Mini-Cornual Excision: a Simple Stepwise Laparoscopic Technique for the Treatment of Cornual Pregnancy

Cornual pregnancy often poses a diagnostic and therapeutic challenge, with a significant risk for morbidity and mortality. Traditional treatment for cornual pregnancy has been through laparotomy, wedge resection, or hysterectomy. Early diagnosis is now possible through transvaginal ultrasonography and highly-sensitive β-human chorionic gonadotropin assays. Consequently, several less-invasive therapies and techniques have been introduced over the last 2 decades. We present a simple, stepwise laparoscopic technique for the definitive, minimally-invasive excision of cornual pregnancy, along with a review of the pertinent literature.     

Staged Second-Look Laparoscopy to Evaluate Ischemic Bowel

Background and Objectives:

An open, second-look laparotomy often is required to assess ischemic bowel after extensive mesenteric lymphadenectomy to cytoreduce midgut carcinoids. Aggressive resection of tumor at the base of the mesentery may compromise the integrity of the blood supply to the involved segment of intestine. Long segments of bowel that initially appear ischemic are sometimes created. The surgeon is faced with the decision to perform a resection or to close the abdomen temporarily knowing that this patient will require a second-look laparotomy.

Methods:

Segments of bowel showing signs of possible ischemia were preserved based on signs of perfusion. A side-side anastomosis was performed in the standard fashion. A Jackson Pratt drain was placed in an area adjacent to the anastomosis and brought out through the abdominal wall, and the incision was closed. Forty-eight hours later, a laparoscopic second-look operation was performed. A pneumoperitoneum was established using the drain tubing as the CO₂ inflation port. The drain was removed, and a 5-mm trocar was inserted into the abdomen via its tract. Segments of previously questionable dusky bowel and the anastomosis were inspected with a laparoscope.

Results:

Our 3 second-look operations were completed in approximately 5 minutes, and the patients recovered without complication or prolonged hospital course. Our fourth patient progressed extremely well postoperatively and was able to avoid the planned second-look laparos-copy.

Conclusions:

This technique provides an easy solution for the intraoperative finding of questionable blood supply in the intestines.     

腹腔镜与开腹结直肠癌手术对血浆血管内皮生长因子水平的影响

目的:评估腹腔镜与开腹结直肠癌根治术对患者血浆血管内皮生长因子(vascu lar endothelial growth factor,pVEGF)水平的影响。方法:回顾分析2007年7月至2008年2月北京医院胃肠外科收治的104例结直肠癌患者的临床资料,腹腔镜组30例,开腹组74例,分别于术前1d和术后1、3、7d采集并分离血浆,用ELISA方法检测pVEGF水平变化。结果:两组术前pVEGF分别为(82.1±79.8)ng/L和(85.9±93.8)ng/L;术后1、3、7d:腹腔镜组分别为(94.8±97.9)ng/L、(108.8±83.1)ng/L和(122.5±90.4)ng/L,开腹组分别为(109.6±99.6)ng/L、(123.5±108.7)ng/L和(133.8±110.7)ng/L。结论:腹腔镜与开腹结直肠癌根治术术后pVEGF水平均较术前升高,腹腔镜组升高幅度略低于开腹组,但两组间差异无统计学意义;各组内术后pVEGF水平升高明显,差异有统计学意义(P=0.00)。     

腹腔镜子宫肌瘤切除术与开腹手术的疗效比较

目的:评价腹腔镜与传统开腹手术行子宫肌瘤切除术的优缺点。方法:回顾分析子宫肌瘤切除术56例中,腹腔镜手术22例,开腹手术34例的临床资料,比较分析两组手术时间、术中出血量及术后恢复情况。结果:腹腔镜组术中出血量,术后应用止痛药、发热时间、住院时间、抗生素使用时间明显好于开腹组,但腹腔镜手术时间长于开腹组。结论:腹腔镜子宫肌瘤切除术具有患者创伤小、康复快、住院时间短等优点,但对术者的技术水平和器械要求较高,尚不能完全取代开腹手术,合理选择术式是手术成功的关键。     

Ⅰ期子宫内膜癌患者腹腔镜手术后中长期随访比较研究

目的探讨腹腔镜手术治疗Ⅰ期子宫内膜癌患者的预后。方法回顾性分析1993年5月～2008年5月腹腔镜手术治疗31例Ⅰ期子宫内膜癌（腹腔镜组）的临床资料,并与同期开腹手术治疗的52例（开腹组）进行比较,比较2种手术方法患者术中长期随访结果。结果2组临床亚分期Ⅰa、Ⅰb、Ⅰc期患者半数生存时间分别为77、51、31个月。83例死亡4例,总生存率95.2%（79/83）。开腹组死亡3例,总生存率94.2%（49/52）;腹腔镜组死亡1例,总生存率为96.8%（30/31）,2组总生存率差异无显著性（Z=0.028,P=0.978）。腹腔镜组与开腹组Ⅰa期患者半数生存时间比较差异无显著性（80月vs63月,P=0.48）,腹腔镜组病理G1级患者半数生存时间明显长于开腹组（77月vs51月,P=0.037）,腹腔镜组与开腹组Ⅰb、Ⅰc期及G2、G3级患者半数生存时间无显著差别（49月vs48月,P=0.78;51月vs49月,P=0.635））。结论鉴于腹腔镜手术的微创伤性及对Ⅰ期子宫内膜癌患者的预后有益,腹腔镜手术应该作为Ⅰ期子宫内膜癌的常规治疗方法。     

腹腔镜与开腹手术治疗卵巢子宫内膜异位囊肿疗效比较

目的:比较初期开展腹腔镜手术与开腹手术治疗卵巢子宫内膜异位囊肿的疗效。方法:回顾分析2007年1月～10月我院收治58例卵巢子宫内膜异位囊肿患者的临床资料。58例中37例行腹腔镜手术,21例行开腹手术,比较两组手术时间、术中出血量、术后病率、抗生素应用时间、术后住院天数、术后镇痛泵使用率、切口愈合等情况。结果:腹腔镜组术中出血量、术后止痛药用量、发热时间、住院时间、抗生素使用时间均明显优于开腹组。结论:腹腔镜是诊治卵巢子宫内膜异位囊肿的金标准,需严格掌握其适应证,熟悉各种并发症的防治方法,掌握中转开腹时机。     

不同的保守治疗方案治疗输卵管妊娠的效果研究

目的：探讨不同的保守治疗方案治疗输卵管妊娠的临床效果。方法：回顾性分析2005年1月至2006年1月间在我院采用不同的保守治疗方案的输卵管妊娠患者84例,总结分析药物保守治疗组和开腹保守治疗组的治疗效果。结果：开腹组患者HCG降至正常时间明显短于药物组,两者比较差异具有统计学意义（P〈0.05）。开腹组患者HCG以及β-HCG下降幅度明显大于药物组,两者比较差异具有统计学意义（P〈0.05）。开腹组患者输卵管通畅率和宫内妊娠率明显高于药物治疗组,两者比较差异具有统计学意义（P〈0.05）。开腹组患者再次异位妊娠率与药物组比较差异无统计学意义（P〉0.05）。结论：药物保守治疗应严格选择病例,而开腹手术因具有更高的宫内妊娠率,疗效好于药物保守治疗措施。     

Stoma siting using CT guidance in a multiply scarred abdomen

The creation of a stoma in a multiply scarred abdomen is often difficult because of intra-abdominal adhesions and limited suitable skin sites. We report a simple technique utilising computed tomography which allowed the easy creation of a defunctioning loop colostomy in such an abdomen by simple trephine rather than laparotomy.     

腹腔镜手术与开腹手术治疗异位妊娠的临床对比研究

目的通过对腹腔镜与开腹手术治疗异位妊娠疗效的对比分析,探讨腹腔镜手术治疗异位妊娠的优越性。方法腹腔镜手术55例(观察组)与开腹手术65例(对照组)术中及术后恢复情况进行回顾性比较。结果两组均顺利完成手术,观察组无中转开腹、膀胱或直肠损伤,观察组术中出血少、术后病率低、住院时间短、肠功能的恢复快。观察组腹部切口较长,愈合后留下瘢痕;在观察组中,术后伤口愈合好,几乎不留瘢痕。结论腹腔镜手术治疗异位妊娠具有创伤小、腹壁美容效果好,术后恢复快,并发症少,住院天数少的优点,对有生育要求者更有临床意义,值得基层医院推广应用。     

Clinical Entity and Treatment Strategies for Adult Intussusceptions: 20 Years-Experience

Purpose Intestinal intussusception in adults is rare and the optimal management of this problem remains controversial. The purpose of this study was to determine the causes of intussusceptions in adults and to assess their treatment. Methods A retrospective review of patients older than aged 18 years who were diagnosed with intestinal intussusception at Tri-Service General Hospital between July 1984 and July 2004 was conducted. Results During the 20-year period, there were 292 patients with intussusception, 24 (8.2 percent) of which were adults. Abdominal pain was the most common presenting complaint (79.2 percent). The diagnosis of adult intussusception was made preoperatively in 18 cases (75 percent) and intraoperatively in 6 cases (25 percent). Of the 24 patients, 20 (83.3 percent) had a defined lesion; 11 (55 percent) lesions were benign and 9 (45 percent) were malignant. In eight patients (33.3 percent), the intussusception was reduced; perforation occurred in one patient (12.5 percent). Segmental resections were performed on 14 patients (58.3 percent), right hemicolectomies on 6 patients (25 percent), laparoscopic low anterior resection on 1 patient (4.2 percent), appendectomy on 1 patient (4.2 percent), and diverticulectomy on 1 patient (4.2 percent). Intraoperative colonoscopy was performed on three patients (12.5 percent) before reduction (lipomas were noted in 2 of the patients (66.7 percent) with limited resection of the ileum and preservation of the antireflux ileocecal valve. There was one perioperative mortality (4.2 percent) and seven postoperative morbidities (29.2 percent). Conclusions Adult intussusception is an unusual and challenging condition and is a preoperative diagnostic problem. We discuss our 20 years of experience in treatment strategies for dealing with such unusual problems. Reprints are not available.