腹腔镜食管壁孔疝修补术和胃底折叠术

食管裂孔疝在临床并不少见 ,胃食管返流性疾病临床更是常见 ,但是此类疾病还没有得到应有的重视 ,行外科治疗者还很少。资料表明 ,美国成人约4 5 %有胸骨后烧灼痛 (胃食管返流性疾病的主要症状 )至少每月 1次 ,7%每天都有此症状出现 ;约5 0 %胃食管返流患者会出现糜烂性食炎、食管狭窄或Ｂａｒｒｅｔｔ′ｓ食管等并发症。胃食管返流性疾病的内科治疗包括改变生活和饮食习惯 ,服用Ｈ2 受体拮抗剂甲氰咪胍等或质子泵抑制剂奥美拉唑及胃肠道动力药西沙比利等。对于内科药物治疗无效或停药后症状复发或出现上述各种并发症则需要手术治疗。腹腔镜…     

经脐单孔腹腔镜下Nissen胃底折叠术治疗食管裂孔疝2例报告

食管裂孔疝的外科治疗历史较久,手术方式众多。虽然这些手术方式经过多次改变,试图得到最佳的治疗效果,但是因为需要行胸腹联合切口,创伤大,术后恢复慢,术后并发症多,医疗费用昂贵等种种原因,传统手术未被     

腹腔镜手术治疗食管裂孔疝的42体会

目的探讨使用腹腔镜行食管裂孔疝修补术的疗效和安全性。方法对42例食管裂孔疝患者行腹腔镜食管裂孔疝修补术,其中32例行胃底360°折叠术(Nissen术),10例行胃底270°部分折叠术(Toupet术)。39例采用4号丝线缝合修补疝缺口,3例应用补片修补疝缺口。结果42例腹腔镜食管裂孔疝修补术全部成功。手术时间平均(138±22)min,失血平均(62±16)ml;无术后并发症;术后平均住院(5.2±1.9)d。术后症状完全消失32例(76%),好转10例(24%)。结论腹腔镜食管裂孔疝修补术具有疗效确定、安全和创伤小的优点,值得进一步推广应用。     

腹腔镜在食管裂孔疝修补术中的临床应用

目的探讨腹腔镜在食道裂孔疝修补术中应用的疗效及安全性。方法运用腹腔镜对21例食道裂孔疝患者行食道裂孔疝修补术,其中13例食道裂孔缺损≥4 cm者使用巴德Cru-raSoft补片进行修补,8例缺损4 cm者用2-0普理灵缝线连续缝合将两膈肌脚关闭。同时将胃底固定于食道左侧膈肌下,以恢复锐性His角。结果 21例均顺利完成疝修补术,无中转开腹,未出现并发症。平均手术时间117 min;平均出血量约36.7 ml;平均住院日3.7 d。术后3个月行胃镜复查,显示患者的食道炎均已明显好转,未见消化性溃疡或糜烂性胃炎;术后随访3～30个月,单纯缝合修补者有2例复发。结论对于老年人要适当控制气腹的压力。腹腔镜手术的高清晰度、宽广视野是直视手术所无法比拟的,用以治疗食道裂孔疝有手术损伤小、出血少、患者恢复快、住院时间短等优点,其并发症的发生率和死亡率都比开腹直视手术要低。腹腔镜下行食道裂孔疝修补的治疗是安全可行的,值得临床推广应用。     

腹腔镜食管裂孔疝修补术并胃底折叠术对患者生存质量的影响

目的:探讨腹腔镜食管裂孔疝修补术并胃底折叠术对患者生存质量的影响。方法:采用消化病生存质量指数(gastrointestinal Lebens qualities index,GLQI)前瞻性地测定29例患者行腹腔镜食管裂孔疝修补术和胃底折叠术前,术后2周、1个月、3个月、6个月的生存质量值,并进行临床分析。结果:术前患者GLQI指数平均(83.62±13.14),明显低于正常人群(121～125分);术后2周平均(86.76±10.16),较术前有所升高,差异无统计学意义(P>0.05),但患者精神、心理较术前改善(P<0.05);术后1个月、3个月平均为(106.83±8.40)及(113.35±8.54),较术前及术后2周明显升高,差异有统计学意义(P<0.05);术后6个月平均(121.45±5.96),接近或达到正常水平。结论:腹腔镜食管裂孔疝修补术和胃底折叠术可提高患者术后生存质量,使其生存质量接近或达到正常人水平。     

腹腔镜Ⅲ、Ⅳ型食管裂孔疝修补术54例临床分析

目的 分析腹腔镜手术治疗Ⅲ、Ⅳ型食管裂孔疝的方法和疗效.方法 回顾性分析2014年1月至2021年1月东南大学附属中大医院普外科收治的54例行腹腔镜手术治疗的Ⅲ、Ⅳ型食管裂孔疝病人的临床资料,手术方式为食管裂孔疝修补术+胃底折叠术.随访观察术后疗效及并发症发生情况.结果 Ⅲ、Ⅳ型食管裂孔疝54例,包括Ⅲ型食管裂孔疝33...     

腹腔镜治疗食管裂孔疝的现状与进展

食管裂孔疝是指腹腔内脏器通过膈食管裂孔进入胸腔所致的疾病。内科治疗无效时需手术治疗。随着微创外科的发展,腹腔镜食管裂孔疝修补和胃底折叠术,以其术野清晰、操作灵活、创伤小、恢复快、住院时间短等优势而迅速成为治疗食管裂孔疝的金标准术式。本文综述应用腹腔镜治疗食管裂孔疝的现状与进展。     

腹腔镜下治疗食管裂孔疝55例报告

目的：探讨腹腔镜下治疗食管裂孔疝的可行性和有效性。方法2008年3月～2013年3月腹腔镜手术治疗55例食管裂孔疝,腹腔镜下完成食管裂孔疝的还纳及修补之后,进一步行胃底折叠术。结果55例均在腹腔镜下完成手术,在食管裂孔修补基础上辅以不同的胃底折叠术,其中Nissen胃底折叠术17例,Toupet 胃底折叠术19例,Dor胃底折叠术19例。3种术式的手术时间：Nissen术式（69．6±13．0）min,Toupet术式（68．0±8．2）min,Dor术式（63．8±10．1）min;3种术式的术中出血量：Nissen术式（20．0±5．8）ml,Toupet术式（20．6±9．5）ml,Dor术式（21．7±5．0）ml,无一例输血;3种术式的术后拔管时间：Nissen术式（3．1±1．1） d,Toupet术式（2．7±0．7） d,Dor术式（2．3±1．1） d;3种术式的术后住院时间：Nissen术式（9．1±4．9）d,Toupet术式（8．4±2．6）d,Dor术式（7．6±1．5）d。术后患者的临床症状均得到有效缓解,无围术期死亡,3例（5．4％）出现术后并发症,其中2例胃排空障碍,1例吞咽困难,治疗后均缓解。55例中位随访时间45个月（6～60个月）,口服钡餐造影或胃镜等检查无食管裂孔疝复发,无食管狭窄和食管憩室发生。结论腹腔镜下治疗食管裂孔疝安全有效,可根据病人的情况选择不同的胃底折叠术。     

腹腔镜食管裂孔疝修补术不同手术方式的临床疗效及预后分析北大核心CSCD

目的比较不同手术方式在腹腔镜食管裂孔疝修补术中的有效性及复发率的差异。方法回顾性分析2016年1月至2022年3月于兰州大学第一医院、甘肃省人民医院及甘肃省中医院行腹腔镜食管裂孔疝修补联合胃底折叠术治疗的90例食管裂孔疝患者的临床资料,其中26例未使用补片,29例使用合成补片,35例使用生物补片。对三组患者进行术后随访,比较三组患者手术时间、术中出血量、手术费用及术后并发症发生率、复发率以及满意度等指标。结果 90例均顺利完成手术,无中转开腹病例。三组患者手术时间、术中出血量、术后住院天数差异均无统计学意义(均P>0.05),未使用补片组住院费用与合成补片和生物补片组相比更具有经济学优势,差异均有统计学意义(P<0.05)。87例患者获得长期随访,随访率为96.7%(87/90),中位随访时间为44个月。术后并发症(腹泻、吞咽困难、腹胀、胸痛)发生率、症状复发率(反酸、烧心)以及患者满意度,三组间差异无统计学意义(P>0.05)。结论在食管裂孔疝修补术中,应根据术中具体情况,谨慎选择补片。     

非气腹腹腔镜巨大食管裂孔疝修补胃底折叠术1例报告

非气腹腹腔镜手术是现代腹腔镜手术与传统开腹手术有机结合、优势互补的产物,拓宽腹腔镜手术范围,使有严重心肺疾病不能耐受气腹的病人可以接受腹腔镜手术.我科对1例巨大食管裂孔疝施行非气腹腹腔镜手术,取得良好效果,报道如下.     

Laparoscopic transhiatal esophagectomy for esophageal cancer

BACKGROUND: Traditional esophagectomy may be associated with mortality, considerable morbidity, and lengthy recovery. It is often performed in cancer patients who are typically older, have associated comorbidities, and are often malnourished, all factors that increase surgical risk. Minimally invasive esophagectomy has the potential advantages of being a less traumatic procedure with an easier postoperative recovery and fewer wound and pulmonary complications. METHODS: A retrospective analysis of patients who underwent laparoscopic transhiatal esophagectomy was performed. Assessed parameters included patient demographics and operative data, pathology results, and long-term follow-up of at least 12 months. RESULTS: Twenty-two patients underwent laparoscopic transhiatal esophagectomy; 19 had esophageal cancer. Two patients were operated on for Barrett esophagus, and 1 patient had achalasia. The majority of patients were men (82%), and the mean age was 59 years (range 15 to 74 years); 1 patient (4.5%) was converted to open surgery. The average operative time was 380 minutes (range 285 to 525 minutes), and the average blood loss was 220 mL; only 3 patients required transfusion. The median hospital stay was 8 days (range 5 to 46 days). Postoperative mortality occurred in 1 patient (4.5%), and postoperative complications developed in 6 patients (27.2%). In the 19 cancer patients, the average number of harvested nodes was 14.3 (range 10 to 19). The average follow-up was 30 months (range 12 to 48 months). The overall survival for cancer patients was 61% (11 of 19), and disease-free survival was 39% (7/19). CONCLUSIONS: Esophagectomy is a major surgery with considerable morbidity and potential mortality. Minimally invasive esophagectomy is a feasible approach that can be safely performed by surgeons with extensive experience in that field. Advantages include less intraoperative blood loss, a smaller incision, and a potentially faster postoperative recovery. In cancer patients, immediate oncologic goals of adequate margins and lymph node dissection can be achieved, and long-term outcome appears to be similar to that found with open approaches.     

Laparoscopic repair of inguinoscrotal hernia with complete herniation of the urinary bladder

Summary We describe a rare case of complete herniation of the urinary bladder into a groin hernia. The hernia was operated successfully using the laparoscopic approach.     

Laparoscopic esophagectomy in the palliative treatment of advanced esophageal cancer after radiochemotherapy

Background Esophageal cancer is associated with a poor long-term prognosis. Only a 10% 5-year survival rate is reported. This article aims to evaluate the feasibility and efficacy of laparoscopic esophagectomy for the palliative treatment of advanced esophageal cancer (T3-T4 Nx-N1) after neoadjuvant therapy.Methods From March 1998 to July 2002, 35 patients (mean age, 64.6 years; range, 35–72 years) affected by advanced cancer of the middle lower third of the esophagus came to the authors observation. All received neoadjuvant radiochemotherapy. Of the 35 patients, 22 (62.9%) showed a positive response to treatment (50% reduction of maximal cross-sectional area of the tumor), and surgical intervention was performed 4 weeks after the end of the therapy. The operations were accomplished through the laparoscopic approach and left lateral cervicotomy.Results The mean operative time was 160 min (range, 120–260 min). One patient (4.5%) experienced a cervical anastomotic leak. Three patients (13.6%) died in the postoperative period: one of myocardial infarction and two of acute respiratory failure. The mean postoperative hospital stay was 12.1 days (range, 9–23 days). After a mean follow-up period of 20.2 months (range, 10–40 months), 13 patients (68.4%) were alive.Conclusions The laparoscopic approach seems to be effective for the palliative treatment of advanced esophageal cancer. Further trials will be necessary to evaluate the advantages of this technique.     

Laparoscopic approach to esophageal perforation secondary to pneumatic dilation for achalasia

Background  Perforation of the esophagus after pneumatic dilation for achalasia is a severe complication which should be treated accurately in order to obtain a successful immediate outcome and a satisfactory result for the underlying condition. Methods  Five consecutive patients presenting with distal esophageal perforation after pneumatic dilation for achalasia were included in this study. All patients had gastrografin swallow performed to confirm the perforation, and one patient was also submitted to flexible esophagoscopy. Laparoscopic approach was performed in all patients with five portals. The phrenoesophageal membrane was opened on its anterior aspect. The distal esophagus was dissected free, and perforations were identified with the help of methylene blue or milk administration through the esophageal tube. All perforations were sutured with interrupted absorbable sutures. Contralateral myotomy and partial anterior Dor fundoplication completed the operation. Endoscopic control of length of myotomy and watertightness of mucosal closure was performed in all cases. Results  There were no intraoperative complications. After surgery all patients were maintained with nil per os until a barium swallow showed no leakage. One patient had a radiologic leakage sustained for 1 week. All patients were dismissed uneventfully. At 6 months after surgery, esophageal manometry was performed. Mean lower esophageal sphincter resting pressure had fallen from 30 to 8.7 mmHg. Conclusions  Laparoscopy offers an excellent approach to treat distal esophageal instrumental perforations, perhaps even better than open surgery. Suture of the perforation, contralateral myotomy and partial anterior fundoplication is a good option in the treatment of perforated achalasia after pneumatic dilation. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Laparoscopic repair of missed blunt diaphragmatic rupture using a prosthesis

A 54-year-old man underwent a therapeutic laparoscopy for giant diaphragmatic rupture complicating a blunt trunk trauma that had occurred 13 months earlier. Laparoscopy revealed a left hemidiaphragm 12-cm defect with an intrathoracic herniation of the omentum, the entire gastric fundus, the splenic flexure of the colon, and the two upper thirds of the spleen. The defect was not suitable for primary suture due to the diaphragmatic edges retraction. We repaired the hernia using a large polypropylene mesh covering the defect with 2-cm overlap. There was no intraoperative surgical or anesthetic complication. Postoperative course was uneventful and 3-month follow-up confirmed the healing of the diaphragmatic hernia. This case is discussed regarding the safety of the procedure, the best minimally invasive approach, and technical aspects of the repair. Received: 6 June 1997/Accepted: 11 August 1997     

胸、腹腔镜治疗贲门失弛缓症的临床分析

目的:探讨腹腔镜治疗贲门失弛缓症的可行性、手术方法及临床应用价值。方法:分析近年腹腔镜治疗贲门失弛缓症29例及胸腔镜组54例的临床资料。术前食管X线钡餐检查,均可见食管近端扩张,贲门呈鸟嘴样狭窄。食管镜检查见食管扩张,贲门紧闭进镜受阻。结果:无手术死亡病例及中转手术。结论:腹腔镜治疗贲门失弛缓症较胸腔镜具有手术时间及住院时间短,并发症少,术后吞咽困难症状缓解率高,食管返流低等优势,手术操作腹腔镜Heller-Dor较Toupet更具优势应作为首选。     

Laparoscopic surgery to treat ureterosciatic herniation after ureteral stent failure

We report on a patient who presented with left flank pain for 6 months. Computed tomography and intravenous urography revealed left ureterosciatic herniation with severe hydronephrosis. Antegrade placement of the ureteral double-J stent was performed and her symptoms subsequently subsided. These symptoms recurred after the removal of the stent 1 year later with persistent hydronephrosis and herniation. We performed laparoscopic ureterolysis, ureteral fixation to psoas muscle, and sciatic hernia repair with hyaluronan-containing mesh. The result was encouraging and the follow-up image at 6 months showed no hydronephrosis and no ureteral herniation.     

Laparoscopic Heller myotomy with epiphrenic diverticulectomy.

BACKGROUND AND OBJECTIVES: To describe the technique and results of laparoscopic Heller myotomy and Toupet fundoplication combined with epiphrenic diverticulectomy. CASE REPORT: A 75-year-old man presented to our institution complaining of dysphagia to solid foods and liquids. The preoperative preparation included a barium swallow, esophagoscopy, and esophageal manometry. Three months earlier, the patient had a botulinum toxin injection, which provided temporary relief. Ten months later, the patient underwent a laparoscopic Heller myotomy and Toupet fundoplication combined with an epiphrenic diverticulectomy. RESULTS: No complications occurred. The patient tolerated clear liquids on postoperative day 1; on postoperative day 2, he was discharged tolerating full liquids. He returned to full activity in 1 week. CONCLUSIONS: Epiphrenic diverticulectomy combined with treatment for the underlying motor disorder and gastroesophageal reflux prevention is an accepted practice. We demonstrate that this rare problem can be approached with the laparoscopic technique. Given this favorable result, we plan to continue this technique and establish a longer follow-up and wider series.     

Laparoscopic cholecystectomy in anticoagulated patients

Summary Although minimally surgically invasive, laparoscopic surgery has yet to be proven safe in patients receiving anticoagulants. Retrospectively, the laparoscopic management of four patients requiring anticoagulation for cardiac valvular prostheses or chronic atrial fibrillation was reviewed with regard to potential hemorrhagic complications. Warfarin was discontinued preoperatively in all cases. Heparin anticoagulation was individualized according to each patient’s risk for thrombosis. Laparoscopic cholecystectomy and intraoperative cholangiography were completed in each patient without resulting hemorrhagic complications. The operative management of patients exhibiting cholecystitis may be complicated by anticoagulation therapy required for preexisting conditions/diseases such as cardiac valve prostheses, chronic atrial fibrillation, deep venous thrombosis, and pulmonary embolism. The minimally invasive nature of laparoscopic surgery lends itself well to cholecystectomy required in the face of anticoagulation treatment. This limited initial series of selected patients demonstrates the feasibility and efficacy of laparoscopic cholecystectomy in patients receiving anticoagulants.     

Laparoscopic incisional/ventral herniorrhaphy: a five year experience

Summary Conventional repairs of incisional hernia are plagued with frequent complications and recurrences. Laparoscopic incision/ventral herniorrhaphy (LIVH) has been reported to be a safe and feasible technique with low morbidity and low early rates of recurrence. In this study, we review our experience with LIVH. All cases of LIVH performed consecutively at St. Joseph's Hospital, Hamilton, Ontario and University of Kentucky Medical Center between November 93 and January 1999 being followed prospectively were reviewed. Seventy-five hernias were repaired in 73 patients (38F, 35M) ranging from 25 to 84 years (mean 57) with a mean American Society of Anesthesiologists (ASA) score of 2.1. Postoperative complications occurred in 14 patients (19%) including seroma (3), wound infection (1), patch infection (2), bowel injury (2), ileus (3), pain (1), atelectasis (1), and congestive heart failure (1). One case was converted to an open procedure and in one case a prosthesis was not placed due to an enterotomy repaired laparoscopically. Postoperative recurrences occurred in 7 (9%) of patients, within two to twelve months. Three of these were repaired laparoscopically. Over the five-year experience, the number of recurrent hernias repaired has increased, operative times have increased, and hospital length of stay has decreased. During that same interval the incidence of recurrence and complications has not changed. In conclusion, LIVH is a safe and feasible technique, applicable to all patient populations including the obese and multi-operated abdomen. Recurrence is low, and may be repaired laparoscopically.