腹腔镜胆囊切除术后假性动脉瘤的诊治

目的:探讨腹腔镜胆囊切除术(LC)后假性动脉瘤的诊治方法。方法:对4例LC术后假性动脉瘤患者的临床资料进行分析,对其诊治要点及预防措施进行探讨。结果:4例患者主要临床表现包括右上腹痛、上消化道出血、黄疸等,彩色多普勒超声检查提示诊断,选择性血管造影明确诊断并同时行栓塞治疗成功,均治愈。结论:彩色多普勒超声和选择性血管造影是本病的主要诊断方法。介入栓塞治疗应作为假性动脉瘤治疗的首选方法。假性动脉瘤的形成与手术操作有关,应重在预防。     

妇科腹腔镜手术几种激光对兔子宫壁损伤的实验研究

为掌握妇科腹腔镜手术所应用的激光器的治疗剂量，对几种激光引起的兔子宫壁热损伤进行观察。实验研究证实：所有激光产生的损伤程度与所用的剂量呈正相关。术后４８ｈ与即刻损伤程度相比，半导体激光的损伤程度明显加深、加宽；但ＣＯ２激光和ＮｄＹＡＧ激光接触式光刀无显著变化。说明应用激光行妇科腹腔镜手术治疗时，所产生的损伤与应用的功率密度有关，为临床合理选用腹腔镜下的激光治疗提供依据     

Surgical technique of laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis

We report herein a new method of performing laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis, using refined surgical techniques. The pyloric tumor was immobilized by grasping the first portion of the duodenum and the anterior wall of the stomach, and electrocoagulation was used prior to incising the pyloric tumor to minimize bleeding during the procedure. Although this technique has been applied in only two patients so far, we present the details herein. We believe that with technical and instrumental refinements, the speed and safety of laparoscopic pyloromyotomy will improve and it will become an alternative to open surgery in pediatric patients.     

Early laparoscopic cholecystectomy for acute cholecystitis

Background: The timing of laparoscopic cholecystectomy for acute cholecystitis remains controversial. Methods: One hundred ninety-four patients with acute cholecystitis were reviewed. The conversion rates for the various number of days of symptoms before surgery were analyzed. The conversion rate dramatically increased from 3.6% for those patients with 4 days of symptoms to 26% for those patients with 5 days of symptoms. The mean number of days of symptoms prior to surgery in those patients who underwent successful laparoscopic cholecystectomy was 4.1 as compared to 8.0 in those patients who required open cholecystectomy (p < 0.0001). Based on this data the patients were divided into two groups. Group 1 consisted of 109 patients who underwent laparoscopic cholecystectomy within 4 days of onset of symptoms and group 2 consisted of 85 patients who underwent laparoscopic cholecystectomy after more than 4 days following onset of symptoms. Results: The conversion rate from laparoscopic to open cholecystectomy was 15%. The conversion rate for group 1 was 1.8% as compared to 31.7% for group 2 (p < 0.0001). Indications for conversion were inability to identify the anatomy secondary to inflammatory adhesions (68%), cholecystoduodenal fistula (18%), and bleeding (14%). The major complication rate for group 1 was 2.7% as compared to 13% for group 2 (p= 0.007). The mortality rate for all patients with attempted laparoscopic cholecystectomy for acute cholecystitis was 1.5%. The average procedure time for group 1 was 100 ± 37 min vs 120 ± 55 min in group 2. The average number of postoperative hospital days in group 1 was 5.5 ± 2.7 days as compared to 10.8 ± 2.7 days in group 2. Conclusions: We advocate early laparoscopic cholecystectomy within 4 days of onset of symptoms to decrease major complications and conversion rates. This decreased conversion rate results in decreased length of procedure and hospital stay. Received: 28 March 1996/Accepted: 12 September 1996     

Laparoscopic treatment of nonparasitic cysts of the liver with omental transposition flap

Background: Between 1991 and November 1994, 18 patients with large, solitary, nonparasitic liver cysts underwent laparoscopic deroofing; the last 13 of them also received an omental transposition flap in addition. Methods: Using three to four trocars, the cystic contents were first aspirated, and the cyst derooted widely using diathermia. An omental transposition flap was fashioned and stapled into the cyst cavity itself. Results: Postoperative complications included one case of pulmonary atelectasis. Another patient developed a subhepatic bile collection which was aspirated percutaneously. On average, patients were discharged on the 4th (2–14) postoperative day. Follow-up was performed with abdominal ultrasound for 2–43 months (mean 19 months). There were two early cyst recurrences, both in cases without an omental transposition flap (overall recurrence rate, 11%; in patients with omental flap, 0). Conclusions: Deroofing in combination with an omental transposition flap is a safe and effective therapy for symptomatic solitary liver cysts and can be performed using minimal-access surgical techniques. Received: 19 January 1996/Accepted: 26 August 1996     

针式腹腔镜在泌尿外科的应用现况

针式腹腔镜是新近出现的直径只有2 mm的腹腔镜设备,目前已用于普通外科、妇产科等一些疾病的治疗上.在泌尿外科方面,针式腹腔镜在肾上腺切除术、小儿隐睾固定术等手术上也得到了应用.虽然对针式腹腔镜手术的定义仍存在争议,目前2 mm的器械也尚有局限性,但其相对于传统腹腔镜有明显的优点,如损伤比传统腹腔镜手术更小、美观性更好、住院时间更短、恢复更快.针式腹腔镜将是常规腹腔镜发展的必然结果.     

腹腔镜术后病人的手术感受对术前病人的作用

目的:为帮助腹腔镜胆囊手术病人掌握健康教育的知识.方法:开展了由腹腔镜手术后的病人向术前病人介绍手术感受.结果:促进术前病人对有关的健康教育知识的掌握,并能延长其术前1d晚的睡眠时间.结论:使病人更好地掌握健康宣教知识,有利于病人的治疗.     

腹腔镜手术并发症27例相关因素分析

目的 探讨腹腔镜手术的并发症及其相关因素。方法 回顾性研究西南医院妇产科近2年的2214例腹腔镜手术病例及27例出现并发症的病例情况。手术包括附件手术1721例，子宫肌瘤挖除术150例，子宫次全切术210例，子宫全切133例。并发症指术中出现的需额外处理或术后出现的因手术本身引起需进行再次手术或保守治疗的情况。结果 并发症发生率为1.22%，需手术处理者2例（0.09%)。附件手术、子宫肌瘤挖除、子宫次全切除术、子宫全切术的并发症发生率分别为0.52%、2.00%、3.33%及6.01%。与穿刺及气腹有关的并发症14例（51.9%)，包括腹壁血管损伤、严重皮下气肿及气腹针断裂；术中并发症3例（11.1%)，其中肠管损伤2例，1例改开腹手术，另1例为电极胸部皮肤烧伤；术后并发症10例（37.0%)，为术后发热。结论 妇科腹腔镜手术并发症不容忽视，并发症的发生与手术难度有关。     

腹腔镜胆囊切除高龄患者血液流变性变化的研究

目的 :探讨腹腔镜胆囊切除术对高龄患者血液流变性的影响 ,进一步认识腹腔镜胆囊切除术的特点。方法 :对 4 0名腹腔胆囊切除术高龄患者气腹前、气腹中、气腹后和术后第一天的全血粘度 (ηb)、血浆粘度 (ηP)、红细胞聚集指数 (EAI)、血沉方程K值 (ESRK)、血球压积 (HCT)和纤维蛋白原 (Fib)进行了检测比较和分析。结果 :高龄患者气腹后患者血液流变性和检测指标有明显的变化 ,气腹消除后未明显缓解 (P <0 .0 5 )。术后第一天 ,变化的指标恢复到气腹前水平 (P >0 .0 5 )。结论 :在一定控制范围内的气腹对腹腔镜胆囊切除高龄患者的血液动力学方面虽未引起明显的变化 ,但对血液流变性产生了影响 ,这种影响在气腹消除后仍可持续一段时间     

Femoral pseudo-hernias

Before surgical intervention in the femoral area, doctors should be mindful of two situations in which surgery is not indicated and, in fact, may cause harm. Electronic Publication