Background:Trocar-site hernia(TSH)is a serious complication after laparoscopic procedures.Although it is a rare entity,it have life-threatening consequences.This study aimed to retrospectively analyze the potential as...Background:Trocar-site hernia(TSH)is a serious complication after laparoscopic procedures.Although it is a rare entity,it have life-threatening consequences.This study aimed to retrospectively analyze the potential associated factors for TSH following gynecologic laparoscopy and summarize prevention strategies based on our experience.Methods:We searched for gynecological laparoscopic surgeries in the medical records system of Peking Union Medical College Hospital(PUMCH)from August 1998 to July 2018 and further sifted through the results for cases involving TSH.All included patients were divided into different groups according to patient characteristics,and the rate of TSH was compared among groups.Moreover,the detailed information of all patients with TSH was recorded and analyzed.Statistical analyses were performed with GraphPad Prism 6.Results:The approximate total rate of post-operative TSH among gynecologic laparoscopy procedures performed at PUMCH in the last 20 years was 0.016%(9/55,244).The rate of TSH was significant higher in elder patients(>60 years old;3/2686,0.112%)than in younger patients(<60 years old,6/52,558;0.011%,P=0.008).Moreover,the approximate rate of TSH was significantly higher after single-incision laparoscopic surgery(SILS,2/534,0.357%)than conventional laparoscopic surgery(7/54,710,0.013%,P=0.003).The average age of patients with TSH was 53.4 years(range,35.0-79.0 years).Two of the nine patients had late-onset TSH following SILS;the other seven had early-onset TSH following conventional laparoscopy.Five TSH cases occurred at right lateral port sites,and the remaining three occurred at the umbilical port site.All patients underwent repair surgery,and one required small bowel resection.Conclusion:Older age and SILS are potential associated factors for TSH development,while reducing excessive manipulation and improving suturing skills,especially at the umbilical trocar site following SILS and the right lateral trocar site,can avoid herniation.展开更多
AIM:To investigate the incidence of clinically detected port-site metastasis(PSM) in patients who underwent robotic surgery for biliary malignancies.METHODS:Using a prospective database,the patients undergoing fully r...AIM:To investigate the incidence of clinically detected port-site metastasis(PSM) in patients who underwent robotic surgery for biliary malignancies.METHODS:Using a prospective database,the patients undergoing fully robotic surgery for biliary malignancies between January 2009 and January 2011 were included.Records of patients with confirmed malignancy were reviewed for clinicopathological data and information about PSM.RESULTS:Sixty-four patients with biliary tract cancers underwent robotic surgery,and sixty patients met the inclusion criteria.The median age was 67 year(range:40-85 year).During a median 15-mo follow-up period,two female patients were detected solitary PSM after robotic surgery.The incidence of PSM was 3.3%.Patient 1 underwent robotic anatomatic left hemihepatectomy and extraction of biliary tumor thrombi for an Klatskin tumor.She had a subcutaneous mass located at the right lateral abdominal wall near a trocar scar.Patient 2 underwent robotic pancreaticoduodenectomy for distal biliary cancer.She had two metachronous subcutaneous mass situated at the right lateral abdominal wall under a same trocar scar at 7 and 26 mo.The pathology of the excised PSM masses confirmed metastatic biliary adenocarcinoma.CONCLUSION:The incidence of PSMs after robotic surgery for biliary malignancies is relatively low,and biliary cancer can be an indication of robotic surgery.展开更多
This study reports a 69-year-old, obese, female patientpresenting with a biliary leakage after laparoscopiccholecystectomy for cholelithiasis. Closure of the um-bilical trocar site had been neglected during the lapa-r...This study reports a 69-year-old, obese, female patientpresenting with a biliary leakage after laparoscopiccholecystectomy for cholelithiasis. Closure of the um-bilical trocar site had been neglected during the lapa-roscopic cholecystectomy. Early, on postoperative dayfive, endoscopic retrograde cholangiopancreatography(ERCP) requirement after laparoscopic cholecystectomyresolved the biliary leakage problem but resulted with amore complicated clinical picture with an intestinal ob-struction and severe abdominal pain. Computed tomog-raphy revealed a strangulated hernia from the umbilicaltrocar site. Increased abdominal pressure during ERCPhad strained the weak umbilical trocar site. Emergencysurgical intervention through the umbilicus revealed anischemic small bowel segment which was treated withresection and anastomosis. This report demonstratesthat negligence of trocar site closure can result in veryearly herniation, particularly if an endoscopic interven-tion is required in the early postoperative period.展开更多
近年来腹腔镜手术由于相对传统手术具有独特的微创优势,逐渐成为外科的主要手术方式。伴随着腹腔镜技术的不断发展与应用,学界对于腔镜手术并发症的认识越来越全面。穿刺孔疝(trocar site hernia, TSH)自1968年被Fear第一次报道后,越来...近年来腹腔镜手术由于相对传统手术具有独特的微创优势,逐渐成为外科的主要手术方式。伴随着腹腔镜技术的不断发展与应用,学界对于腔镜手术并发症的认识越来越全面。穿刺孔疝(trocar site hernia, TSH)自1968年被Fear第一次报道后,越来越多的类似病例被报道,穿刺孔疝导致的术后安全问题逐渐引起注意。穿刺孔疝的发生是由于穿刺部位存在缺损,腹腔内组织或脏器通过缺损突出皮下间隙所致。穿刺孔疝一旦发生,不仅会降低患者生活质量,而且如果伴发肠道嵌顿将危及患者生命。因此,腹腔镜术后穿刺孔疝应当引起重视,识别相关危险因素,做好必要的预防措施具有重要的临床意义。本文就穿刺孔疝的发生及预防作一综述,以期为临床提供参考。展开更多
目的分析腹腔镜术后Trocar部位疝(trocar site hernia,TSH)的CT表现特点以及与临床之间的关系。资料与方法回顾性分析经手术证实的2例腹腔镜术后TSH并发肠梗阻患者的CT影像学资料并与临床手术对照,结合相关文献对其发生率、发病机制、...目的分析腹腔镜术后Trocar部位疝(trocar site hernia,TSH)的CT表现特点以及与临床之间的关系。资料与方法回顾性分析经手术证实的2例腹腔镜术后TSH并发肠梗阻患者的CT影像学资料并与临床手术对照,结合相关文献对其发生率、发病机制、分型、临床表现进行分析,探讨该病的CT诊断特点。结果 2例患者CT像上均表现为左下腹壁小肠局部疝出并高位小肠梗阻,结合患者手术史,CT均拟诊为TSH;手术也均证实部分小肠嵌顿于Trocar切口内,近端小肠扩张积液。结论 CT对腹腔镜术后TSH的早期诊断和鉴别诊断具有重要价值,对TSH的早期手术治疗也具有很好的指导意义。展开更多
文摘Background:Trocar-site hernia(TSH)is a serious complication after laparoscopic procedures.Although it is a rare entity,it have life-threatening consequences.This study aimed to retrospectively analyze the potential associated factors for TSH following gynecologic laparoscopy and summarize prevention strategies based on our experience.Methods:We searched for gynecological laparoscopic surgeries in the medical records system of Peking Union Medical College Hospital(PUMCH)from August 1998 to July 2018 and further sifted through the results for cases involving TSH.All included patients were divided into different groups according to patient characteristics,and the rate of TSH was compared among groups.Moreover,the detailed information of all patients with TSH was recorded and analyzed.Statistical analyses were performed with GraphPad Prism 6.Results:The approximate total rate of post-operative TSH among gynecologic laparoscopy procedures performed at PUMCH in the last 20 years was 0.016%(9/55,244).The rate of TSH was significant higher in elder patients(>60 years old;3/2686,0.112%)than in younger patients(<60 years old,6/52,558;0.011%,P=0.008).Moreover,the approximate rate of TSH was significantly higher after single-incision laparoscopic surgery(SILS,2/534,0.357%)than conventional laparoscopic surgery(7/54,710,0.013%,P=0.003).The average age of patients with TSH was 53.4 years(range,35.0-79.0 years).Two of the nine patients had late-onset TSH following SILS;the other seven had early-onset TSH following conventional laparoscopy.Five TSH cases occurred at right lateral port sites,and the remaining three occurred at the umbilical port site.All patients underwent repair surgery,and one required small bowel resection.Conclusion:Older age and SILS are potential associated factors for TSH development,while reducing excessive manipulation and improving suturing skills,especially at the umbilical trocar site following SILS and the right lateral trocar site,can avoid herniation.
文摘目的:通过病例报告并结合文献复习,分析腹腔镜术后Trocar 部位疝(TSH)的发生原因、分型、临床表现、诊断、治疗及预防措施,提高对腹腔镜术后TSH 的诊疗水平.方法:报告1例泌尿外科腹腔镜术后发生TSH患者的诊治经过及随访结果,并结合文献复习对TSH的发生原因、分型、临床表现、诊断、治疗及预防措施进行分析.结果:51岁女性患者因'左侧脓肾切除术后,切口疼痛伴流脓,左肾区肿物'行腹腔镜下左侧肾区肿物切除术、窦道切除术,术后第4天出现左下腹12 mm Trocar部位疝并发肠梗阻,急诊剖腹探查,行肠管松解术和切口缝合术,术后7天患者痊愈出院,术后随访至今,无复发.结论:TSH是一种少见的腹腔镜手术并发症,发生率为0.18%~2.80%,多见于普外科和妇产科等经腹腔入路腹腔镜手术,我国泌尿外科腹腔镜手术多采用后腹腔入路,故极少发生,TSH临床上主要分为早发型、迟发型和特殊型三种,其发生涉及多种因素,一旦发生,无自愈可能,多需手术治疗.预防TSH的方法包括逐层严格关闭切口、改进Trocar外形、控制腹压等.
基金Supported by Eleven-five Special Subject of PLA Medicine and Health,No.08Z016
文摘AIM:To investigate the incidence of clinically detected port-site metastasis(PSM) in patients who underwent robotic surgery for biliary malignancies.METHODS:Using a prospective database,the patients undergoing fully robotic surgery for biliary malignancies between January 2009 and January 2011 were included.Records of patients with confirmed malignancy were reviewed for clinicopathological data and information about PSM.RESULTS:Sixty-four patients with biliary tract cancers underwent robotic surgery,and sixty patients met the inclusion criteria.The median age was 67 year(range:40-85 year).During a median 15-mo follow-up period,two female patients were detected solitary PSM after robotic surgery.The incidence of PSM was 3.3%.Patient 1 underwent robotic anatomatic left hemihepatectomy and extraction of biliary tumor thrombi for an Klatskin tumor.She had a subcutaneous mass located at the right lateral abdominal wall near a trocar scar.Patient 2 underwent robotic pancreaticoduodenectomy for distal biliary cancer.She had two metachronous subcutaneous mass situated at the right lateral abdominal wall under a same trocar scar at 7 and 26 mo.The pathology of the excised PSM masses confirmed metastatic biliary adenocarcinoma.CONCLUSION:The incidence of PSMs after robotic surgery for biliary malignancies is relatively low,and biliary cancer can be an indication of robotic surgery.
文摘This study reports a 69-year-old, obese, female patientpresenting with a biliary leakage after laparoscopiccholecystectomy for cholelithiasis. Closure of the um-bilical trocar site had been neglected during the lapa-roscopic cholecystectomy. Early, on postoperative dayfive, endoscopic retrograde cholangiopancreatography(ERCP) requirement after laparoscopic cholecystectomyresolved the biliary leakage problem but resulted with amore complicated clinical picture with an intestinal ob-struction and severe abdominal pain. Computed tomog-raphy revealed a strangulated hernia from the umbilicaltrocar site. Increased abdominal pressure during ERCPhad strained the weak umbilical trocar site. Emergencysurgical intervention through the umbilicus revealed anischemic small bowel segment which was treated withresection and anastomosis. This report demonstratesthat negligence of trocar site closure can result in veryearly herniation, particularly if an endoscopic interven-tion is required in the early postoperative period.
文摘近年来腹腔镜手术由于相对传统手术具有独特的微创优势,逐渐成为外科的主要手术方式。伴随着腹腔镜技术的不断发展与应用,学界对于腔镜手术并发症的认识越来越全面。穿刺孔疝(trocar site hernia, TSH)自1968年被Fear第一次报道后,越来越多的类似病例被报道,穿刺孔疝导致的术后安全问题逐渐引起注意。穿刺孔疝的发生是由于穿刺部位存在缺损,腹腔内组织或脏器通过缺损突出皮下间隙所致。穿刺孔疝一旦发生,不仅会降低患者生活质量,而且如果伴发肠道嵌顿将危及患者生命。因此,腹腔镜术后穿刺孔疝应当引起重视,识别相关危险因素,做好必要的预防措施具有重要的临床意义。本文就穿刺孔疝的发生及预防作一综述,以期为临床提供参考。
文摘目的分析腹腔镜术后Trocar部位疝(trocar site hernia,TSH)的CT表现特点以及与临床之间的关系。资料与方法回顾性分析经手术证实的2例腹腔镜术后TSH并发肠梗阻患者的CT影像学资料并与临床手术对照,结合相关文献对其发生率、发病机制、分型、临床表现进行分析,探讨该病的CT诊断特点。结果 2例患者CT像上均表现为左下腹壁小肠局部疝出并高位小肠梗阻,结合患者手术史,CT均拟诊为TSH;手术也均证实部分小肠嵌顿于Trocar切口内,近端小肠扩张积液。结论 CT对腹腔镜术后TSH的早期诊断和鉴别诊断具有重要价值,对TSH的早期手术治疗也具有很好的指导意义。
