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1.
Laparoscopic resection of large leiomyomas of the gastric fundus 总被引:6,自引:0,他引:6
A. Tangoku K. Yamamoto K. Hirazawa T. Takao N. Mori K. Tada M. Oka 《Surgical endoscopy》1999,13(10):1050-1052
Two patients with a large leiomyoma arising from the gastric fundus underwent laparoscopic resection. In case 1, the tumor
was located in the anterior wall of the gastric fundus. To prevent stenosis and preserve the volume of the residual stomach,
intragastric resection was adopted. The tumor was markedly and resected with laparosonic coagulating shears with a 1-cm safety
margin. In case 2, a large tumor was detected in the duodenal bulb. Serious hemorrhage mandated emergency resection. The tumor
originated from the posterior wall of the fundus. Attempts at reduction with the forceps failed. Reduction by digital manipulation
via laparoscopic port sites was successful. An endostapler was used to resect the tumor and close the anterior wall. Both
patients recovered uneventfully.
Received: 15 November 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.
An improved technique for laparoscopic highly selective vagotomy using harmonic shears 总被引:1,自引:0,他引:1
N. Katkhouda D. J. Waldrep G. M. R. Campos E. Tang S. Offerman A. P. Trussler J. Gugenheim J. Mouiel 《Surgical endoscopy》1998,12(8):1051-1054
Background: Results from classic highly selective vagotomy (HSV) are technique dependent because an incomplete operation will result
in early recurrence of duodenal ulcer. Few reports describe laparoscopic completion of the procedure. All techniques use clips
for division of neurovascular branches, making the laparoscopic approach tedious and thus the results, uncertain.
Methods: Ten patients with intractable duodenal ulcer and negative Helicobacter pylori status underwent an extended HSV. All procedures were performed laparoscopically using a new surgical tool, the harmonic
shears.
Results: All procedures were completed laparoscopically and took approximately 1 h. There were no deaths and no postoperative complications.
Patients were discharged the next day. Follow-up endoscopy at 2 months showed healing of duodenal ulcer in all cases, and
postoperative acid secretion studies demonstrated a decrease in basal acid output (BAO) by 74% (8.2 meq/h to 2.16 meq/h) and
maximal acid output (MAO) by pentagastrin stimulation by 79.2% (40 to 8.32).
Conclusions: Harmonic shears expedite laparoscopic HSV. The operation can be taught safely, yields good results in early follow-up, and
represents an acceptable option in patients with intractable duodenal ulcers who are H. pylori negative.
Received: 9 July 1997/Accepted: 11 November 1997 相似文献
4.
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
5.
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
6.
Background: Percutaneous balloon-tipped laparoscopic cannulas designed for preperitoneal hernia repair can be readily used to treat gastric
bleeding laparoscopically.
Methods: Between 1995 and 1997, we successfully used balloon-tipped cannulas to visualize, biopsy, and suture acutely bleeding gastric
lesions in five patients. These case histories are reviewed for this study.
Results: Patients received an average of six units of blood preoperatively (range, 0–15). Operative time averaged 207 min (range,
149–270). At surgery, gastrotomies were made for cannula placement under laparoscopic visualization. Operative findings included:
lesser curve gastric ulcer, Mallory-Weiss tear, prepyloric ulcer, duodenal ulcer, and angiosarcoma. Three patients had successful
percutaneous suture of bleeding gastric lesions. One patient was converted to open surgery. One patient had local resection
of an angiosarcoma.
Conclusion: The laparoscopic use of balloon-tipped cannulas allows the expeditious diagnosis and treatment of acute gastric hemorrhage.
Received: 31 March 1998/Accepted: 26 February 1999 相似文献
7.
S. H. Kim J. W. Milsom J. M. Church K. A. Ludwig A. Garcia-Ruiz J. Okuda V. W. Fazio 《Surgical endoscopy》1997,11(10):1013-1016
Background: Because of the inability to palpate colonic tumors during laparoscopy, their location must be precisely identified before
resection is undertaken.
Method: A retrospective study was performed of 58 patients in order to be able to describe our methods of tumor localization for
laparoscopic colorectal operations and to review their effectiveness.
Results: In all patients, the entire colon was examined preoperatively by colonoscopy. In one patient, preoperative colonoscopic localization
was inaccurate. In 31 patients, tumors were easily detectable at surgery. In five patients with the tumor in the right colon,
even though the lesion was not detectable at surgery, right colectomy was performed without marking because preoperative colonoscopy
reliably identified the lesion adjacent to the ileocecal valve. Twenty-two patients required some type of procedure to localize
the tumor. The procedures and their problems were as follows: preoperative tattoo (five)—tattoo not visualized (one); intraoperative
colonoscopy alone (six), combined with intraoperative tattoo (four) or clip (three)—poor operative exposure due to bowel distension
(nine), hard to see the clip (three), dislodged clip (two), inadequate resection margin (one); intraoperative proctoscopy
alone (two), combined with laparoscopic stitch (two)—no problems. In no patient was tumor present at a resection line and
in no patient was the wrong segment resected.
Conclusions: Reliable preoperative identification of the tumor adjacent to the ileocecal valve can permit right colectomy without marking.
Lesions in the upper rectum can be approached via intraoperative proctoscopy ± suture placement. If the surgeon anticipates
intraoperative localization may be difficult, lesions other than rectal or cecal ones should probably be marked by preoperative
tattooing. Further studies regarding the technique of tattooing are warranted.
Received: 18 July 1996/Accepted: 10 March 1997 相似文献
8.
Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn's disease 总被引:17,自引:6,他引:11
M. S. Dunker A. M. Stiggelbout R. A. van Hogezand J. Ringers G. Griffioen W. A. Bemelman 《Surgical endoscopy》1998,12(11):1334-1340
Background: The objectives of this study were to evaluate body image, cosmetic results, and quality of life in patients with Crohn's
disease of the terminal ileum who had either laparoscopic-assisted or open ileocolic resection, and to determine how patients
experienced the pre- and postoperative periods after both procedures.
Methods: Thirty-four patients participated: 11 patients after open resection (OR), 11 patients after laparoscopic-assisted resection
(LR), and 12 patients without resection (WR). Retrospectively, the patients filled out several questionnaires pertaining to
body image, hospital experiences, and quality of life. One-way analysis of variance, Student's t-tests, and Pearson's correlation were used for statistical analysis.
Results: The cosmetic score was significantly higher in the LR than in the OR group (p < 0.01). Body image correlated strongly with cosmesis and with quality of life. The hospital experiences of the laparoscopic
and open groups were similar.
Conclusions: Laparoscopic surgery was associated with better cosmesis than open surgery. Patients do not experience laparoscopic surgery
any differently from open surgery.
Received: 29 September 1997/Accepted: 21 January 1998 相似文献
9.
Postoperative pain and fatigue after laparoscopic or conventional colorectal resections 总被引:16,自引:0,他引:16
Background: Conventional colorectal resections are associated with severe postoperative pain and prolonged fatigue. The laparoscopic
approach to colorectal tumors may result in less pain as well as less fatigue, and may improve postoperative recovery after
colorectal resections.
Methods: Sixty patients were included into a prospective randomized trial to determine the influence of laparoscopic (n= 30) or conventional (n= 30) resection of colorectal tumors on postoperative pain and fatigue. Major endpoints of the study were dose of morphine
sulfate during patient-controlled analgesia (PCA), visual analog scale for pain while coughing (VASC), and visual analogue
scale for fatigue (VASF). Efficacy of pain medication was assessed by visual analogue score at rest (VASR).
Results: Preoperative age, sex, stage, and localization of tumors were comparable in both groups. The PCA dose of morphine given immediately
after surgery until postoperative day 4 was higher in the conventional group (median, 1.37 mg/kg; 5–95 percentile 0.71–2.46
mg/kg) than the laparoscopic group (0.78 mg/kg; 0.24–2.38 mg/kg, p < 0.01). Postoperative VASR was comparable between both groups, but VASC was higher from the first to the seventh postoperative
day (p < 0.01). Postoperative fatigue was higher after conventional than after laparoscopic surgery from the second to the seventh
day (p < 0.05).
Conclusions: This study confirms that analgetic requirements are lower and pain is less intense after laparoscopic than after conventional
colorectal resection. Patients also experience less fatigue after minimal invasive surgery. Because of these differences,
the duration of recovery is shortened, and the postoperative quality of life is improved after laparoscopic colorectal resections.
Received: 4 July 1997/Accepted: 16 November 1997 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.
Background: Laparoscopic surgery has been successfully applied to several gastrointestinal procedures. Although the totally laparoscopic
gastrectomy is feasible, tactile sensation and manipulation of the organ as well as the lesion are decreased when compared
to open surgery. The Dexterity Pneumo Sleeve is a new device which allows the surgeon to insert a hand into the abdominal
cavity while preserving the pneumoperitoneum. This device was used for patients who underwent laparoscopic gastric surgery.
Methods: The first patient presented with a non-Hodgkin's lymphoma of the stomach. A laparoscopically assisted distal gastrectomy
was performed with Roux-en-Y reconstruction. The second patient had a 5-cm leiomyoma involving the greater curve of the stomach,
and this device was used for manipulation of the tumor. The last patient suffered from morbid obesity with its associated
medical complications and a ventral hernia. The Sleeve was applied at the hernia site and a laparoscopically assisted gastric
bypass was performed.
Results: The Pneumo Sleeve was useful in these cases for tactile localization of the tumor and for retraction and manipulation of
the stomach and surrounding upper abdominal organs.
Conclusions: The utilization of this device resulted in a more easily performed dissection, resection, and anastomosis and was felt to
decrease operation time.
Received: 18 September 1996/Accepted: 26 December 1996 相似文献
12.
Late rejection of the mesh after laparoscopic hernia repair 总被引:4,自引:0,他引:4
We report the first case of late rejection of a mesh after laparoscopic hernia repair. It occurred in a 48-year-old man who
had had a laparoscopic hernia repair by transabdominal preperitoneal approach 3 years earlier. The most characteristic finding
was the slow development of a firm mass in the right groin, without pain or fistula. At admission 3 months later, US and CT
scans demonstrated a necrotic mass extending into both iliac fossa. The mass was approached through a midline incision. Pus
was taken for microscopic examination (negative), and the mesh was removed, along with several staples. Ultramicroscopic examination
of the mesh showed breakdown of the fibers, collagen reduction, and no chronic inflammatory cells. No infectious cause of
inflammation was identified.
Received: 5 May 1997/Accepted: 11 July 1997 相似文献
13.
Early international results of laparoscopic gastrectomies 总被引:9,自引:4,他引:5
Background: The first totally laparoscopic Billroth II gastrectomy was performed in 1992. To date, laparoscopic gastrectomy has been
performed by a small number of surgeons around the world and the laparoscopic approach has been extended to Billroth I and
total gastrectomy. The aim of this study is to review the state of laparoscopically performed gastrectomies in the international
scene.
Methods: Questionnaires were prepared and sent to every surgeon in the world known by the authors or their contacts to have performed
a laparoscopic gastrectomy. A questionnaire survey was started in July 1994 and completed by November 1994. Data collected
included age, sex, type of gastric resection, technique of reconstruction after resection, average duration of surgery, time
to liquid and solid intake, postoperative hospital stay, complications, and opinions of the surgeons.
Results: Sixteen surgeons contributed to this study. A total number of 118 cases of laparoscopic gastrectomies, comprising Billroth
I (11), Billroth II (87), vagotomy and antrectomy (10), and total gastrectomy (10) had been performed. The indications were
gastric and/or duodenal ulcers and benign and malignant gastric tumors.
Conclusions: Laparoscopic gastrectomy was found to be superior to the open technique by 10 of 16 surgeons because of faster recovery,
less pain, and better cosmesis. The procedure was an expensive and long operation according to four. Two surgeons were uncertain
of any benefit because of limited experience.
Received: 7 August 1996/Accepted: 28 October 1996 相似文献
14.
Laparoscopy in the management of gastric submucosal tumors 总被引:11,自引:3,他引:8
Background: Gastric tumors, including early gastric cancers, can be safely removed laparoscopically. They do not require an open laparotomy.
Methods: From March 1995 to December 1998, we used laparoscopy to resect gastric submucosal lesions in 32 patients. There were 22
men and 10 women. The patients ranged in age from 23 to 67 years (median, 51.4 yr). The lesions were located in the upper
third in one patient, in the middle third in 20 patients, and in the lower third in 11 patients. The tumors ranged in size
from 2 to 6 cm in diameter. The operative procedures were wedge resection in 19 patients, wedge resection with gastrotomy
in two patients, intragastric surgery in nine patients, intragastric surgery with gastrotomy in one patient, and proximal
gastrectomy in one patient, using a four- or five-port technique. The exophytic mass was resected with an Endo-GIA, and the
tumors on the mucosal surface were exposed via a gastrotomy and excised. The gastrotomy was closed with an intracorporeal
suture. In all cases, the operation was finished after the confirmation of tumor-free margins on frozen-section biopsy specimens.
Results: The duration of the operation ranged from 80 to 180 mins. The final pathologic findings were leiomyoma in 24 patients, adenomyoma
in three patients, hyperplastic polyp in two patients, lipoma in one patient, hamartoma in one patient, and leiomyosarcoma
in one patient. One case (3.1%) was converted to a mini-laparotomy due to technical difficulty; in one other case, more margin
was resected laparoscopically due to the tumor-positive margin; and in one further patient, leakage was repaired by laparoscopic
suturing on the 1st postoperative day. There were no other major complications and no deaths. The hospital stay ranged from
6 to 7 days. The maximum follow-up to date in these patients, including a case of leiomyosarcoma, was 42 months. There has
been no evidence of tumor recurrence.
Conclusion: The application of laparoscopy to submucosal tumors of the stomach is technically feasible, safe, and useful. It should be
considered a viable alternative to open surgery and gastroscopic management because of its low invasiveness and good postoperative
results.
Received: 10 May 1999/Accepted: 22 November 1999/Online publication: 13 June 2000 相似文献
15.
J. Buyske M. McDonald C. Fernandez J. L. Munson L. E. Sanders J. Tsao D. H. Birkett 《Surgical endoscopy》1997,11(11):1084-1087
Background: Benign gastric tumors and tumors of low-grade malignancy can be safely removed laparoscopically.
Methods: Seven patients were considered candidates for laparoscopic resection of gastric tumors. Inclusion criteria included small
tumor size (less than 6 cm), exophytic or endophytic tumor morphology, and benign characteristics. Indications for surgical
intervention included bleeding, weight loss, and need for tissue diagnosis. Patients ranged in age from 38 to 70. There were
five female and two male patients. All patients underwent preoperative upper GI endoscopy. The procedures were performed using
a four- or five-port technique. An Endo-GIA (US Surgical Company, Norwalk, Connecticut) was used to amputate those tumors
located on the serosal surface of the stomach. Tumors on the mucosal surface were exposed via a gastrotomy, then likewise
amputated using an Endo-GIA. The gastrotomy closure was then either hand sewn or stapled. Operating time ranged from 95 to
225 min.
Results: Final pathologic diagnoses included lipoma, lymphoma, leiomyoma, and leiomyosarcoma. There was a 28% conversion rate. There
were no complications. Length of postoperative stay ranged from 4 to 7 days. There have been no tumor recurrences in 6–38-month
follow-up.
Conclusions: Minimally invasive management of benign and low-grade gastric tumors can be performed safely with excellent short- and long-term
results.
Received: 17 March 1997/Accepted: 28 May 1997 相似文献
16.
Laparoscopic management of ovarian tumors 总被引:1,自引:0,他引:1
Background: Laparoscopy can be used with minimal operative morbidity to evaluate adnexal masses. We report our experience with the endoscopic
approach to the diagnosis and treatment of ovarian tumors. In particular, we describe 11 patients who incidentally underwent
laparoscopy and in whom the ovarian masses were found to be malignant.
Methods: Between September 1994 and September 1996, 292 patients with 316 ovarian tumors were treated laparoscopically in the Department
of Obstetrics–Gynaecology, University of Ulm. We assessed vaginal ultrasonography, clinical assessment, the tumor marker CA
12-5, and the intraoperative low-power magnification for their value in predicting the final diagnosis in all laparoscopically
treated ovarian tumors.
Results: From a total of 292 patients with ovarian tumors, 11 were diagnosed, intraoperatively or after final histologic examination,
as having a malignant or borderline ovarian tumor. All applied pre- and intraoperative diagnostic procedures were by themselves
too unreliable to exclude early stages of ovarian carcinoma exactly.
Conclusions: On the basis of the present findings, we are tempted to conclude that laparoscopic surgery is justified in the management
of ovarian tumors. Even with an accurate preoperative selection of suitable patients for laparoscopic surgery, the presence
of an undetected ovarian carcinoma cannot be entirely excluded.
Received: 23 September 1997/Accepted: 4 December 1997 相似文献
17.
A cost and outcome comparison between laparoscopic and Lichtenstein hernia operations in a day-case unit 总被引:8,自引:5,他引:3
Background: Laparoscopic hernia repair has often been criticized for its high costs.
Methods: To compare the costs of laparoscopic and open hernia repair, 40 patients were randomized for either transabdominal laparoscopic
or Lichtenstein mesh repair (under local anesthesia) in a day-case surgery unit.
Results: Median operative times for the laparoscopic and open groups were 62 and 65 min, respectively. Postoperative pain was comparable
for the two groups. The period before return to normal life was 14 days in the laparoscopic group and 21 days in the open
group. The hospital costs were 2051 FIM ($1 US = 4.6 FIM) higher in the laparoscopic group, but the total costs for employed
patients (including expenses due to lost work days) were lower.
Conclusion: Although the Lichtenstein operation is cheaper for the hospital, the total costs for working patients are lower with the
laparoscopic technique, when the cost of lost work days is factored into overall expense.
Received: 5 May 1997/Accepted: 28 October 1997 相似文献
18.
Port-site metastases 总被引:11,自引:0,他引:11
L. N. L. Tseng F. J. Berends Ph. Wittich N. D. Bouvy R. L. Marquet G. Kazemier H. J. Bonjer 《Surgical endoscopy》1998,12(12):1377-1380
Background: Port-site metastases after laparoscopic procedures in patients with digestive malignancies have evoked concern. The pathogenesis
of port-site metastases remains unclear. Two experiments in rats were performed to determine the impact of both tissue trauma
and leakage of CO2 along trocars (chimney effect) in the development of port-site metastases.
Methods: Experiment I: Ten WAG rats had four 5-mm incisions in all abdominal quadrants. The incisions on the right side were crushed to induce tissue
trauma. After inserting 5-mm trocars in all incisions, a pneumoperitoneum was created, and CC-531 tumor cells were injected
intraperitoneally. CO2 was insufflated for 20 min. Experiment II: Ten WAG rats had 5-mm incisions in the left and right abdominal upper quadrant. A 5-mm trocar was inserted in the incision
in the left upper quadrant, and a 2-mm trocar was inserted in the incision in the right upper quadrant. After insufflating
the abdomen, CC-531 tumor cells were injected intraperitoneally. Total leakage of CO2 along the trocar in the right quadrant was 10 liters. After 4 weeks, in both experiments, the tumor deposits at the trocar
sites were assessed. Statistical analysis was performed by the Wilcoxon matched-pairs test.
Results: Experiment I: The median weight of tumor deposits at the trocar sites without induced tissue trauma was 22 mg. At the traumatic port sites,
median weight of tumor deposits was 316 mg (p= 0.007). Experiment II: The median weight of tumor deposits at the leaking trocar sites was 478 mg and at the control sites 153 mg (p= 0.009).
Conclusion: Tissue trauma at trocar sites and leakage of CO2 along a trocar appear to promote implantation and growth of tumor cells at port sites.
Received: 15 May 1997/Accepted: 3 March 1998 相似文献
19.
A new technique for laparoscopic resection of a submucosal tumor on the posterior wall of the gastric fundus 总被引:8,自引:0,他引:8
M. Sekimoto S. Tamura Y. Hasuike M. Yano A. Murata M. Inoue H. Shiozaki M. Monden 《Surgical endoscopy》1999,13(1):71-74
Several reports have been published which describe the technique of using an Endo GIA to resect submucosal tumors on the
anterior wall of the stomach. Lesions on the posterior wall, however, especially near the esophagocardiac junction (ECJ),
are difficult to resect using these reported techniques. This is because the surgeon must divide the omentum and enter the
omental bursa in order to use a similar extraluminal technique. Furthermore, special care must be taken to ensure that resections
do not involve the ECJ and narrow the esophagus. In order to overcome these difficulties, we have proposed a new technique
for the laparoscopic excision of a submucosal tumor located on the posterior wall of the gastric fundus. The principle of
this procedure involves the intraluminal resection of the submucosal tumor, including the surrounding stomach wall, using
the Endo GIA. This technique is safe, simple, and effective. We believe that we are the first to address the excision of a
submucosal lesion by resecting the full thickness of the posterior gastric wall lesion intraluminally.
Received: 11 November 1996/Accepted: 2 April 1997 相似文献
20.
J. L. Bouillot K. Aouad A. Badawy B. Alamowitch J. H. Alexandre 《Surgical endoscopy》1998,12(12):1393-1396
Background: Although several recent reports described the different methods utilized for laparoscopic colon resection, only a few of
them questioned whether the procedure is appropriate for the surgical treatment of diverticular disease. To assess this question,
we performed a retrospective study of 50 consecutive patients operated using laparoscopic assistance to remove the sigmoid
colon for diverticular disease.
Method: The surgical technique was a laparoscopically assisted procedure that included mobilization of the left colon and vascular
ligation laparoscopically and then, via a small abdominal incision, division of the colon, removal of the specimen, and hand-sewn
anastomosis.
Results: The surgical goal was achieved in 46 cases, with a conversion rate of 8%. The mean operative time was 195 min (range 150–280
min). There was no mortality, and the morbidity rate was 14%. There were no complications directly related to the laparoscopic
technique. The mean return of regular bowel habits was 3.2 days, and the median postoperative stay was 10 days.
Conclusions: These preliminary results suggest that laparoscopic-assisted sigmoidectomy can be used safely for the surgical treatment
of diverticular disease.
Received: 30 July 1997/Accepted: 21 January 1998 相似文献