腹腔镜胆囊切除术中的联合手术

<正> 腹腔镜胆囊切除(LC)已在基层医院普遍开展,随着经验的不断积累,发现有许多患者,尤其是女性患者,在患有胆囊良性疾患的同时,还并存其它需要手术的腹部疾患。我院于1999年6月～2002年12月采用腹腔镜胆囊切除术中联合手术的方法,治疗二处或二处以上的腹部疾患46例,效果满意,现总结报告如下。 1 临床资料 1.1 一般资料:本组46例均为女性患者,年龄28～66岁。其中结石性胆囊炎39例,胆囊息肉7例,均以胆囊良性疾患为主要病变而被施行LC。术前明确需联合手术者38例,术中探查发现需附加手术者10例。全组病例中,联合肝囊肿开     

腹腔镜技术在多器官疾病手术中的联合应用

目的 探讨腹腔镜技术在多器官疾病中联合应用的可行性.方法 回顾性分析2001年以来我们施行腹腔镜联合手术63例的临床资料.结果 联合手术均获成功.术中出血10～60ml,平均30ml;手术时间50～180min,平均120min.病人术后12～38h肛门排气,无并发症.术后住院3～7d,平均4.9d.结论 只要严格掌握手术指征,腹腔镜联合手术能安全、有效地同时处理多个器官共存的疾病,具有良好的应用前景.     

腹腔镜联合手术的现状

随着腹腔镜手术的不断完善与发展,腹腔镜联合手术应运而生,它继承和发扬了传统腹腔镜手术的创伤小、术后恢复快的优点,而且又在处理多个腹部病变方面展示了较大的优势,使得多个病变一次性联合手术解决成为可能,极大的方便了患者,大大加强了学科之间的交流与合作,从而是进一步促进了腹腔镜手术的推广与应用.     

腹腔镜胆囊切除联合手术的临床应用

目的探讨腹腔镜胆囊切除联合手术的临床应用价值。方法回顾性分析2001年4月至2010年3月198例腹腔镜胆囊切除联合手术的临床资料。结果全部病例手术均获成功,无中转开腹,无术后并发症。与腹腔镜胆囊切除术患者比较,术后平均住院时间相近。结论腹腔镜胆囊切除联合手术能安全、有效、经济地处理多种腹部疾病,充分体现微创外科手术的优越性,值得推广。     

腹腔镜胆囊切除联合手术

腹腔镜联合手术指的是在1次腹腔镜手术中同时处理两种或以上腹部疾病的手术。本院自1999年1月至2004年12月共开展的124例腹腔镜胆囊切除联合手术。现总结报告如下。     

腹腔镜联合手术的应用

目的：探讨腹腔镜联合手术的临床应用价值。方法：回顾分析32例腹腔镜联合手术的临床资料。结果：32例均获成功,无并发症发生及中转开腹,术后3～7d痊愈出院。结论：腹腔镜联合手术能安全有效的处理多种腹部疾病,可在同一专科或多专科中联合应用,但需严格掌握手术适应证。     

腹腔镜在腹部联合手术中的应用

目的总结腹腔镜下腹部多脏器联合手术的临床经验。方法回顾性分析在2005年8月~2015年12月对69例患者行腹腔镜下腹部联合手术的临床资料。结果所有患者均成功完成了腹腔镜手术,均无严重并发症。结论腹腔镜在腹部联合手术中应用是安全、有效的,但需严格掌握手术适应证。     

腹腔镜胆囊切除联合肝囊肿开窗术

<正> 自1992我院开展腹腔镜胆囊切除术以来,共行手术3000多例,其中13例同时合并有非寄生虫性肝囊肿,联合行胆囊切除、肝囊肿开窗术,现报告如下。 临床资料 本组13例,男性4例,女性9例,年龄20～80岁,12例为慢性胆囊炎胆囊结石合并肝囊肿,1例为胆囊息肉合并肝囊肿。术前仅诊断为胆囊疾患而术中发现合并肝囊肿3例。肝囊肿位于肝右叶8例,肝左叶4例,左右叶均有1例。孤立囊肿10例,多发囊肿3例,囊肿直径2～18cm,联合手术时间较单纯腹腔镜胆囊切除术时间平均多10～20分钟,但术后恢复时间和住院时间与腹腔镜胆囊切除术相同,无1例并发症,均痊愈出院,随访半年无异常。     

腹腔镜胆囊、阑尾联合切除术在基层医院的临床应用

腹腔镜手术因其微创优势得以在临床科室广泛开展,随着手术经验的积累和技术水平的提高,多种疾病的腹腔镜联合手术也日益受到重视。2007年1月～2010年1月,我院行35例腹腔镜胆囊、     

腹腔镜技术在胰腺疾病治疗中的应用

胰腺是腹膜后器官，解剖位置较深，而且紧邻门静脉、肠系膜上血管和脾血管。胰腺手术一直被视为腹部外科的高难度、高风险手术之一。目前腹腔镜技术被大量应用于腹部外科，但腹腔镜胰腺外科手术发展仍比较滞后，虽然随着技术水平的提高、经验的积累及手术器械的改进，近年来有了一定的发展，但其应用范围、普及程度非常有限，在整个腹腔镜外科中，成为仅次于肝脏手术的又一大难点。     

Laparoscopic surgery in pregnancy

A 32-year-old white lady suffering from tubal infertility was referred to our institution in November 1992 because of low abdominal pain due to a heterotopic pregnancy (one intrauterine sac and the other in the right tube). The patient had undergone, 8 weeks before, her second successful attempt at in vitro fertilization and embryo transfer. We decided to perform a laparoscopic salpingectomy. At inspection, the presence of tubo-ovarian adhesions was noted, secondary to the previous tubal microsurgical procedure, that were lysed by means of monopolar electrocoagulation. Salpingectomy was performed by combined bipolar cauterization and blunt-scissor dissection of the mesosalpinx. No uterine contractions were noted after surgery and the patients were discharged the next day. The rest of the pregnancy was uneventful and the patient spontaneously delivered vaginally a healthy female newborn weighing 3,060 g (Apgar score=9) on June 20, 1993, at 39 weeks of gestation. A review of the published literature on laparoscopic surgery in pregnancy is given.     

腹腔镜多器官联合手术283例报告

目的:探讨腹腔镜多器官联合手术的优势。方法:回顾分析2006年9月至2011年10月为283例患者行腹腔镜多器官联合手术的临床资料,腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)联合胆总管取石T管引流术120例,LC联合肝组织活检术6例,LC+阑尾切除术(laparoscopic appendectomy,LA)66例,LC联合胃穿孔修补术5例,LC+子宫肌瘤切除术15例,LA+子宫肌瘤切除术2例,LC+卵巢囊肿剥除术22例,LA+卵巢囊肿剥除术4例,LC+肝囊肿开窗术8例,LA+肠粘连松解术6例,LC+肠粘连松解术28例,横结肠癌+直肠癌根治术1例。结果:2例中转开腹,余均顺利完成联合手术,术后1例发生切口感染。结论:只要严格把握手术治疗原则及联合手术适应证,腹腔镜联合处理多种腹部病变安全有效,具有患者创伤小、痛苦少、康复快、灵活方便、多病联治的优点。     

应用腹腔镜技术施行腹部联合手术(附120例报告)

目的:总结120例应用腹腔镜技术施行腹部联合手术的治疗结果。方法:回顾性分析2001年10月至2004年6月间进行的120例应用腹腔镜技术的腹部联合手术,其中胆囊切除联合胃手术10例;胆囊与阑尾联合切除术7例;胆囊切除联合腹股沟斜疝修补术8例;胆囊切除联合肾囊肿开窗引流术20例,肝囊肿开窗引流术32例,肝肾囊肿开窗引流术6例,卵巢囊肿切除术3例;胆囊与子宫肌瘤联合切除9例;胆囊与脾脏联合切除术1例;胆囊切除联合直肠癌根治术5例(其中开腹行Dixon手术2例);腹腔镜下带血管蒂回肠段移植阴道成形术11例;食管下段癌经腹腔镜胃分离术3例;肠粘连松解联合阑尾切除术3例,子宫内膜异位症与阑尾联合切除术2例。结果:120例联合手术均获成功,无并发症。结论:将腹腔镜技术应用于腹部联合手术应正确选择手术适应证和手术顺序,方能安全、有效地处理两种或两种以上的腹部病变因减轻了本需开腹作联合手术的腹部创伤,具有明显的社会效益和经济效益。     

腹腔镜胆囊切除联合十二指肠镜技术治疗选择性胆总管结石

目的探讨腹腔镜胆囊切除(laparoscopic cholecystectomy, LC)联合十二指肠镜技术治疗选择性胆总管结石的价值. 方法回顾性分析2002年1月～2003年12月32例选择性胆总管病变行LC联合内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography, ERCP)治疗的临床资料. 结果 LC术前ERCP 24例,发现胆总管结石19例,括约肌狭窄3例,正常2例,病变均经ERCP EST(内镜乳头括约肌切开术, endoscopic sphincterotomy)后行LC术.LC术后ERCP 8例,发现胆总管结石4例,括约肌狭窄3例,正常1例,除1例取石失败开腹手术外,所有病变均经EST治愈. 结论 LC与ERCP相结合对选择性胆总管结石的治疗有很高的临床应用价值,扩大了胆道微创治疗的范围.     

Laparoscopic cholecystectomy

Stones are sometimes spilled at the time of cholecystectomy. Retrieval may be difficult, especially during laparoscopic cholecystectomy. Little is known about the natural history of missed stones which are left behind in the peritoneal cavity. We present a case in which a patient developed an intraabdominal abscess around such a stone. The abscess recurred after drainage and removal of the stone was needed for resolution. This case suggests that care should be taken to avoid stone spillage, and that stones which are spilled into the abdomen should be retrieved.Currently in practice in St. Paul, MN, USA     

基层医院腹腔镜联合手术的体会

目的:探讨腹腔镜联合手术的可行性和优越性。方法:回顾分析2001年9月至2006年3月本院开展的42例腹腔镜联合手术的临床资料。其中腹腔镜胆囊切除术(laparoscop ic cholecystectomy,LC)+腹腔镜阑尾切除术(laparoscop ic ap-pendectomy,LA)12例;LC+子宫手术10例;LC+附件手术6例;LC+肝囊肿开窗引流术4例;LC+肾囊肿去顶减压术2例;子宫手术+LA 3例;附件手术+LA 5例。结果:手术均顺利完成,无手术并发症。结论:在熟练掌握腹腔镜技术的基础上,严格掌握手术适应证,腹腔镜联合手术是可行的,充分体现了微创的优越性。     

腹腔镜外科技术在结直肠恶性肿瘤切除术中的应用

目的探讨腹腔镜在结直肠恶性肿瘤切除手术中的应用. 方法经腹腔镜施行结直肠恶性肿瘤切除术17例,其中行右半结肠根治性切除术3例,乙状结肠根治性切除3例,直肠癌行Dixon术7例、Mile术2例、Park术2例.采用完全腹腔镜手术6例,腹腔镜辅助手术8例,手助腹腔镜手术3例. 结果全部病例均治愈出院,无死亡病例,无并发症发生,无中转开腹病例,手术时间150～240 min,平均190 min,术中出血20～300 ml,平均55 ml,术后平均住院9.6 d,有6例使用镇痛剂,术后近期随访1～6个月无复发. 结论经腹腔镜结直肠恶性肿瘤切除术是安全可行的,近期效果满意.     

Laparoscopic pancreaticoduodenectomy for benign and malignant diseases

Background Laparoscopy still is not universally accepted as an alternative approach for pancreatoduodenectomy. This study aimed to assess the feasibility and safety of laparoscopic pancreatoduodenectomy for benign and malignant lesions of the pancreas, and to examine whether this procedure obtains adequate margins and follows oncologic principles. To the best of the authors’ knowledge, their series of laparoscopic pancreatoduodenectomies is the largest reported to date. Methods A prospective study of laparoscopic pancreatoduodenectomy was undertaken between March 1999 and June 2005. The study enrolled 25 patients (16 women and 9 men) with a mean age of 62 ± 14 years. All the operations were performed in a single institution. Results The operations were performed without serious complications. Three patients underwent conversion to open surgery. For 13 patients, the anastomosis was performed intracorporeally. For the remaining 9 patients, the resection was performed laparoscopically, with the reconstruction performed through a small midline incision. There was no intraoperative mortality. The mean operating time was 287 ± 39 min, and the mean blood loss was 107 ± 48 ml. The mean time to the first bowel movement was 6 ± 1.5 days, and the mean time to independent self-care was 4.8 ± 0.8 days. Seven patients experienced postoperative complications. One patient died of a cardiac event 3 days after uncomplicated surgery. The mean hospital stay was 16.2 ± 2.7 days. All resected margins were tumor free. The mean number of retrieved lymph nodes for the malignant lesions was 18 ± 5. Conclusion: Laparoscopic pancreatoduodenectomy for selected cases of benign and malignant lesions performed by highly skilled laparoscopic surgeons is feasible and safe. This method can obtain adequate margins and follow oncological principles. Larger series and longer follow-up periods are needed to establish the current results.