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91.
Shinya Kodashima Mitsuhiro Fujishiro Naohisa Yahagi Naomi Kakushima Masanori Nakamura Masao Omata 《Digestive endoscopy》2006,18(2):151-153
Endoscopic resection has been accepted as the standard treatment for intramucosal gastric tumors of differentiated type. However, the indication was limited to small tumors to achieve en bloc resection and prevent local recurrence in cases of conventional endoscopic mucosal resection (EMR) such as the strip biopsy and the cap technique. To avoid multi‐fragmental resection, we have developed endoscopic submucosal dissection (ESD) as a new endoscopic resection technique. ESD is a remarkable technique, because we make it possible to remove the lesions en bloc regardless of size, shape, coexisting ulcer, and location. However, it is difficult or impossible to resect recurrent tumors en bloc in conventional EMR owing to hard fibrosis, and some patients need laparotomy. Using ESD, we can dissect the submucosal layer as we directly look at the submucosa, and remove the lesion safely and reliably even in cases of hard fibrosis. The key to treatment of recurrent tumors in ESD are as follows: (i) using enough submucosal injection solution (we use a mixture of Glyceol and 1% 1900 kDa hyaluronic acid preparation); (ii) incising the mucosa without fibrosis; (iii) understanding characteristics of various cutting devices, and changing other devices in difficult situations. In these ways we can remove the majority of the recurrent tumors en bloc. Hence, we consider that ESD is a very effective treatment which achieves excellent en bloc and complete resection rates and enables patients with intramucosal gastric tumors to a recurrent‐free survival even in recurrent tumors. 相似文献
92.
Optimal surgery remains the mainstay of best outcome for rectal cancer. The demonstration, during the 3rd Annual Pelican Surgical Workshop Symposium, of an abdomino‐perineal excision (APE) performed in the ‘Berlin position’, further added to the debate on optimal surgical technique. Much interest was created at the 1st Pelican symposium with the demonstration, by the Swedish surgeon Dr Torbjorn Holm, of a prone APE and the delivery of a ‘cylindrical’ specimen and the potential to reduce local recurrence using this approach. The high rates of local recurrence following APE and the discussions as to optimal technique have led to the development of a proposed MERCURY Study Group study to assess the benefit of a radical APE, with careful assessment of the impact that this operation may have on morbidity. A German study has also been proposed adopting the UK's multidisciplinary team approach. It aims at targeting preoperative chemoradiotherapy at those patients in whom a radical APE or total mesorectal excision is likely to result in an involved surgical resection margin. In this article we review the evidence for improving the surgical technique for low rectal cancer. We believe improvements may be best achieved through continued European prospective, multi‐centre, multidisciplinary studies. 相似文献
93.
Teruo Iwasaki Katsuhiro Nakagawa Motoaki Yasukawa Hiroyuki Shiono Teruaki Nagano Kunimitsu Kawahara 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2006,54(1):35-39
Ectopic cervical or cervico-mediastinal thymomas are very rare and most of them are asymptomatic, except for the presence
of a cervical mass. We present the case of a 71-year-old man with an ectopic cervico-mediastinal thymoma threatening superior
vena cava syndrome. He had a slight headache and presented with venous dilatation on the chest wall. A computed tomographic
scan and magnetic resonance, imaging of the chest demonstrated a mass extending from the right neck to the hilum, that indented
the trachea and compressed and displaced the brachiocephalic veins anteriorly. Under a right hemicollar incision and median
sternotomy, the mass was resected en bloc together with the thymus. The resected specimen was an encapsulated mass measuring 11×7×4 cm. The pathological diagnosis
was type AB, non-invasive thymoma, confirmed by 3-color flow, cytometry of tumor-derived lymphocytes. Flow cytometry using
biopsy material may contribute to the preoperative diagnosis of ectopic thymoma. 相似文献
94.
95.
J. Zieren H. U. Zieren J. M. Müller 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》1994,379(3):159-167
Zusammenfassung Im Rahmen einer retrospektiven Untersuchung wurden 50 Resektionen wegen primärer Lebermalignome, die vom 1. 6. 1979 bis zum 31. 12. 1991 an der Chirurgischen Universitätsklinik Köln durchgeführt wurden, analysiert. Die Resektionsrate betrug 28 %. Die Kliniksletalität betrug insgesamt 22 % und konnte in den letzten 5 Jahren auf 4% gesenkt werden. Die Ein-, Dreiund Fünfjahresüberlebensraten betrugen unter Einschluß der Kliniksletalität 55%, 30% und 24%. Wichtigster Prognosefaktor war die chirurgische Radikalität. In einer Literaturanalyse wurden die Ergebnisse von 8725 Leberresektionen wegen primärer Lebermalignome, die zwischen 1980 bis 1992 publiziert wurden, untersucht. Die Resektionsrate betrug im Durchschnitt 32 ± 17%. Die Kliniksletalität konnte von 15 ± 5% (Resektionen vor 1970) auf 6 ± 2% (Resektionen nach 1980) gesenkt werden. Die Ein-, Drei- und Fünfjahresüberlebensraten betrugen 66 ± 17%, 39 ± 15% und 27 ± 10%. Bis auf eine geringere Kliniksletalität asiatischer Studien (4 % vs. 7%) waren die Resektionsraten und Langzeitergebnisse von asiatischen, amerikanischen und europäischen Studien durchaus vergleichbar. Die Langzeitprognose wird in erster Linie durch die erreichte chirurgische Radikalität sowie die Größe und Ausdehnung des Tumors zum Zeitpunkt der Resektion beeinflußt. Die Effektivität adjuvanter Therapien ist noch nicht ausreichend untersucht.
Liver resection for primary liver tumors. Our own results and an analysis of the literature
In a retrospective study we analysed 50 resections for primary liver tumors performed between 1 July 1979 and 31 December 1991 at the Department of Surgery of the University of Cologne. The mean resectability rate was 28 %. Hospital mortality after resection was 22% and could be reduced to 4% during the last 4 years. The overall survival rates after 1, 3 and 5 years were 55%, 30% and 24% respectively. The surgical radicality is the most important prognostic factor. In a review of the literature the results of 8,725 resections for primary liver malignancies published between 1980 and 1992 were analyzed. The mean resectability rate was 32 ± 17%. The hospital mortality after resection could be reduced from 15 ± 5% (resections before 1970) to 6 ± 2 % (resections after 1980). The overall survival rates after 1, 3 and 5 years were 66 ± 17%, 39 ± 15% and 27 ± 10%, respectively. Apart from a lower hospital mortality in Asian studies (4 % vs. 7 %) the resection rates and long-term results of Asian, American and European studies were similar. Long-term prognosis predominantly depended on the surgical radicality and on the size and extension of the tumor at the point of resection. The effectivity of an adjuvant tumor therapy is not analyzed sufficiently.相似文献
96.
Franz Thomas Ballmer Peter Matthias Ballmer Bernhard Aebi Reinhold Ganz M.D. 《Orthopedics and Traumatology》1994,3(1-2):78-87
Surgical Principles
The lateral approach is routinely combined with an osteotomy of the greater trochanter. We resect the newly formed callus
located at the anterior, posterior and caudal aspect of the femoral neck distal to the epiphysis. No shortening of the femoral
neck results from this procedure. One can safely avoid a vascular injury by performing a careful dissection, since the posteriorly
reflected articular capsule containing the nutrient vessels to the head is detached from the femoral neck like a banana peel.
The resection manoeuvre is performed next to the physeal plate of the slipped epiphysis. After callus resection, reduction
of the femoral head by longitudinal traction and internal rotation of the limb is easy. The aim is complete correction of
the slippage. When there is excess physeal cartilage, we resect it with a curette and then the head is fixed using 2 screws.
Revised Version from: Operat. Orthop. Traumatol. 4 (1992), 77–85 (German Edition). 相似文献
97.
OBJECTIVE: Circumferential resection margin (CRM) involvement has been correlated with a high risk of developing local recurrence. The aim of this study was to examine the prognostic significance of the CRM involvement after curative resection of rectal cancer in patients treated with preoperative radiotherapy and postoperative chemotherapy where indicated. METHOD: All patients with rectal cancer treated in a regional central unit from 1996 to 2004 were identified. A surgical resection was performed on 257 patients, and in 229 of these this was assessed as potentially curative. The CRM was examined in all patients. A CRM of < or = 1 mm was considered positive. RESULTS: A positive margin was seen in 19 (8%) patients. At a median follow up of 40 months, only four (1.7%) patients had developed local recurrence, one of whom had a positive CRM. In the four patients the tumour was 5 cm or less from the anal verge. There were no significant differences regarding local recurrence and survival between CRM positive and negative tumours. CONCLUSION: Rectal cancer managed by combined radiochemotherapy and surgery resulted in a low positive CRM rate and a low local recurrence rate. An involved CRM was not a predictor of local recurrence. 相似文献
98.
Ingmar Königsrainer Wolfgang Steurer Maria Witte Alfred Königsrainer 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(4):485-488
Background Nowadays, liver resection is a routine operative procedure in surgical centers, and strategies must be aimed at avoiding additional
risk factors. Extrahepatic isolation of portal vein, hepatic artery and hepatic duct, as well as lymphadenectomy of the liver
hilum are generally accepted steps of liver resection, even for metastatic and benign indications. Our primary aim was to
analyze the feasibility, blood loss, blood transfusion requirements, incidence of complications, and outcome using the approach
for intrahepatic devascularization leaving the extrahepatic hilus untouched.
Materials and methods Thirty-eight consecutive patients with resection for metastases and benign liver tumors were selected. After hilar examination,
the extrahepatic structures remain intact, and during parenchyma dissection, the whole right or left or the appropriate bi-segmental
pedicle is isolated intrahepatically and then transected using a stapler device.
Results The used technique was feasible in all cases, and no intra- or postoperative surgical complications were observed. To date,
no tumor recurrence was found in the hilum during the follow-up period.
Conclusion The intrahepatic pedicle stapling technique appears to be feasible and safe in liver resection. Hilar dissection can, thus,
be avoided in liver metastasis and benign liver tumors. 相似文献
99.
腹腔镜腹会阴联合切除术治疗低位直肠癌疗效评价 总被引:1,自引:0,他引:1
目的前瞻性评估腹腔镜直肠癌腹会阴联合切除术的临床优劣性。方法将2003年7月至2006年4月收治的低位直肠癌患者随机分为两组,37例行腹腔镜腹会阴联合切除术(腹腔镜组),另37例常规开腹行腹会阴联合切除术(开腹组);比较两组的手术时间、清除淋巴结数目和腹部出血量、术后排气时间、起床活动时间、住院时间、并发症发生率和复发转移率及卫生经济学情况。结果腹腔镜全组患者均顺利完成手术,无中转开腹者;手术时间两组比较差异无统计学意义(P〉0.05),但前10例手术时间比开腹组长(P〈0.01);腹部出血量少于开腹组(P〈0.01).但前10例较开腹组多(P〈0.01);术后肛门排气时间两组差异无统计学意义(P〉0.05);起床活动时间腹腔镜组早于开腹组(P〈0.01);住院时间长短两组无差异,但腹腔镜会阴闭合较开腹组早:腹腔镜组腹部创口相关并发症明显少于开腹组(P〈O.05);两组的清除淋巴结枚数、局部复发及远处早期复发率差异无统计学意义(P〉0.05);手术费用腹腔镜组明显高于开腹组,但医疗总费用两组差异无统计学意义(P〉0.05)。结论腹腔镜直肠癌腹会阴联合切除术不仅创口小、术中出血少、与腹部创口相关并发症少、术后恢复快,且其手术时间、医疗总费用和肿瘤根治性与开腹手术无差异。 相似文献
100.
Jürgen Treckmann Andreas Paul Georgios C. Sotiropoulos Hauke Lang Arzu Özcelik Fuat Saner Christoph E. Broelsch 《Journal of gastrointestinal surgery》2008,12(2):313-318
Introduction Delayed massive hemorrhage induced by pancreatic fistula after pancreaticoduodenectomy is a rare but life-threatening complication.
The purpose of this study was to analyze the clinical course of patients with late hemorrhage, with or without sentinel bleeding,
to better define treatment options in the future.
Material and Methods From April 1998 to December 2006, 189 pancreaticoduodenectomies were performed. Eleven patients, including two patients referred
from other hospitals, were treated with delayed massive hemorrhage occurring 5 days or more after pancreaticoduodenectomy.
Sentinel bleeding was defined as minor blood loss via surgical drains or the gastrointestinal tract with an asymptomatic interval
until development of hemorrhagic shock. The clinical data of patients with bleeding episodes were analyzed retrospectively.
Results Eight of the 11 patients had sentinel bleeding, and seven of them had it at least 6 h before acute deterioration. Seven out
of 11 patients died, five out of eight with sentinel bleeding. No differences could be detected between patients with or without
sentinel bleeding before delayed massive hemorrhage. The only difference found was that non-surviving patients were significantly
older than surviving patients. Delayed massive hemorrhage is a common cause of death after pancreaticoduodenostomy complicated
by pancreatic fistula formation. The observation of sentinel bleeding should lead to emergency angiography and dependent from
the result to emergency relaparotomy to increase the likelihood of survival. 相似文献