A case of laparoscopic cystogastrostomy for pancreatic abscess

To the Editor:Open surgery is considered the gold standard for pancreatic abscess.1 With the development of laparoscopic ultrasound and laparoscopic skills,laparoscopic internal drainage for pancreatic abscess becomes feasible.We report a successful application of the laparoscopic cystogastrostomy for pancreatic abscess in a patient.     

后入路腹腔镜胰腺假性囊肿胃吻合术

目的：探讨腹腔镜下胰腺假性囊肿胃吻合技术在治疗胰腺假性囊肿手术中的临床应用价值。方法：回顾 分析收治的胰腺假性囊肿患者21例。患者均行完全腹腔镜下胰腺假性囊肿胃吻合术。分析患者的术中出血量、手术 时间、术后下床时间、排气和排便时间、术后并发症、住院时间及随访结果。结果：21例均成功施行腹腔镜下手 术。平均手术时间为90(62~120) min,术中出血量均在100 mL以内,术后平均住院时间为8 d。术后随访12~18个月, 患者恢复良好,均无并发症发生。结论：全腹腔镜经后入路胰腺假性囊肿胃吻合术安全可行,创伤小,值得临床推 广应用。     

腹腔镜技术治疗胰腺假性囊肿 5 例报 告简

目的 总结腹腔镜下囊肿-胃吻合术治疗胰腺假性囊肿的临床经验和疗效.方法 回顾性分析5例实施完全腹腔镜下囊肿-胃吻合术的胰腺假性囊肿患者资料,观察手术时间、出血量、肛门恢复排气时间、住院时间及并发症,记录随访结果.结果 5例手术均腹腔镜下完成,无中转开腹;手术时间为120～200 min,平均150 min,出血量50～200 mL,平均100 mL,2.5 d肛门排气,术后平均住院时间为8d.5例患者均顺利恢复,无并发症发生,随访1年,无胰腺炎、糖尿病和肠粘连等并发症发生,囊肿无复发.结论 完全腹腔镜胰腺假性囊肿-胃吻合术是安全可行的,具有创伤小、恢复快及并发症少等优点,值得推广.     

Endoscopic ultrasonography-guided cystogastrostomy for large pancreatic pseudocyst with obstructive jaundice--a case report

The patient was a 45-year-old man with a history of heavy drinking. A pseudocyst about 30 mm in diameter was found in the head of his pancreas. About four weeks later an upper abdominal mass, abdominal pain and obstructive jaundice were confirmed. Abdominal CT revealed that the cyst had increased in size to about 60 mm, compressing the lower common bile duct and the surrounding digestive tract. Therefore endoscopic ultrasonography-guided cystogastrostomy following percutaneous transhepatic biliary drainage (PTBD) was performed. Postoperatively, the cyst quickly decreased in size and jaundice improved. Because of persistent common bile duct stenosis, an endoscopic retrograde biliary stent was implanted. There has been no recurrence at ten months after the endoscopic therapy. While invasive surgery is generally employed in the treatment of pancreatic pseudocyst complicated by obstructive jaundice, EUS-guided cystogastrostomy appears to be a useful procedure, particularly when considering the relatively minor degree of surgical invasion.     

Laparoscopic partial splenectomy for large splenic epidermoid cyst

Splenic epidermoid cysts are relatively rare lesions traditionally treated by splenectomy. Concerns about overwhelming postsplenectomy sepsis have led to the development of splenic preservation procedures in the treatment of cystic diseases of the spleen. Better understanding of the splenic segmental anatomy and advances in laparoscopic skills has made laparoscopic partial splenectomy a preferred treatment for splenic cysts while preserving splenic function. We reported a case of a 30-year-old male patient with a large epidermoid splenic cyst managed successfully by laparoscopic partial splenectomy. The patient recovered well after operation and was asymptomatic on a follow-up of 1 year with no recurrence on ultrasonography and a normal platelet count. Laparoscopic partial cystectomy is an acceptable procedure for the treatment of splenic cysts which locate in the pole of spleen. On the one hand, it cures the disease preserving the splenic tissue without risk of bleeding or recurrence; on the other hand, this minimally invasive technique induces a reduced hospital stay and a more rapid recovery.

     

Laparoscopic partial splenectomy for large splenic epidermoid cyst

Splenic epidermoid cysts are relatively rare lesions traditionally treated by splenectomy. Concerns about overwhelming postsplenectomy sepsis have led to the development of splenic preservation procedures in the treatment of cystic diseases of the spleen. Better understanding of the splenic segmental anatomy and advances in laparoscopic skills has made laparoscopic partial splenectomy a preferred treatment for splenic cysts while preserving splenic function. We reported a case of a 30-year-old male patient with a large epidermoid splenic cyst managed successfully by laparoscopic partial splenectomy. The patient recovered well after operation and was asymptomatic on a follow-up of 1 year with no recurrence on ultrasonography and a normal platelet count. Laparoscopic partial cystectomy is an acceptable procedure for the treatment of splenic cysts which locate in the pole of spleen. On the one hand, it cures the disease preserving the splenic tissue without risk of bleeding or recurrence; on the other hand, this minimally invasive technique induces a reduced hospital stay and a more rapid recovery.     

腹腔镜部分脾切除治疗巨大脾表皮样囊肿一例

Splenic epidermoid cysts are relatively rare lesions traditionally treated by splenectomy. Concerns about overwhelming postsplenectomy sepsis have led to the development of splenic preservation procedures in the treatment of cystic diseases of the spleen. Better understanding of the splenic segmental anatomy and advances in laparoscopic skills has made laparoscopic partial splenectomy a preferred treatment for splenic cysts while preserving splenic function. We report a rare case of a 30-year-old male patient with a large epidermoid splenic cyst managed successfully by laparoscopic partial splenectomy. The patient recovered well after operation and was asymptomatic on a follow-up of 1 year with no recurrence on ultrasonography and a normal platelet count. Laparoscopic partial cystectomy is an acceptable procedure for the treatment of splenic cysts which locate in the pole of spleen. On the one hand, it cures the disease preserving the splenic tissue without risk of bleeding or recurrence; on the other hand, this minimally invasive technique reduces hospital stay and the patient recovery rapidly.     

腹腔镜阑尾切除术219例临床应用体会

目的:总结腹腔镜阑尾切除术的临床应用体会。方法:回顾性分析219例接受腹腔镜阑尾切除术的患者资料。结果:219例中,215例行腹腔镜阑尾切除术,4例行腹腔镜阑尾周围脓肿引流术。手术均顺利完成,无1例中转开腹,术后无1例发生切口感染、肠粘连、肠梗阻、腹腔残余脓肿形成等并发症,全部治愈出院。结论:腹腔镜阑尾切除术具有创伤小、恢复快、住院时间短、术野清晰、探查范围广、并发症少等优点,尤其在术前诊断不明确时可弥补开腹阑尾切除术的不足,值得进一步推广。     

Laparoscopic surgery in pancreatic diseases: Pushing the boundaries

BackgroundLaparoscopic surgery has expanded exponentially in the last two decades but, somehow it is limited in pancreatic surgery by virtue of the pancreas being a friable, retroperitoneal organ with difficult access and adjacent major vessels risking torrential bleed. It is thought to be unforgiving if not handled well. However, improvements in technology and surgeon's expertise have pushed the boundaries of minimal access surgery (MAS) to include pancreas in its domain. We present our series of laparoscopic pancreatic surgery (LPS) with an aim to look at the feasibility and outcomes.MethodsThis is a retrospective review of all LPS done at the Gastrointestinal Surgery (GIS) centre of a tertiary care Armed Forces Hospital over a period of 3 years.ResultsA total of 24 LPS were done during this period. The median age of the patients was 46 years (range; 13–81). There were 14 male and 10 female patients. Nine patients had at least one co-morbidity. Three patients underwent laparoscopic lateral pancreaticojejunostomy, 4 distal pancreatectomy, 4 laparoscopic Whipples pancreaticoduodenectomy, 6 laparoscopic pancreatic necrosectomy, 6 laparoscopic cystogastrostomy and 1 roux en y cystojejunostomy.ConclusionLPS can be performed for almost all open pancreatic surgeries and can be done with reasonable outcomes. However, it has a steep learning curve and therefore, a hybrid approach leading to a totally laparoscopic approach may be the way forward.     

脓肿型乳腺炎的微创手术及综合治疗的临床研究分析

目的：观察并分析临床中运用微创手术以及综合治疗的方式对脓肿型乳腺炎进行治疗的效果。方法：选取本院2010年2月-2012年3月收治的42例脓肿型乳腺炎患者的临床资料按照随机数字表法将其分为观察组和对照组各21例,对观察组运用微创手术及综合治疗,对照组采用传统的切开方式,观察两组治疗效果。结果：对本院脓肿型乳腺炎患者运用微创手术治疗后,观察组术后的愈合速度、治疗期间所承受的疼痛程度、哺乳情况均明显优于对照组,且与治疗前相比较均有明显改善,比较差异均有统计学意义（P〈0.05）。两组患者术后均无并发症出现,比较差异无统计学意义（P〉0.05）。结论：对脓肿型乳腺炎患者采用微创手术的方式进行治疗,其治疗过程安全可靠,患者术后的康复情况较为理想,治疗期间所承受的疼痛相对较低,治疗效果较为显著。     

假性门静脉瘤误诊为胆囊窝脓肿致穿刺引流治疗陷入致命危险1例报告

肝脏门静脉瘤比较少见,并发于腹腔镜下胆囊切除术的假性门静脉瘤更为少见。当依据患者临床症状和影像学检查将假性门静脉瘤误判为术后胆囊窝脓肿时,临床上极易作出对“脓肿”实施穿刺引流的治疗决策,此举陡增穿刺出血风险。本文报道1例因此情形行发生出血时的成功抢救经验,并对该患者腹腔镜胆囊切除术后形成假性门静脉瘤的可能机制、假性门静脉瘤超声影像和核磁共振成像误诊的原因进行剖析。     

困难情况下的腹腔镜胰十二指肠切除术2例分析（附手术视频）

  目的  介绍我中心在胰头恶性肿瘤侵犯周围血管以及肿块型胰腺炎合并致密炎症粘连等困难情况下所采用的个体化腹腔镜胰十二指肠切除术。  方法  回顾性分析我院近年来开展的困难情况下的腹腔镜胰十二指肠切除术的2例病例资料,包括手术策略、手术时间、术中出血情况、术后住院时间、治疗方案及预后情况。  结果  患者1,65岁男性患者,术前诊断为胰腺钩突占位伴肠系膜上静脉侵犯、梗阻性黄疸。术中行肠系膜上动脉优先入路的联合肠系膜上静脉切除重建的腹腔镜胰十二指肠切除术（操作见视频1）,手术时间340 min,出血200 mL,术中未输血。患者术后康复顺利,术后住院9 d。术后病理学诊断:胰腺中-低分化导管腺癌。患者行GS（吉西他滨+替吉奥）方案化疗6个周期,术后1年随访患者情况良好,无复发转移情况。患者2,47岁中年男性,因反复腹痛入院,术前诊断胰头占位伴梗阻性黄疸,既往接受过开腹Roux-en-Y胆肠吻合术、小肠切除、肠肠吻合术。术中采用超声刀、电钩、剪刀等多种方式处理患者腹腔不同部位粘连,调整传统模块化手术流程行腹腔镜胰十二指肠切除术,改用Easy-first原则行手术切除（操作见视频2）。术中采取双主刀模式处理例如出血等突发情况。手术时间400 min,出血500 mL,术中未输血。患者术后康复顺利,术后住院11 d。术后病理学诊断为胰头部慢性炎症肿块,最大径6 cm,未见明显癌变。术后20个月随访患者情况良好,未再发急性胰腺炎。  结论  在有经验的胰腺微创中心,通过不同的手术方式、采取个体化的手术策略,当肿瘤侵犯周围血管以及肿块型胰腺炎合并致密炎症粘连等情况腹腔镜胰十二指肠切除术是安全可行的。     

孤立性化脓性胰腺脓肿一例报道并文献复习

孤立性化脓性胰腺脓肿是一种较为罕见的疾病,临床表现为腹痛、发热,伴白细胞计数升高。在有结核病、沙门菌等感染时,尤其在糖尿病患者中发现胰腺肿块时需警惕该病。目前孤立性化脓性胰腺脓肿的病因和发病机制尚不明确。本文报道了1例2018-03-26在河北省人民医院消化科住院发现孤立性化脓性胰腺脓肿患者,并对其临床病例资料及治疗过程进行了回顾性分析,总结出孤立性化脓性胰腺脓肿诊治过程中易误诊为胰头癌或胰腺囊肿,认为需结合腹部增强CT、肿瘤标志物及超声内镜穿刺活检病理特征进一步明确诊断,从而早期诊断及治疗,以免误诊、漏诊。     

重症急性胰腺炎非手术治疗方法的探讨

为探讨重症急性胰腺炎 (SAP)的非手术治疗措施及中转手术的时机。对 2 2 3例SAP患者均先行包括重要脏器功能的支持、防治感染及促进胃肠功能恢复等非手术综合治疗 ,以后根据有无胰腺感染等并发症决定是否中转手术。结果 :前期组 ( 1 990～ 1 994年 ) 97例 ,患者一经诊断胰腺感染即手术治疗 ,病死率为 1 1 .3% ;近期组 ( 1 995～1 999年 ) 1 2 6例 ,选择性延期手术 ,将胰腺感染局限作为手术时机 ,病死率为 5.6%。全部患者非手术治疗过程中因胰腺感染中转手术 2 3例 ,其中胰腺感染局限者的手术病死率 ( 7.7% )显著低于感染未局限者 ( 50 % ) (P <0 .0 5)。结果提示 ,SAP应以积极、有效、综合的非手术治疗为主 ,胰腺感染局限者中转手术的效果优于感染未局限者     

女性盆腔脓肿60例临床分析

目的探讨女性盆腔脓肿的临床特点和处理方法。方法对2002至2008年在同济大学附属东方医院治疗的60例女性盆腔脓肿患者的临床资料进行回顾性分析,分析其病史、临床表现、入院诊断及治疗方法,并对腹腔镜手术和剖腹探查术的治疗效果进行比较。结果盆腔脓肿大部分发生在育龄妇女,临床表现发热、腹痛及盆腔包块,临床诊断正确率61.6%,误诊率38.4%。所有患者均经腹腔镜及开腹手术治疗,在手术时间、术中出血、术后体温及血象恢复正常的时间、术后感染及住院时间等方面,前者优于后者。结论女性盆腔脓肿病因复杂,临床表现多样,其临床症状缺乏特异性,误诊率高。宫颈分泌物培养和MR I检查在诊断盆腔脓肿中发挥重要作用。治疗以腹腔镜手术治疗效果好,一旦确诊,应尽早手术。     

腹腔镜手术治疗异位妊娠临床分析

目的:观察腹腔镜手术治疗异位妊娠的临床疗效,评价其临床应用价值.方法:随机选择2009年1月至2010 年12月间89例异位妊娠患者行腹腔镜手术者及89例开腹手术的异位妊娠患者,比较两组手术时间、出血量、并发症、术后住院时间及术后妊娠率等.结果:腹腔镜组术中出血量、术后镇痛药使用率等明显低于开腹组(P<0.05),术后肛门排气时间、住院时间明显短于开腹组(P < 0.05).腹腔镜组再次妊娠成功率为76.32%,开腹组为73.43% (P > 0.05).两组患者术后并发症、输卵管通畅率、持续性异位妊娠等差异有统计学意义(P<0.05).结论:腹腔镜手术治疗异位妊娠安全有效,并发症少,可作为异位妊娠的首选术式予以推广.     

妇科腹腔镜临床应用现状

急腹症是妇科常见疾病,若不能及时作出诊断和治疗,可危及患者生命。腹腔镜手术作为妇科疾病诊治的一个重要手段,已被公认为是急腹症诊治的金标准。应用腹腔镜诊治妇科急腹症,既可提高临床治疗效果,又能减少并发症。目前腹腔镜手术在妇科疾病诊疗中的使用率颇高,以腹腔镜为代表的微创手术已经成为现代妇科手术的必然趋势。腹腔镜手术的开展既提高了临床诊疗技术水平,又减少了患者开腹手术的机会,对减轻患者痛苦十分重要。     

腹腔镜治疗早期重症急性胰腺炎16例的临床分析

目的探讨经腹腔镜灌洗、引流治疗早期重症急性胰腺炎（severe acute pancreatitis,SAP）的疗效。方法对1998年4月-2007年11月间收治的16例早期重症急性胰腺炎的患者,进行腹腔镜下胃结肠韧带切开,胰腺被膜切开减压,吸尽胰周渗液及清除坏死组织,并置多管腹腔引流和灌洗治疗的临床资料进行回顾性分析。结果15例治愈,1例发生胰腺假性囊肿,无围手术期死亡。结论腹腔镜灌洗、引流治疗早期重症胰腺炎方法简单、安全、有效,可降低SAP的病死率,减少并发症。     

经腹及腹腔镜治疗女性盆腔脓肿比较

目的探讨女性盆腔脓肿的临床特点和处理方法。方法对1999-2010年在我院治疗的49例女性盆腔脓肿临床资料进行回顾性分析。结果盆腔脓肿大部分发生在育龄妇女,临床表现为发热、腹痛及盆腔包块,所有患者均经腹腔镜及开腹手术治疗,在术中出血、术后体温、感染及住院时间等方面前者优于后者。结论宫颈分泌物培养和MRI检查在盆腔脓肿诊断中发挥重要作用;腹腔镜手术治疗效果好,一旦确诊应尽早手术。     

胰腺假性囊肿的外科治疗83例分析

目的:探讨对胰腺假性囊肿的治疗方式和效果。方法:结合有关文献及对我院1990年1月至2007年6月收治的83例胰腺假性囊肿的处理方式、效果及并发症进行回顾性分析。结果:期待疗法自愈4例,采用非手术和非介入的期待处理10例,5例囊肿明显缩小,5例囊肿消失;B超引导下经皮囊肿穿刺抽液1例。B超引导下经皮置管引流3例;外引流术5例。单纯囊肿切除术6例。囊肿胰尾脾切除术3例。其余均行内引流术:囊肿与胃吻合23例。囊肿与空肠Roux-en-Y吻合28例,囊肿与十二指肠吻合2例,均获一次性治愈,无近期、远期并发症发生。结论:应采用个体化的治疗原则,根据囊肿形成的大小、时间、部位选择期待疗法、非手术引流(经皮穿刺吸液、内镜治疗),胃囊肿吻合、十二指肠囊肿吻合、空肠囊肿吻合、囊肿切除术。