目的 探讨腹腔镜阑尾切除术的临床经验和应用价值。方法 回顾性分析腹腔镜二孔法阑尾切除术 39例(二孔法组)和三孔法阑尾切除术70例(三孔法组)的临床资料。结果 顺利完成手术107例； 中转开腹2例,其中阑尾严重粘连1例,腹膜后阑尾1例。术后发生粘连性肠梗阻1例,经保守治疗痊愈出院。住院时间2~9 d,平均3 d。随访全部患者2~24个月,平均12个月,未发生其他并发症。结论 腹腔镜阑尾切除术具有创伤少、并发症发生率低及恢复快的优点,将成为阑尾切除术的首选术式。腹腔镜二孔法阑尾切除术操作简单,易于推广; 三孔法则具有处理复杂阑尾切除术的优势。
Objective To investigate the effect of laparoscopy combined with choledochoscopy on common bile duct (CBD) stones with primary suture of the CBD. Methods Totally 523 patients of gallbladder stone companied with CBD stones or choledochectasia (diameter ≥0.8 cm) from September 1998 to December 2008 were retrospectively analyzed. Results The primary suture of the CBD incision was successfully performed in 487 patients. The CBD stones were completely removed during the operation in 400 patients. Nothing was found in 87 cases. In 10 cases conversion to open surgery were performed and in 26 cases the T tube drainage was put into the CBD in choledocholithotomy. Average operative time was 90 min and average bleeding volume was 50 ml. All patients took food at 24 h, returned general activity on 2-3 d and discharged on 5 d after operation. Postoperative biliary leakage occurred in 29 cases with drainage average volume of 35 ml/d and continued 1-6 d, which were cured by non-operation therapy. Conclusions The primary suture of the CBD during the laparosocopy combined with choledochosopy in choledocholithotomy is a safe and effective operation with less invasion, less pain and quicker recovery. CBD incision suture without T tube drainage can be done when CBD stones are cleared completely and no stenosis is found in extrahepatic bile duct.
目的:评价腹腔镜辅助阴式子宫切除术(LAVH)的临床价值。方法:对35例子宫良性病变者行LAVH手术的临床治疗进行分析,并与腹腔镜Doderlein式子宫切除术(LDH)32例进行比较。结果:两组手术在手术时间,术后镇痛,肛门排气时间,住院时间等方面差异无统计学意义,但术中出血量比较: LAVH组(96.2±58.56)mL, LDH组(186.2±62.5) mL,差异有统计学意义(Plt;0.05)。结论: LAVH手术镜处理子宫动脉,能有效控制术中出血量,值得临床推广应用。
Objective To explore the important role of preperitoneal space in laparoscopic transabdominal preperitoneal （TAPP） and totally extraperitoneal （TEP） hernia repair. Methods The clinical data of 66 patients （78 sides） performed laparoscopic TAPP and TEP hernia repair from January 2008 to April 2011 in this hospital were analyzed retrospectively. Results TAPP hernia repair were performed in 16 cases （20 sides），TEP hernia repair were performed in 50 cases （58 sides）. Three cases of TEP hernia repair transferred to TAPP hernia repair. The unilateral operation time was （86.92±36.38） min，intraoperative bleeding was （6.08±3.43） ml. Postoperative complication rate was 16.7% （11/66），including 3 cases of postoperative serum swelling，3 cases of temporary paraesthesia of nerve feeling in the repair area，2 cases of scrotum emphysema，2 cases of urinary retention，and 1 case of intestinal obstruction. There were 2 cases of recurrence. The hospital stay was （4.52±0.99） d. The return to activities and working time was （10.32±1.86） d after discharge. Sixty-six cases were followed up for （18.56±1.96） months （range 1-38 months），the patch infection，chronic pain，and testicular atrophy complications were not been observed. Conclusions Acquainting and mastering laparoscopic preperitoneal space and its important structure are the key to avoid intraoperative and postoperative complications of laparoscopic inguinal hernia repair.
【摘要】目的 探讨心功能Ⅱ级患者在低气腹压下行腹腔镜胆囊切除术的可能性。 方法 总结我院2003年7月至2004年7月间收治的18例心功能Ⅱ级患者行低气腹压腹腔镜胆囊切除术的临床资料。 结果 18例心功能Ⅱ级患者中17例完成腹腔镜胆囊切除，1例中转开腹。 结论 心功能Ⅱ级患者行低气腹压腹腔镜胆囊切除术是可行的。
目的 探讨后腹腔镜手术治疗肾盂输尿管连接部梗阻(ureteropeluic junction obstruction, UPJO)的手术技巧和临床效果。 方法 回顾性分析2006年7月-2009年10月59例采用后腹腔镜手术治疗UPJO患者的临床资料。后腹腔镜下行UPJO周围压迫组织松解术18例，Y-V成形术25例，离断成形术16例。 结果 术后随访3～36个月。所有患者手术均顺利完成。静脉肾盂造影均提示造影剂通过良好，肾积水均得到明显改善。 结论 后腹腔镜治疗UPJO创伤小，患者术后痛苦小、恢复快、住院时间短、疗效显著，可作为UPJO治疗的首选治疗方法。
【Abstract】Objective To investigate the effects and advantages of laparoscopic hernioplasty for hernia. Methods From June 1995 to June 2005, 222 patients with hernia were treated with laparoscopy. Transabdominal preperitoneal hernia repair (TAPP) were performed in 166 patients. Totally extraperitoneal hernia repair(TEP) were performed in 25 patients. Closure of the internal orifice of hernia was performed in 21 patients. Furthermore, incisional hernia in 2 patients, diaphragmatic hernia in 1 patient and mesenteric hernia in 1 patient were performed by laparoscopic hernioplasty and 6 patients with hernia of oesophagus finestra performed hernioplasty combined collapse gastric fundus with laparoscopy. In this series 45 patients associated with other abdominal disease were simultaneously treated with laparoscopy. Results All cases were operated successfully. The span of operation reduration was 42.5 min 〔(10～180 min)〕. The average length of postoperative hospital stay were 4.6 days. There was one early failure owing to the use of too small a piece of mesh.Conclusion The results indicate that mesh repair of hernias is a satisfactory technique with a low recurrence rate and a low major complication rate.
Objective To investigate the clinical therapeutic effects of two types of vaginoplasty. Methods From January 1996 to March 2005, 63 patients wih the congenital absence of the vagina were treated by two types of vaginoplasty. Of the 63 patients, 37 underwent vaginoplasty using the amnion and 26 underwent an improved laparoscopic Vecchitti operation. The durations ofthe operation and hospitalization, as well as the blood loss were compared between the two types of vaginoplasty. The vaginal moulds were improved during the operations. Results According to the follow-up for 2 months to 4 years in the 35 patients. Compared with vaginoplasty using the amnion, vaginoplasty by an improved laparoscopic Vecchitti operation had advantages of significantly shorter surgical duration, shorter hospitalization, and less blood loss (Plt;0.05). After the operations, the artificial vagina of all the 63 patients could hold a speculum and the mucosa appeared so soft and smooth with normal lubrication. The married patients were satisfied with the intercourse. However, after vaginoplasty using the amnion, an infection of the amnion occurred in 3 patients, scar contracture in 2 patients, one of whom underwent scar incision 13 months after operation with a success; but the other refuse to accept another operation. But the improved laparoscopic Vecchitti operation achieved a success in the patients without any infectionor scar contracture, according to the 2 month-2.5 years follow-up. Conclusion The improved laparoscopic Vecchitti operation is a preferred procedure of constructing a vagina for the patients suffering from the congenital absence of the vagina.