325例腹腔镜附件手术的临床分析

目的:评价腹腔镜在附件疾病治疗中的价值及安全性。方法:回顾性分析325例附件良性疾病腹腔镜手术治疗情况。随机选取妇科附件良性肿瘤、异位妊娠、输卵管粘连及伞端不通、卵巢破裂、巧克力囊肿,卵巢冠囊肿等病例;采用腹腔镜手术治疗。术式根据病情不同,采取卵巢(冠)囊肿剥除术、附件切除术、输卵管切除术及造口术。结果:腹腔镜手术占同期手术42．54%,手术成功率100%,发生并发症5例(1．54%)。结论:腹腔镜微创手术,副作用少,适应证掌握得当,妇科大部分附件手术可在腹腔镜下完成。     

后腹腔腹膜镜下肾囊肿去顶术的手术配合

单纯性肾囊肿是肾脏疾病常见的类型,随着腹腔镜技术在外科的应用,后腹腔镜肾囊肿去顶术成为治疗单纯性肾囊肿的最佳方法。该法优点:损伤小、痛苦轻、出血少、康复快,对腹腔脏器干扰小,减少胃肠反应及术后腹腔感染和肠粘连的机会[1],且对呼吸循环影响小。我院自2002年1月~2006年6月应用后腹腔镜治疗肾囊肿48例,取得满意效果。1临床资料本组男28例,女20例,年龄20~75岁。囊肿直径4·5~12 cm,其中单侧46例,双侧2例;位于肾上极17例,肾中极15例,肾下极16例。全部病例术前均经B超、CT诊断为单纯性肾囊肿。患者手术过程均顺利,术后恢复好。2护理配…     

超声引导下经皮穿刺抽液并硬化治疗肝、肾囊肿的疗效观察

目的 观察肝、肾囊肿在超声引导下经皮穿刺囊肿抽液及注入无水乙醇的治疗效果.方法 76例患者术前常规检查,治疗前禁食4-6 h,采用俯卧位,选择最佳穿刺位置在超声引导下穿刺抽出囊液后注入无水乙醇硬化治疗.结果 本组患者术中无明显并发症发生,仅有部分病例术中感觉局部疼痛和术后出现一次性血尿改变.3~6个月后复查,有效率为94.7%,囊肿基本消失占80.3%.结论 该法创伤小、安全、简便、并发症少、治疗有效率高,对单纯性肝、肾囊肿治疗效果好;多囊肝、肾治疗复杂,疗效不是十分满意.     

腹腔镜手术治疗肾盂旁囊肿的体会(附67例报告)

目的:探讨腹腔镜技术治疗肾盂旁囊肿的方法和疗效,并结合治疗体会,为临床提供更多的参考依据。方法:对2006年3月~2011年9月我科收治的67例肾盂旁囊肿患者的临床资料进行回顾性分析,其中采用经腹膜后途径29例,经腹腔途径20例,单孔腹腔镜技术18例。分析患者的手术时间、术中出血量、并发症的发生情况、术后住院时间及复查随访情况。结果:所有病例的手术均成功,手术时间38~120min,平均时间(70.3±9)min;术中出血量10~125 ml,平均(47.3±15.7)ml;均未出现肾蒂及肾盂损伤等并发症。术后2~6天(平均3.4天)拔除引流管,术后住院3~7 d,平均(4.2±0.6)d。术后1月复查,腰酸、腰痛、镜下血尿以及肾积水、高血压等临床症状均消失。术后随访1~47个月,未见囊肿复发。结论:腹腔镜手术治疗肾盂旁囊肿具有暴露充分、创伤小、出血少、恢复快等优点,可作为肾盂旁囊肿治疗的首选方法。术者应严格掌握其适应症,术前完善相关检查,术中仔细辨认肾静脉壁与囊肿,操作轻柔,填入肾门脂肪可有效防止囊肿的术后复发。     

开窗减压对颔骨牙源性囊性病变治疗作用研究

目的:探讨开窗减压对颌骨牙源性囊性病变的治疗作用.方法:102例牙源性颌骨囊性病变按囊肿大小分成两组,直径大于3.5cm且颌面部畸形明显的37例为甲组,全部采用开窗减压术;直径小于3.5cm的65例为乙组,其中27例(乙组A)采用开窗减压或开髓引流术,38例(乙组B)采用一次性手术切除.定期复查观察囊肿及颌骨变化情况,记录曲面断层片上囊腔影像面积变化,术后6月视情况采取Ⅱ期手术治疗.结果:甲组开窗减压术后囊肿逐步缩小,骨质再生情况良好,颌面部外形改善,未出现神经及周围重要结构损伤症状,6月后囊肿面积平均缩小75.03%,与术前囊腔面积比较有显著差异(P＜0.01),有效率100%,Ⅱ期手术完成治疗;乙组A开窗减压或开髓引流组6月后有效率70.37%,大多采用二次手术治疗;乙组B一次手术切除治疗组囊腔愈合良好,6月后颌骨形态结构基本恢复正常,有效率100%,与乙组A有显著差异(P＜0.05).全部病例观察3至6年未见复发.结论:开窗减压术对大型颌骨囊性病变有很好的治疗作用;小型牙源性囊性病变最好选择一次性手术治疗.     

腹腔镜手术治疗卵巢冠囊肿254例临床分析

目的:探讨腹腔镜手术治疗卵巢冠囊肿的临床疗效.方法:回顾性分析经腹腔镜手术治疗的254例卵巢冠囊肿患者的临床资料.结果:254例全部在腹腔镜下顺利完成,其中行卵巢冠囊肿剥除术219例,卵巢冠囊肿剥除加榆卵管切除术18例,附件切除术17例.囊肿最大者直径约40 cm,直径>12 cm者31例(12.2%).手术时间在10～100min之间,平均(37.1±3.9)min;术中出血约2～50ml,平均(12.1±1.5)ml;术后平均住院日(3.9±0.5)d,均无术中、术后并发症发生.结论:腹腔镜手术治疗卵巢冠囊肿具有创伤小、术中出血少、术后恢复快等优点,是治疗卵巢冠囊肿的首选治疗方法.     

腹腔镜手术治疗妇科57 例卵巢囊肿的临床分析

目的:探讨腹腔镜下手术治疗妇科卵巢囊肿的临床应用价值和手术要点。方法:对2009年5月～2011年5月期间我院57例进行腹腔镜手术的卵巢囊肿患者(巧克力囊肿32例,单纯性浆液性囊腺瘤19例,良性畸胎瘤6例)的手术资料进行回顾性分析。结果:57例腹腔镜手术全部成功,无中转开腹手术,平均手术时间58min,平均术中出血48ml,术后平均住院2.4d,无病理性恶变。结论:腹腔镜手术治疗妇科卵巢囊肿具有术后恢复快、住院时间短,微创、并发感染率低及其他并发症少、安全有效等明显优势,是妇科手术治疗卵巢囊肿的首选术式。     

纵隔胸腺囊肿的诊断及外科治疗

目的:总结纵隔胸腺囊肿的诊断和外科治疗.方法:对我院纵隔胸腺囊肿患者的临床资料进行回顾性分析.结果:全组共25例患者,其中男性11例,女性14例,平均46.1岁.全组患者术前均行胸部正侧位片检查,其中20例患者行胸部CT检查,6例行MRI检查.所有患者均接受手术治疗,并均获得完整切除.其中常规手术17例,微创手术8例,微创手术患者较常规手术患者术后住院时间短.所有手术标本均经病理证实为胸腺囊肿.共发生手术相关并发症2例,随访2个月至7年,均朱见复发.结论:胸腺囊肿的临床诊断主要依据影像学检查,CT和MRI能明确肿块的囊性特征,大多数胸腺囊肿根据其囊性特征,术前即可作出正确诊断.纵隔胸腺囊肿一经诊断应该首选手术治疗,手术应根据肿物特点选择合理的手术方式,胸腔镜等微创技术适合于纵隔胸腺囊肿的治疗.     

腹腔镜开窗术治疗单纯性肝囊肿的临床观察

目的:近年来,腹腔镜作为微创外科的代表,以创伤小、恢复快、治愈率高等优点被广泛应用于外科手术中。腹腔镜肝囊肿开窗术适用于孤立性的单纯性肝囊肿进行减压引流,手术效果较好。本文通过观察腹腔镜下开窗术治疗单纯肝囊肿的临床疗效,探讨腹腔镜手术的特点及优势,为临床肝胆疾病的手术治疗提供研究依据。方法:选取2009年2月-2012年12月在我院接受治疗的单纯肝囊肿患者76例,随机分为观察组和对照组。其中观察组患者采取腹腔镜下开窗术治疗,对照组患者采取传统开腹手术治疗。观察并比较两组患者的手术时间、术中出血量、胃肠功能恢复时间、住院时间等。结果:观察组患者的术中出血量、手术时间、胃肠功能恢复时间及住院时间均优于对照组,差异显著具有统计学意义(P0.05)。结论:腹腔镜手术创伤小、术中出血量少、术后恢复快、最大程度的减轻患者痛苦,腹腔镜开窗术治疗单纯肝囊肿的临床效果显著,值得临床推广应用。     

先天性耳前瘘管二次手术68 例治疗体会

目的:探讨先天性耳前瘘管术后复发原因,以及二次手术临床治疗的效果。方法:回顾性分析我院自2006年1月至2010年12月的共诊断收治的68例复发先天性耳前瘘管病例,观察其二次手术效果。结果:68例先天性耳前瘘管复发患者中,66例Ⅰ期愈合,治愈率97.06%。结论:再次手术是治疗先天性耳前瘘管术后复发的有效途径,完全切除残余的瘘管及上皮组织是防止再复发的关键。     

输尿管囊肿的超声诊断价值探讨

目的:探讨超声显像对输尿管囊肿的诊断价值,提高本病的诊断及鉴别诊断水平。方法:对我院例输尿管囊肿的超声检查资料进行回顾性分析。结果:全部病例均经手术病理证实,右侧11例,左侧11例,双侧2,5例合并重复肾及双输尿管,二维超声可直接显示输尿管囊肿形态、部位大小及其变化,超声诊断合率96%(25/26)。结论:超声显像诊断输尿管囊肿的符合率高,具有方便、快捷、经济、无创伤、无痛苦、重复性好、无需造影剂、可实时动态观察等优点,可迅速发现早期病变,直接观察囊肿部位、大小、形态、输尿管来源、输尿管开口位置、有无尿路出口梗阻及其多种并发症的诊断,可做为本病的常规首选检查项目。     

鼻内窥镜辅助下大型颌骨囊肿开窗减压并拔除埋藏智齿病例报告及文献复习

摘要 目的：分析大型颌骨囊肿开窗减压术联合鼻内窥镜辅助下拔除低位埋藏智齿的临床应用效果。方法：选择9例大型颌骨含牙囊肿患者,自磨牙或磨牙后区或者磨牙后外侧前庭沟处开窗形成引流通道,在鼻内窥镜下联通各个囊腔并拔除因被囊肿挤压而低位埋藏的第三磨牙,术后以阻塞器维持开窗口并保持日常冲洗治疗,观察术后囊肿大小及囊壁周围骨质变化情况。结果：术后随访6-18个月,9例含牙囊肿治疗效果明显,有效率为100%。术后复查对比入院时均有不同程度的骨再生,囊腔皆有明显缩小,局部畸形及损伤也有不同程度恢复,其中3例均未行II期刮治术,无复发。结论：颌骨囊肿的开窗治疗保留了颌骨的形态及功能,对于提升患者的生活质量效果明显;同时,鼻内窥镜在颌骨大型囊肿中引导连通各个囊腔以及拔除因囊肿移位的牙齿发挥了重要作用。     

抑那通对子宫内膜异位症患者术后血清HE4及ENA78水平的影响

目的:探究抑那通对子宫内膜异位症患者术后HE4、ENA78水平的影响及临床疗效。方法:选择我院收治的子宫内膜异位症患者64例,将其随机分成实验组及对照组。对照组31例予腹腔镜手术剥除异位囊肿,术后服用孕三烯酮胶囊治疗;实验组33例予腹腔镜手术剥除异位囊肿,术后辅以抑那通治疗。比较两组的临床疗效及治疗前后HE4、ENA78水平的变化。结果:实验组总有效率93.9%,显著高于对照组67.7%(P0.05)。治疗后,两组血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)及人附睾蛋白4(HE4蛋白)、上皮中性粒细胞活化肽(ENA78)水平均较治疗前显著下降(P0.05);与对照组比较,实验组血清FSH、LH、E2、HE4蛋白及ENA78水平较低,差异均具有统计学意义(P0.05)。与对照组比较,实验组复发率较低、妊娠率较高(P0.05)。结论:子宫内膜异位症患者在手术治疗后辅以抑那通治疗能够有效降低术后复发率,增高妊娠率,推测其机制与降低HE4及ENA78水平有关。     

Diagnosis and Surgical Treatment of Renal Hydatid Disease: a Retrospective Analysis of 30 Cases

Echinococcosis (CE) is an infection which is caused by the larval stage of a tapeworm and is endemic in stockbreeding regions of developing countries. The kidney is the most commonly affected organ in the urinary tract. However, reports on renal hydatid disease are limited in the literature, and usually there are no specific clinical characteristics and promising operative methods. The purpose of this study is to assess the most appropriate surgical technique for the patient with urinary tract CE. We retrospectively analyzed thirty patients with renal hydatid cysts who received different surgical treatments in the urology department of the First Affiliated Hospital of Xinjiang Medical University from February 1985 to April 2010. Twenty patients were males and ten were females. The diagnostic accuracy was 74%, 87.5%, and 66.6% respectively by using of ultrasound, CT, and laboratory tests. Thirty patients were followed up for 1–15 years after surgery. One patient experienced a recurrence of renal CE. The ultrasound, CT, and immunological tests are an important means of diagnosis. The surgical treatment principle of renal hydatid should be based on residual renal function, hydatid cyst size, number, location, and surgical techniques to determine the surgical plan to retain the renal function.     

后腹腔镜肾囊肿去顶减压术治疗成人型多囊肾的疗效观察

目的评价后腹腔镜肾囊肿去顶减压术治疗多囊肾的临床疗效。方法2005年1月至2009年12月期间,行后腹腔镜肾囊肿去顶减压术的ADPKD患者17例,于术后1月、6月进行随访,观察患者的腰腹部胀痛情况、血压、血清肌酐、GFR的变化。结果腰腹部胀痛、血压明显低于术前,但随着时间推移,效果有所减弱;血清肌酐、GFR无变化。结论对于单侧症状明显的多囊肾患者,行后腹腔镜肾囊肿去顶减压术能改善腰腹部胀痛及血压。     

Primary Renal Hydatid Cyst: Mis-Interpretation as a Renal Malignancy

Primary renal echinococcosis, a rare disease involving the kidney, accounts for 2-3% of human echinococcosis. A 64-year-old female patient from Uzbekistan presented with complaints of left flank pain. A CT scan revealed a cystic mass in the upper to midpole of the left kidney. We regarded this lesion as a renal malignancy and hand-assisted laparoscopic radical nephrectomy was performed to remove the renal mass. The mass consisted of a large unilocular cyst and multiple smaller cysts without any grossly visible renal tissue. The final pathologic diagnosis was a renal hydatid cyst. For patients from endemic areas, hydatid cyst should be included in the differential diagnosis. Here, we present a case of renal hydatid cyst in a female patient who relocated from Uzbekistan to Korea.     

Laparoscopic management of ovarian cysts: an endocrinologist view.

The management of certain ovarian cysts has evolved from the traditional and often quite radical surgical approach to a more conservative approach. Much of this change can be attributed to the improvement in laparoscopic surgical technique. After a brief discussion of the differential diagnosis and clinical presentation of ovarian cysts, ultrasonographic features of certain ovarian cysts will be reviewed. Certainly the ability to characterize cysts ultrasonographically has facilitated gynecologists' ability to predict the neoplastic potential of a cyst and therefore to justify the more conservative approach. The various techniques of laparoscopic ovarian cyst aspiration, fenestration, and cystectomy will then be described.     

Les kystes intraprostatiques: à propos de trois observations

Introduction

Intraprostatic cysts are considered to be rare. Some forms may be responsible for male infertility. The authors study the various clinical aspects, with the aim of defining guidelines for the exploration and treatment of different types of intraprostatic cysts.

Materials and methods

Between 2002 and 2007, we studied 3 cases of intraprostatic cyst in 3 men aged between 32 and 39 years.

Results

The clinical presentation was primary infertility (2 cases) and pelvic pain (2 cases). Digital rectal exam revealed prostate mass in 2 cases. Spermogram results were abnormal in 2 cases. The diagnosis was confirmed by prostate ultrasound. Trans-rectal ultrasound guided needle aspiration was performed in one case with secondary recurrence. Two patients had urethroscopy showing an absence of communication between the cyst and urethral channel. Transurethral incision of the cyst was made with resection of the protruding dome. Progress was favourable in all cases with improvement of semen and dissipation of symptoms without recurrence.

Conclusion

Intraprostatic cysts are benign lesions, often of congenital origin. Imaging is an essential component of diagnosis and can sometimes guide therapeutic procedures. The treatment is not yet codified, but symptomatic and/or complicated cysts can be treated by effective and minimally invasive endoscopic methods.