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71.
M. P. Gosselink J. J. Busschbach† C. M. Dijkhuis§ L. P. Stassen¶ W. C. Hop‡ W. R. Schouten 《Colorectal disease》2006,8(1):15-22
BACKGROUND: After total mesorectal excision for rectal cancer, many surgeons try to avoid an abdominoperineal resection (APR) by performing a transanally double stapled low colo-rectal anastomosis (LRA), frequently without a pouch. This policy is mainly based on the assumption that the quality of life after such LRA is higher than after APR. It has been suggested that a better functional outcome and therefore a higher quality of life might be achieved by a colo-anal J-pouch anastomosis (CPA). The aim of this study was to assess quality of life among disease-free survivors after APR, LRA and CPA. METHODS: The charts of 301 consecutive patients who had undergone surgery for cancer in the middle or lower third of the rectum were analysed. Two hundred four patients were eligible for inclusion. The quality of life among these patients was assessed using one generic (EQ-5D) and two disease-specific questionnaires (EORTC QLQ-C30 and EORTC QLQ-CR38). RESULTS: The response rate was 82%. The median follow-up was 31 months. Overall, quality of life was good but CPA patients had better quality of life scores than APR and LRA patients. This difference was not only due to the better functional outcome but also to the lower incidence of disturbed micturition and sexual problems in the CPA group. CONCLUSION: The quality of life after colo-anal J-pouch anastomosis is better than after abdominoperineal resection (APR) and low colo-rectal anastomosis (LRA). The quality of life after APR is similar to that after LRA. 相似文献
72.
73.
A comparison of segmental vs subtotal/total colectomy for colonic Crohn''s disease: a meta-analysis 总被引:3,自引:0,他引:3
P. P. Tekkis S. Purkayastha S. Lanitis T. Athanasiou A. G. Heriot T. R. Orchard† R. J. Nicholls‡ A. W. Darzi 《Colorectal disease》2006,8(2):82-90
OBJECTIVE: Using meta-analytical techniques the present study evaluated differences in short-term and long-term outcomes of adult patients with colonic Crohn's disease who underwent either colectomy with ileorectal anastomosis (IRA) or segmental colectomy (SC). METHODS: Comparative studies published between 1988 and 2002, of subtotal/total colectomy and ileorectal anastomosis vs segmental colectomy, were used. The study end points included were surgical and overall recurrence, time to recurrence, postoperative morbidity and incidence of permanent stoma. Random and fixed-effect meta-analytical models were used to evaluate the study outcomes. Sensitivity analysis, funnel plot and meta-regressive techniques were carried out to explain the heterogeneity and selection bias between the studies. RESULTS: Six studies, consisting of a total of 488 patients (223 IRA and 265 SC) were included. Analysis of the data suggested that there was no significant difference between IRA and SC in recurrence of Crohn's disease. Time to recurrence was longer in the IRA group by 4.4 years (95% CI: 3.1-5.8), P < 0.001. There was no difference between the incidence of postoperative complications (OR = 1.4., 95% CI 0.16-12.74) or the need for a permanent stoma between the two groups (OR = 2.75, 95% CI 0.78-9.71). Patients with two or more colonic segments involved were associated with lower re-operation rate in the IRA group, a difference which did not reach statistical significance (P = 0.177). CONCLUSIONS: Both procedures were equally effective as treatment options for colonic Crohn's disease however, patients in the SC group exhibited recurrence earlier than those in the IRA group. The choice of operation is dependent on the extent of colonic disease, with a trend towards better outcomes with IRA for two or more colonic segments involved. Since no prospective randomised study has been undertaken, a clear view about which approach is more suitable for localised colonic Crohn's disease cannot be obtained. 相似文献
74.
Kuniya Tanaka M.D. Hiroshi Shimada M.D. Shinji Togo M.D. Yasuhiko Nagano M.D. Itaru Endo M.D. Hitoshi Sekido M.D. 《Journal of gastrointestinal surgery》2006,10(7):980-986
Consensus is lacking concerning how to manage afferent vessels during hepatectomy, particularly as to the Pringle maneuver
vs. selective hemihepatic clamping. Data for 81 hepatocellular carcinoma patients with chronic hepatitis or liver cirrhosis
whose liver resection was limited to one section or less, including intraoperative data and postoperative liver function data,
were analyzed retrospectively to compare two strategies. No significant differences of intraoperative data or postoperative
clinical course were seen between the two groups, even in patients with chronic hepatitis or liver cirrhosis whose postoperative
deterioration of liver function could be expected to be more than patients with a normal liver. The difference was evident
only in serum alanine aminotransferase level on postoperative day 10 (mean ± SEM, 64.5±5.1 IU in the Pringle group vs. 51.6±4.4
IU in the selective clamping group; P<0.05). During liver resection limited to one section or less, even with underlying chronic hepatitis or cirrhosis, intermittent
use of the Pringle maneuver preserved liver function to the same extent as selective clamping. 相似文献
75.
C. COLETTE M. C. GOUTTEBEL† L. H. MONNIER B. SAINT-AUBERT† H. JOYEUX† 《European journal of clinical investigation》1986,16(4):271-276
Seventeen patients who had undergone extensive small bowel resection were studied for calcium absorption (FACa) and plasma vitamin D metabolites. FACa was measured by a double radio-tracer technique and expressed as percentage of total oral dose. FACa was decreased compared with controls (34%, range: 3-46 v 65%, range: 57-73, P less than 0.01). A positive correlation (r = 0.49, P = 0.05) was found between FACa and the remaining length of small bowel (SBL). As wide variations in both SBL and duration after surgery were observed among the seventeen investigated patients, we were led to individualize less heterogeneous subgroups of patients. Better correlations were found when the patients were divided into two subgroups according to whether the time interval between the resection and the investigation was shorter (r = 0.75, n = 11, P less than 0.02) or longer (r = 0.89, n = 6, P = 0.05) than 2 years. In thirteen patients who had a SBL shorter than 100 cm, a positive correlation was observed between FACa and the time interval after surgery (months): r = 0.65, P less than 0.05. Plasma 1,25 (OH)2D was markedly reduced in the whole group (31 pmol l-1, range: 8-108) compared with controls (103 pmol-1, range: 59-134, P less than 0.01). The present study shows that in extensively small bowel resected patients, calcium absorption is reduced, the alteration being dependent both on the length of the remnant small bowel and on the time after surgery.(ABSTRACT TRUNCATED AT 250 WORDS) 相似文献
76.
目的:探讨基质金属蛋白酶-2(MMP-2)在椎动脉血管表达的意义及复方川脊片的干预效果。方法:40只兔随机分为正常组,模型组,颈复康组,复方川脊片组。硬化剂注射法造模,4周后,模型组,颈复康组及川脊片组分别以生理盐水、颈复康及川脊片混悬液灌胃。治疗4周后检测椎动脉血管搏动指数,全血黏度及血浆黏度,椎动脉血管MMP-2的表达。结果:与正常组相比模型组搏动指数提高,全血黏度及血浆黏度增加,MMP-2表达增多(P<0.05);与模型组相比,治疗组搏动指数降低,全血黏度及血浆黏度降低,MMP-2表达较少(P<0.05)。结论:部分的抑制MMP-2在椎动脉的表达可能是复方川脊片治疗颈椎病的机制之一。 相似文献
77.
Choroid plexus papillomas (CPPs) are typically considered as benign tumors, with a favorable long-term prognosis. Drop metastasis of CPP into the spinal subarachnoid space is rare. We report a 42-year-old woman who presented with headache and back pain 6 years after removal of a posterior fossa CPP. Magnetic resonance imaging revealed mass lesions in the lumbosacral subarachnoid space and recurrent intracranial tumor. The lesions were resected and histologically diagnosed was CPP. We consider that CPP can spread via cerebrospinal fluid pathways and cause spinal drop metastasis. Therefore, it is necessary to evaluate the whole spinal axis and to perform periodic follow-up examinations in patients with CPP. 相似文献
78.
A Alzahrani M Anvari B Dallemagne D Mutter J Marescaux 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2007,11(1):97-100
OBJECTIVE: We report on 3 patients who underwent laparoscopic antireflux procedures for persistent symptoms of GERD after biopolymer injection. METHODS: Experienced laparoscopic surgeons completed all 3 procedures laparoscopically. In 2 patients, there was an extramural extravasation of the polymer outside and adherent to the esophageal wall. In these patients, a partial posterior fundoplication was used. The third patient, who had the polymer material deposits removed preoperatively by endoscopic mucosal resection, underwent a Nissen fundoplication. RESULTS: Postoperative recovery was uneventful in all cases. At follow-up of 6 to 12 months, all patients were symptom free, off medical therapy, and experiencing no dysphagia. CONCLUSION: Surgical therapy for patients after failed biopolymer injection is safe and effective. The choice of surgery may depend on whether the polymer mass can be removed preoperatively. 相似文献
79.
目的探讨左半结肠癌急性梗阻Ⅰ期切除吻合的Ⅰ临床应用价值。方法对1988年1月至2006年12月24侧实施左半结肠癌急性梗阻Ⅰ期切除吻合手术患者的资料进行回顾性总结。结果24例均未发生吻合口漏,仅3例发生切口感染,经局部换药处理Ⅱ期愈合。结论积极的术前准备、术中彻底的肠减压能为左半结肠癌急性梗阻Ⅰ期切除吻合提供安全保证. 相似文献
80.
目的 探讨腮腺手术中耳大神经后支保留的可行性、方法及临床价值。方法 我们对48例腮腺肿瘤患者,按常规隐蔽切口腮腺手术方法进行治疗,保留或不保留耳大神经后支。分别于术后10d及1、6、12个月进行随访,检测耳廓上部、耳垂、耳下区、耳前区和耳后区的触觉、痛觉,并观察其感觉变化情况。结果 48例中35例耳大神经后支保留,耳廓上部及耳后区感觉无减退。术后早期耳前、耳垂及耳下区感觉有不同程度的减退,以耳前区最明显,随着时间延长症状逐步好转,6个月时感觉接近正常。另13例耳大神经切断患者感觉减退症状更加明显,恢复时间延长。结论 腮腺手术中耳大神经后支保留是可行的,所采用的方法可靠,可减轻局部麻木感,提高患者术后早期生活质量,降低神经切断后产生局部永久性麻木的可能性。 相似文献