目的:探讨半椎板入路显微外科切除椎管内肿瘤的可行性和安全性.方法:回顾性分析我院33例椎管内肿瘤经半椎板入路,显微外科切除椎管内肿瘤的方法.结果:椎管内肿瘤33例,其中肿瘤全切32例,近全切除1例.无手术死亡,2例创腔积液,3例轻度脑脊液漏,经局部处理愈合.结论:经半椎板入路行椎管内肿瘤切除术,能充分暴露肿瘤,并在显微镜下安全切除肿瘤,并发症少,患者恢复快,适用于各级医院开展.

Objective Summarize the experience of single port video-assisted thoracoscopic surgery (SPVATS).Evaluate the value of SPVATS for thoracic diseases.Methods 32 patients underwent SPVATS from March 2011 to May 2011,including 28 males and4 females,with an average age of (26.5 ±9.2) years (ranged 18-72 years).There were twenty-seven cases of spontaneous pneumothorax ( including 2 cases of single stage bilateral surgery),three cases of unknown pleural effusion,one case of bilateral pulmonary nodules,and one case of pulmonary metastasis tumor.Results All procedures were successfully accomplished without conversion to conventional multi-port VATS or open approach.There was no major complication or operative death.All procedures were using self-developed specialized surgical instruments and two-incision joint protection.The procedures inluded resection of lung bullae in 27 cases,purulent drainage fiber stripping pleural lavage in 3,parietal pleural biopsy in 1,and pulmonary wedge resection in 1.The operating time ranged from (22.0 ± 9.5 ) min.The average intraoperative blood loss was ( 14.5 ± 8.8 )ml.The mean chest tube duration was (3.1 ± 0.6 ) days.The average postoperative hospital stay was (6.8 ± 1.6 ) days.Conclusion SPVATS is a new approach for treatment of thoracic diseases.This technique is preferred as a minimally invasive and cosmetic procedure with decreased operative time,quickened postoperative recovery,few complications,and satisfactory short-term outcome.

Objective To summarize our experience on digestive tract reconstruction by using the transorally inserted anvil(OrVil,Covidien)in total thoracoscopic and laparoscopic esophagectomy,and to evaluate its feasibility and safety.MethodsBetween January 2010 and April 2010,5 patients(3 men and 2 women,mean age 67.0 years,ranging from 58 to 76 years),underwent total thoracoscopic and laparoscopic esophagectomy with OrVil in our hospital.In the patients,the tumor was located at the middle esophagus in one case,the lower esophagus in 3 cases,and at the cardia orifice in the other.The mean length of the tumor was 4.3 cm(ranged from 1.5 to 5 cm).During the operation,we separated the stomach under a laparoscope to form a tube,and then,after removing intra-abdominal lymph nodes,we separated the thoracic esophagus,and resected thoracic lymph nodes.Finally,esophagus-stomach anastomosis was perfomed.Results All the procedures were carried out smoothly without converting to open surgery,or leading to serious complications nor death.The mean operation time in this series was 260 minutes(ranged from 210 to 300 minutes).The mean intraoperative blood loss was 352 ml(120-450 ml).All the patients received liquid diet in 5 to 7 days after the operation.The mean hospital stay was 20 days(ranged from 14 to 26 days).The patients were followed up for 30 to 100 days,during which no anastomotic complications occurred.Conclusion OrVil system is safe and effective for digestive tract reconstruction in total thoracoscopic and laparoscopic esophagectomy.

2004年4月~2005年2月,我院行后腹腔镜手术治疗肾脏疾病22例。其中肾结核3例,重度肾积水4例,肾萎缩继发高血压1例,行单纯性肾切除术;T2期肾盂癌2例,行根治性肾输尿管全切术;单纯性肾囊肿12例,行肾囊肿去顶减压术。手术全部成功,无严重并发症,疗效满意。

目的探讨后腹腔镜肾切除术的手术要点和适应证。方法采用后腹腔镜肾切除术治疗各类肾脏疾患20例。结果19例手术成功,1例中转开放手术,术中、术后无明显并发症,术后住院6~8d。结论后腹腔镜肾切除术创伤小、患者康复快,在手术器械改进和手术技巧熟练的情况下,疗效优于开放手术。