Backgrounds: Surgical interventions especially minimally invasive treatments are recommended for symptomatic midline prostatic cysts. The endoscopic unroofing of cysts close to urethra is easy and simple, but it has l...Backgrounds: Surgical interventions especially minimally invasive treatments are recommended for symptomatic midline prostatic cysts. The endoscopic unroofing of cysts close to urethra is easy and simple, but it has little effect on the large cysts and cysts lying deeply, in contrast with the laparoscopic approach. Therefore, the selection of minimally invasive therapeutic approaches is important. The aim of this study is to describe our experience in the diagnosis and selection of minimally invasive treatment for midline prostatic cyst. Methods: 15 cases of midline prostatic cyst were studied.10 cases presented with prostatitis-like symptoms, 1 with dysuria and acute urinary retention, 3 with secondary infertility and the rest 1 with hemospermia. 6 patients presented with small cysts (≤2 cm × 2 cm) close to urethra and underwent transurethral unroofing. The other 9 patients with large cysts (>2 cm × 2 cm) or cysts lying closely behind the prostate received the laparoscopic excision. Results: The average duration of transurethral unroofing and laparoscopic excision was 39 mins and 118 mins respectively, whereas the average time of hospitalization was 2.7 days and 4.5 days respectively. After a follow-up of 21 months, all cases were treated successfully without complications and recurrence. Their prostatitis-like symptoms disappeared, and the three patients presented with secondary infertility achieved conception within one year after the operation. Conclusions: A midline prostatic cyst can present with chronic prostatitis-like symptoms and secondary infertility. It can be cured by minimally invasive treatments, but these procedures should be carefully selected according to the size and location of the cyst.展开更多
Cholellthiasis is a kind of common and multiple diseases. In recent years, traolttonal laparommy has been challenged by a minimally invasive surgery. Through literature review, the therapeutic method, effect, and comp...Cholellthiasis is a kind of common and multiple diseases. In recent years, traolttonal laparommy has been challenged by a minimally invasive surgery. Through literature review, the therapeutic method, effect, and complications of minimally invasive treatment of intrahepatic and extrahepatic bile duct stones by combining our practical experience were summarized as follows. （1） For intrahepatic bile duct stones, the operation may be selected by laparoscopie liver resection, laparoscopic common bile duct exploration （LCBDE）, or percutaneous transhepatic cholangioscopy. （2） For concomitant gallstones and common bile duct stones, the surgical approach can be selected as follows： laparoscopic cholecystectomy （LC） combined with endoscopic sphincterotomy （EST） or endoscopic papillary balloon dilatation, LC plus laparoscopic transcystic common bile duct exploration, LC plus LCBDE, and T-tube drainage or primary suture. （3） For concomitant intrahepatic and extrahepatic bile duct stones, laparoscopic liver resection, choledochoscopy through the hepatic duct orifice on the hepatectomy cross section, LCBDE, EST, and percutaneous transhepatic cholangioscopic lithotripsy could be used. According to the abovementioned principle, the minimally invasive treatment approach combined with the surgical technique and equipment condition will be significant in improving the therapeutic effect and avoiding the postoperative complications or hidden dangers of intrahepatic and extrahepatic bile duct stones.展开更多
肝内外胆管结石是一种常见、多发疾病,其传统的开腹手术近年来受到微创手术的挑战.本文通过文献检索,结合作者的实践经验,在全面总结肝内、外胆管结石的微创治疗现状基础上,探讨出一种可有效提高其微创治疗效果的策略:(1)对于肝内胆管结...肝内外胆管结石是一种常见、多发疾病,其传统的开腹手术近年来受到微创手术的挑战.本文通过文献检索,结合作者的实践经验,在全面总结肝内、外胆管结石的微创治疗现状基础上,探讨出一种可有效提高其微创治疗效果的策略:(1)对于肝内胆管结石:可根据指征选用腹腔镜肝切除、腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration,LCBDE)、经皮经肝胆道镜取石术;(2)对于胆囊结石合并胆总管结石:可根据指征选用腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)+经内镜十二指肠乳头括约肌切开(endoscopic sphincterotomy,EST)或经内镜乳头气囊扩张术(endoscopic papillary balloon dilatation,E P B D)、L C+经胆囊管胆总管探查取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)、LC+LCBDE+T管引流或一期缝合术;(3)对于肝内合并肝外胆管结石,可根据指征选用腹腔镜肝切除、经肝断面胆管胆道镜取石、LCBDE、EST、经皮经肝胆道镜碎石术.根据上述策略,结合术者的技术和设备条件,合理选择微创治疗方法,对于提高肝内、外胆管结石的治疗效果具有重要意义.展开更多
AIM To evaluate the clinical advantages of single-port laparoscopic hepatectomy(SPLH) compare to multiport laparoscopic hepatectomy(MPLH).METHODS We retrospectively reviewed the medical records of 246 patients who und...AIM To evaluate the clinical advantages of single-port laparoscopic hepatectomy(SPLH) compare to multiport laparoscopic hepatectomy(MPLH).METHODS We retrospectively reviewed the medical records of 246 patients who underwent laparoscopic liver resection between January 2008 and December 2015 at our hospital. We divided the surgical technique into two groups; SPLH and MPLH. We performed laparoscopic liver resection for both benign and malignant disease. Major hepatectomy such as right and left hepatectomy was also done with sufficient disease-free margin. The operative time, the volume of blood loss, transfusion rate, and the conversion rate to MPLH or open surgery was evaluated. The post-operative parameters included the meal start date after operation, the number of postoperative days spent in the hospital, and surgical complications was also evaluated.RESULTS Of the 246 patients, 155 patients underwent SPLH and 91 patients underwent MPLH. Conversion rate was 22.6% in SPLH and 19.8% in MPLH(P = 0.358). We performed major hepatectomy, which was defined as resection of more than 2 sections, in 13.5% of patients in the SPLH group and in 13.3% of patients in the MPLH group(P = 0.962). Mean operative timewas 136.9 ± 89.2 min in the SPLH group and 231.2 ± 149.7 min in the MPLH group(P < 0.001). The amount of blood loss was 385.1 ± 409.3 m L in the SPLH group and 559.9 ± 624.9 m L in the MPLH group(P = 0.016). The safety resection margin did not show a significant difference(0.84 ± 0.84 cm in SPLH vs 1.04 ± 1.22 cm in MPLH, P = 0.704). Enteral feeding was started earlier in the SPLH group(1.06 ± 0.27 d after operation) than in the MPLH group(1.63 ± 1.27 d)(P < 0.001). The mean hospital stay after operation was non-significantly shorter in the SPLH group than in the MPLH group(7.82 ± 2.79 d vs 7.97 ± 3.69 d, P = 0.744). The complication rate was not significantly different(P = 0.397) and there was no major perioperative complication or mortality case in both groups. CONCLUSION Single-port laparoscopic liver surgery seems to be a feasible approach for various kinds of liver diseases.展开更多
文摘Backgrounds: Surgical interventions especially minimally invasive treatments are recommended for symptomatic midline prostatic cysts. The endoscopic unroofing of cysts close to urethra is easy and simple, but it has little effect on the large cysts and cysts lying deeply, in contrast with the laparoscopic approach. Therefore, the selection of minimally invasive therapeutic approaches is important. The aim of this study is to describe our experience in the diagnosis and selection of minimally invasive treatment for midline prostatic cyst. Methods: 15 cases of midline prostatic cyst were studied.10 cases presented with prostatitis-like symptoms, 1 with dysuria and acute urinary retention, 3 with secondary infertility and the rest 1 with hemospermia. 6 patients presented with small cysts (≤2 cm × 2 cm) close to urethra and underwent transurethral unroofing. The other 9 patients with large cysts (>2 cm × 2 cm) or cysts lying closely behind the prostate received the laparoscopic excision. Results: The average duration of transurethral unroofing and laparoscopic excision was 39 mins and 118 mins respectively, whereas the average time of hospitalization was 2.7 days and 4.5 days respectively. After a follow-up of 21 months, all cases were treated successfully without complications and recurrence. Their prostatitis-like symptoms disappeared, and the three patients presented with secondary infertility achieved conception within one year after the operation. Conclusions: A midline prostatic cyst can present with chronic prostatitis-like symptoms and secondary infertility. It can be cured by minimally invasive treatments, but these procedures should be carefully selected according to the size and location of the cyst.
文摘Cholellthiasis is a kind of common and multiple diseases. In recent years, traolttonal laparommy has been challenged by a minimally invasive surgery. Through literature review, the therapeutic method, effect, and complications of minimally invasive treatment of intrahepatic and extrahepatic bile duct stones by combining our practical experience were summarized as follows. （1） For intrahepatic bile duct stones, the operation may be selected by laparoscopie liver resection, laparoscopic common bile duct exploration （LCBDE）, or percutaneous transhepatic cholangioscopy. （2） For concomitant gallstones and common bile duct stones, the surgical approach can be selected as follows： laparoscopic cholecystectomy （LC） combined with endoscopic sphincterotomy （EST） or endoscopic papillary balloon dilatation, LC plus laparoscopic transcystic common bile duct exploration, LC plus LCBDE, and T-tube drainage or primary suture. （3） For concomitant intrahepatic and extrahepatic bile duct stones, laparoscopic liver resection, choledochoscopy through the hepatic duct orifice on the hepatectomy cross section, LCBDE, EST, and percutaneous transhepatic cholangioscopic lithotripsy could be used. According to the abovementioned principle, the minimally invasive treatment approach combined with the surgical technique and equipment condition will be significant in improving the therapeutic effect and avoiding the postoperative complications or hidden dangers of intrahepatic and extrahepatic bile duct stones.
文摘肝内外胆管结石是一种常见、多发疾病,其传统的开腹手术近年来受到微创手术的挑战.本文通过文献检索,结合作者的实践经验,在全面总结肝内、外胆管结石的微创治疗现状基础上,探讨出一种可有效提高其微创治疗效果的策略:(1)对于肝内胆管结石:可根据指征选用腹腔镜肝切除、腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration,LCBDE)、经皮经肝胆道镜取石术;(2)对于胆囊结石合并胆总管结石:可根据指征选用腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)+经内镜十二指肠乳头括约肌切开(endoscopic sphincterotomy,EST)或经内镜乳头气囊扩张术(endoscopic papillary balloon dilatation,E P B D)、L C+经胆囊管胆总管探查取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)、LC+LCBDE+T管引流或一期缝合术;(3)对于肝内合并肝外胆管结石,可根据指征选用腹腔镜肝切除、经肝断面胆管胆道镜取石、LCBDE、EST、经皮经肝胆道镜碎石术.根据上述策略,结合术者的技术和设备条件,合理选择微创治疗方法,对于提高肝内、外胆管结石的治疗效果具有重要意义.
文摘AIM To evaluate the clinical advantages of single-port laparoscopic hepatectomy(SPLH) compare to multiport laparoscopic hepatectomy(MPLH).METHODS We retrospectively reviewed the medical records of 246 patients who underwent laparoscopic liver resection between January 2008 and December 2015 at our hospital. We divided the surgical technique into two groups; SPLH and MPLH. We performed laparoscopic liver resection for both benign and malignant disease. Major hepatectomy such as right and left hepatectomy was also done with sufficient disease-free margin. The operative time, the volume of blood loss, transfusion rate, and the conversion rate to MPLH or open surgery was evaluated. The post-operative parameters included the meal start date after operation, the number of postoperative days spent in the hospital, and surgical complications was also evaluated.RESULTS Of the 246 patients, 155 patients underwent SPLH and 91 patients underwent MPLH. Conversion rate was 22.6% in SPLH and 19.8% in MPLH(P = 0.358). We performed major hepatectomy, which was defined as resection of more than 2 sections, in 13.5% of patients in the SPLH group and in 13.3% of patients in the MPLH group(P = 0.962). Mean operative timewas 136.9 ± 89.2 min in the SPLH group and 231.2 ± 149.7 min in the MPLH group(P < 0.001). The amount of blood loss was 385.1 ± 409.3 m L in the SPLH group and 559.9 ± 624.9 m L in the MPLH group(P = 0.016). The safety resection margin did not show a significant difference(0.84 ± 0.84 cm in SPLH vs 1.04 ± 1.22 cm in MPLH, P = 0.704). Enteral feeding was started earlier in the SPLH group(1.06 ± 0.27 d after operation) than in the MPLH group(1.63 ± 1.27 d)(P < 0.001). The mean hospital stay after operation was non-significantly shorter in the SPLH group than in the MPLH group(7.82 ± 2.79 d vs 7.97 ± 3.69 d, P = 0.744). The complication rate was not significantly different(P = 0.397) and there was no major perioperative complication or mortality case in both groups. CONCLUSION Single-port laparoscopic liver surgery seems to be a feasible approach for various kinds of liver diseases.
