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154 min，其中腹腔镜组165 min，手助腹腔镜组115 min； 平均出血量约170 ml，平均肛门排气时间36 h。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。
Objective To discuss the safety and feasibil ity of treating complex renal aneurysm with ex vivo aneurysmectomy and renal revascularization and renal autotransplantation after hand-assisted retroperitoneoscopic nephrectomy. Methods In October 2006, one male patient with complex renal aneurysm was treated. The preoperative color Doppler ultrasonograph, CT and DSA showed that there was an aneurysm (3.4 cm × 4.3 cm × 4.5 cm) located in the main renalartery bifurcation and its five branches of the left kidney. The patient had a history of hypertension with no response to treatment. After successful hand-assisted retroperitoneoscopic nephrectomy, the kidney off-body was perfused by the renal irrigating solution immediately to protect the kidney. Then ex vivo aneurysmectomy and renal artery revascularization were performed, the renal artery was reconstructed with an autologous right internal il iac artery. The reconstructed left kidney was re-implanted into the right il iac fossa. Results The operation was successful and the patient recovered without perioperative complications. The postoperative renal function was normal and the color Doppler ultrasonograph showed that the blood circulation in the transferred renal artery of the right il iac fossa and its branches was smooth, the blood circulation of the renal venous was smooth and no stenosis in the ureter 2 weeks after operation. Thirteen months follow-up showed the blood pressure was recovered to normal and the renal function was normal. Conclusion The method of ex vivo aneurysmectomy and autotransplantation is safe, feasible and minimally invasive for treating complex hilar renal artery aneurysms.
ObjectiveTo investigate the feasibility of hand-assisted laparoscopic surgery in radical gastrectomy for gastric cancer. MethodsThe data of two cases undergoing hand-assisted laparoscopic radical gastrectomy for gastric cancer, including operative time, operation related complications, intraoperative bleeding volumes, number of harvested lymph nodes, postoperative complications, time to restoration of bowel function, and length of postoperative hospital stay, etc, were retrospectively analyzed. ResultsTwo patients had undergone the successful hand-assisted laparoscopic radical total gastrectomy and distal gastrectomy without operation related complications. The operative time was 310 min and 220 min, respectively. While, the intraoperative bleeding volume was 120 ml and 80 ml with the number of harvested lymph node being 38 and 52, respectively. There were no postoperative bleeding, intestinal fistula, and anastomotic leakage， etc. The patients were discharged with smooth and fully recovery. ConclusionThe application of hand-assisted laparoscopic surgery in radical gastrectomy for gastric cancer is feasible and safe. However, the effectiveness needs further exploring.
目的探讨腹腔镜脾切除术的安全性及疗效。 方法回顾分析2008年5月至2012年10月期间笔者所在医院完成的63例腹腔镜脾切除术患者的资料。其中特发性血小板减少性紫癜8例，自身免疫性溶血性贫血1例，脾囊实性占位性病变6例，肝硬变伴门静脉高压、脾功能亢进48例。 结果63例患者均顺利完成腹腔镜脾切除术，无中转开腹，手术时间80～250 min，平均136.5 min；术中出血100～2 100 mL，平均220 mL；住院时间6～14 d，平均7.4 d。术后无手术死亡。 结论腹腔镜脾切除术安全、有效、可行，手术成功的关键是防止术中大出血。