多学科团队协作护理模式在单孔腹腔镜下膀胱肿瘤根治术中的应用

目的:探讨多学科团队协作护理模式在经脐单孔腹腔镜根治性全膀胱切除术患者中的临床应用价值。方法:将2014年2月到2015年12月在我科进行诊治的膀胱癌患者60例,根据随机抽签原则分为观察组与对照组各30例,2组都给予经脐单孔腹腔镜根治性全膀胱切除术加输尿管腹壁造口术,对照组在围手术期给予常规护理,观察组在对照组护理的基础上给予基于多学科团队协作护理模式的综合护理干预。结果:手术时间、术中出血量、术后排气时间、术后住院时间、生理职能、活力、生理机能、一般健康状况等评分2组比较,差异有统计学意义(P0.05)。并发症发生率观察组为10.0%,对照组为30.0%,2组比较差异有统计学意义(P0.05)。护理投诉率观察组为0,对照组为13.3%,2组比较差异有统计学意义(P0.05)。患者满意度评分与医生满意度评分2组比较,差异均有统计学意义(P0.05)。结论:多学科团队协作护理模式有利于提高经脐单孔腹腔镜下根治性全膀胱切除术患者护理质量,促进康复,减少并发症,提高其生活质量。     

经脐单孔腹腔镜输尿管及肾盂切开取石术18例临床分析

目的 探讨经脐单孔腹腔镜下输尿管及肾盂切开取石术的应用.方法 2014年5月至2015年5月,行经脐单孔腹腔镜输尿管及肾盂切开取石术18例21侧,包括男性5例,女性13例,平均年龄35.5岁,均为单发结石,平均最大径为2.5 cm,结石分别位于输尿管上段13枚,中段3枚,下段2枚,肾盂3枚;感染或积脓5例.患侧高70°斜卧位,取脐周“U”形切口约3 cm,置入“1环3通道”装置,30°腹腔镜及普通腹腔镜器械,用改良法置入D-J管后,间断缝合输尿管壁,改良法打结.结果 手术均成功完成,单侧手术时间平均97 main,术中平均出血15 mL,术后平均3.5d出院,术后1～2个月D-J管拔除后影像学复查,未见局部狭窄及结石残留,伤口愈合美观,温哥华疤痕评分平均为2.3分.结论 对于较大的、感染性的、复杂的输尿管或肾盂结石,不宜采用输尿管镜或经皮肾镜等微创治疗手段或治疗失败的患者,可选择经脐单孔腹腔镜输尿管或肾盂切开取石术治疗.     

Single-center comparison of outcomes between laparoscopic appendectomy and transumbilical laparoscopic assisted appendectomy

PurposeAppendectomy is the most common pediatric emergency surgery performed to date. This study compared outcomes between laparoscopic appendectomy (LA) and transumbilical laparoscopic assisted appendectomy (TULAA) for 1154 uncomplicated patients across 5 years at a single institution. Primary outcomes include length of stay (LOS), post-operative complications, pain score, and operating room (OR) time.MethodsDemographic and clinical data was collected for 1154 eligible patients treated for uncomplicated appendicitis between August 2014–October 2019, with 830 patients in the LA group, and 324 in the TULAA group. Mixed effects modeling procedure using logistic and linear regression examined the effect of surgery type on the four primary outcomes after adjustment for potential clustering effect of surgeon and confounding factors.ResultsOf 1154 patients, 62.7% were male, and mean (SD) age was 10.9 (3.6) years. Median [IQR] LOS was 28.0 h [22.0, 36.0], mean (SD) OR time was 29.0 (10.0) minutes, and median [IQR] pain at maximum level was 5.5 (2.7). The complication rate overall was <5.0% and did not differ between TULAA and LA groups (p > 0.05). OR time was reduced by an average of 5.2 min in the TULAA group (p < 0.001), pain did not differ between groups overall (p > 0.05), and patients were more likely to be discharged within 24 h in patients who underwent TULAA (OR = 5.3 [1.6, 17.4], p = 0.007).ConclusionRetrospective analysis of 1154 pediatric appendectomies, found no difference in complications between single- and three-incision laparoscopic procedures (TULAA vs. LA). Findings suggest TULAA is a safe procedure for acute appendicitis in pediatrics.Level of EvidenceIV.     

手辅助经脐单孔腹腔镜保留生育功能的卵巢恶性肿瘤手术的临床效果

目的:探讨手辅助经脐单孔腹腔镜保留生育功能的卵巢恶性肿瘤手术的安全性、实用性以及其与多孔腹腔镜和开腹手术的临床效果差异。方法:收集2013年3月至2019年10月在我院妇科住院行保留生育功能的卵巢恶性肿瘤手术的39例患者的住院病历资料,根据手术方式分为三组:A组:开腹手术组;B组:多孔腹腔镜手术组;C组:手辅助经脐单孔腹腔镜手术组。比较C组与另外两组的手术时间、手术出血量、肛门排气时间、术后病率、术后恢复时间,评价手辅助单孔腹腔镜手术的临床效果。结果:C组的手术时间、手术出血量、肛门排气时间、术后病率、术后恢复时间均少于A组,差异有统计学意义(P＜0.05)。C组的手术时间少于B组,差异具有统计学意义(P＜0.05);C组的其它观察指标与B组差异无统计学意义(P＞0.05)。结论:手辅助经脐单孔腹腔镜与多孔腹腔镜同样具有微创、术后恢复快等优势,同时,其拥有的大孔径入口可牵拉出大网膜进行切除,较开腹和镜下切除大网膜更加快速、便利、可靠,在只需要切除附件及大网膜的保留生育功能的卵巢恶性肿瘤手术中具有明显优势。     

经脐三孔法腹腔镜下阑尾切除术的临床应用

目的 探讨经脐三孔法腹腔镜阑尾切除术的方法和可行性.方法 回顾分析我院2010年2月至2010年7月50例经脐三孔腹腔镜阑尾切除患者的临床资料.结果 本组50例均通过普通腹腔镜器械经脐行三孔阑尾切除取得成功,无并发症,手术时间30-120 min,术后腹壁疤痕不明显.结论 经脐三孔腹腔镜阑尾切除术安全可行但操作较为困难...     

经脐单孔腹腔镜肾盂离断成形术临床分析

目的 探讨经脐单孔腹腔镜手术治疗肾盂输尿管连接部狭窄的手术技巧与临床应用价值.方法 2009年8月至2010年3月对15例肾盂输尿管连接部狭窄患者行经脐单孔腹腔镜肾盂离断成形术.男12例,女3例;平均年龄20(12～55)岁.均采用利尿性肾图、IVU、磁共振尿路造形术(MRU)等检查确诊,其中左侧9例,右侧6例.依病变部位在脐患侧缘行长约3.5 cm的切口建立单孔操作通道.采用Olympus四方向可弯曲腹腔镜,主要采用标准腹腔镜器械.肾盂离断成形方法基本同普通腹腔镜方法.结果 手术均成功,无中转开放手术者.平均手术时间为90(75～145)min.术中未出现器官损伤,术后未出现尿漏.患者平均住院时间6(4～8)d.术后随访4～6个月,患者腰痛症状消失,IVU和(或)B超检查肾积水明显减轻或消失,无吻合口再狭窄.结论 经脐单孔腹腔镜手术治疗肾盂输尿管连接部狭窄安全、有效.

Abstract：

Objective To evaluate the surgical techniques and clinical applications of single-port transumlilical laparoscopic dismembered pyeloplasty for the treatment of ureteropelvic junction obstruction (UPJO). Methods From August 2009 to March 2010, 15 patients were treated with single-port transumbilical laparoscopic dismembered pyeloplasty. There were 12 males and 3 females,aged 12 to 55 years with an average age of 20 years, who were diagnosed by diuretic renography,IVU, and MRU et al. A single umbilical incision of 3. 5cm was made for single-port trocar and a flexible-tip 0°digital video-laparoscope was used in all cases. The procedures were performed according to the methods used in classical laparoscopic dismembered pyeloplasty with general instruments. ResultsAll operations were performed successfully without conversion to open surgery. The mean operative time was 90 (75-145) min, and the mean hospital stay length was 6 days. No organs injury occurred during operation, and no urine leakage was found afer operation. The symptoms of low back pain disappeared and hydronephrosis reduced apparently or dispeared without any anastomotic stenosis after follow-up of 4-6 months. Conclusions Single-port transumbilical laparoscopic dismembered pyeloplasty is feasible, effective and safe for the treatment of UPJO.     

经脐"小三角置人法"单孔腹腔镜胆囊切除术临床应用研究

目的 探讨经脐"小三角置入法"单孔腹腔镜胆囊切除术的可行性和安全性.方法 17例胆囊良性疾病(12例结石,5例息肉)均行经脐"小三角置人法"单孔腹腔镜胆囊切除术.先在脐部正中横行切开1.5～2.0cm切口,游离皮肤和皮下脂肪,倒三角形置人腹腔镜及相关器械完成胆囊切除.结果 17例手术均获成功,手术时间最长120分钟...     

经脐腹腔镜结肠肛门拖出术治疗儿童神经节细胞减少症

目的探讨经脐腹腔镜结肠肛门拖出术用于儿童神经节细胞减少症的治疗效果。方法回顾性分析2009年6月至2010年6月间在华中科技大学同济医学院附属同济医院接受经脐腹腔镜肛门拖出手术的12例神经节细胞减少症患儿的临床资料。结果手术使用特制的弯曲手柄型加长器械进行操作,无一例患儿中转开腹或改行传统腹腔镜手术。术中无腹部血管、肠管、输尿管或输精管损伤．平均手术时间140min．平均术中失血量45ml,平均切除病变肠管长度40cm。术后无吻合口瘘、吻合口狭窄、便秘、污粪、排粪失禁等并发症出现,平均术后住院时间9d。术后1个月复诊时均未见明显手术瘢痕。术后经10～22（中位时间16）个月的随访,无一例复发。结论经脐腹腔镜肛门拖出术治疗神经节细胞减少症简单、安全并有效。     

经脐入路腹腔镜手术:存在问题与争议

近年来腹壁无瘢痕手术成为微创外科研究热点。与经自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)相比,经脐入路内镜手术(transumbilical endoscopic surgery,TUES)具有操作简单、安全及空间定位良好等优点,而且TUES可以带来更好的腹壁美容效果,但同时也增加了手术难度。作者认为取得良好治疗效果是LESS的基本目标,其次才是美观。     

耻骨上辅助经脐微双孔腹腔镜技术治疗精索静脉曲张的临床应用(80例报告)

目的:探讨耻骨上辅助经脐微双孔腹腔镜技术(SAU-LEMDS)治疗精索静脉曲张的安全性、可行性和有效性。方法:本组80例精索静脉曲张男性患者,年龄28.5±2.6(24~44)岁。单纯左侧58例,单纯右侧6例,双侧16例。Ⅰ度25例,Ⅱ度45例,Ⅲ度10例。患者精液分析检查均为弱精子症。蛛网膜下腔麻醉联合静脉麻醉,头低脚高15°仰卧位。于脐左右侧缘分别置入一5 mm Trocar,其中一个Trocar插入分离钳或剪刀等操作器械,另一个Trocar中置入5 mm 30°腹腔镜,自耻骨联合上方阴毛覆盖区置入一5 mm Trocar及操作杆。保留精索内动脉,用丝线双重结扎精索内静脉。如为双侧病变,同法处理对侧。随访观察精液变化及睾丸萎缩、睾丸鞘膜积液发生率等指标,比较患者手术前后精液参数变化。结果:全部手术均成功。单侧手术时间10.0±5.0(8~25)min,双侧手术时间18.0±6.5(15~30)min。失血量1.5±0.5(1~2)ml,住院时间2.0±0.5(1.5~3)d,术后随访12.0±2.5(6~24)个月。精子活力(PR)明显改善[(19.62±3.56)%vs(28.53±5.21)%,P0.05],精子活力恢复正常28例(35.0%,28/80),术后出现睾丸鞘膜积液7例(8.75%,7/80),复发4例(5.0%,4/80),没有睾丸萎缩病例。脐部切口愈合良好,被周围的皱褶所遮蔽,耻骨上小切口被阴毛覆盖,瘢痕不明显,美容效果良好。结论:SAU-LEMDS精索内静脉高位结扎治疗精索静脉曲张安全、有效、可行,与传统的经脐单孔腹腔镜(U-LESS)技术比较具有创伤更小,操作更简便,美容效果更佳的优势,值得临床推广应用。