经脐单孔腹腔镜肝囊肿开窗术

目的 总结经脐单孔腹腔镜肝囊肿开窗术的临床应用初期经验,探讨其可行性、安全性及技术方法.方法 回顾性分析2009年11月至2010年6月解放军总医院采用经脐下缘置入3个相邻的5 mmTrocar方法,完成4例经脐单孔腹腔镜肝囊肿开窗术患者的临床资料.术中使用常规5 mm腹腔镜器械及5nm 30°腹腔镜,手术步骤同传统腹腔镜肝囊肿开窗术.结果 4例患者均顺利完成手术,其中1例联合胆囊切除,平均手术时间38 min(25～70 min),术中无明显出血,无中转开腹或转为传统多孔腹腔镜肝囊肿开窗术.所有患者于术后1～3 d出院,住院及随访期间无任何手术相关并发症发生.结论 经脐单孔腹腔镜肝囊肿开窗术切口美观,恢复快,安全可行,但需要一定的腹腔镜手术技巧和严格掌握适应证.     

经脐单孔腹腔镜手术19例体会

目的 介绍早期开展经脐单孔腹腔镜手术的经验.方法 回顾性分析从2009年8月28日至12月31日完成经脐单孔腹腔镜胆囊切除术11例、经脐单孔腹腔镜肝囊肿开窗引流术3例及经脐单孔腹腔镜阑尾切除术5例的临床资料.结果 19例手术中,除1例经脐单孔腹腔镜肝囊肿开窗引流术因术中出血而中转开腹,其余均获成功.第1例经脐单孔腹腔镜胆囊切除术手术时间为157min,后面的手术时间平均约为70min;经脐单孔腹腔镜肝囊肿开窗引流术,时间约为50min;经脐单孔腹腔镜阑尾切除术时间约为40min.术后无并发症.术后住院时间3～4d,最快1例阑尾术后2d出院.1～3个月后随访,脐部无明显手术瘢痕.结论 经脐单孔腹腔镜技术是微创手术的一个补充,随着手术经验的不断累积、手术器械的不断创新,该手术将会有更大的临床推广价值.     

经脐腹腔镜单纯性肝囊肿开窗术12例临床分析

目的 探讨经脐腹腔镜单纯性肝囊肿开窗术的可行性及临床应用价值。方法 回顾性分析2015年6月至2018年8月东南大学医学院附属江阴医院由同一术者采用围绕脐孔作3个5 mm切口置入3个5 mm Trocar的方法完成12例腹腔镜肝囊肿开窗术患者的临床资料,其中5例囊肿位于肝脏左外叶,5例位于中肝叶,2例位于肝脏右后叶。所有囊肿均凸出于肝脏表面,囊肿直径约6.0～12.5 cm,平均（8.6±2.2）cm。结果 所有患者均顺利完成手术,手术时间35～76 min,平均（52.1±11.8）min,无中转开腹或转为常规多孔腹腔镜手术,术后住院时间2～5 d,平均（3.5±0.9）d,术后无出血、胆漏、切口感染等近期并发症,远期随访除一例肝脏右叶膈面囊肿复发,其余病例无切口疝、囊肿复发等并发症,患者恢复良好。结论 在掌握适应证和手术技巧的情况下开展经脐腹腔镜肝囊肿开窗术安全可行,切口美观,且疗效好。     

单孔腹腔镜手术20例报告

目的:总结单孔腹腔镜手术的手术经验。方法:回顾分析2011年11月至2011年12月施行的经脐单孔腹腔镜手术的临床资料,其中10例行阑尾切除术,6例行胆囊切除术,胆囊造瘘术、肝囊肿开窗术、肝癌射频消融术、腹壁疝修补术各1例。结果:20例手术均获成功,无一例中转开腹及术后并发症发生。经脐单孔腹腔镜肝癌射频消融术手术时间3 h;首例经脐单孔腹腔镜阑尾切除术手术时间121 min,其后的阑尾切除术手术时间平均55 min;经脐单孔腹腔镜胆囊切除术手术时间平均65 min;巨大肝囊肿单孔腹腔镜开窗术手术时间60 min;腹壁疝修补术90 min。术后平均住院3.5 d,4例胆囊手术患者术后1天出院。结论:单孔腹腔镜手术可实现真正腹壁无疤痕的效果,相对传统腹腔镜手术,其手术时间稍长,存在体内器械相互碰撞、手术空间缺乏、单孔Tri-port密封口漏气等缺点,但随着技术水平的不断提高及手术器械的研发完善,单孔腹腔镜手术会逐渐发展并得到广泛推广。     

经脐单孔腹腔镜手术102例回顾分析

目的 探讨经脐单孔腹腔镜在普通外科中的应用,总结早期手术经验。方法 回顾性分析2008年8月至2010年8月天津市南开医院经脐单孔腹腔镜手术102例病人的临床资料。结果 在102例病人中,51例行经脐单孔腹腔镜阑尾切除术,其中9例因粘连严重中转为三孔法操作（中转率17.65%）;39例行经脐单孔腹腔镜胆囊切除术,其中5例因暴露困难中转为四孔法手术（中转率10.20%）;经脐单孔腹腔镜胆囊切除联合肝囊肿开窗引流术3例,经脐单孔腹腔镜胆囊切除联合阑尾切除术9例,均顺利完成。术后1例病人发现胆总管结石行十二指肠镜取石治疗,2例病人出现胆囊床感染,行腹腔穿刺引流术;无切口感染,无手术相关并发症;术后随访4～24个月,无胆道损伤、出血等并发症。结论 经脐单孔腹腔镜手术安全可行,具有微创、美观、疗效确切等优点,手术操作难度较传统腹腔镜手术高,应谨慎把握手术适应证,由经验丰富的腹腔镜医师开展。     

经脐单切口腹腔镜开窗引流术治疗小儿先天性肝囊肿

目的 探讨经脐部单切口腹腔镜开窗引流术治疗小儿先天性肝囊肿可行性、安全性.方法 2012年3月～2019年3月我科行经脐单孔腹腔镜肝囊肿开窗引流术治疗8例单发性肝囊肿,开窗引流选择肝囊肿最低处,用电钩沿囊壁距肝实质1 cm尽可能多切除囊壁,以求最大限度开窗.结果 8例顺利完成经脐单切口腹腔镜肝囊肿开窗引流术,无一例中转...     

经脐单孔腹腔镜手术212例报告

目的:总结经脐单孔腹腔镜手术的早期应用经验,探讨其安全性及可靠性。方法:回顾分析2009年3月至2011年6月为212例患者行经脐单孔腹腔镜手术的临床资料。结果:176例成功施行经脐单孔腹腔镜胆囊切除术,其中7例因显露困难或需放置引流管中转两孔或三孔法腹腔镜手术,1例术后毛细胆管漏行开放手术。17例成功施行经脐单孔腹腔镜阑尾切除术,其中3例因粘连严重中转三孔法手术。3例行单孔腹腔镜小儿斜疝高位结扎术,4例行腹腔镜胆囊联合阑尾切除术,4例行单孔腹腔镜胆囊联合肝囊肿开窗术3,例行单孔腹腔镜精索静脉曲张高位结扎术,3例行经脐单孔腹腔镜肾囊肿去顶术2,例行经脐单孔腹腔镜胆囊联合卵巢囊肿切除术。术后脐部切口均I期愈合,脐部无可见手术瘢痕,术后随访3～27个月,无胆道损伤、胆囊床感染、出血等相关并发症发生。结论:经脐单孔腹腔镜手术安全可行,具有疼痛更轻、微创及美容效果更好等优点,是现阶段最具可行性的"No scar"技术。     

经脐单孔腹腔镜手术在肝胆外科中的应用

目的:探讨经脐单孔腹腔镜手术在肝胆疾病中的应用,总结其可行性及局限性。方法:回顾分析经脐单孔腹腔镜胆囊切除术24例、肝血管瘤2例、肝囊肿3例、脾囊肿1例共30例患者的临床资料。经脐下缘做约1.5 cm弧形切口,穿刺3个5mm Trocar,其中2例采用Tri-Port切除肝血管瘤,术中使用多角度可旋转分离钳。结果:30例均完成经脐单孔腹腔镜手术,24例胆囊患者平均住院1.2d,5例肝脏手术、1例脾囊肿患者平均住院4d,术后30例患者均未发生胆漏、出血等严重并发症。结论:经脐单孔腹腔镜手术安全、可行,患者疼痛轻,同时具有手术瘢痕小、美观的特点,但腹腔镜器械尚待进一步研发。     

单孔腹腔镜技术在肝胆外科手术中的应用

目的 探讨单孔下腹腔镜行胆囊切除术、肝囊肿开窗引流及囊壁切除术、肝脓肿切开引流术、胆总管切开取石术、左肝外叶血管瘤切除术的手术技巧、手术难点、器械改进及治疗效果.方法 经脐下缘作一切口（若病变在右肝后叶、左外叶或胆道,则将孔上移置入Triport）分别置入光源、胆囊抓钳及电极钩或超声刀,完成胆囊结石胆囊切除术185例,肝囊肿开窗引流及囊壁切除术36例,胆总管切开取石46例,肝脓肿切开引流27例,左肝外叶血管瘤切除22例.结果 316例均在单孔腹腔镜下完成,手术时间30 ～ 182 min,平均46 min.术中出血量5～100 mL,平均20 mL;住院时间3～7d,平均4.8d.术后无漏胆、出血、膈下感染等发生.结论 与常规四乳、三孔、二孔相比,腹腔镜下单孔法行胆囊切除、肝囊肿开窗引流及囊壁切除术、肝脓肿切开引流术、胆总管切开取石术、左肝外叶血管瘤切除术.手术时间稍延长、出血量无明显增多,但术后患者疼痛明显减轻,下床活动时间明显提前,住院时间明显缩短,住院费用降低,切口愈合后更美观,更具微创性.     

经脐单孔腹腔镜肝囊肿去顶减压术8例临床分析

目的:探讨经脐单孔腹腔镜肝囊肿去顶减压术治疗单纯性肝囊肿的可行性及安全性。方法:回顾分析2009年5月至2010年5月为8例单纯性肝囊肿患者行经脐单孔腹腔镜肝囊肿去顶减压术的临床资料。结果:8例手术均获成功。手术时间30~75min,平均40.8min。术后平均住院3.7d。术后随访2~12个月,平均7个月,除1例患者原有的小囊肿增大外,无再发病例。结论:经脐单孔腹腔镜肝囊肿去顶减压术虽然较传统的多孔腹腔镜手术操作略复杂,但安全有效,腹壁无可见疤痕,患者创伤小,痛苦轻,康复快,住院时间短。     

Scarless surgery for a huge liver cyst: A case report

IntroductionSymptomatic or complicated liver cysts sometimes require surgical intervention and laparoscopic fenestration is the definitive treatment for these cysts. We performed minimally invasive surgery, hybrid natural orifice transluminal endoscopic surgery (NOTES) without scarring, for a huge liver cyst.Presentation of caseAn 82-year-old female presented with a month-long history of right upper abdominal pain. We diagnosed her condition as a huge liver cyst by morphological studies. She denied any history of abdominal trauma. Her serum CEA and CA19-9 were normal and a serum echinococcus serologic test was negative. Laparoscopic fenestration, using a hybrid NOTES procedure via a transvaginal approach, was performed for a huge liver cyst because we anticipated difficulty with an umbilical approach, such as single incision laparoscopic surgery (SILS). Her post-operative course was uneventful and she was discharged from our hospital three days after surgery. Pain killers were not required during and after hospitalization. No recurrence of the liver cyst or bulging was detected by clinical examination two years later.DiscussionA recent trend of laparoscopic procedure has been towards minimizing the number of incisions to achieve less invasiveness. This hybrid NOTES, with a small incision for abdominal access, along with vaginal access, enabled painless operation for a huge liver cyst.ConclusionWe report a huge liver cyst treated by hybrid NOTES. This approach is safe, less invasive, and may be the first choice for a huge liver cyst.     

肝囊肿158例临床治疗分析

目的：比较硬化治疗、腹腔镜和剖腹开窗引流术治疗肝囊肿的疗效及其优缺点,探寻外科治疗肝囊肿的合理方法。方法：回顾性分析2006年2月—2009年6月行剖腹开窗术（42例,剖腹组）、腹腔镜下开窗术（52例,腔镜组）及硬化治疗（64例,硬化组）的肝囊肿患者的临床资料,并对手术时间、术中出血量、住院时间、住院费用、手术并发症及复发率进行对比分析。结果：158例均顺利实施手术,无手术死亡病例。手术时间和出血量剖腹组明显高于腔镜组;住院时间剖腹组明显长于其他2组,硬化组短于其他2组（P〈0.05）;术后并发症3组间差异无统计学意义（P〉0.05）;住院费用腔镜组与剖腹组差异无统计学意义（P〉0.05）,硬化组低于其他2组（P〈0.05）;复发率硬化组高于其他2组（P〈0.05）,但剖腹组与腹腔镜组差异差异无统计学意义（P〉0.05）。结论：常用的3种治疗肝囊肿的方法各有优缺点,对于需要外科治疗的肝囊肿,要严格把握手术适应证及禁忌证,结合囊肿的部位、大小、形态、囊液的性状、肝功能以及全身情况等因素综合评估,选择最佳治疗方案。     

Risk for laparoscopic fenestration of liver cysts

Background: Laparoscopic fenestration is considered the best treatment for symptomatic simple liver cysts. Conversely, the laparoscopic approach for the management of hydatid simple liver cysts is not widely accepted because of the risk for severe complications. Despite improvement in imaging techniques, the probability of preoperatively mistaking a hydatid liver cyst for a simple liver cyst remains about 5%. Therefore, laparoscopic fenestration, planned for a liver cyst could be performed unintentionally for an undiagnosed hydatid liver cyst. Methods: From January 2000 to January 2001, 15 patients with a diagnosis of liver cyst underwent laparoscopy for fenestration. In all cases preoperative serologic and imaging assessment had excluded hydatid liver cyst. To further exclude hydatid liver cyst, preliminary aspiration of the cyst with assessment of cystic fluid characteristics was performed. Results: In two patients with presumedly simple liver cyst, hydatid liver cyst was diagnosed instead at laparoscopy by aspiration of cystic fluid. The procedure was converted to laparotomy with subtotal pericystectomy. Conclusions: The risk of misdiagnosing a hydatid liver cyst for a simple liver cyst, especially in the presence of a solitary cyst, should be considered before laparoscopic fenestration is performed. Intraoperative aspiration of cyst fluid before fenestration can minimize this risk, thus avoiding severe intraoperative and late complications.     

The laparoscopic treatment of non-parasitic liver cysts. Five years experience

The incidence of cystic liver lesions seems to be more frequent as previously suggested. The treatment of symptomatic non-parasitic cysts is controversial. Ultrasonography (US) or computer tomography (CT) guided drainage and/or sclerotization versus surgical fenestration or partial resection, even liver resection has been advocated. Recently with the development of laparoscopic surgery this minimal invasive approach was also applied in the surgical treatment of single or multiple cystic lesions. Between 1994 and April 1999 21 patients with non-parasitic cysts were treated by laparoscopic fenestration or partial resection at the 1st Department of Surgery, Semmelweis University of Medicine. In 13 cases the symptomatic cyst presented the indication for surgery, while in the others cholelithiasis and GERD was the primary cause of intervention in 7 and 1 patient respectively. There were 16 woman and 5 men with a mean age of 42.3 years (17-78). The cyst was solitary in 17 cases and multiple 3-6-number in four patients. The size varied between 1.5-25 cm (average 7.2 cm). Patients were selected for the laparoscopic approach according to the US and/or CT appearance and superficial localization of the cyst. Wide unroofing or partial resection of the cyst wall till the margin of normal liver tissue was performed in all cases. The cystic cavity was drained. All operations were completed laparoscopically. Intraoperative complication did not occur. Bleeding from the resected margin could be well controlled by electrocautery or clipping. Patients left the ward after the drains were removed on postoperative day 2-4 depending upon the amount of serious discharge. No complication was observed postoperatively. During the average of 12.5 months (1 to 54 months) follow-up of 19 patients no recurrence was observed. Two patients required reoperation. In one 17 year old male patient cystadenocarcinoma was verified by histology, upon reoperation the lesion was found unresectable. In another case left hemi-hepatectomy was performed because of cyst recurrence caused by cholangiocell adenoma. In selected cases of superficially located symptomatic, non-parasitic cysts the laparoscopic fenestration might be the first choice of treatment. The method is safe and effective in the hands of surgeons experienced in both laparoscopic and liver surgery. Careful exploration of the cystic cavity and histological examination of the resected cyst wall is mandatory to avoid diagnostic mishaps.     

Endoscopic treatment of quadrigeminal cistern arachnoid cysts.

Five patients with arachnoid cysts of the quadrigeminal cistern treated by endoscopic fenestration are reported and another eleven well-documented cases from the literature are reviewed. Among the five personal cases four were children and one was adult; the cyst fenestration was performed from the lateral ventricle in three cases and from the third ventricle in two. In four patients the endoscopic treatment resulted in clinical remission, whereas a two-month-old baby later required a shunt. The lateral ventricle-cystostomy and the third ventricle-cystostomy (according to the cyst extent) are the best endoscopic procedures, whereas the cyst fenestration through a suboccipital supracerebellar approach is no longer used. The rate of cured or improved patients after endoscopic surgery (14/16 or 87.5%) was rather similar to that of a group of twenty patients treated by traditional surgery (craniotomy and cyst excision and/or shunt) (85%). These data confirm that endoscopic fenestration of quadrigeminal cistern cysts must be performed as the first procedure because it is less invasive and avoids shunt dependency.     

Laparoscopic management of symptomatic nonparasitic cysts of the liver. Indications and results.

OBJECTIVE: This clinical study evaluated the results of and defined the indications for laparoscopic fenestration of symptomatic nonparasitic hepatic cysts, either solitary or diffuse. SUMMARY BACKGROUND DATA: Different surgical treatments have been proposed for highly symptomatic hepatic cysts: enucleation, fenestration, hepatic resection, and liver transplantation. The advent of laparoscopic surgery has given new opportunities but, at the same time, has increased the uncertainties concerning the proper management of these patients. METHODS: Eight patients with solitary cysts and nine with polycystic liver and kidney disease (PLD) were seen during a period of 2 years. After a careful review of the symptoms, 6 patients were excluded from surgical treatment and 11 (4 solitary cysts and 7 PLD) were treated by laparoscopic fenestration. Postoperative morbidity and mortality rates, hospital stay, and clinical early and late results were evaluated. RESULTS: In the solitary cyst group, there was no surgical morbidity or deaths, and a complete regression of symptoms occurred in all patients. No recurrences were observed. In the PLD group, two patients had to be converted to laparotomic fenestration (28%). There were no deaths, and the surgical morbidity was limited to two cases of postoperative ascites. Symptomatic relief was obtained in 80% of patients, but the symptoms recurred in 60%. A subgroup of PLD at high risk for recurrence was identified. CONCLUSIONS: The best indications for laparoscopic fenestration seem to be solitary cyst and PLD characterized by large cysts mainly located on the liver surface (type 1), whereas PLD characterized by numerous small cysts all over the liver (type 2) should be considered a contraindication to laparoscopic fenestration.     

Fiberscopic fenestration and prophylactic stenting of periaqueductal cysts: technical report on three cases.

The authors report on three consecutive cases of periaqueductal cysts, causing non-communicating hydrocephalus, successfully treated with endoscopic fenestration and aqueductal stenting. Navigation and cyst fenestration were accomplished using a slim (1.1 mm outside diameter) optic fiberscope inserted via a pre-coronal-paramedian burr hole. Third ventriculostomy was also performed after cyst fenestration in two cases. Because of the lack of data regarding such lesions and the possible recurrence with simple fenestration, an aqueductal stent connected to a subcutaneous reservoir was placed, in all 3 cases, under direct visualization. Average duration of the procedure was less than sixty minutes and there were no intra- or perioperative complications. All patients recovered clinically and their postoperative neuroimaging assessment confirmed a decrease in size of both the ventricular system and cyst (mean follow-up: 6.8 months). The authors conclude than this minimally invasive procedure is a promising, safe and effective method to treat cerebral symptomatic periaqueductal cysts and associated non-communicating hydrocephalus.     

Highly symptomatic adult polycystic liver disease: options and results of surgical management

BACKGROUND: The majority of patients afflicted with adult polycystic liver disease (APLD) are asymptomatic. For those who are symptomatic, there are a variety of treatment procedures that have been proposed but these lack verification through long-term studies with respect to safety and long-term effectiveness. Choice of surgical procedure is related to the severity of APLD and morphology of the cysts within the liver. The aim of the present study was to analyse the immediate and long-term results of fenestration and combined resection-fenestration at Singapore General Hospital. METHODS: A retrospective analysis of clinical, operative, imaging and follow-up data was carried out for 12 patients (10 women and two men) with symptomatic APLD who underwent surgery from January 1992 to December 2000. The primary outcome measures assessed were postoperative alleviation of symptoms, performance status, complications, mortality and long-term recurrence of symptoms. RESULTS: Nine patients underwent 12 fenestration procedures and three patients had combined resection-fenestration. Fenestration was carried out for eight of nine patients with a dominant cyst morphology and combination resection-fenestration was carried out for those three patients with diffuse cyst morphology. There was no operative mortality and all patients were discharged from hospital free of their preoperative symptoms. Overall morbidity rate was 58%. The mean follow up for the present cohort was 29.3 months. Only two patients had recurrence of symptoms. One patient with dominant cyst morphology who underwent laparoscopic fenestration had recurrence at 26 and 43 months but this was successfully treated finally with open fenestration. The other patient had diffuse cyst morphology and was treated with fenestration for recurrent cyst infection that recurred 1 month postoperatively. This required subsequent intravenous antibiotics and percutaneous drainage for resolution of symptoms. CONCLUSION: Treatment for symptomatic APLD should be based on the morphology of the liver cysts. Fenestration is a safe and acceptable procedure for patients with a dominant cyst pattern where liver size can be reduced after the cysts collapse. A combination of resection-fenestration is suitable for those with a diffuse cyst pattern where grossly affected segments are resected in combination with fenestration to allow for reduction in liver size.     

成人多囊肝病外科治疗

目的 研究ＡＰＬＤ的临床特征和有效的治疗方法。方法 ２８例ＡＰＬＤ经开窗术，肝叶、段切除术，部分病例联合肾囊肿开窗术等外科治疗。结果 经术前检查及手术证实２８例ＡＰＬＤ合并多囊肾（ＰＫＤ）２４例，４例联合胰腺囊肿，脾脏和卵巢肿各两例，妇女均有生育史、最多达８次。结论 ＡＰＬＤ 弥漫性肝囊肿致肝脏损害为特点，经内科治疗无显效。外科手术治疗获得较好疗效。