腹腔镜胆囊切除术中胆管损伤的原因及对策

目的 探讨腹腔镜胆囊切除术(LC)胆道损伤的原因,找准其预防对策,减少胆道损伤.方法 回顾分析该院1997年5月-2007年8月实施的4000例LC术中21例胆管损伤的原因.结果 胆总管损伤9例;汇合部分离性损伤6例;穿孔性胆管损伤4例;右侧副肝管损伤2例.21例全部治愈,20例随防2-10年无严重并发症.结论 为了减少胆管损伤,应严格掌握LC手术适应证,其对策是预防为主,关键是在Calot三角的安全区进行解剖,遇到困难时及时中转开腹手术,由有经验的医生共同努力确保患者的手术一次获得成功.     

腹腔镜胆囊切除术中胆管损伤的MRCP分析

目的：探讨MRCP对腹腔镜胆囊切除术中胆管损伤的诊断价值。方法：分析9例腹腔镜胆囊切除术中胆管损伤的MRCP表现，判断胆管损伤的部位、程度及类型，并与手术结果对照。结果：2例狭窄位于肝总管近端，7例位于胆总管中上段，其中环形狭窄3例，线形狭窄3例，杵状狭窄2例，胆管中断1例。结论：MRCP对腹腔镜胆囊切除术中胆管损伤具有重要的诊断价值。     

手助腹腔镜与开腹脾切除加门奇断流术对机体免疫功能和创伤反应影响临床研究

目的 :研究手助腹腔镜和开腹脾切除加门奇断流两种术式对机体免疫功能及创伤反应的影响 ,探讨其差异及新术式的可行性。方法 :监测 5 0例 (手助腹腔镜及开腹各 2 5例 )肝硬变、门静脉高压症患者术前、术后第1天 ,术后第 3天的外周血淋巴细胞 (PBL)亚群、C -反应蛋白 (CRP)、白细胞介素 6 (IL - 6 )和肿瘤坏死因子(TNF)的变化并进行对比研究。结果 :开腹组术后第 3天成熟的T淋巴细胞 (CD3 )、辅助性T细胞 (CD4)、CD4与抑制性T淋巴细胞 (CD8)比值较术前明显下降 (P <0 .0 5或P <0 .0 1)。且两组相比较开腹组明显低于手助腹腔镜组 (P <0 .0 1)。开腹组术后第 1天或 /和术后第 3天CRP、IL - 6、TNF较术前明显升高 (P <0 .0 1)。且两组比较开腹组明显高于手助腹腔镜组 (P <0 .0 1)。结论 :手助腹腔镜组对机体免疫及细胞因子水平影响较小 ,这构成手助腹腔镜组脾切除加断流术术后恢复较快及创伤反应小的病理、生理基础 ,同时也证明了该新术式治疗肝硬变、门静脉高压症的可行性及优越性。     

腹腔镜下输卵管妊娠挤胚术的临床探讨

目的探讨腹腔镜下输卵管妊娠挤胚术治疗输卵管妊娠的价值。方法对比分析2003年至2005年腹腔镜下35例输卵管挤胚术（挤胚术）和30例输卵管开窗术（开窗术）的临床资料。结果两组患者年龄及临床表现相似,挤胚术组及开窗术组的宫内妊娠率分别为63.86%和33.33%,两组相比,差异有统计学意义（P〈0.05）。结论腹腔镜下挤胚术后输卵管再通率及宫内妊娠率高,腹腔镜下输卵管妊娠挤胚术是异位妊娠特别是要求保留生育功能者首选的手术方式。     

腹腔镜胆囊切除联合手术的临床应用

目的 探讨腹腔镜胆囊切除联合手术的临床应用价值。方法 回顾性分析156例腹腔镜胆囊切除（LC）联合手术的临床资料，其中LC联合阑尾切除术41例，联合胆总管探查49例，联合肝囊肿开窗术19例，联合腹股沟疝修补术5例，联合肾囊肿开窗术5例，联合精索静脉曲张高位结扎术8例，联合妇科手术29例。结果 156例手术均获得成功，无1例中转开腹，术后发生胆漏3例，均经非手术疗法治愈。结论 腹腔镜胆囊切除联合手术能安全、有效、经济地处理多精腹部疾病，充分体现微创外科手术的优越性，值得推广。     

Laparoscopic anterior and posterior native tissue repair: a new pelvic floor approach

Introduction: Traditionally, a cystocele caused by a midline defect of the pelvic fascia is treated by vaginal fascia duplication, also known as anterior colporraphy. The rectocele is managed by suturing the posterior fascia and, frequently, the levator ani muscles. We developed the approach of laparoscopic anterior and posterior fascia repair by native tissue.

Material and methods: The methods were based on anterior and posterior exposure of pelvic fascia similar to the preparation of an extended sacral colpopexy. The fascia was compressed and narrowed by absorbable woven sutures, size 1. Twenty-seven patients were followed up for 6–13?months. All patients received additional apical fixation by pectopexy.

Results: In the examination group, 13 patients underwent anterior laparoscopic fascia repair and 23 had posterior repair. We detected one apical and one posterior relapse, and also one in the anterior repair group. The patient with the apical relapse reported pain and de novo urgency. Anatomical reconstruction was achieved in all other patients.

Summary: Laparoscopic anterior and posterior native tissue repair appears to be a feasible method for the treatment of midline cystocele and rectocele. No new risks were observed. The technique leaves no scar in the vagina and is well accepted.

Abbreviations: POPQ: Pelvic Organ Prolapse Quantification System; FDA: Food and Drug Association; US: United States; Fig: Figure; ICIQ: International Consultation on Incontinence Questionnaire     

超声在腹腔镜胆囊切除术后腹部并发症中的应用

目的总结超声在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后腹部并发症中的应用价值.方法对本院1992年8月～2003年8月完成的5 536例LC术后患者进行常规腹部超声检查,观察有无并发症及其声像图特点.结果 LC术后腹部并发症74例:腹腔积液55例(74.3%),胆总管残余结石7例(9.5%),残余胆囊、切口脓肿各4例(5.4%),假性肝动脉瘤、切口血肿、切口疝、可疑胆总管狭窄各1例(1.4%).在超声引导下对腹腔积液和切口下积脓、积血诊断性穿刺54例(73.0%),介入治疗42例(56.8%).结论合理应用超声检查及其引导下诊断性穿刺、介入治疗,对LC术后腹部并发症的诊治具有重要意义.     

HF-Electro-Surgery, Ultrasound-Dissection or Laser for the Laparoscopic Cholecystectomy and for Liver-Wedge-Resection. An Experimental Study in Pigs

laparoscopic wedge-resection of the liver is performed in 6 pigs, in three of these a cholecystectomy is carried out during the same operation. The method of resection chosen was: Monopolar HF-current, ultrasound and laser (Nd:YAG-laser and Holmium:YAG-laser). The least damage to the healthy liver tissue was seen using the Holmium:YAG-laser. Healing (after18 days) was best when the Holmium:YAG-laser had been used. Cautery was worst in both tissue damage and delayed healing.     

小儿腹腔镜胆囊切除术的效果,安全性和费用分析

目的 :分析腹腔镜胆囊切除术 (LC)在儿外科实践的效率。方法 :回顾性研究两所儿童医疗中心开展儿童LC(1 993年 3月～ 2 0 0 0年 5月 )的效果 ,安全性和费用材料。统计分析用Student’st检验。结果 :1 1 8例胆囊切除术中 ,32例OC(2 7% ) ,86例LC(73 % )中 ,3例中转OC(3 .5 % )。手术时间LC =96 .3min与OC =96 .7min ,P >0 .0 5。住院时间LC比OC减少 2 .8d ,P <0 .0 5。两组均无手术技术并发症。LC总费用与OC比较没有明显增加 ,LC是 (30 4 2 9± 897)元与OC是 (30 2 4 5± 6 842 )元 ,P =0 .91。结论 :LC应用于儿童安全而有效。LC明显缩短了住院时间。经过培养的医生做LC ,不会增加并发症。与OC比较 ,LC不增加医疗费用