腹腔镜与开腹结肠憩室切除术的疗效对比

目的:比较腹腔镜与开腹结肠憩室切除术的临床疗效.方法:将43例结肠憩室患者随机分为腹腔镜组和开腹组,对比两组手术时间、术后4d疼痛评分、肛门排气排便时间、术后并发症发生率及术后住院时间.结果:两组手术时间、术后疼痛及术后并发症发生率等方面差异无统计学意义,术后排气排便时间及住院时间差异有统计学意义.结论:腹腔镜结肠憩室...     

手助腹腔镜下右半结肠切除术12例报告

目的 总结应用改良手助式腹腔镜右半结肠切除术的经验。方法 自2001年9月至2003年12月。应用手助式腹腔镜技术行右半结肠切除12例。结果 12例病人手术均获成功，无一例中转开腹，手术时间为180～220min，术后恢复良好，无切口感染、吻合口瘘、肠梗阻等并发症。随访1～24个月，无切口肿瘤复发及肠梗阻的发生。结论 对于无远处转移的右侧结肠恶性肿瘤病人，应用手助腹腔镜行右半结肠切除术是安全、可行的。     

腹腔镜和开腹结肠切除手术治疗先天性巨结肠临床观察

目的 比较经腹腔镜结肠切除术及传统开腹结肠切除术治疗先天性巨结肠的疗效.方法 2009年4月至2010年12月我科收治先天性巨结肠患儿104例,分为两组,腹腔镜结肠切除术组70例,开腹结肠切除术组34例,比较两组患儿术前一般情况、术中情况、术后并发症及术后1年的排便情况.结果 左半结肠切除手术,腹腔镜组和开腹组治疗患儿的年龄和体重差异有统计学意义(P<0.05);无论是左半结肠切除还是次全结肠切除手术,腹腔镜组的术中出血均比开腹组明显减少(P<0.05);次全手术开腹组比腹腔镜组手术时间要短(P<0.05).两组术后并发症发生率差异无统计学意义,发生小肠结肠炎腹腔镜组12.8%,开腹组为17.7%.术后1年随访两组间情况差异无统计学意义.结论 腹腔镜手术治疗先天性巨结肠,不仅能获得传统开腹手术同样的效果,而且减小了手术对患儿的创伤,在伤口美观方面使患儿获益.     

腹腔镜全结肠切除术在家族性腺瘤性息肉病中的临床应用(附4例报道)

目的探讨腹腔镜全结肠切除术在家族性腺瘤性息肉病（FAP）中的应用价值。方法回顾性分析我院2008年1月至2009年10月期间收治的行腹腔镜全结肠切除术的4例FAP患者的临床资料,对手术安全性和术后恢复情况进行分析。结果 4例患者均顺利行腹腔镜全结肠切除术,无中转开腹,无手术并发症及死亡。腹部切口长6.0cm,手术时间300～380min（平均330min）,术中出血量90～250ml（平均160ml）。术后2～3d肛门开始排气,术后住院时间7～11d（平均9d）出院。出院后大便稀薄,8～12次/d,给予易蒙停治疗后缓解。随访2～22个月（平均14个月）,无近期并发症发生。结论腹腔镜全结肠切除术治疗FAP安全、有效,近期效果良好。     

腹腔镜下全结肠切除17例体会

目的 探讨腹腔镜下全结肠切除术的可行性和安全性.方法 回顾分析腹腔镜全结肠切除术17例的临床资料.17例均为家族性腺瘤性息肉病,在腹腔镜下行全结肠切除术,如有癌变者同时行肿瘤区域淋巴结清扫术.结果 17例手术顺利完成,无中转开腹,无手术死亡.平均手术时间320 min,平均出血量150 ml,辅助切口平均长度6 cm,平均术后住院8 d,无严重手术并发症.结论 腹腔镜全结肠切除术安全可行,手术创伤小,恢复快.     

手助腹腔镜与开腹肝切除术的临床对照研究

目的：探讨手助腹腔镜肝切除术的可行性及微创性。方法：随机将60例肝切除患者分为两组,30例行手助腹腔镜肝切除术,30例行开腹肝切除术,比较两组的手术时间、术中出血量、切口长度、术后肛门排气时间、术后住院时间、术后并发症、术前及术后第1、4、7天C反应蛋白（CRP）及中性粒细胞的动态变化。结果：手助腹腔镜组与开腹组的平均手术时间（114.3minvs.105.8min）和切缘距肿瘤边缘（3.22cmvs.3.33cm）差异无统计学意义（P〉0.05）。手助腹腔镜组术中平均出血量明显少于开腹组（212mlvs.376.5ml,P〈0.05）,切口长度差异有统计学意义（6.95cmvs.22cm,P〈0.01）。手助腹腔镜组术后胃肠功能恢复时间明显早于开腹组（术后肛门排气时间2.34dvs.3.48d,P〈0.05）。手助腹腔镜组住院时间明显短于开腹组（8.35dvs.10.8d,P〈0.01）。手助腹腔镜组与开腹组均无严重并发症发生。两组术后第7天CRP值比较有显著差异（23.23vs.63.35,P〈0.05）。两组于术后第4天中性粒细胞值比较有显著差异（6.45vs.9.51,P〈0.05）。结论：手助腹腔镜肝切除安全可行,并且具有创伤小、术后康复快等特点,是值得选择的微创肝切除方式。     

腹腔镜全结肠切除术中超声刀的应用

目的 评价经腹腔镜行全结肠切除术中应用超声刀的安全性和可行性。方法 回顾性分析2002年4月至。2004年5月间应用超声刀进行腹腔镜全结肠(次全)切除术的临床资料。结果 15例患者均为结肠慢传输性便秘，经完全腹腔镜全结肠切除3例，手助腹腔镜结肠次全切除12例。平均手术时间为267min，术中平均失血量147ml。术后排便困难症状均有明显缓解，平均排便为2次／d。结论 在腹腔镜全结肠切除术中应用超声刀分离结肠系膜是安全、有效的方法，但手术时间稍长。     

经腹腔镜和开腹肛管直肠癌切除结肠肛管吻合术的对比研究

目的探讨经腹腔镜肛管直肠癌切除结肠肛管吻合术的安全性和技术要点。方法回顾性对比分析2001年7月至2009年3月间腹腔镜和开腹肛管切除结肠肛管吻合术治疗低位直肠癌患者的临床资料,包括病理指标、术后恢复指标、术后并发症和肛门自制功能等。腹腔镜组22例,开腹组28例。结果两组均无手术死亡病例,腹腔镜组无中转开腹手术,腹腔镜组4例同时行胆囊切除术,1例行全结肠切除术后行回肠肛管吻合术。两组性别、年龄、腹部手术史、术后病理、术后并发症发生率及术后肛门功能等类似,腹腔镜组手术时间、手术中估计失血量、术后镇痛、排气时间、下床活动时间及住院天数均明显少于开腹组。结论腹腔镜腹肛管切除结肠肛管吻合术治疗低位直肠癌安全、有效、经济,具有显著的微创优势。     

腹腔镜辅助与开腹右半结肠切除术非随机临床对比研究

目的对比腹腔镜辅助右半结肠切除术和开放右半结肠切除术的临床效果。方法分析同期行26例腹腔镜辅助右半结肠切除术(腔镜组)和37例行传统开放右半结肠切除术(开腹组)的临床资料,比较两组的手术时间、术中出血量、术后镇痛药的需求、术后肛门排气时间、排便时间、术后引流量、术后引流时间、术后住院时间、术后并发症等指标。结果两组的手术时间、术后引流量、术后引流时间间差异无统计学意义;腔镜组的出血量(113.20±60.60)mL明显少于开腹组(295.95±76.72)mL(t=-9.982,P=0.000);腔镜组术后镇痛药需求比例(48.0%)低于开放组(83.8%)(χ2=7.384,P=0.007);术后肛门排气排便时间腔镜组均小于开腹组(P=0.000);术后住院时间腔镜组(6.20±1.32)d短于开腹组(11.43±2.35)d,(t=-11.169,P=0.000)。结论腹腔镜辅助右半结肠切除术是一种安全、可行的办法,具有明显的微创效果。     

腹腔镜和手助腹腔镜结直肠手术18例报告

目的 探讨腹腔镜和手助腹腔镜技术在结直肠手术中的应用价值。方法 选择性进行腹腔镜和手助腹腔镜下结直肠手术18例，其中右半结肠切除术4例。横结肠乙状结肠吻合术1例，左半结肠切除术4例，直肠前切除术6例，腹会阴联合根治术3例。结果 18例手术全部成功。平均手术时间154min．其中腹腔镜组165min，手助腹腔镜组115min；平均出血量约170ml。平均肛门排气时间36h。全组病例无邻近脏器损伤，无吻合口漏。恶性肿瘤13例，随访1～18个月．未见肝转移、切口种植及吻合口复发。结论 腹腔镜和手助腹腔镜结直肠手术在应用技术上可行，手助腹腔镜技术架起了开腹手术和腹腔镜手术之间的桥梁，扩大了腹腔镜手术的范围和适应证；选择适当的病例，微创结直肠手术有良好的应用前景。     

Laparoscopic total colectomy: hand-assisted vs standard technique

Background: Although hand-assisted laparoscopic surgery (HALS) has been proposed as an alternative to laparoscopically assisted surgery (LAP), little is known about its role in total colectomy. The objectives of the study were to compare the outcomes in patients undergoing total colectomy via either HALS or LAP and to determine what benefits HALS might have in extensive colorectal procedures. Methods: We reviewed the data for 23 patients who underwent total proctocolectomy (TPC) or total abdominal colectomy (TAC) using either a HALS or LAP technique. Results: There were 12 HALS (five TPC, seven TAC) and 11 LAP (seven TPC, four TAC) for ulcerative colitis (n = 17), familial polyposis (n = 5), and colonic inertia (n = 1). One LAP was converted (9.1%). The operative time was shorter for HALS than for LAP (210 vs 273 min; p = 0.03). Blood loss and incision length were similar. Postoperative recovery and morbidity rates were comparable. Conclusion: HALS reduces the operative time but patient morbidity rates and recovery are similar to LAP. HALS may be preferable for extensive colorectal procedures such as TPC and TAC. Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Los Angeles, CA, USA, 13–15 March 2003.     

手助腹腔镜外科技术在腹部外科中的应用(附113例报告)

目的:探讨手助腹腔镜外科(hand-assisted laparoscopic surgery,HALS)技术在复杂外科手术中的应用价值。方法:2002年2月至2006年12月应用HALS技术治疗113例患者,对临床相关指标,如手术时间、术中出血量、术后并发症等进行观察和分析。结果:113例患者中,110例获得成功,术后并发症发生率为5.45%,无死亡病例。结论:HALS技术可提高复杂腹腔镜手术的效率和安全性,并在一定程度上保留了微创手术创伤小、康复快的优势。     

Incisional hernia risk after hand-assisted laparoscopic surgery

Hand-assisted laparoscopic surgery (HALS) bridges traditional open surgery and pure laparoscopy. The HALS technique provides the necessary site for organ retrieval, reduces operative time, and realizes the postoperative benefits of laparoscopic techniques. Although the reported rates of incisional hernia should be theoretically low, we sought to determine our incidence of hernia after HALS procedures. A retrospective review of all HALS procedures was performed from July 2006 to June 2011. All patients who developed postoperative incisional hernias at the hand port site were confirmed by imaging or examination findings. Patient factors were reviewed to determine any predictors of hernia formation. Over the 5 years, 405 patients undergoing HALS procedures were evaluated: colectomy (264), nephrectomy (107), splenectomy/pancreatectomy (18), and ostomy reversal (10). The overall incidence of incisional hernia was 10.6 per cent. There were three perioperative wound dehiscences. The mean body mass index was significantly higher in the hernia group versus the no hernia cohort (32.1 vs 29.2 kg/m(2); P = 0.001). The hernia group also had a higher incidence of renal disease (18.6 vs 7.2%; P = 0.018). Mean time to hernia formation was 11.4 months (range, 1 to 57 months). Follow-up was greater than 12 months in 188 (46%) of patients, in which the rate of incisional hernia was 17 per cent. The rate of incisional hernia formation after hand-assisted laparoscopic procedures is higher than the reported literature. Because the mean time to hernia development is approximately 1 year, it is important to follow these patients to this end point to determine the true incidence of incisional hernia after hand-assisted laparoscopy.     

Comparison of conventional laparoscopic and hand-assisted oncologic segmental colonic resection

Background Laparoscopically assisted colon resection has evolved to be a viable option for the treatment of colorectal cancer. This study evaluates the efficacy of hand-assisted laparascopic surgery (HALS) as compared with totally laparoscopic surgery (LAP) for segmental oncologic colon resection with regard to lymph node harvest, operative times, intraoperative blood loss, pedicle length, incision length, and length of hospital stay in an attempt to help delineate the role of each in the treatment of colorectal cancer. Methods Patient charts were retrospectively reviewed to acquire data for this evaluation. Between June 2001 and July 2005, 40 patients underwent elective oncologic segmental colon resection (22 HALS and 18 LAP). The main outcome measures included lymph node harvest, operative times, intraoperative blood loss, pedicle length, incision length, and length of hospital stay. Results The two groups were comparable in terms of demographics. The tumor margins were clear in all the patients. The HALS resection resulted in a significantly higher lymph node yield than the LAP resection (HALS: 16 nodes; range, 5–35 nodes vs LAP: 8 nodes; range, 5–22 nodes; p < 0.05) and significantly shorter operative times (HALS: 120 min; range, 78–181 min vs LAP: 156 min; range, 74–300 min; p < 0.05). Both groups were comparable with regard to length of hospital stay, pedicle length, and intraoperative blood loss. However, the LAP group yielded a significantly smaller incision for specimen extraction (LAP: 7 cm; range, 6–8 cm vs HALS: 5.5 cm; range, 5–7 cm; p < 0.05). Conclusion The findings suggest that hand-assisted laparoscopic oncologic segmental colonic resection is associated with shorter operative times, more lymph nodes harvested, and equivalent hospital stays, pedicle lengths, and intraoperative blood losses as compared with the totally laparoscopic approach. The totally laparoscopic technique was completed with a smaller incision. However, this less than 1 cm reduction in incision length has doubtful clinical significance.     

手助腹腔镜行结肠癌切除

目的:探讨手助腹腔镜(HALS)行结肠癌根治术的临床效果。方法:将2010年1月—2011年5月住院的结肠癌患者,随机分成HALS组(21例),传统腹腔镜(LS)组(25例)和常规开腹组(24例),对其临床资料效果进行对比分析。结果:HALS组21例全部完成HALS,LS组23例完成LS,2例中转开腹,但两组中转率差异无统计学意义。HALS组较LS组平均手术时间短(153.9 min vs.171.7 min)(P=0.011)。HALS组与LS组相比术中失血量、平均住院日、总费用、术后排气时间、淋巴结清扫数目均无统计学差异(均P>0.05)。与开腹组比较,HALS组手术时间有所增加(153.9 min vs.131.8 min)(P=0.002),但术中失血量,术后排气时间,住院时间均明显缩短(均P<0.05),两组清除淋巴结数量无统计学差异。结论:HALS结肠癌根治术同样具备传统腹腔镜手术微创,安全,术后恢复快的优点,同时缩短了手术时间。     

Comparison of Gas-less laparoscopy-assisted surgery, hand-assisted laparoscopic surgery and pure laparoscopic surgery for radical nephrectomy

BACKGROUND: We report our experience with Gas-less laparoscopy-assisted surgery (Gas-less LAS), hand-assisted laparoscopic surgery (HALS) and pure laparoscopic surgery (LS) for renal carcinoma and compare the characteristics and usefulness of these methods. METHODS: Seventeen, 14 and 16 patients were subjected to Gas-less LAS, HALS and LS, respectively. The study started with Gas-less LAS and then gradually shifted to HALS and LS. We evaluated the operative and postoperative parameters for each group. The learning curve effect was evaluated based on data from the first 10 cases of each group, which were operated on by the same surgeon and operation team. RESULTS: The learning curve of operation times in the LS group demonstrated that the operation time for this procedure is acceptable even in early-stage cases. Differences in mean operative time between the three surgical groups, excluding the conversion cases, were not statistically significant; however, there was a significant difference in blood loss volume between the groups (P 相似文献   

Laparoscopic-assisted operation for familial adenomatous polyposis patients-two case reports.

OBJECTIVE: We describe herein the results of 2 laparoscopic operations to treat patients with familial adenomatous polyposis (FAP). METHODS: Two female FAP patients, aged 32 and 29 years old, were treated with restorative proctocolectomy and total colectomy with ileorectal anastomosis (hand-assisted laparoscopic surgery), respectively. RESULTS: The operative time was 360 minutes for the restorative proctocolectomy and 150 minutes for the total colectomy with ileorectal anastomosis. The blood loss was 500 cc for the restorative proctocolectomy and minimal for the total colectomy patient. The return of bowel movements took 3 days for each patient, and no complication occurred. Patients were discharged on the 15th and 7th postoperative days. CONCLUSION: A laparoscopic approach for restorative proctocolectomy or total colectomy with ileorectal anastomosis is safe and technically feasible, and provides good cosmesis.     

腹腔镜手助与辅助技术在右半结肠切除术中应用的对比研究

目的 比较腹腔镜手助与辅助技术在右半结肠癌根治术中的应用效果.方法 回顾性分析北京协和医院基本外科同一组医师2002年3月至2006年11月采用腹腔镜手助技术(HALS组,47例)和2007年1月至2009年12月采用腹腔镜辅助技术(LAS组,48例)完成的右半结肠癌根治术患者的临床资料.对比其手术安全性、术后恢复情况和并发症、肿瘤根治性、医疗费用和随访结果.结果 HALS组和LAS组术中、术后均无严重并发症和死亡病例.HALS组与LAS组相比,术中出血(P<0.01)、手术时间(P<0.05)和切口长度(P<0.05)差异均有统计学意义;但中转开腹、术中副损伤术后肛门排气时间、下床时间、住院天数、进食时间、术后镇痛例数方面的差异均无统计学意义(均P>0.05).HALS组手术切除标本长度为(25.6±9.9)cm,与LAS组的(26.8±7.9)cm比较,差异无统计学意义(P>0.05):HALS组淋巴结清扫总数为(18.2±12.1)枚,与LAS组的(24.1±9.3)枚比较,差异有统计学意义(P<0.05).LAS组的医疗费用(28 049.8±7576.1)元,多于HAKS组的(21 132.7±5323.4)元(P<0.05).HALS组和LAS组3年生存率分别为91.3%和87.9%,差异无统计学意义(P=0.452).结论 腹腔镜手助和辅助技术在右半结肠切除术中可获得相同的微创效果和肿瘤学疗效.

Abstract：

Objective To compare the outcomes of right hemicolectomy performed either by the hand-assisted laparoscopic (HALS) or conventional laparoscopic surgery (LAS). Methods Ninety-five patients undergoing HALS(n=47) from March 2002 to November 2006 or by LAS (n=48) from January 2007 to December 2009 were retrospectively studied. All the operations were performed by the same surgical team. Patient safety, postoperative recovery, complications, oncologic outcomes, medical expenses, and the follow-up results were compared between the two groups. Results No severe complications or perioperative deaths were oberved. There were significant differences between the two groups in terms of intraoperative bleeding, operative time, and length of incision (all P<0.05). However, the conversion rate, intraoperative injuries, time to first bowel movement, postoperative bedrest time, hospital stay, time to first oral intake, and the number of patients requiring postoperative analgesia were comparable between the two groups (P>0.05). Length of surgical specimen was (25.6±9.9) cm in the HALS group and was (26.8±7.9) cm in the LAS group, the diffenence was not statistically significant (P<0.05).The mean number of lymph nodes retrieved in HALS group was 18.2± 12.1, which was significantly lower than that in LAS group (24.1 ±9.3, P<0.05). The medical expense of the LAS group was (28 049.8±7576.1) RMB, which was significantly higher than that of the HALS group (21 132.7±5323.4) RMB (P<0.05). A follow-up rate of 93.7% was achieved in the HALS group with 3 patients lost to follow-up. The follow-up duration ranged from 45.4 to 101.9 months with a median of 66.7 months. In LAS group, the follow-up rate was 96% with 2 patients lost to follow-up and the follow-up duration ranged from 12.4 to 45.7 months with a median of 21.6 months. There was no significant difference in 3-year disease-free survival (91.3% vs. 87.9%, P> 0.05) between the two groups. Conclusion HALS and LAS can achieve similar minimal invasiveness efficacy and oncologic outcomes for right hemicolectomy.     

Hand-assisted laparoscopic surgery (HALS): a report of 150 procedures

Background: This study was performed to evaluate the (long-term) morbidity associated with hand-assisted laparoscopic surgery (HALS) for various indications. Methods: HALS procedures for various indications were evaluated prospectively from 1995 to 2002. The primary outcome parameters were postsurgical complications and the development of incisional hernias. Results: Twenty-six splenectomies, 51 hand-assisted laparoscopic donor nephrectomies (HLDN), 34 segmental bowel resections, 29 proctocolectomies, and 10 emergency colectomies were evaluated. A Küstner or Pfannenstiel incision was used for handport placement. Minor complications (i.e., wound complications, urinary tract infection) occurred in 15%, 12%, 26%, 7%, and 33% of the patients after, respectively, splenectomy, HLDN, bowel resection, proctocolectomy, and emergency colectomy. Major complications (i.e., hemorrhage, anastomotic leakage) occurred in 15% and 12% of the patients after, respectively, bowel resection and proctocolectomy. Incisional hernias occurred in six patients (4%), all after a wound complication in the Küstner incision. Conclusion: HALS is fast, safe, and feasible for various indications, especially HLDN and (procto-)colectomies. Little advantage can be expected when HALS is applied in splenectomy and segmental bowel (sigmoid) resection.     

脾破裂手助腹腔镜切除术的应用

目的:探讨手助腹腔镜技术在脾破裂切除术中的应用。方法:用手助腹腔镜技术为15例外伤性脾破裂患者行脾切除术。结果:14例顺利完成手术,1例术中大出血中转开腹,平均手术时间105min,术中平均失血110ml,平均住院6.5d。结论:手助腹腔镜技术治疗外伤性脾破裂是安全可行的,适用于无脑、胸损伤,血液动力学稳定的患者。