腹腔镜手术治疗精索静脉曲张22例报告

目的:探讨腹腔镜手术治疗精索静脉曲张的疗效。方法:应用腹腔镜为22例患者施行精索静脉高位结扎术。结果:22例手术均获成功。手术平均时间32m in(18~45min),2~3d出院,随访3个月,曲张静脉均消失,伴男性不育症者精液质量明显改善。结论:腹腔镜精索静脉结扎术效果可靠、对机体干扰轻、并发症少、康复快、复发率低,且可同时施行双侧手术,值得临床推广应用。     

腹腔镜手术治疗精索静脉曲张15例报告

目的:探讨两孔法腹腔镜术中超声刀、电凝钩在精索静脉高位结扎术中的应用。方法:回顾分析两孔法腹腔镜电凝钩分离、超声刀夹闭切断精索内静脉15例患者的临床资料,其中左侧10例,双侧5例。结果:15例手术均获成功,无并发症发生,平均手术时间25min,平均住院4.8d,疗效满意。结论:两孔法腹腔镜电凝钩分离、超声刀结扎治疗精索静脉曲张具有患者创伤小,康复快,疗效确切,术后不留异物等优点。     

腹腔镜胃癌根治术联合术中腹腔温热化疗预防肿瘤复发的研究

目的:研究腹腔镜胃癌根治术联合术中腹腔内温热化疗对预防术后肿瘤复发,提高胃癌术后生存率的临床效果。方法:腹腔镜胃癌根治术46例,随机分为两组,其中23例胃癌根治术中施行腹腔内温热化疗,23例术中常规用生理盐水冲洗腹腔,观察术后并发症、毒副反应和近期随访结果。结果:两组术后并发症和毒副反应基本相同(P>0.05),随访2年,治疗组死亡6例(26.1%),明显低于对照组死亡的13例(34.8%),其中2例肿瘤复发,明显少于对照组的8例(P<0.05)。结论:腹腔镜胃癌根治术联合术中腹腔内温热化疗可在术中杀死腹腔内游离癌细胞,对预防术后肿瘤复发,提高术后生存率有一定的效果。     

Laparoscopic management of splenic cysts: marsupialization, cavity lining with surgicel and omentopexy to prevent recurrence

INTRODUCTION: Open total splenectomy, once the treatment of choice for splenic cysts, has largely been replaced by laparoscopic, splenic preserving procedures. These techniques have resulted in reduced hospitalization times and rates of overwhelming postsplenectomy infection. We report 2 cases of laparoscopic management of large, symptomatic splenic cysts. METHODS: Two patients presented with symptomatic splenic cysts. The first was a simple cyst by history, the second a posttraumatic cyst. Both patients were treated by laparoscopic cyst marsupialization followed by lining the cavity with Surgicel (Ethicon, Somerville, NJ) and performance of an omentopexy. RESULTS: Both procedures were performed without complication. At 25 months, neither patient showed any evidence of symptomatic or radiologic recurrence. Pathology confirmed the preoperative diagnoses. CONCLUSIONS: Laparoscopic marsupialization of splenic cysts in combination with lining the cyst cavity with Surgicel and omentopexy is a safe, feasible, and efficacious method of management with excellent results at 25-month follow-up.     

腹腔镜精索内静脉结扎术11例报告

应用腹腔镜技术为11例患者行精索曲张静脉高位结扎术。硬膜外麻醉,手术均获成功,无一例发生并发症,手术时间20～70min,术后当天下床活动,次日出院。对该手术方法的优缺点和适应证进行了讨论。     

Concomitant incidence of fertility chance reducing varicocele and chromosome aberration.

Authors describe the case of a male patient with varicocele, oligozoospermatism and subfertility, a 46 XY t (8; 10) (q22; p15) balanced chromosome carrier. Following varicectomy, successful pregnancy has developed even with balanced translocation meaning only 50% fertility chance. Prenatal diagnostics by chorion biopsy showed a fetus of normal chromosome constellation. Authors call attention to the fact that even minor, step-by-step improvements in fertility chance may lead to success in multiple aberrations.     

Laparoscopic occlusion of testicular veins for clinical varicocele.

Surgery via the laparoscope is now a reliable and cost-effective alternative to some open surgical procedures. Advances in videoendoscopy, incorporating optical magnification combined with the development of instruments with which to dissect, ligate, and transect blood vessels provide the urologist the opportunity to surgically correct a varicocele. In the outpatient setting, 4 patients (14-26 years of age) underwent laparoscopic ligation of the left internal spermatic veins for painful left varicocele. Carbon dioxide pneumoperitoneum was obtained using a Veress needle. A 10-mm laparoscope was placed intraperitoneally through a cannula inserted in the infraumbilical border. Utilizing two additional endosurgical ports (5 mm and 10 mm) through which 5-mm dissecting instruments and vaso-occlusive endoclips were placed, three veins were individually isolated and ligated in each of the 4 patients. In all 4 patients, the left testicular artery was visualized and preserved. There was no blood loss or other intraoperative complication. In each patient the varicocele was successfully corrected. Analgesic medication was not required postoperatively. We conclude that laparoscopic ligation of the internal spermatic veins is a safe and effective way of treating a varicocele without immediate postoperative sequelae. Long-term follow-up is necessary to determine the place of the endoscopic approach.     

腹腔镜下精索静脉高位结扎术治疗精索静脉曲张(附32例报告)

目的:评价腹腔镜下精索静脉高位结扎术的有效性、安全性及其价值。方法:回顾分析32例腹腔镜下精索静脉高位结扎术的疗效和康复情况。结果:32例手术均获成功,平均手术时间34m in,基本无出血,术后平均住院2.8d,随访3~10个月,2例复发,复发率为6.25%。结论:腹腔镜下精索静脉高位结扎术具有创伤小、恢复快、效果好、并发症少等优点,对双侧精索静脉曲张及预防术后复发更具价值。     

精索筋膜肌管折叠术治疗精索静脉曲张及远期随访

１９７６年７月至１９８７年１月采用精索筋膜肌管折叠术治疗精索静脉曲张２７例（２９侧）。２０例２２侧平均随访１３６．１个月，静脉曲张均消失，随访４例合并不育症者３例已育，１例术前无精子者恢复了生育力，介绍了手术方法及精索筋膜肌管的解剖及组织和形态学研究结果。     

Laparoscopic inguinal hernia repair: a NICE operation

Published evidence comparing laparoscopic and open herniorraphy is controversial. NICE recommends that open techniques are used for first time repairs and that TEP be considered for bilateral/recurrent repairs undertaken in specialist units. We report a consecutive series of 224 patients undergoing 268 TEP repairs between 1996 and 2001. Operating time, complications, return to normal activity/full time employment and recurrence were examined. The median operating time was 30 minutes. There was one conversion. Ninety four percent of patients drove on the third post-operative day. The median time to normal activity was 4 days (1-10 days). The median time to return to professional employment in 82 patients was 3 days (range 2-9 days). Four patients (1.7%) had self-limiting minor groin pain. There were 3 recurrences (1.4%) and none since altering the surgical technique to use a larger anchored mesh. We have demonstrated TEP to be an easily learnt, safe, effective technique with low morbidity, and with sufficient experience, takes no longer than an open repair. It can be performed at little increased cost and restores selected patients to an early return to full-time employment. We believe that the choice between open and laparoscopic repair is a subjective decision for patient and surgeon     

A modified Ross operation to prevent pulmonary autograft dilatation.

A modification in Ross operation is described in which the free-standing pulmonary autograft root is suspended in a Dacron prosthetic vascular jacket with a view to prevent dilatation of the neo-aortic root. In a group of 13 patients operated consecutively using this technique, there was no significant increase in the diameters of the neo-aortic root after a mean 16-month follow-up. Aortic valve function remained also satisfactory.     

腹腔镜治疗精索静脉曲张235例

目的探讨腹腔镜治疗精索静脉曲张的疗效. 方法回顾分析1993年9月～2003年7月235例经腹腔镜精索静脉高位结扎术的临床资料. 结果 235例手术均获成功,手术时间5～20 min,平均12 min.术后住院2～5 d,平均3 d.210例随访6～18个月,9例复发,复发率4.3%(9/210),不育11例术后6～12个月后其妻受孕. 结论腹腔镜精索静脉高位结扎术微创、美观、疗效好,对双侧精索静脉曲张、开放性手术后复发和有腹股沟区手术史者尤为适用.