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RETROPERITONEAL LAPAROSCOPIC APPROACH COMBINED WITH ANTEROLATERAL MINI-INCISION FOR LUMBAR SPINE TUBERCULOSIS

ObjectiveTo investigate the effectiveness of retroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis. MethodsA retrospective analysis was made on the cl inical data of 22 patients with lumbar spine tuberculosis undergoing focus clearance, fusion, and internal fixation by retroperitoneal laparoscopic approach combined with anterolateral mini-incision between June 2006 and June 2012. There were 14 males and 8 females, with an average age of 42.6 years (range, 26-57 years) and with a mean disease duration of 7.3 months (range, 3-10 months). There were 17 patients with single-level spinal tuberculosis (L1, 2 in 3, L2, 3 in 6, L3, 4 in 4, L4, 5 in 2, and L5 in 2) and 5 patients with double-level spinal tuberculosis (L1-3 in 2 and L2-4 in 3). The preoperative Cobb's angle of lumbar spine was 5-28° (mean, 20°). In 6 patients having compression symptom, 4 cases were rated as grade D and 2 as grade C according to Frankel classification. The operative time, intraoperative blood loss, and postoperative complications were recorded. At last follow-up, the neurologic function was assessed according to Frankel grade, the Cobb's angle after operation was measured on lumbar lateral X-ray film; the efficacy was evaluated according to Nakai criteria, and the fusion was evaluated according to Suk criteria. ResultsAll operations were successfully completed. The operation time was 110-250 minutes (mean, 140 minutes), and intraoperative blood loss was 120-280 mL (mean, 180 mL). The symptoms of femoral nerve injury and sympathetic nerve injury occurred in 1 case respectively and was relieved at 1-3 weeks after operation. All incisions healed by first intention. The patients were followed up 16-50 months (mean, 21 months). During the follow-up period, no loosening or breakage of implants and no tuberculosis recurrence were found. At last follow-up, the nerve function was recovered to grade E in the others except 1 case at grade D. The Cobb's angle was 2-16° (mean, 7.8°). According to Nakai criteria for efficacy evaluation, the results were excellent in 9 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 86.4%. The bony fusion rate was 95.5% (21/22) according to Suk criteria. ConclusionRetroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis is a safe and effective approach with minimal invasion and less complications.

The Observation of Retroperitoneal Laparoscopic Decortication of 6 Adrenal Cysts

目的:分析经后腹腔镜肾上腺囊肿去顶减压术的疗效,安全性和临床价值。方法:我院2004年12月至2007年12月6例经后腹腔镜肾上腺囊肿去顶减压临床资料进行回顾分析。结果:经后腹腔镜5例肾上腺囊肿患者顺利切除去顶,其中左侧肾上腺囊肿3例,右侧肾上腺囊肿3例。1例转开放,为双侧肾上腺囊肿。平均手术时间(45.73±1.32)min,平均术中出血量(7.35±0.45)mL。平均住院天数(7.67±0.24)天,平均术后住院天数(5.0±0.11)天。结论:经后腹腔镜肾上腺囊肿去顶减压是一种安全,有效且可行的治疗方式,必要时应及时转开放。

多学科诊疗模式救治腹膜后异位妊娠合并血肿致失血性休克一例

TREATMENT OF PANCRATIC INFECTED NECROSIS BY LUMBO-POST PERETONEAL DRAINAGE AND POSTOPERATIVE LAVAGE （REPORT OF 20 CASES）

目的 探讨急性胰腺炎继发感染的治疗方法。方法 分析总结我院1998～1999年收治的20例胰腺感染患者，采用经后上腰腹膜后引流及灌洗方法治疗的资料。结果 术后并发症： 残余脓肿2例，消化道出血1例，肠瘘4例，胰瘘6例，经治疗后患者全部治愈。结论 该治疗方法残余感染及死亡率低。

The Surgical Management of Primary Peritoneal Tumor Involving Iliac Vessels

Objective　To discuss the surgical management in resection of primary peritoneal tumors involving iliac vessels. Methods　The clinical data of 124 patients with primary peritoneal tumors involving iliac vessels， that underwent surgical procedures from December 2006 to December 2011 were analyzed retrospectively. There were 68 menand 56 women with an age raging from 16-72 years old （mean 44 years old）. Results　All patients underwent operative treatment. Fifty-two patients with tumors infiltrating or surrounding the major illiac vessels， 72 patients with tumors compressing the iliac vessels. Primary peritoneal tumors involving iliac vessels were completely resected in 90 patients， were incompletely resected in 31 patients， and were palliatively resected in 3 patients. Resectoin of primary peritoneal tumors and iliac vessel reconstruction were performed in 42 patients with tumors infiltrating or surrounding the major illiac vessels. There was no death during perioperative period. There were complications in 2 patients， that including urinary fistula in 1 patient and fat liquefaction of incision in 1 patient. Complications were not found in the rest of the patients. All patients were followed-up from 12-24 months （mean 16 months）. Thirty-eight patients relapsed locally in 90 patients with tumor completely resected. Nine patients died in those tumor incompletely resected（6 patients died because of recurrence， 3 patients died because of cadiovasuclar and cerebrovascular accidents）. Three patients follwing palliative resected were dead during the follow-up period （3 patients died because of recurrence）. Among the 42 patients underwent the procedure of iliac vessels， recurrence occured in 3 patients without involving iliac vessels， 1 patient relapsed involving inferior vena cava （IVC） which resulted in IVC obstruction and deep venous thrombosis following 7 months after operation. Recurrence occured in 2 patients involving common iliac veins following 8 months after operation. Venous thrombus of common iliac vein graft occured in 1 patientin in 10 months after operation. Conclusion　Resection completely and involved iliac vessel reconstruction would reduce recurrence of tumor and promote long term survival in patients with primary peritoneal tumors involving iliac vessels

Laparoscopic Surgical Treatment of Primary Retroperitoneal Tumor (Report of 12 Cases)

目的探讨原发性腹膜后肿瘤行腹腔镜手术的安全性和疗效。 方法回顾性分析新疆医科大学第二附属医院普外科2008年4月至2013年4月期间行腹腔镜手术治疗的12例原发性腹膜后肿瘤患者的临床资料。 结果12例患者均行腹腔镜手术，其中1例中转开腹手术，其余行腹腔镜手术成功。平均手术时间190 min，术中平均出血300 mL，术后平均8.5 d出院。术后左下肢深静脉血栓形成1例，经保守治疗好转。围手术期无死亡患者。术后病理类型：良性肿瘤5例，其中神经鞘瘤1例，脂肪瘤1例，腹膜后囊肿2例，畸胎瘤1例；恶性肿瘤7例，其中纤维肉瘤2例，平滑肌肉瘤1例，恶性淋巴瘤2例，脂肪肉瘤2例。良性肿瘤平均直径8.1 cm，恶性肿瘤平均直径5.6 cm。随访7例恶性肿瘤患者，平均随访时间13个月，无复发及转移。 结论通过本组有限的病例资料初步得出，原发性腹膜后肿瘤的诊断主要依靠影像学检查。对于肿瘤直径≤10 cm的良性肿瘤或直径≤6 cm的恶性肿瘤且未侵犯主要血管者行腹腔镜手术治疗安全、可行。

单纯性肾囊肿3种手术治疗效果的比较

目的:比较和评价后腹腔镜去顶减压术、开放性去顶减压术和穿刺硬化术的治疗单纯性肾囊肿的效果。方法:138例单纯性肾囊肿者中采用后腹腔镜去顶减压术48例,开放性去顶术56例,穿刺硬化术34例。对3种术式的临床疗效、术后恢复及费用等进行对比研究。结果:3组患者在年龄、性别、侧别、随访时间及囊肿大小上差异无统计学意义。腹腔镜组症状消失者72.9%,症状好转者22.9%,无复发;开放手术组症状消失者69.6%,症状好转者26.8%,无复发;穿刺硬化组症状消失者35.3%,症状好转者58.8%,复发29.4%。腹腔镜组术后均未注射止痛剂,平均发热21d,住院35d,伤口疼痛麻木持续1.5个月;开放手术组术后39.3%(22/56)注射止痛剂,平均发热4.4d,住院5.4d,伤口疼痛麻木持续5.6个月;穿刺硬化组术后无注射止痛剂,平均发热0.2d,住院0.8d,伤口疼痛麻木持续0.5月。术后并发症发生率腹腔镜组为6.3%(3/48),主要为肾周血肿和感染;开放手术组为8.9%(5/56),主要为伤口感染、应激性溃疡等;穿刺硬化组为2.9%(1/34),主要为肾周血肿。腹腔镜组和开放手术组费用显著高于穿刺硬化手术组(Plt;0.05)。结论:腹腔镜肾囊肿去顶术疗效确切、复发率低、并发症少、费用高;开放性肾囊肿去顶术疗效确切、复发率低、并发症多、费用高;穿刺硬化术疗效确切、复发率高、并发症少、费用低。在单纯性肾囊肿的治疗中,腹腔镜手术已经成为治疗的金标准,但根据患者的病情和经济社会情况可选择开放手术和穿刺硬化手术治疗。

Efficacy of High-dose Three-dimensional Conformal Radiotherapy Combined with Surgery on Primary Retroperitoneal Soft Tissue Sarcoma

【摘要】　目的　评价大分割适形放射治疗对腹膜后软组织肿瘤术后患者的治疗作用。　方法　对1998年10月-2003年4月收治的16例腹膜后软组织急性肿瘤术后患者行大分割适形放射治疗，设计临床靶区等效生物剂量为55～62 Gy，观察放疗后2、5年局部控制率、生存率和无病生存情况。　结果　2、5年局部控制率较未行放疗患者明显提高并和其他放射治疗方式达到较高治疗剂量者近似；远期生存无改善，无病生存率较未行放疗患者有提高。　结论　大分割适形放射治疗方式对腹膜后软组织急性肿瘤术后患者有较好的局部控制作用，无瘤生存率有提高，远期生存无改善，无严重的远期放疗后遗症。【Abstract】　Objective　To observe the effect of high-dose three-dimensional conformal radiotherapy combined with surgery on primary retroperitoneal soft tissue sarcoma.　Methods　A total of 16 patients with primary retroperitoneal soft tissue sarcoma underwent high-dose three-dimensional conformal radiotherapy after sarcoma excision from October 1998 to April 2003. The biologically effective dose was 55-62 Gy for CTV. The local control rate and long-term survival rate and disease free survival after 2 and 5 years were observed.　Results　The local control rate obviously raised in these patients after 2 and 5 years; but the long-term survival rate didn’t improve and the disease free survival improved in these patients compared with those wasn’t radiated.　Conclusion　High-dose three-dinensional comfomal radiotherapy is effective on the patients with retroperitoneal soft tissue sarcoma in local control rate and disease free survival, but long-term survival rate is not improved and the side-effect is not serious.

腹膜后巨大淋巴管瘤合并肝脓肿1例报道

两种腹膜后腔建立方法的比较

【摘要】 目的 比较气囊法组和直接法组建立腹膜后腔的临床价值。 方法 对2005年5月-2008年12月32例后腹腔镜手术建立腹膜后腔的临床资料进行比较，统计分析两种腹膜后腔建立方法在时间、空间大小、食指经穿刺孔能否触及肾脏、并发症发生率、出血量等的差别。 结果 两种方法均成功建立腹膜后腔。气囊法组建立腹膜后腔时间平均为（13.17±1.40） min，直接法组为（4.45±1.20） min。气囊法组腹膜后腔空间为（396.00±13.33） mL，直接法组为（85.50±6.05） mL。气囊法组食指经穿刺孔能触及肾脏6例（50%），直接法组无1例（0%）。组间比较，差异有统计学意义（Plt;0.01）。两组患者建立空间后经观察均为少量渗血，气囊法组发生气囊爆裂1例。 结论 直接法组在时间上明显优于气囊法组，与气囊法组比较并未增加相关并发症，但建立的空间较小；在熟练掌握了气囊法组后可以运用直接法组建立腹膜后腔。