腹膜后入路单孔腹腔镜肾上腺切除术临床应用观察

目的探讨经腹膜后入路单孔腹腔镜肾上腺切除术的可行性。方法肾上腺肿瘤患者6例,采用腹膜后入路腹腔镜肾上腺切除术进行治疗。结果 6例均顺利完成手术。手术时间85～130 min,术中出血量15～45ml,术后住院时间5～7 d。围手术期未出现并发症。结论经腹膜后入路单孔腹腔镜肾上腺切除术安全可行。     

腹腔镜下两种入路切除巨大肾上腺肿瘤的安全性和可行性比较

目的比较腹腔镜下经腹腔入路和腹膜后入路切除巨大肾上腺肿瘤的安全性和可行性,评价其手术效果。方法回顾性分析郑州大学附属洛阳中心医院在2010-10～2017-05期间收治的87例巨大肾上腺肿瘤患者的手术治疗资料,其中行经腹腔入路肾上腺切除术47例,行腹膜后入路肾上腺切除术40例,比较两种方法的手术时间、术中失血量、术后进食恢复时间及术后住院时间等。结果 87例手术均顺利完成,均无明显手术并发症。经腹腔入路手术时间较腹膜后入路短,术中失血量较经腹膜后入路少(P0.05);经腹膜后途径患者术后进食恢复时间、术后住院时间较经腹腔途径患者短(P0.05)。结论两种入路均可切除肾上腺肿瘤,应根据病变性质、肿瘤大小、位置及患者的具体情况选择手术入路。     

后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿

目的观察后腹腔镜下肾蒂淋巴管结扎术治疗乳糜尿的疗效。方法采用后腹腔镜下肾蒂淋巴管结扎术治疗乳糜尿11例（均为乳糜尿试验阳性及膀胱镜检确诊）。结果手术时间100～180 min,平均120 min;术中出血35～80 ml,平均60 ml。无中转开放手术。术后3～5 d拔出腹膜后引流管,切口均一期愈合,术后乳糜尿消失。随访6～24个月,乳糜尿均无复发。结论后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿疗效确切,在手术创伤、住院时间、术后恢复等方面优于开放手术。     

腹膜后腹腔镜下肾切除术37例临床观察

目的探讨腹膜后腹腔镜肾切除术的临床疗效。方法采用腹腔镜经腹膜后途径对37例患者的无功能。肾行肾切除术,观察手术时间、术中出血量、手术并发症及术后一般情况。结果37例手术均获得成功,手术时间（102．9±22．3）min,术中出血量（48．6±14．2）ml,平均住院7．5d;1例术中分离粘连时腹膜撕裂,余病例无明显并发症发生;术后均获随访1—15个月,肿瘤患者未见肿瘤复发或远处转移,肾结核患者B超及肾功能检查未发现明显异常。结论腹膜后腹腔镜下肾切除术微创、安全、有效。     

后腹腔镜手术治疗肾上腺疾病(附27例报告)

对27例肾上腺疾病行后腹腔镜手术治疗.手术均获得成功,手术时间为 25～70 min,术中出血为40～150 ml.术后随访1～19个月,无肿瘤复发及转移.认为后腹腔镜手术治疗肾上腺疾病具有创伤小、解剖清晰、术中出血少、术后恢复快等优点,是一种安全、有效的治疗方法.     

腹腔镜肾切除术34例疗效观察

采用经腹腔、腹膜后入路共行腹腔镜肾切除术34例，手术全部成功，手术时间1．5～3．0h，出血量50-400ml，未发生严重并发症。认为根据患者病情选择手术入路可提高腹腔镜肾切除成功率。     

后腹腔镜下腹膜后神经鞘瘤切除术26例临床观察

26例腹膜后神经鞘瘤均经腹膜后途径于腹腔镜下切除。肿瘤位于左侧肾上腺周围9例、右侧肾上腺周围7例、左肾下极2例、右肾下极1例、腹主动脉旁2例、下腔静脉旁5例。其中25例手术成功,切除肿瘤直径1.5－5.0 cm,手术时间45－105 min,出血量15－110 ml。腹膜损伤1例,中转开放手术,无后遗症。无大血管损伤、大出血及膈肌损伤病例。认为后腹腔镜下切除腹膜后神经鞘瘤,出血少,创伤小,手术成功率高。     

后腹腔镜肾上腺肿瘤切除术临床应用观察

目的观察后腹腔镜肾上腺肿瘤切除术的疗效与安全性。方法肾上腺肿瘤患者34例,均行后腹腔镜肾上腺肿瘤切除术。结果 34例均手术成功,术中、术后无并发症发生。手术时间30～140 min,术中出血20～100ml,住院时间5～9 d。结论后腹腔镜肾上腺肿瘤切除术创伤小、安全性高、疗效好。     

腹腔镜下经腹腔径路肾上腺切除术治疗肾上腺疾病(附80例报告)

目的探讨腹腔镜下经腹腔径路肾上腺切除术治疗肾上腺疾病的适应证、手术技巧及优缺点。方法对80例肾上腺疾病患者行腹腔镜下经腹腔径路肾上腺切除术。结果80例手术均获成功,无1例中转开放手术;手术时间30～200(60±18)分钟;术中出血10～150(35±12)ml;住院时间3～12(6±2)天。结论腹腔镜经腹腔径路肾上腺切除术创伤小、出血少、并发症少,术后患者恢复快、住院时间短。肿瘤<10cm,无转移及局部重要脏器、大血管浸润和粘连的肾上腺肿瘤均适合行腹腔镜手术切除。     

后腹腔镜手术切除肾上腺囊肿效果观察

目的观察后腹腔镜手术切除肾上腺囊肿的效果。方法选择4例肾上腺囊肿患者,采用后腹腔镜技术行肾上腺囊肿切除术。结果本组患者手术均获成功,囊肿均完整切除;手术时间40～110 min,平均70 min;术中出血量20～150 mL,平均50 mL;术中及术后无明显并发症发生。患者术后1～2 d排气进食,1～3 d下床活动,5～7 d出院,随访12～24个月囊肿均无复发。结论后腹腔镜手术切除肾上腺囊肿手术效果确切、损伤小、并发症少、患者恢复快。     

State of knowledge of helminth fauna of freshwater fishes of Poland

A total 89 fish and lamprey species has been recorded from Polish freshwater habitats. Twenty-seven of them (30.3%) have not been surveyed for parasitic helminthes. Some of the latter fishes are either rare or not easily accessible. Other live only in specific habitats in scattered localities. An important obstacle for studying parasite faunas of some fishes may be their status on an endangered species. Among the non-surveyed fishes, are those which have been relatively recently introduced to Poland or migrated there on their own. The present paper attempts to review all hitherto not studied helminthologically fish species, their habitats, localities and current protection status.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

Investigation of mode of action of biofeedback in treatment of fecal incontinence

A study was carried out in 25 incontinent patients to evaluate some of the factors thought to be responsible for the success of retraining for fecal incontinence. Subjects were initially allocated to one of two groups; one group was trained to perceive small rectal volumes (active retraining), the other group carried out the same maneuvers but were not given any information or instruction. Active sensory retraining reduced the sensory threshold from 32 +/- 8 to 7 +/- 2 ml (P less than 0.001), corrected any sensory delay that was present (P less than 0.004), and reduced the frequency of incontinence from 5 +/- 1 to 1 +/- 1 episodes per week (P less than 0.01). Sham retraining caused a modest reduction in the sensory threshold (from 29 +/- 9 to 20 +/- 8; P less than 0.05) but did not significantly reduce the frequency of incontinence. Subsequent strength and coordination training did not significantly improve continence, although at the end of the study, 50% of patients had no incontinent episodes at all and 76% of patients had reduced the frequency of incontinence episodes by more than 75%. This improvement in continence was not associated with any change in sphincter pressures or in the continence to rectally infused saline but was associated with significant improvements in rectal sensation. The functional improvement was sustained over a period of two years in 16 of the 22 patients available for follow-up. In conclusion, the results support the use of retraining in the management of fecal incontinence and suggest that retraining may work by enhancing rectal sensitivity and instilling confidence.