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1.
危重型胆总管囊肿的诊治体会 总被引:1,自引:0,他引:1
目的 提高对危重型胆总管囊肿的诊治水平,方法 对收治的23例危重型胆总管囊肿患儿进行回顾性分析总结,结果 23例中3岁以下婴幼儿占20例(86.95%)均为囊肿型,有囊肿破裂腹膜为炎5例,囊肿直径超过10cm17例,死亡5例(21.7%),23例中行囊肿外引流术7例(死亡1例,行Ⅱ期手术治愈6例)囊肿内引流术13例(死亡2例)囊肿切除胆道重建术3例(死亡2例)结论 危重型胆总管囊肿具有起病急,病情 相似文献
2.
Objective To evaluate the feasibility and indication of laparoscopie duodenoduoden-ostorny for neonates with congenital duodenal obstruction- Methods From May 2004 to Feburary 2008,6 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 5~8 mmHg and a suspending suture for right liver elevator, the procedure was performed using 3 cannulas of 3.3 mm to 5.5 mm diameter. Under the laparoscopic vision, the cause of duodenal obstruction was diagnosed and a sutured anastomosis was performed after the duodenum mo-bilized. Results Findings at laparoscopy included duodenal diaphragm in 3 cases,annular pancreas in 2 cases, and preduodenal portal vein in 1 case. Three cases with duodenal diaphragmatic stenosis were en-countered a partial excision of the diaphragm after vertical incision of the anterior part of duodenum followed laparoscopically by a transverse suture. A diamond-shaped side-to-side duodenoduodenal anas-tomosis was successfully carried out in 2 cases of annular pancreas through a laparoseopic approach, but a duodenojejunostomy was converted to mini-laparotomy during the laparoscopic course of a predu-odenal portal vein. The average operative time was 102 16.5 min (85~135 min). Visualization was ex-cellent, and there were no intraoperative complications. Feedings were started on postoperative day 3 to 5. All cases were on full feedings after 8 to 10 days. Follow-up upper gastrointestinal tests showed no evidence of stricture or obstruction. Conclusions The duodenoduodenostomy with laparoseopy can be performed in neonates securely and appropriated for a full-term newborn with tolerance CO2 pneumo-peritoneum. It provides an excellent and micro-invasive way to evaluate and treat congenital duodenal obstruction. 相似文献
3.
目的:总结腹腔镜手术诊治先天性胆管扩张症(congenital biliary dilatation,CBD)的经验,评价腹腔镜肝外扩张胆管切除、肝管空肠吻合术的可行性及安全性。方法:回顾2002~2010年腹腔镜手术治疗106例CBD患者的临床资料,分析其手术技术、围手术期并发症及随访情况。结果:62例胆总管呈囊状扩张、44例呈梭形扩张。其中,83例行术中胆道造影,77例显示胰胆管合流异常。103例成功完成腹腔镜手术,3例中转开腹,其中1例囊肿巨大,1例Ⅲ型囊肿损伤十二指肠,1例合并炎性血管瘤出血。24例伴有肝内胆管局限性扩张(IV-A型)同时行肝门胆管狭窄段切开或切除扩大成形术。手术时间平均(214.9±58.3)min,术后平均住院(7.7±2.3)d。围手术期发生并发症8例,1例术中门静脉损伤,5例暂时性胆漏,1例胆支空肠袢扭转,1例应激性溃疡。随访6个月~8年,1例发生肝门吻合口狭窄行二次手术解除,1例术后切口疝经手术修复,2例肠梗阻经保守治疗后缓解。余者恢复良好。结论:腹腔镜术中胆胰管造影可确定CBD类型及胆胰管合流情况,腹腔镜提供的视野放大效果有助于根除病变、避免损伤胆胰管连接部和矫治肝门胆管狭窄,腹腔镜手术可安全地施行并取得满意效果。 相似文献
4.
内结扎法腹腔镜巨脾切除联合选择性贲门周围血管离断术 总被引:5,自引:1,他引:5
目的总结腹腔镜下内结扎法巨脾切除联合选择性贲门周围血管离断术的经验。方法采用丝线结扎结合超声刀或LigaSure,进行腹腔镜巨脾切除和选择性贲门周围血管离断术治疗门静脉高压症并发食管胃底静脉曲张6例。结果6例手术全部镜下顺利完成,术中出血量80-200ml,平均130ml,无输血,无中转开腹,手术时间150-210min平均190min。无并发症,术后5天恢复正常活动。术后随访3—10个月,平均8个月,无再发出血。结论应用内结扎法腹腔镜巨脾切除联合选择性贲门周围血管离断术治疗门静脉高压症安全有效,出血少,微创。 相似文献
5.
直肠海绵状血管瘤临床少见,其主要症状是无痛性大量的直肠出血或便血。治疗方法有硬化剂注射、瘤体局部缝扎或直肠切除术。2006年2月我们治疗1例,采用腹腔镜下结扎供应血管瘤主要血管,游离盆底,经肛门直肠内套叠切除病变,行乙状结肠肛管袖套式吻合治愈,报道如下。 相似文献
6.
完全腹腔镜下小儿胰腺肿瘤切除的初步体会 总被引:1,自引:2,他引:1
腹腔镜技术目前已应用于大部分小儿外科腹部疾病的诊治工作中,并取得了良好的效果.而在小儿胰腺肿瘤的诊治方面,由于胰腺血供丰富,解剖复杂,一旦发生并发症,后果比较严重.因此,腹腔镜胰腺外科的发展相对滞后,尤其是腹腔镜下小儿胰腺肿瘤的切除病例在国内尚未见报道.我院小儿外科于2006年5月和2007年3月分别对2例胰腺囊实性乳头状瘤实施了完全腹腔镜下胰体尾切除术和胰十二指肠切除术,报道如下. 相似文献
7.
Objective To evaluate the feasibility and indication of laparoscopie duodenoduoden-ostorny for neonates with congenital duodenal obstruction- Methods From May 2004 to Feburary 2008,6 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 5~8 mmHg and a suspending suture for right liver elevator, the procedure was performed using 3 cannulas of 3.3 mm to 5.5 mm diameter. Under the laparoscopic vision, the cause of duodenal obstruction was diagnosed and a sutured anastomosis was performed after the duodenum mo-bilized. Results Findings at laparoscopy included duodenal diaphragm in 3 cases,annular pancreas in 2 cases, and preduodenal portal vein in 1 case. Three cases with duodenal diaphragmatic stenosis were en-countered a partial excision of the diaphragm after vertical incision of the anterior part of duodenum followed laparoscopically by a transverse suture. A diamond-shaped side-to-side duodenoduodenal anas-tomosis was successfully carried out in 2 cases of annular pancreas through a laparoseopic approach, but a duodenojejunostomy was converted to mini-laparotomy during the laparoscopic course of a predu-odenal portal vein. The average operative time was 102 16.5 min (85~135 min). Visualization was ex-cellent, and there were no intraoperative complications. Feedings were started on postoperative day 3 to 5. All cases were on full feedings after 8 to 10 days. Follow-up upper gastrointestinal tests showed no evidence of stricture or obstruction. Conclusions The duodenoduodenostomy with laparoseopy can be performed in neonates securely and appropriated for a full-term newborn with tolerance CO2 pneumo-peritoneum. It provides an excellent and micro-invasive way to evaluate and treat congenital duodenal obstruction. 相似文献
8.
超声多普勒血管显像在内结扎法腹腔镜脾切除术中的应用 总被引:2,自引:1,他引:2
目的探讨超声多普勒血管显像在内结扎法腹腔镜脾切除术中的应用价值。方法2006年1月至2008年1月收治脾相关血液病患儿28例,均行内结扎法腹腔镜脾切除术。术前应用超声多普勒血管显像探测脾蒂血管解剖类型、走行及与胰腺的关系,并将其与术中所见进行对比分析。结果超声多普勒血管显像与术中记录脾血管分支类型(X^2=1,P〉0.05)及与胰腺的关系(X^2=2,P〉0.05)基本符合。28例腹腔镜脾切除术均获成功,无一例中转开腹。结论超声多普勒血管显像可明确脾蒂血管解剖分支类型、走行及其与胰腺的毗邻关系,有助于弥补腹腔镜缺乏手部触觉功能和三维视觉效果的局限,指导实施腹腔镜脾切除术。 相似文献
9.
结肠次全切除术在先天性巨结肠症中的应用 总被引:1,自引:0,他引:1
目的 总结应用结肠次全切除术治疗先天性巨结肠的经验,探讨手术适应症,术中注意事项,术后腹泻的治疗及排便功能的恢复规律。方法 采用回顾性研究的方法,对临床治疗经过及随访资料分析。结果 12例手术患儿住院经过顺利,仅1例发生切口感染。随访8例,便秘症状全部消失。术后4年以上者4例,排便正常;术后1年者2例,排便基本正常、术后半年者2例,排便不正常。结论 结肠次全切除术是治疗某些类型先天性巨结肠症的有效 相似文献
10.
Objective To evaluate the feasibility and indication of laparoscopie duodenoduoden-ostorny for neonates with congenital duodenal obstruction- Methods From May 2004 to Feburary 2008,6 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 5~8 mmHg and a suspending suture for right liver elevator, the procedure was performed using 3 cannulas of 3.3 mm to 5.5 mm diameter. Under the laparoscopic vision, the cause of duodenal obstruction was diagnosed and a sutured anastomosis was performed after the duodenum mo-bilized. Results Findings at laparoscopy included duodenal diaphragm in 3 cases,annular pancreas in 2 cases, and preduodenal portal vein in 1 case. Three cases with duodenal diaphragmatic stenosis were en-countered a partial excision of the diaphragm after vertical incision of the anterior part of duodenum followed laparoscopically by a transverse suture. A diamond-shaped side-to-side duodenoduodenal anas-tomosis was successfully carried out in 2 cases of annular pancreas through a laparoseopic approach, but a duodenojejunostomy was converted to mini-laparotomy during the laparoscopic course of a predu-odenal portal vein. The average operative time was 102 16.5 min (85~135 min). Visualization was ex-cellent, and there were no intraoperative complications. Feedings were started on postoperative day 3 to 5. All cases were on full feedings after 8 to 10 days. Follow-up upper gastrointestinal tests showed no evidence of stricture or obstruction. Conclusions The duodenoduodenostomy with laparoseopy can be performed in neonates securely and appropriated for a full-term newborn with tolerance CO2 pneumo-peritoneum. It provides an excellent and micro-invasive way to evaluate and treat congenital duodenal obstruction. 相似文献