共查询到20条相似文献,搜索用时 718 毫秒
1.
Effect of surgical stress on endogenous morphine and cytokine levels in the plasma after laparoscopoic or open cholecystectomy 总被引:2,自引:0,他引:2
Yoshida S Ohta J Yamasaki K Kamei H Harada Y Yahara T Kaibara A Ozaki K Tajiri T Shirouzu K 《Surgical endoscopy》2000,14(2):137-140
Background: Endogenous morphine in the brain leads to various biological responses after surgery. The aim of this study was to determine
whether morphine levels in the plasma would be enhanced by open laparotomy rather than by laparoscopic procedures.
Methods: We compared 19 patients who underwent laparoscopic cholecystectomy with five patients who underwent resection of the gallbladder
by open laparotomy. Morphine levels in the plasma were measured by an electrochemical detection system.
Results: Postoperative endogenous morphine levels were higher with open laparotomy than with the laparoscopic technique (three h after
surgery: open, 200 ± 52.6 fmol/ml vs laparoscopy, 17.6 ± 3.7, p < 0.01). This morphine elevation accounted for higher levels of cytokine, greater pain scores, and longer duration of fasting
in open laparotomized patients than in laparoscopic cholecystectomy patients. Stress hormone levels in the plasma were also
higher with open laparotomy than with laparoscopy.
Conclusion: Morphine synthesis was enhanced by open laparotomy, resulting in greater biological response postoperatively than that seen
with laparoscopic cholecystectomy.
Received: 21 October 1998/Accepted: 3 April 1999 相似文献
2.
J. D. F. Allendorf M. Bessler K. D. Horvath M. R. Marvin D. A. Laird R. L. Whelan 《Surgical endoscopy》1998,12(8):1035-1038
Background: Surgery can suppress immune function and facilitate tumor growth. Several studies have demonstrated better preservation of
immune function following laparoscopic procedures. Our laboratory has also shown that tumors are more easily established and
grow larger after sham laparotomy than after pneumoperitoneum in mice. The purpose of this study was to determine if the previously
reported differences in tumor establishment and growth would persist in the setting of an intraabdominal manipulation.
Methods: Syngeneic mice received intradermal injections of tumor cells and underwent either an open or laparoscopic cecal resection.
In study 1, the incidence of tumor development was observed after a low dose inoculum; whereas in study 2, tumor mass was
compared on postoperative day 12 after a high-dose inoculum.
Results: In study 1, tumors were established in 5% of control mice, 30% of laparoscopy mice, and 83% of open surgery mice (p < 0.01 for all comparisons). In study 2, open surgery group tumors were 1.5 times as large as laparoscopy group tumors (p < 0.01), which were 1.5 times as large as control group tumors (p < 0.02).
Conclusion: We conclude that tumors are more easily established and grow larger after open laparoscopic bowel resection in mice.
Received: 27 October 1997/Accepted: 19 January 1998 相似文献
3.
Background: Most patients presenting with pancreatic cancer are irresectable at the time the diagnosis is made. Therefore, they are in
need of palliative treatment that can guarantee minimal morbidity, mortality, and hospital stay. To address this need, we
designed a study to test the feasibility of laparoscopic gastroenterostomy and hepaticojejunostomy and to compare their results
with those achieved with open techniques.
Methods: We performed a case control study of a new concept in laparoscopic palliation based on the findings of preoperative imaging
and diagnostic laparoscopy. Laparoscopic side-to-side gastroenterostomy and end-to-side hepaticojejunostomy (Roux-en-Y) were
done in irresectable cases. Of 14 patients who underwent laparoscopic palliation, three had a laparoscopic double bypass,
seven had a gastroenterostomy, and four underwent staging laparoscopy only. The results were compared with a population of
14 matched patients who had conventional palliative procedures.
Results: Postoperative morbidity was 7% vs 43% for laparoscopic and open palliation, respectively (p < 0.05). There were no mortalities in the laparoscopic group, as compared to 29% in the group who had open bypass surgery
(p < 0.05). Postoperative hospital stay averaged 9 days in the laparoscopic group and 21 days in the open group (p < 0.06). Operating time tended to be shorter in the laparoscopic group (p < 0.25). Morphine derivatives were necessary for a significantly shorter period after laparoscopic surgery (p < 0.03).
Conclusions: Our preliminary experience strongly suggests that laparoscopic palliation can reduce the three major drawbacks of open bypass
surgery—i.e., high morbidity, high mortality, and long hospital stay.
Received: 24 February 1999/Accepted: 13 May 1999 相似文献
4.
Efficacy of routine laparoscopy for the acute abdomen 总被引:16,自引:4,他引:12
Background: Laparoscopic surgery of selected acute abdominal conditions has been shown to be highly effective. Therefore, we investigated
the diagnostic accuracy and therapeutic efficacy of routine laparoscopic surgery for the acute abdomen.
Methods: After appropriate investigations, patients with acute abdomen, with or without a specific diagnosis, were offered the options
of either laparoscopic or open surgery. Postoperatively, we analyzed the outcome measures of diagnostic accuracy, complications,
and operating time of laparoscopy. The hospital stays for our patients were compared to case-matched controls.
Results: The accuracy of laparoscopic diagnosis is the same as laparotomy. The 62% of our patients who were managed totally laparoscopically
required shorter hospitalization than the case-matched controls treated by open operation. Morbidity was not increased by
laparoscopy in patients who required conversion to open operation. The additional cost of laparoscopy appeared modest.
Conclusions: Routine laparoscopy for the acute abdomen is safe and accurate. Patients eligible for laparoscopic treatment also require
less hospitalization time.
Received: 3 April 1997/Accepted: 9 June 1997 相似文献
5.
Postoperative complications of laparoscopic-assisted colectomy 总被引:4,自引:2,他引:2
A. M. Lacy J. C. García-Valdecasas S. Delgado L. Grande J. Fuster J. Tabet C. Ramos J. M. Piqué A. Cifuentes J. Visa 《Surgical endoscopy》1997,11(2):119-122
Background: This study was performed to prospectively assess the complications of 118 consecutive patients who underwent laparoscopic
assisted colorectal resections.
Methods: The variables included were: indication for surgery, type of resection, duration of operation, duration of postoperative
ileus, length of hospital stay, port-site recurrence, and complications in relation to the laparoscopic technique.
Results: 118 Laparoscopic-assisted procedures were performed between July 1992 and October 1995. Surgical indications were: 106 patients
for colonic malignancy, six for diverticulitis, two for Crohn's disease, two for benign polyps, one for endometriosis, and
one for ischemic colitis. Fifteen patients required conversion to open techniques for completion of the operations (12.7%).
The mean operating time was 168.8 min. The amount of operative blood loss was 98 ml. The mean time for passing flatus was
36 ± 16 h. Mean postoperative stay was 5.4 (range 3–13) days. Eight patients (6.8%) sustained complications: four unrelated
to laparoscopy (three wound infection, one anastomotic leak); and four complications related to the laparoscopic approach:
one small-bowel obstruction, one trocar injury, one rotation of the anastomosis, and one misdiagnosed synchronous adenocarcinoma.
Conclusions: We suggest that with the development of improved technical devices and more experience, the indications for laparoscopic
colectomy should continue to expand. The low incidence of infectious complications suggests an important role for the laparoscopic
approach to colorectal surgery.
Received: 25 March 1996/Accepted: 8 July 1996 相似文献
6.
R. Cadrobbi G. Zaninotto P. Rigotti N. Baldan G. Sarzo E. Ancona 《Surgical endoscopy》1999,13(10):985-990
Background: Laparoscopic treatment of pelvic lymphocele secondary to kidney transplant has gained popularity in the last few years, although
lesions of the urinary tract (ureter, renal pelvis, and bladder) have been reported frequently. To evaluate the result of
this treatment and the associated risk of urinary tract lesions, we reviewed our experience and reports in the medical literature
on open and laparoscopic surgery.
Methods: From 1991 to 1999, we laparoscopically treated 12 patients (7 men and 5 women; median age, 43 years; range, 17–59 years)
with symptomatic pelvic lymphocele causing a deterioration of renal function because of compression on the ureter in 10 of
the 12 patients and lymphocele compression of the iliac vein in the other 2 patients. In nine patients, the lymphocele wall
was opened and sutured to the peritoneum to keep the window open. In two patients, an omentoplasty was performed, and in the
remaining patient, both techniques were used. All patients were followed up clinically with ultrasound and biochemistry for
a median period of 33 months (range, 1–96 months). Using Medline, we reviewed the medical literature from 1980 to 1998 and
collected 252 cases in which operations had been performed to drain an internal lymphocele secondary to kidney transplantation.
Results: Laparoscopic treatment was successful in 11 of the 12 patients. One patient was converted to open surgery because of a lesion
in the transplanted ureter. One patient needed repeat laparoscopy 24 hours after the operation because of bleeding from the
peritoneal window. The median duration of the operation was 120 min (range, 70–200 min), and the median postoperative hospital
stay was 5 days (range, 2–12 days). None of the patients needed to discontinue oral cyclosporine assumption. The serum creatinine
level dropped significantly after surgery (p < 0.05). No symptomatic recurrences were observed. Of the 252 patients found in the medical literature, in 129 the procedure
was performed with open surgery and in 123 laparoscopically (our 12 patients included). The prevalence of iatrogenic lesions
to the urinary tract increased threefold with the use of laparoscopic surgery (from 1.6% in open surgery to 7% in laparoscopy).
The recurrence rate of symptomatic lymphocele, however, decreased from 15% to 4%.
Conclusions: Laparoscopic drainage of posttransplantation lymphocele is a relatively simple method for treating this complication, although
it bears the burden of an increased incidence of urinary tract lesions, as confirmed by a review of the literature. The major
advantage of the laparoscopic approach is the absence of postoperative ileus with the opportunity to continue the enteral
immunosuppressive regimen and a lower recurrence rate. These data suggest that laparoscopic lymphocele treatment might be
considered the therapy of choice, provided the iatrogenic lesions of the urinary tract diminish as more experience with this
technique is gained.
Received: 1 March 1999/Accepted: 1 July 1999 相似文献
7.
Laparoscopic anatomy of the region of the esophageal hiatus 总被引:1,自引:0,他引:1
8.
A. S. Lowham C. J. Filipi R. A. Hinder L. L. Swanstrom K. Stalter A. dePaula J. G. Hunter T. G. Buglewicz K. Haake 《Surgical endoscopy》1996,10(10):979-982
Background: This study retrospectively assesses the mechanisms of 13 esophageal or gastric injuries resulting from dilator or nasogastric
tube placement during laparoscopic foregut surgery and is intended to assist in determining methods of prevention.
Methods: Information regarding esophageal or gastric injury during laparoscopic foregut surgery was obtained from six experienced
laparoscopic surgeons. The specific mechanisms of injury were determined by discussion with the operating surgeon and review
of the operative reports.
Results: Eleven cases of esophageal or gastric perforation occurred during bougie insertion and two perforations occurred secondary
to nasogastric tube placement during Nissen fundoplication or Heller myotomy. Five perforations required conversion to open
operation for repair including two delayed thoracotomies. The 13 injuries occurred during the performance of 1,620 laparoscopic
foregut operations for an overall incidence of 0.8%.
Conclusion: Foregut injury resulting from esophagogastric intubation during laparoscopic surgery is more common than expected. Risk factors
include esophageal anatomy, intrinsic pathologic changes of the esophagus, and inexperience. Prevention must focus on close
communication between the surgeon and anethesiologist and safe techniques of dilator insertion. 相似文献
9.
C. Balagué E. M. Targarona M. Pujol X. Filella J. J. Espert M. Trias 《Surgical endoscopy》1999,13(8):792-796
Background: Laparoscopic surgery has a lower incidence of surgical infection than open surgery. Differential factors that may modify
the bacterial biology and explain this finding to some extent include CO2 atmosphere, less desiccation of intraabdominal structures, fewer temperature changes, and a better preserved peritoneal and
systemic immune response. Previous data suggest that the immune response and acute phase response are better preserved after
laparoscopy. Therefore, we designed a study to evaluate the early peritoneal response to sepsis in an experimental peritonitis
model comparing open surgery with CO2 and abdominal wall lift laparoscopy.
Methods: The study subjects comprised 360 mice distributed into the following four groups: group 1, n= 72 (controls); group 2, n= 96 (open surgery), 2–3 cm laparotomy, with abdominal cavity exposed to the air for 30 min; group 3, n= 96, CO2 laparoscopy (5 mmHg pneumoperitoneum) for 30 min; group 4, n= 96, wall lift laparoscopy for 30 min. Intraabdominal contamination in the four groups was induced with 1 ml of E. coli suspension (1 × 104 CFU/ml) 10 min before abdomen closure. Peritoneal fluid and blood samples were obtained 1.5, 3, 24, and 72 h after surgery,
and TNF, IL-1, and IL-6 were measured (via ELISA), as well as quantitative culture.
Results: The number of CFU (colony-forming units) obtained in peritoneal fluid and positive blood culture rates were significantly
lower in the laparoscopic groups than in the open group. IL-1 peritoneal levels were significantly lower after 24 h and 72
h in the laparoscopy groups. IL-6 levels decreased sharply in the laparoscopy groups at 24 h and 72 h. There were no differences
between the two types of laparoscopy models (CO2 and wall lift).
Conclusions: Peritoneal response to sepsis is better preserved after laparoscopy than after open surgery. CO2 does not seem to influence bacterial growth. According to these findings, laparoscopy entails less local trauma and better
preserved intraabdominal conditions.
Received: 29 June 1998/Accepted: 25 August 1998 相似文献
10.
Background: This prospective study was conducted to evaluate the accuracy and the therapeutic relevance of staging laparoscopy.
Methods: Between June 1993 and February 1997 staging laparoscopy was performed in 389 patients with various neoplasms. Additionally,
144 selected patients of this group were examined with laparoscopic ultrasound using a semiflexible ultrasound probe (7.5
MHz).
Results: Compared to conventional imaging methods, laparoscopy and laparoscopic ultrasound improved the accuracy of staging in 158
of 389 patients (41%). Statistical subgroup analysis of 131 patients with gastric cancer showed that the accuracy of staging
laparoscopy in the detection of distant metastases (68%) was significantly higher (p < 0.01) than that of ultrasound (63%) or computed tomography (58%). In the whole group, laparoscopy alone disclosed intraabdominal
tumor dissemination or nonresectable disease in 111 patients. Laparoscopic ultrasound displayed additional metastases—i.e.,
liver metastases (n = 9), M1 lymph nodes (n = 15), or nonresectable tumors (n = 6) in 30 patients. Although metastastic disease
was suggested by preoperative imaging, benign lesions were found in five patients with laparoscopy and in a further 12 patients
with ultrasonography. The findings of staging laparoscopy changed the treatment strategy in 45% of the patients. Conversion
to open surgery was necessary in 5% of the cases, and complications related to laparoscopy occured in 4% of the patients.
Conclusions: Laparoscopy with laparoscopic ultrasound improves the staging of gastrointestinal tumors and has a significant impact on
a stage-adapted surgical therapy.
Received: 3 April 1997/Accepted: 26 September 1997 相似文献
11.
The use of diagnostic laparoscopy supported by laparoscopic ultrasonography in the assessment of pancreatic cancer 总被引:13,自引:0,他引:13
Background: Pancreatic resection with curative intent is possible in a select minority of patients with carcinomas of the pancreatic
head. Diagnostic laparoscopy supported by laparoscopic ultrasonography combines the proven benefits of staging laparoscopy
with high-resolution intraoperative ultrasound, thus allowing the surgeon to perform a detailed assessment of the pancreatic
cancer.
Methods: In a prospective study of 26 patients with obstructive jaundice from a carcinoma of the head of the pancreas, the curative
resectability of tumors was assessed by ultrasound (26 cases), computerized tomography (26 cases), endoscopic ultrasound (16
cases), and a combination of diagnostic laparoscopy and laparoscopic ultrasound (26 cases).
Results: The findings of ultrasound and computerized tomography were comparable: 50% of patients were excluded from curative resection.
Endoscopic ultrasound provided precise information on the primary tumors. The accuracy of the combined diagnostic laparoscopy
and laparoscopic ultrasound, when compared with ultrasound, computerized tomography, and endoscopic ultrasound, was better
with respect to minute peritoneal or hepatic metastasis: 80.7% (or a further 30.7%) of patients did not qualify for curative
resection.
Conclusions: Diagnostic laparoscopy supported by laparoscopic ultrasonography enables detection of previously unsuspected metastases;
thus, needless laparotomy can be avoided. It should therefore be considered the first step in any potentially curative surgical
procedure.
Received: 12 April 1997/Accepted 30 April 1998 相似文献
12.
Background: Colonic perforations associated with colonoscopy are rare but major complications. Conservative treatment is less invasive
than major surgery, but any case of failure leads to more extensive surgical procedures with a higher morbidity and mortality
than the immediate operative repair. To reduce the invasiveness of major surgery and avoid the risk of failure, we introduced
laparoscopic techniques to deal with iatrogenic colonic perforations.
Methods: Each colonic perforation was identified by diagnostic laparoscopy. The perforation was then characterized by size and extent
of thermal damage into one of three types, followed by type-dependent treatment (suture, tangential resection, segmental resection,
or open procedure). Operative time, complications, clinical outcome, and patient satisfaction were recorded.
Results: Seven patients underwent diagnostic laparoscopy for colonic perforations. Laparoscopic treatment was performed on five patients
(one simple closure by suture, three tangential resections, and one segmental resection). Two cases required open procedures.
There was one intraoperative complication that necessitated conversion. There were no postoperative complications. All laparoscopically
treated patients were satisfied with their clinical outcome and cosmetic results.
Conclusions: Laparoscopic treatment seems to reduce the invasiveness and morbidity of major surgery. At the same time, it is more definitive
than conservative treatment, so that we now prefer to use laparoscopic techniques to treat colonic perforations related to
colonoscopy.
Received: 25 February 1998/Accepted: 22 June 1998 相似文献
13.
An ergonomic evaluation of surgeons' axial skeletal and upper extremity movements during laparoscopic and open surgery 总被引:7,自引:0,他引:7
Nguyen NT Ho HS Smith WD Philipps C Lewis C De Vera RM Berguer R 《American journal of surgery》2001,182(6):720-724
BACKGROUND: Many surgeons have complained of fatigue and musculoskeletal pain after laparoscopic surgery. We evaluated differences in surgeons' axial skeletal and upper extremity movements during laparoscopic and open operations. METHODS: Five surgeons were videotaped performing 16 operations (8 laparoscopic and 8 open) to record their neck, trunk, shoulder, elbow, and wrist movements during the first hour of surgery. We also compared postprocedural complaints of pain, stiffness, or numbness between the two groups. RESULTS: Compared with surgeons performing open surgery, surgeons performing laparoscopic surgery exhibited less lateral neck flexion; less trunk flexion; more internal rotation of the shoulders; more elbow flexion; more wrist supination and wrist ulnar and radial deviation. There was a trend of more shoulder stiffness after laparoscopic operations than after open operations. CONCLUSIONS: Laparoscopic surgery involves a more static posture of the neck and trunk, but more frequent awkward movements of the upper extremities than open surgery. Ergonomic changes in the operating room environment and instrument design could ease the physical stress imposed on surgeons during laparoscopic operations. 相似文献
14.
Is laparoscopic sonography a reliable and sensitive procedure for staging colorectal cancer? 总被引:2,自引:2,他引:0
O. Goletti G. Celona C. Galatioto B. Viaggi P. V. Lippolis L. Pieri E. Cavina 《Surgical endoscopy》1998,12(10):1236-1241
Background: Laparoscopic colectomy has developed rapidly with the explosion of technology. In most cases, laparoscopic resection is performed
for colorectal cancer. Intraoperative staging during laparoscopic procedure is limited. Laparoscopic ultrasonography (LUS)
represents the only real alternative to manual palpation during laparoscopic surgery.
Methods: We evaluated the diagnostic accuracy of LUS in comparison with preoperative staging and laparoscopy in 33 patients with colorectal
cancer. Preoperative staging included abdominal US, CT, and endoscopic US (for rectal cancer). Laparoscopy and LUS were performed
in all cases. Pre- and intraoperative staging were related to definitive histology. Staging was done according to the TNM
classification.
Results: LUS obtained good results in the evaluation of hepatic metastases, with a sensitivity of 100% versus 62.5% and 75% by preoperative
diagnostic means and laparoscopy, respectively. Nodal metastases were diagnosed with a sensitivity of 94% versus 18% with
preoperative staging and 6% with laparoscopy, but the method had a low specificity (53%). The therapeutic program was changed
thanks to laparoscopy and LUS in 11 cases (33%). In four cases (12%), the planned therapeutic approach was changed after LUS
alone.
Conclusions: The results obtained in this study demonstrate that LUS is an accurate and highly sensitive procedure in staging colorectal
cancer, providing a useful and reliable diagnostic tool complementary to laparoscopy.
Received: 2 May 1997/Accepted: 11 February 1998 相似文献
15.
Role of laparoscopic ultrasonography in intraoperative localization of pancreatic insulinoma 总被引:11,自引:3,他引:8
Background: A combination of digital palpation and ultrasonography plays an important role in locating insulinomas intraoperatively.
Laparoscopic resection of insulinomas has been described recently, but experience in locating insulinomas during laparoscopy
is lacking.
Methods: From January 1998 to January 1999, three patients with pancreatic insulinomas underwent laparoscopy and laparoscopic ultrasonography
aimed at intraoperative localization and potential resection. The role of laparoscopy and laparoscopic ultrasonography in
locating insulinomas is evaluated.
Results: Preoperative localization studies were routinely performed, and two patients had an occult tumor before laparoscopy. None
of the tumors was detected by laparoscopic examination, but laparoscopic ultrasonography identified solitary tumors located
at the body and tail of the pancreas. Conversion to laparotomy was performed in one patient as a planned procedure. One patient
underwent laparoscopic enucleation, whereas the other had a laparoscopic distal pancreatectomy.
Conclusions: Laparoscopic ultrasonography seems to be sensitive in locating insulinomas at the body and tail of the pancreas. It optimizes
and facilitates resection of insulinomas through a minimally invasive approach.
Received: 8 March 1999/Accepted: 10 August 1999/Online publication: 7 September 2000 相似文献
16.
Background: This report describes a visual field tracking camera for laparoscopic surgery that allows the visual field to be changed
without moving the laparoscope. We also report on our early experience with this camera for single-surgeon laparoscopic cholecystectomy.
Methods: The visual field tracking camera has a tracking mechanism (composed of a zoom lens and a charge-coupled device [CCD] slide
mechanism) built into the camera head. The 80° visual field observed with the laparoscope can be expanded using the zoom lens,
and the field can be shifted by changing the size of the area being viewed by the CCD. This is accomplished by pushing a switch
on the forceps or by verbal command. Cholecystectomy was carried out on 12 patients with gallstones using this camera. The
operations were performed by either a single surgeon or two surgeons. Forceps held with a forceps holder were inserted through
the right port to lift the fundus of the gallbladder. The single surgeon used the other two ports to resect the gallbladder
by the two-handed technique.
Results: In all cases, cholecystectomy was completed without any need to move the laparoscope at any point during the operation. Seven
operations were performed by a single surgeon. Mainly for education purposes, five other operations were performed by a pair
of surgeons. The mean time required for surgery was 76 ± 17 min. This time did not differ from that of laparoscopic cholecystectomy
performed during the same period on 22 patients by teams of three surgeons using conventional cameras.
Conclusions: Using the visual field tracking camera, laparoscopic cholecystectomy can be performed without any need to touch the laparoscope.
This camera allowed laparoscopic cholecystectomy to be performed by a single surgeon.
Received: 30 April 1999/Accepted: 10 January 2000/Online publication: 4 August 2000 相似文献
17.
F. Köckerling J. Rose C. Schneider H. Scheidbach H. Scheuerlein M. A. Reymond Th. Reck J. Konradt H. P. Bruch C. Zornig E. Bärlehner A. Kuthe G. Szinicz H. A. Richter W. Hohenberger 《Surgical endoscopy》1999,13(7):639-644
Background: We report on a prospective observational multicenter study of more than 1,000 consecutive patients undergoing laparoscopic
colorectal procedures. The aim of the current study was to investigate the safety of laparoscopic colorectal surgery as reflected
by the anastomotic insufficiency rates in the various sections of the bowel, and to compare these rates with those of open
colorectal surgery.
Methods: The study was begun on August 1, 1995. Twenty-four centers in Germany, Austria, and Switzerland participated in this prospective
multicenter study. All patients undergoing laparoscopic colorectal surgery were included in the study. No selection criteria
were applied, which means that every operation begun as a laparoscopic procedure was included. Data on patient demographics,
surgical indications, surgical course, and patient outcome were recorded prospectively in a computer database. All data were
rendered anonymous.
Results: Between August 1995 and February 1998, the 24 participating centers treated 1,143 patients (male/female ratio, 1:1.36; mean
age, 60.7 years). In all, 626 operations were performed for benign indications and 517 for cancer. Most procedures involved
the sigmoid colon and rectum (80.9%). An anastomosis was performed in 83% of the operations. Most of the anastomoses were
laparoscopically assisted using the stapling technique. We observed an overall leakage rate of 4.25% (colon 2.9%; rectum 12.7%),
and surgical reintervention was required in 1% of the cases. The rate of conversion to open surgery was 5.6%. Intraoperative
complications occurred in 5.9%, and reoperation was necessary in 4.1% of the cases. The overall morbidity rate was 22.3%,
and the 30-day mortality rate was 1.57%.
Conclusions: The feasibility and safety of the laparoscopic colorectal approach is demonstrated clearly. The current study shows that
the laparoscopic or laparoscopically assisted approach to colorectal surgery is not associated with a higher risk of anastomotic
leaks. Morbidity and mortality rates with this method approximate those seen with conventional colorectal surgery.
Received: 24 August 1998/Accepted: 25 November 1998 相似文献
18.
Measurement of urinary N-acetyl-β-D-glucosaminidase to assess renal ischemia during laparoscopic operations 总被引:1,自引:0,他引:1
Micali S Silver RI Kaufman HS Douglas VD Marley GM Partin AW Moore RG Kavoussi LR Docimo SG 《Surgical endoscopy》1999,13(5):503-506
Background: Oliguria during laparoscopy is a well-documented phenomenon of unknown etiology. Experimental evidence suggests that renal
perfusion is reduced during pneumoperitoneum. N-acetyl-β-D-glucosaminidase (NAG), which is present in renal tubular cells,
is released into the urine in response to tubular insults. In this study, urinary NAG was measured before and after procedures
to assess for ischemic renal injury.
Methods: A total of 31 patients underwent laparoscopic procedures while 28 patients had conventional surgery. Urine was obtained first
at the time of preoperative Foley catheter placement and later during the recovery room stay. NAG levels were measured and
indexed to urinary creatinine.
Results: Operative time for the laparoscopy group was 105 min (range, 15–255); for the conventional group, it was 179 min (range,
75–385) (P < 0.05). No differences were noted between pre- and postoperative NAG levels or between the groups. There was no correlation
between urinary NAG levels and operative time.
Conclusion: Pneumoperitoneum is not associated with a change in the urinary concentration of NAG. This finding suggests that there is
no significant renal tubular injury associated with laparoscopic surgery.
Accepted: 8 April 1997 相似文献
19.
Background: The aim of this study was to evaluate the development and outcome of laparoscopic gallstone surgery in Germany in a nationwide
representative survey.
Methods: A written questionnaire, which included 111 structured items about diagnostic and therapeutic approaches, number of procedures,
complications, and mortality, was sent to 449 randomly selected German surgeons (20% of the registered German general surgeons)
annually from 1991 to 1994.
Results: A total number of 72,455 operations for gallstone disease was reported. The frequency of laparoscopic cholecystectomies increased
from 24.9% in 1991 to 65.3% in 1993. In 1994, 92% of the polled surgeons were using the laparoscopic approach as compared
with 10% in 1991. The results demonstrated significantly lower morbidity (6% vs. 9%) and mortality figures (0.14–0.45%) than
for the open procedure. The percentage of common bile duct (CBD) injuries was significantly higher for the laparoscopic group
than for the open treatment group (0.7% vs. 0.4%). In 1993 the data shows a significant decrease in surgical complications
such as bleeding, CBD injuries, and relaparotomy rate for the laparoscopic procedures. No changes were seen in the mortality
rate.
Conclusions: These results show learning curves that project a positive trend in the overall risk incurred by laparoscopic cholecystectomy
in Germany during the past few years. This can be seen as an effect of better training and experience. Obviously, CBD injuries
and technical problems especially have passed their peak of incidence.
Received: 24 October 1997/Accepted: 28 August 1998 相似文献
20.
van den Broek WT Bijnen AB van Eerten PV de Ruiter P Gouma DJ 《Surgical endoscopy》2000,14(10):938-941
Background: Diagnostic laparoscopy has been introduced as a new diagnostic tool for patients with acute appendicitis. We performed diagnostic
laparoscopy when the clinical diagnosis of appendicitis was in doubt. The aims of this study were to evaluate this strategy
and to analyze the efficacy of diagnostic laparoscopy in patients with suspected appendicitis.
Patients and Methods: All patients referred to our hospital with suspected appendicitis during the period 1994–1997 were evaluated prospectively.
The clinical diagnosis was determined by the surgeon or resident on call based on the patient's history, physical examination,
and leukocyte count. The patients were divided into three groups: group 1: appendicitis not likely. These patients were observed
for 24 h or discharged. When they showed signs of appendicitis in 24 h, they were transferred to either group 2 or 3; group
2: doubt concerning diagnosis. These patients underwent diagnostic laparoscopy, and appendectomy was performed if indicated;
group 3: In these patients the diagnosis appendicitis was felt to be certain. They were treated by primary appendectomy by
an open procedure. In this study, 1,050 patients, 531 women (51%), 389 men (37%), and 130 children (12%) <11 yrs, were evaluated.
Results: Altogether, 377 diagnostic laparoscopies were performed, leaving 109 healthy-looking appendices in place. This reduced the
negative appendectomy rate from 25% to 14% in all surgically managed patients. The negative appendectomy rate for the women
in group 2 was reduced from 49% to 14%, and for the men from 22% to 11%, so it also seemed worthwhile to perform diagnostic
laparoscopy in men. Because the appendix sana was left in place in only three children, the benefit from laparoscopy is relatively
small for children. In 48% of these patients a second diagnosis was obtained, most of them gynecologic in nature. There were
no false-negative laparoscopies and no complications resulting from the laparoscopic procedure.
Conclusions: Diagnostic laparoscopy is a safe procedure that reduced the appendix sana rate without increasing the total number of operations.
It is a useful method for obtaining other, mostly gynecologic, diagnoses. To further reduce the appendix sana rate, better
criteria for laparoscopic assessment of the appendix are needed.
Received: 7 September 1999/Accepted: 21 February 2000/Online publication: 22 August 2000 相似文献