。有腹部手术史8例(其中5例绝育术,2例阑尾切除术,1例胃大部切除术),主诉腹痛10例,月经异常6例,盆腔包块8例,不育6例,痛经3例。妇科检查、B超或CT发现有盆腔     

妇科腹腔镜手术并发症36例分析

目的 探讨妇科腹腔镜手术的并发症及其相关因素. 方法 回顾性分析本院近5年的705例腹腔镜手术病例及36例出现并发症的病例情况.手术包括附件手术570例,腹腔镜辅助的阴式子宫切除术105例,子宫肌瘤剔除术30例. 结果 并发症发生率为5.1％.需开腹手术处理者4例.附件手术、阴式子宫切除术及肌瘤剔除术的并发症发生率分别为1.8％、13.3％及3.3％.与穿刺及气腹有关的并发症14例,术中并发症6例,术后并发症16例. 结论 阴式子宫切除术并发症的发生高于子宫肌瘤剔除手术及附件手术.     

腹腔镜下同时完成胆囊、子宫切除术6例报告

目的 :探讨电视腹腔镜同时完成胆囊、子宫切除术的可行性及手术并发症的预防。方法 :回顾分析 6例的手术过程及随访结果。结果 :6例中 4例一次完成胆囊、子宫切除术 ,平均手术时间 16 0min ,胆囊切除术平均 4 0min ,子宫切除术平均 12 0min ;1例腹腔镜下切除子宫 ,开腹完成胆囊手术 ;1例腹腔镜下完成胆囊手术 ,开腹完成子宫手术。结论 :腹腔镜下同时完成两种手术不增加手术危险性及并发症及术后病率。同时完成两种手术减少了患者的痛苦及手术费用 ,术后患者康复满意     

Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.

OBJECTIVE: A prospective randomized study was undertaken to compare early with delayed laparoscopic cholecystectomy for acute cholecystitis. SUMMARY BACKGROUND DATA: Laparoscopic cholecystectomy for acute cholecystitis is associated with high complication and conversion rates. It is not known whether there is a role for initial conservative treatment followed by interval elective operation. METHOD: During a 26-month period, 99 patients with a clinical diagnosis of acute cholecystitis were randomly assigned to early laparoscopic cholecystectomy within 72 hours of admission (early group, n = 49) or delayed interval surgery after initial medical treatment (delayed group, n = 50). Thirteen patients (four in the early group and nine in the delayed group) were excluded because of refusal of operation (n = 6), misdiagnosis (n = 5), contraindication for surgery (n = 1), or loss to follow-up (n = 1). RESULTS: Eight of 41 patients in the delayed group underwent urgent operation at a median of 63 hours (range, 32 to 140 hours) after admission because of spreading peritonitis (n = 3) and persistent fever (n = 5). Although the delayed group required less frequent modifications in operative technique and a shorter operative time, there was a tendency toward a higher conversion rate (23% vs. 11%; p = 0.174) and complication rate (29% vs. 13%; p = 0.07). For 38 patients with symptoms exceeding 72 hours before admission, the conversion rate remained high after delayed surgery (30% vs. 17%; p = 0.454). In addition, delayed laparoscopic cholecystectomy prolonged the total hospital stay (11 days vs. 6 days; p < 0.001) and recuperation period (19 days vs. 12 days; p < 0.001). CONCLUSIONS: Initial conservative treatment followed by delayed interval surgery cannot reduce the morbidity and conversion rate of laparoscopic cholecystectomy for acute cholecystitis. Early operation within 72 hours of admission has both medical and socioeconomic benefits and is the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.     

腹腔镜肝脏手术治疗肝脏占位性病变

目的 :探讨腹腔镜肝脏手术的可行性、适应证及方法。方法 :分析 1998年 6月至 2 0 0 2年 8月腹腔镜下肝脏手术 2 3例的临床资料。结果 :2 3例手术均在腹腔镜下完成 ,其中肝左外叶切除术 2例 ,肝癌局部切除术 7例 ,肝局限性结节状增生局部切除术 3例 ,肝血管瘤摘除术 1例 ,肝癌射频治疗 2例 ,肝囊肿开窗引流术 +胆囊切除术 7例 ,肝脓肿引流术 1例。平均手术时间 16 5min ,平均出血 12 0ml,术后 4 8h内胃肠功能恢复 ,术后平均住院 7.6d ,痊愈出院 ,无严重并发症发生。结论 :腹腔镜下肝脏手术 ,包括肝切除术是一种安全、有效、微创的手术 ,但应严格掌握适应证     

Technical considerations in laparoscopic liver surgery

BACKGROUND: Laparoscopic solid organ surgery has gained growing acceptance, but this does not hold for laparoscopic surgery of the liver. Laparoscopic liver surgery mainly comprizes diagnostic procedures and treatment of liver cysts. However, we believe there is room for a laparoscopic approach to the liver in selected cases, with the benefits that may be expected from laparoscopic solid organ surgery. METHODS: Between 1993 and 2000, 10 patients with various lesions of the liver underwent laparoscopic surgery. Indications consisted of cystic disease (n = 2), hemangioma (n = 2), focal nodular hyperplasia (n = 2), liver abcess (n = 1), and liver metastasis (n = 3). Laparoscopic treatment varied from fenestration (n = 3) to wedge resections (n = 5), and formal left lateral hepatectomy (n = 2). RESULTS: The mean patient age was 54 years (range, 34-71 years). The mean operative time, including laparoscopic ultrasonography, measured 180 min (range, 80-240 min). Peroperative blood loss ranged from 200 to 450 ml. There was no mortality. In two patients, conversion to laparotomy was necessary. There were no postoperative complications. The mean hospital stay was 6 days (range, 4-11 days). CONCLUSION: Laparoscopic treatment should be considered in selected patients with benign and malignant lesions in the left lobe or frontal segments of the liver.     

Laparoscopic Roux-en-Y gastric bypass in morbidly obese and super morbidly obese patients

BACKGROUND: Our objective was to compare the outcomes after laparoscopic Roux-en-Y gastric bypass (RYGB) in morbidly obese (body mass index [BMI] <50) patients with super morbidly obese (BMI >50) patients. METHODS: A prospective analysis of 120 patients who underwent laparoscopic RYGB at a community based teaching hospital between January 2002 and August 2002 was performed. Sixty patients with BMI <50 were compared with 60 patients with BMI >50. Study endpoints included: operative time, length of stay, and overall complication rates including early (<7 days) and late (>7 days) complications. RESULTS: Mean BMI in the obese group was 44.6 (range 39 to 49) versus 58.6 (range 50 to 100) in the superobese group. Medical comorbidities, age, and sex distribution were similar in both groups. Mean operative time in the obese group was 128 minutes (range 75 to 225) versus 144 minutes (range 75 to 240) in the superobese group. The overall complication rate was 10% in the obese group versus 20% in the superobese group. (P = 0.2) With regard to the obese group, the early complication rate was 5% (n = 3). These included 2 upper gastrointestinal bleeds and 1 respiratory failure. The late complication rate in this group was also 5% (n = 3). These were all anastomotic strictures requiring endoscopic dilation. In comparison, in the superobese group, the early complication rate was 8% (n = 5). These included 2 upper gastrointestinal bleeds, 1 pneumonia, 1 superficial wound infection, and 1 small bowel obstruction. The late complication rate in this group was 12% (n = 7). These included 4 anastomotic strictures, 1 incisional hernia, 1 pulmonary embolism, and 1 anastomotic leak. There were no conversions to open gastric bypass or deaths in either group. Median length of stay in both groups was 2 days. CONCLUSIONS: Our data demonstrate no significant difference in operative times, complication rates or length of stay between morbidly obese and super morbidly obese patients undergoing laparoscopic RYGB. Laparoscopic RYGB is safe and technically feasible in the super morbidly obese patient population.     

Bowel Obstruction after Laparoscopic Roux-en-Y Gastric Bypass

Background: Bowel obstruction has been frequently reported after laparoscopic Roux-en-Y gastric bypass (LRYGBP). The aim of this study was to review our experience with bowel obstruction following LRYGBP, specifically examining its etiology and management and to strategize maneuvers to minimize this complication. Methods: We retrospectively reviewed the charts of 9 patients who developed postoperative bowel obstruction after LRYGBP. Each chart was reviewed for demographics, timing of bowel obstruction from the primary operation, etiology of obstruction, and management. Results: 9 of our initial 225 patients (4%) who underwent LRYGBP developed postoperative bowel obstruction. The mean age was 46 ± 12 years, with mean BMI 47 ± 9 kg/m². 6 patients developed early bowel obstruction, and 3 patients developed late bowel obstruction. The mean time interval for development of early bowel obstruction was 16 ±16 days. The causes for early bowel obstruction included narrowing of the jejunojenunostomy anastomosis (n=3), angulation of the Roux limb (n=2), and obstruction of the Roux limb at the level of the transverse mesocolon (n=1). The mean time interval for development of late bowel obstruction was 7.4 ± 0.5 months. The causes for late bowel obstruction included internal herniation (n=2) and adhesions (n=1). 6 of 9 bowel obstructions (66%) were considered technically related to the learning curve of the laparoscopic approach. Eight of the 9 patients required operative intervention, and 6 of the 8 reoperations were managed laparoscopically. Management included laparoscopic bypass of the jejunojejunostomy obstruction site (n=5), open reduction of internal hernia (n=2), and laparoscopic lysis of adhesion (n=1). Conclusions: Bowel obstruction is a frequent complication after LRYGBP, particularly during the learn ing curve of the laparoscopic approach. Specific measures should be instituted to minimize bowel obstruction after LRYGBP as most of these complications are considered technically preventable.     

腹腔镜手术治疗卵巢囊肿80例临床分析

目的:探讨腹腔镜手术用于治疗卵巢囊肿的临床应用价值.方法:回顾分析2006年1月至2008年1月为230例卵巢囊肿患者行腹腔镜手术的临床资料.其中施行腹腔镜囊肿剥除术80例,传统开腹手术70例,介入治疗80例,分析术后疗效.结果:腹腔镜组2例因快速病理诊断为卵巢浆液性囊腺癌中转开腹,78例完成腹腔镜手术.3组手术时间差...     

腹腔镜手术治疗妇科急性内出血273例临床分析

目的：探讨腹腔镜诊治妇科急性内出血的效果和可行性。方法：回顾分析2005年10月至2009年10月用腹腔镜诊治273例妇科急性内出血患者的临床资料。结果：273例妇科急性内出血患者均在腹腔镜下得到确诊,272例顺利完成腹腔镜手术,1例中转开腹,无一例发生并发症。结论：腹腔镜手术治疗妇科急性内出血性疾病,具有患者创伤小、术中出血少、术后康复快、疗效肯定等优点,有取代开腹手术的应用前景。     

Laparoscopic distal pancreatic resection

Laparoscopic resection is not an established treatment for pancreatic tumors. Previous reports, mainly in Europe and Japan, have demonstrated the potential utility of laparoscopic distal pancreatectomy (LDP). However, few reports have been published from the United States. We instituted a pilot program to assess LDP. A total of 11 patients were included from December 2003 to December 2004. All patients were staged with preoperative endoscopic ultrasound and received vaccinations for possible splenectomy. The indications for surgery were as follows: neuroendocrine tumor (n = 7), unspecified tumor (n = 1), and cystic neoplasm (n = 3). All procedures began with diagnostic laparoscopy and intraoperative ultrasound. Three patients underwent laparoscopic enucleation of a discrete pancreatic nodule. In eight patients, LDP was attempted. One patient required conversion to an open procedure. In the other seven patients, the procedure was completed laparoscopically, two with hand-assist. The average operative time was 5 hours and 3 minutes; average length of stay was 5 days; and the splenectomy rate was 57 per cent (n = 4). There was one complication of an infected hematoma. There were no pancreatic leaks, deaths, nor readmissions. LDP with or without splenectomy is feasible and can be performed with minimum morbidity and only slightly increased operative time.     

Laparoscopic Adrenalectomy for Pheochromocytoma Versus Other Surgical Indications

Objective:

Laparoscopic adrenalectomy is widely recognized as the preferred technique for surgical removal of adrenal masses. This study aimed to evaluate the outcomes of consecutive laparoscopic adrenalectomies performed at a high-volume referral center and compare operative results for pheochromocytomas with that of other adrenal diseases.

Materials and Methods:

We retrospectively reviewed a single surgeon''s experience with laparoscopic adrenalectomy performed between July 2002 and June 2007. Patient records were analyzed in regards to demographics, pathology diagnoses, operative time, postoperative complications, tumor size, hospital stay, among others.

Results:

Seventy-two consecutive laparoscopic adrenalectomies were performed on 70 patients, including 2 bilateral adrenalectomies and one partial adrenalectomy. Surgical indications included pheochromocytoma (n=11), aldosteronoma (n=26), malignant adrenal disease (n=4), nonfunctioning adenomas (n=17), Cushing''s disease (n=6), and other adrenal disease (n=8). No mortality was observed. Perioperative complications occurred in 7 cases (9.7%). When a comparison between pathological diagnosis groups was made, no statistical differences were seen between pheochromocytomas and other adrenal neoplasms with respect to estimated blood loss, open conversion rate, length of stay, preoperative and postoperative hemoglobin values, blood transfusion rates, peri-operative complication occurrence, tumor size, and ASA class.

Conclusion:

Laparoscopic adrenalectomy is a safe and appropriate surgical technique for most adrenal lesions, including pheochromocytomas.     

Laparoscopic surgery for Crohn's disease: reasons for conversion

OBJECTIVE: To examine factors influencing conversion from a laparoscopic to an open procedure in patients requiring surgery for Crohn's disease. SUMMARY BACKGROUND DATA: Laparoscopic management of patients with complications of Crohn's produces better outcomes than traditional open approaches, but it is difficult to determine before surgery who will be amenable to laparoscopic management. In this series, a laparoscopic approach was offered to virtually all patients to determine reasons for laparoscopic failure. METHODS: Data regarding patients who underwent attempted laparoscopic procedures for Crohn's (January 1993 to June 2000) were collected prospectively. The bowel was mobilized laparoscopically and extracorporeal anastomoses were performed. Conversion to open surgery was defined as creation of an incision of more than 5 cm. RESULTS: One hundred ten patients (age 37 +/- 1.1 years, 58% female) underwent 113 attempted laparoscopic interventions. Indications for surgery included obstruction (77%), failure of medical management (35%), fistula (27%), and perineal sepsis (4%). Sixty-eight procedures (60%) were completed laparoscopically. Procedures completed laparoscopically included ileocecectomy (n = 46), small bowel resection (n = 22), fecal diversion (n = 7), intestinal stricturoplasty (n = 7), resection of prior ileocolonic anastomosis (n = 5), segmental colectomy (n = 1), and lysis of adhesions (n = 1). Forty-five procedures (40%) were converted as a result of adhesions (n = 21), extent of inflammation or disease (n = 9), size of the inflammatory mass (n = 7), inability to dissect a fistula (n = 5), or inability to assess anatomy (n = 3). Factors associated with conversion were internal fistula as an indication for surgery, smoking, steroid administration, extracecal colonic disease, and preoperative malnutrition. In laparoscopic patients, mean times to passage of flatus and first bowel movement were 3.6 +/- 0.2 days and 4.4 +/- 0.2 days, respectively. Mean time to discharge was 6 +/- 0.2 days. CONCLUSIONS: Attempted laparoscopic management is safe and effective if there is an appropriate threshold for conversion to an open procedure. Conversion factors identified in this study largely reflect technical challenge and severity of disease. Patients taking steroids and those with known fistulas or colonic involvement threaten laparoscopic failure, but many of these patients can be managed laparoscopically and have better outcomes. By understanding the reasons for conversion, it is hoped that the chances of laparoscopic success can be improved by modifying standard preoperative medical management or using additional technological capabilities (e.g., robotics).