Incidentally discovered adrenal schwannoma.

Schwannoma is a rare tumor of neural crest cell origin that is rarely seen arising from the adrenal gland. We report a case of an adrenal mass discovered incidentally in a 70-year-old man as part of a hematuria workup. Metabolic evaluation was unremarkable, and imaging studies did not meet strict imaging criteria for a typical adenoma. Following surgical excision and pathologic evaluation with confirmatory immunohistochemical staining, the mass was reported as a benign nerve sheath neoplasm.     

Laparoscopic treatment of retroperitoneal benign schwannoma

PURPOSE/METHODS: We report on a case of retroperitoneal benign schwannoma treated by laparoscopic surgery. RESULTS/DISCUSSION: The difficulties of diagnosis and the advantages of laparoscopic management are discussed.     

腹腔镜下迷走神经切断加溃疡穿孔粘堵治疗十二指肠溃疡穿孔38例报告

目的:探讨腹腔镜在溃疡穿孔治疗中的应用价值。方法:将明胶海绵卷成锥体栓,尖端塞入穿孔,基底部稍高于浆膜面,均匀滴入生物蛋白胶1.0~1.5m l在明胶海绵栓及其周围,采用H ill术式,切断迷走神经后干和高选择性切断前干。结果:全部病例术后8~9d痊愈出院。全部随访复查胃镜检查溃疡面愈合情况,38例中36例溃疡面愈合,另2例给予内科药物治疗痊愈。结论:腹腔镜下行迷走神经切断术加溃疡穿孔粘堵术治疗十二指肠溃疡穿孔疗效可靠,创伤小,值得推广。     

腹腔镜全结肠系膜切除术

In the latest 50 years,the radical dissection rate of colonic cancer and the 5-year survival rate have been improved as colonic surgery techniques improve.In 1991,Jacob performed the first laparoscopic...     

腹腔镜下修补术治疗十二指肠溃疡急性穿孔的临床疗效与安全性分析

目的分析腹腔镜下修补术治疗十二指肠溃疡急性穿孔的临床疗效与安全性。方法回顾性分析2013年6月至2015年6月行十二指肠溃疡急性穿孔修补术的124例患者临床资料,根据手术方法不同分为腹腔镜组(腹腔镜下进行穿孔修补手术,62例)和开腹组(传统开腹穿孔修复手术,62例),采用SPSS 17.0软件进行分析,围术期各种指标及住院时间等计量资料采用平均值±标准差表示,进行t检验;术后体温高于38℃例数、胃肠道不良反应、术后疼痛程度情况以及术后并发症发生情况等计数资料采用例数或率表示,进行χ~2检验;P0.05差异有统计学意义。结果腹腔镜组患者的手术时间、术后首次下床活动时间、首次排气时间及平均住院时间均短于开腹组(P0.05);腹腔镜组术中出血量为(7.7±1.1)ml,明显少于开腹组(P0.05);术后体温高于38℃例数、胃肠道不良反应发生情况和并发症的发生率、术后第1天和第3天疼痛降低程度均明显优于开腹组(P0.05);术后12个月,腹腔镜组复发率为9.7%明显低于开腹组25.8%,以上差异均有统计学意义(P0.05)。结论腹腔镜下修补术治疗十二指肠溃疡急性穿孔具有安全性好、疗效好、并发症少、恢复快等优点,值得广泛推广和应用。     

Laparoscopic total mesorectum excision.

The main controversy of colon-rectal laparoscopic surgery comes from its use as a cancer treatment. Two points deserve special attention: the incidence of port-site tumor implantation and the possibility of performing radical cancer surgery, such as total mesorectum excision. Once these points are addressed, the laparoscopic approach will be used routinely to treat rectal cancer. To clarify these points, 32 patients with cancer of the lower rectum participated in a special protocol that included preoperative radiotherapy and laparoscopic total mesorectum excision. All data were recorded. At the same time, all data recorded from the experience of a multicenter laparoscopic group (Brazilian Colorectal Laparoscopic Surgeons - 130 patients with tumor of the lower rectum) were analyzed and compared with the data provided by our patients. Analysis of the results suggests that a laparoscopic approach allows the same effective resection as that of conventional surgery and that preoperative irradiation does not influence the incidence of intraoperative complications. The extent of lymph nodal excision is similar to that obtained with open surgery, with an average of 12.3 lymph nodes dissected per specimen. The rate of local recurrence was 3.12%. No port site implantation of tumor was noted in this series of patients with cancer of the lower rectum.     

腹腔镜在治疗十二指肠溃疡穿孔所致急性腹膜炎中的应用体会

目的探讨腹腔镜技术在治疗十二指肠溃疡穿孔引起的急性腹膜炎中的作用,为腹腔镜的临床应用提供科学依据。方法利用腹腔镜施行十二指肠溃疡穿孔修补的56例病例,观察疗效。结果所有病人无中转开腹,手术顺利,术后恢复顺利,未出现近期相关并发症。腹膜炎各项相关指标术后3 d基本恢复正常。结论电视腹腔镜对十二指肠溃疡穿孔引起的急性腹膜炎有较好的治疗作用,因此在临床上有进一步的推广利用价值。     

Robotic repair of congenital duodenal atresia: a case report

Although repair of duodenal atresia has been performed laparoscopically, it can be a difficult procedure using rigid handheld laparoscopic instruments. Only a few pediatric surgeons are performing this operation with a minimally invasive approach. Robotic surgery may help overcome the obstacles presented by the use of traditional rigid laparoscopic instruments. We present the world's first robotic repair of congenital duodenal atresia in a 2.4-kg, 1-day-old newborn. The procedure took less than 3 hours, and the patient had an unremarkable postoperative course.     

Laparoscopic abdominoperineal excision of the rectum

In laparoscopic abdominoperineal resection of the rectum (LAP-AP) an abdominal incision is completely avoided as the tumor is delivered through the perineal incision. It is our belief that the view provided in the pelvis by laparoscopy is significantly better than at laparotomy and allows excellent anatomical definition and meticulous dissection. In this study we compared the adequacy of excision of the first 12 patients undergoing LAP-AP to the last 16 patients undergoing open abdominoperineal resection (OP-AP). In all patients the procedure was carried with curative intent for adenocarcinoma and the Dukes staging and Jass score's were similar in both groups. The data demonstrate similar nodal harvest in both groups as well as extent of radial excision. However, two patients in the open group had microscopic radial margin involvement despite being macroscopically clear at surgery. We conclude that although long-term follow-up is required to address the issue of local cancer recurrence, laparoscopic rectal dissection appears as good as open surgery and may allow a more precise assessment of excision margins.     

Laparoscopic excision of a duodenal neuroendocrine tumor

A 75-year-old woman with melena was found to have a carcinoid tumor in the posterior wall of the duodenal bulb. The biology was normal. The tumor measured 10 mm in size, and endoscopic ultrasonography showed only submucosal involvement. There was no liver metastasis and no regional lymph nodes. Tumoral resection was performed laparoscopically with success. Postoperative course was uneventful. Laparoscopic resection could be an appropriate minimally invasive treatment for selected small size duodenal tumors.     

全腔镜全胃切除术

切开胃结肠韧带,游离至脾脏下极,于根部离断胃网膜左血管,清扫第4组淋巴结,离断胃短血管直至脾上极。游离胃窦部,于胰腺上缘离断胃网膜右静脉,显露胃十二指肠动脉后,于根部离断胃网膜右动脉,并完成第六组淋巴结的清扫。显露胃窦后壁,离断胃右血管,清扫肝门部淋巴结。距幽门2 cm离断十二指肠。沿胰腺上缘解剖脾动脉根部,于根部离断胃左静脉。显露腹腔干及胃左动脉,向右侧清扫第8组淋巴结,于根部离断胃左动脉后,向头侧清扫第1,2组淋巴结。游离食管腹段,解剖出迷走神经左右支后离断。悬吊肝左叶后,距贲门2 cm离断食管,取上腹正中辅助切口3 cm,移除胃标本及大网膜。重建气腹后,距TREIZ韧带20 cm离断空肠,行食管左后壁与近端空肠侧侧吻合(OVERLAP法),手工缝合共同开口。距此吻合口40 cm,借助辅助切口完成小肠侧侧吻合(ROUX－Y)吻合。     

腹腔镜扩大左半结肠切除术

采用5孔法,经典中间入路。在右侧输尿管内侧2 cm切开,进入左侧Toldt间隙,自尾侧向头侧锐性分离,清扫肠系膜下动脉根部的淋巴脂肪组织。解剖降结肠及乙状结肠动脉,根部离断。十二指肠空肠曲左侧离断肠系膜下静脉根部,向外侧拓展降结肠后间隙、乙状结肠后间隙和直肠上段后间隙,确认左输尿管及生殖血管以防止损伤。切开并游离横结肠系膜,在胰颈下缘显露中结肠动静脉,于根部离断。沿降结肠沟剪开左侧腹膜,上至脾曲,下至直肠上段,与之前已拓展完成的左结肠后间隙汇合。自胃大弯侧血管弓内离断血管分支,直至根部切断胃网膜左血管,并切断脾结肠韧带,完全游离脾曲。于左侧经腹直肌切口切开腹壁,长约5 cm,将左半结肠拖出体外。在肿瘤近远端10～15 cm横断结肠,行端端吻合术。     

Intra-osseous sphenoorbital schwannoma

Summary. A 40-year-old man without stigmata of neurofibromatosis presented with proptosis and impairment of lateral gaze of the left eye. Neuro-imaging studies revealed an extra-axial lytic spheno-orbital mass. The mass was completely removed. Classic schwannoma was documented histopathologically.Schwannosis or hyperplasia of Schwann cells of perivascular nerve plexus may be attributed in the histogenesis of this unusually located schwannoma.     

Facial nerve function and hearing preservation after retrosigmoid excision of vestibular schwannoma: Christchurch Hospital experience with 97 patients

BACKGROUND: Between January 1988 and December 2002, 97 patients underwent surgery for excision of vestibular schwannoma via the retrosigmoid approach at Christchurch Hospital. METHODS: A retrospective review was undertaken of the clinical notes with emphasis on facial nerve function and hearing preservation postoperatively. RESULTS: Of patients with small and medium-sized tumours, 81% had good facial nerve function at 1 year (House-Brackmann grade 1 and grade 2), 16% had moderate function (grade 3 and grade 4) and 3% had poor function (grade 5). Of patients with large tumours, 22% had good facial function (grade 1 and grade 2), 37% had moderate function (grade 3 and grade 4) and 41% had poor function (grade 5 and grade 6). Useful postoperative hearing was preserved in 21% of the 47 patients with tumours <3 cm and useful preoperative hearing. In the last 5 years the authors have been operating in conjunction with an ear, nose and throat surgeon (PAB) trained in base-of-skull surgery. Over this period, useful hearing was preserved in 32% of patients with small and medium-sized tumours and useful preoperative hearing. CONCLUSIONS: Tumour size was an important predictor of the postoperative facial and cochlear nerve function. The multidisciplinary approach to these tumours offers better results. These results compare well with other published series.     

Penile schwannoma

Schwannoma of the penis is extremely rare. A 65-year-old man presented with a subcutaneous tumor of penile shaft without any other symptoms. Histopathologic examination of the excised tumor revealed benign schwannoma. No recurrence has been observed over the 6 months since the surgery.     

腹腔镜与开腹胃十二指肠溃疡穿孔修补术的对比研究

目的:比较腹腔镜与开腹胃十二指肠溃疡穿孔修补术的疗效。方法:回顾分析我院确诊为胃十二指肠溃疡穿孔52例患者的临床资料,其中28例行腹腔镜胃十二指肠溃疡穿孔修补术(腹腔镜组),24例行开腹胃十二指肠溃疡穿孔修补术(开腹组),比较两组手术时间、术中出血量、并发症发生率、术后肠道功能恢复时间、术后体温及住院时间。结果:腹腔镜组与开腹组手术时间分别为(78.75±25.178)min和(97.50±26.029)m in(P<0.05),术中出血量分别为(43.21±12.488)ml和(77.50±21.518)m l(P<0.001),并发症分别为3例和8例(P<0.05),术后体温>38℃分别为5例、11例,术后肠蠕动恢复时间分别为(2.33±0.816)d和(3.75±1.035)d(P<0.001),术后住院分别为(6.83±1.169)h和(10.00±1.309)h(P<0.001)。结论:胃十二指肠溃疡穿孔患者行腹腔镜手术与开腹手术一样安全,且具有创伤小、康复快、住院时间短等优点。     

Resection of a duodenal web using single-incision pediatric endosurgery

Single-incision pediatric endosurgery (SIPES) is used in many centers for routine cases such as appendectomies and cholecystectomies, but more complex procedures are still infrequently performed. We report the case of a 9-month-old girl with Down syndrome diagnosed with a duodenal web who underwent duodenal web resection and tapering using a SIPES technique. The procedure was performed through a single 2-cm incision in the umbilicus and took 209 minutes. Postoperatively, the patient was feeding well, gaining weight, and had no appreciable scar at a follow up of 6 months. SIPES duodenal web resection in an infant is a reasonable alternative to conventional triangulated laparoscopy that can be performed safely with good functional and cosmetic postoperative results.     

腹腔镜卵巢良性肿瘤剥除内翻缝合术78例临床分析

目的:评价腹腔镜卵巢肿瘤剥除内翻缝合术的临床应用价值。方法:回顾分析2003年4月至2008年4月78例行腹腔镜卵巢肿瘤剥除内翻缝合术患者的临床资料,并与同期开腹卵巢肿瘤剥除内翻缝合术和腹腔镜卵巢肿瘤剥除术患者进行对比。结果:腹腔镜卵巢肿瘤剥除内翻缝合组和腹腔镜卵巢肿瘤剥除组的手术时间、术中出血量、术后镇痛剂使用次数、胃肠道功能恢复时间均少于开腹组(P<0.01)。腹腔镜卵巢肿瘤剥除加内翻缝合组术后出血量及肠粘连例数均少于开腹组和腹腔镜卵巢肿瘤剥除组(P<0.01)。结论:腹腔镜卵巢肿瘤剥除加内翻缝合术在预防术后卵巢创面出血和减少腹腔粘连方面有较好的临床应用价值。     

Laparoscopic duodenal atresia repair using surgical U-clips: a novel technique

Laparoscopic repair of duodenal atresia has been reported. Reports to date have indicated use of standard laparoscopic suturing and knot tying. Unfortunately, there has been a high leak rate associated with the technique. We report our technique of using U-clips for the duodenoduodenostomy, thus limiting trauma to the duodenum during the anastomosis and less risk for postoperative leakage.