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1.
Early experience with laparoscopic abdominoperineal resection 总被引:4,自引:0,他引:4
Background: Laparoscopic abdominoperineal resection (LAPR) has not been fully evaluated as a technique in the treatment of rectal and
anal cancer or inflammatory bowel disease. The purpose of our study was to evaluate the early experience with laparoscopic
abdominoperineal resection at Washington University Medical Center.
Methods: A prospective analysis was performed on the first 21 patients undergoing the procedure at Washington University Medical Center.
Indications for surgery included rectal cancer (14 patients), anal squamous cell cancer (four patients), inflammatory bowel
disease (two patients), and anal melanoma (one patient).
Results: The procedure was converted to open procedure in four patients (19%). The mean (±SEM) operative time and blood loss for completed
and converted LAPR were 239 ± 11 min and 424 ± 43 ml, respectively. Postoperative hematocrit dropped a mean of 8.3% ± 1.2%
SEM; five patients required blood transfusion (24%). Wound complication occurred in four patients (19%; three perineal, one
trocar site). Bowel function returned after a mean of 3 days, and mean postoperative hospital stay for the completed LAPR
group was 5 days. Mild pain was experienced by 81% of patients (17/21) while 19% (4/21) noted moderate pain, usually of the
perineal wound. The mean duration of patient-controlled analgesia use was 2 days. During the 1–44-month follow-up, six patients
(29%) died from cancer (stage III or IV at operation) and only one patient developed local recurrence in the pelvis (5%).
There were no trocar-site implants of cancer. Furthermore, there was no relationship between prior abdominal operations, the
amount of blood loss, postoperative drop of hematocrit, or blood transfusion requirement and the length of hospitalization
or complication rates.
Conclusion: Laparoscopic abdominoperineal resection is a feasible alternative to the conventional open technique in both cancer and colitis
patients.
Received: 23 April 1996/Accepted: 8 July 1996 相似文献
2.
Background: The management of rectal cancer has been changing to include more sphincter-sparing procedures. We report our initial experience
with a new technique incorporating laparoscopy and a transsacral approach for low or midlevel rectal cancer. Here, we tried
to determine whether this sphincter-sparing method could produce acceptable morbidity and recurrence rates.
Methods: Patients with rectal cancer 4 to 8 cm from the dentate line underwent laparoscopically-assisted transsacral resection (LTR)
with primary anastomosis. With this technique, the rectosigmoid is mobilized via laparoscopy while the patient is in the supine
position. Next, the patient is placed in the prone jackknife position, and a segment of rectum is resected by a transsacral
approach. Age, estimated blood loss, length of time in the operating room, length of stay, and postoperative complications
were noted. Aspects of the tumor pathology regarding stage, lymph nodes, tumor size, and presence of tumor at resection margins
also were recorded.
Results: A total of 13 patients, ages 26 to 70 years (mean, 52.5 years), underwent the procedure. No perioperative deaths occurred.
The mean hospital stay was 9.6 days. The average size of the rectal lesion was 4.3 cm in the largest dimension. The average
specimen contained 11.5 total, and 2.0 metastatic lymph nodes. Postoperative complications included two anastomotic breakdowns
and two other wound complications. Late follow-up evaluation ranged from 10 to 30 months, with 11 of 13 patients alive (85%
survival). Two local recurrences and three distant recurrences were noted at long-term follow-up assessment.
Conclusions: In selected patients with low or midlevel rectal cancer, LTR may be a viable option. Further experience is necessary to define
its oncologic efficacy and whether routine temporary diverting colostomy is indicated.
Received: 16 June 1999/Accepted: 1 November 1999/Online publication: 12 July 2000 相似文献
3.
Background: Laparoscopic adrenalectomy has been shown to be a safe and effective therapy for benign adrenal lesions. We review our experience
with this procedure, including the use of laparoscopic ultrasound.
Methods: We retrospectively reviewed our experience with 36 patients who underwent resection of 42 adrenal glands. Data gathered included
preoperative evaluation and diagnosis, operative time, blood loss, complications, and follow-up status. Laparoscopic ultrasound
was used to guide dissection and characterize a variety of adrenal lesions.
Results: Thirty-five of 36 patients underwent successful laparoscopic adrenalectomy. There was one conversion to the open procedure
in a patient with bilateral adrenal metastases from an endometrial cancer. For the bilateral laparoscopic procedure, the operative
time averaged 262 mins, blood loss was 160 cc, and hospital stay was 3.0 days. For unilateral cases, operative time averaged
193 min, blood loss was 108 cc, and hospitalization was 1.1 days. Six patients experienced perioperative complications, most
of which were minor and transient. Laparoscopic ultrasound was useful to define anatomy and to identify the adrenal vein,
especially on the left side.
Conclusions: Laparoscopic adrenalectomy is the procedure of choice for benign adrenal disease. Laparoscopic ultrasound is useful to localize
and aid in the dissection of the left adrenal vein.
Received: 24 December 1998/Accepted: 12 February 1999 相似文献
4.
Determinants of outcomes in laparoscopic colorectal surgery 总被引:3,自引:3,他引:0
5.
Background: A technique of fully thoracoscopic pulmonary lobectomy with rib-segment resection for specimen extraction is described, and
preliminary results in 18 patients are presented.
Methods: Surgery is performed through four 15-mm ports. For all lobes except one, the surgeon operates in front of the patient, where
the rib spaces are widest and rib-space trauma is less. When lobar dissection is complete, specimen extraction is performed
after resection of a rib segment proportional to tumor size. Muscle section is kept to a minimum. There is no rib retraction.
Results: There were no deaths, three conversions to open surgery, and three major complications. Average postoperative stay was 5.4
days for patients without complications and 9.6 days for patients with complications. In total six patients presented with
some degree of air leaks, and two had post-thoracotomy pain (>2 month's duration). The literature is reviewed to analyze current
techniques and to define parameters of a truly minimally invasive pulmonary lobectomy.
Conclusions: This technique is safe and promising; however, thoracoscopic lobectomy still needs refining. Before valid randomized studies
comparing thoracoscopic lobectomy and muscle-sparing thoracotomy or posterolateral thoracotomy can be credible, technical
issues related to the production of a truly minimally invasive procedure should be resolved.
Received: 20 August 1996/Accepted: 19 September 1996 相似文献
6.
Laparoscopic inguinal herniorrhaphy has traditionally been performed using one 5-mm and two 11-mm trocars. In this report,
we evaluate the feasibility of the preperitoneal repair of inguinal hernias using the needlescopic method (2-mm ports) and
describe the technique used in this repair. A total of 11 inguinal hernias were treated with needlescopic extraperitoneal
repair. There were five direct and six indirect hernias. One patient had a bilateral hernia. The average operative time was
54 min. One patient was converted to the standard laparoscopic extraperitoneal method. All patients were discharged a few
hours after the procedure. They were able to resume activity within a few days and required only minimal analgesic intake.
Follow-up ranged from 1 to 6 months. All patients were followed up by one of the surgeons at 1, 3, and 6 weeks, and then at
6 months. No complications were encountered. There have been no recurrences to date. Overall, needlescopic extraperitoneal
repair of inguinal hernias is a feasible procedure in male patients seeking better cosmetic results than can be achieved with
standard laparoscopic extraperitoneal repair. This procedure is technically more demanding. The operative time is longer.
The cosmetic aspect is the only advantage of this technique.
Received: 22 July 1998/Accepted: 13 October 1998 相似文献
7.
Background: Some patients with achalasia treated by botulinum toxin injection still require an esophagomyotomy. In this study, we analyzed
the impact of botulinum toxin injection on the technical aspects and outcome of esophagomyotomy.
Methods: We studied 57 patients, with a mean age of 46 years (range, 12–97) who were treated between January 1995 and March 1998 by
esophagomyotomy performed via minimally invasive techniques by one team. Operative reports, videotapes, and clinical outcome
were analyzed to define the technical difficulties, perforations, and outcome.
Results: Fifteen of the 57 patients had received one or more injections of botulinum toxin (botox group) preoperatively. Difficulties
in dissection of the submucosal plane were encountered in eight of the 15 cases (53.3%), and a mucosal laceration (perforation)
occurred in two cases (13.3%). Forty-two of the 57 patients had not received any injections (non-botox group). In three patients
(7%), difficulties in identifying or following the submucosal plane were encountered, although 29 patients had one or more
previous dilations, and perforation occurred in one case (2.4%). All mucosal injuries were repaired laparoscopically, and
the patients recovered without obvious sequelae. Dysphagia improved significantly after the operation in both groups (botox
group, from preoperative score of 3.8 to a postoperative score of 0.7; non-botox, from a score of 3.4 preoperatively to 0.5
postoperatively). Regurgitation also improved in both groups (botox, 2.7 preoperatively, 0.92 postoperatively; non-botox group,
2.0 preoperatively, 0.56 postoperatively).
Conclusions: Injection of botulinum toxin significantly increases the technical difficulties and thus the potential risk of esophagomyotomy.
The immediate results were equally good for both groups in our series, but the long-term sequelae of repeated injections are
unknown. Laparoscopic Heller myotomy is a safe and effective procedure even after unsuccessful treatment with botulinum toxin.
Received: 12 May 1998/Accepted: 25 August 1998 相似文献
8.
J. Kuriansky M. Ben Chaim D. Rosin J. Haik O. Zmora P. Saavedra M. Shabtai A. Ayalon 《Surgical endoscopy》1998,12(6):898-900
Laparoscopic splenectomy (LS) is effective and technically feasible for treating various hematological diseases, especially
idiopathic thrombocytopenic purpura (ITP). An anterior approach to the vascular pedicle is usually described. However, in
this approach to the splenic hilum, the dissection of the splenic artery is often difficult. A total of 13 patients with ITP
underwent elective laparoscopic splenectomy. We utilized a laparoscopic posterolateral approach involving dissection of the
suspensory ligaments at the lower pole, then dissection and division of the posterolateral attachments, followed by the dissection
and ligation of all splenic branches near the splenic parenchyma. This procedure was completed in 11 of our 13 patients and
converted to open surgery in the other two patients. Mean operative time was 3 h; mean postoperative stay was 3 days. No blood
transfusion was required, and no complications were noted in the postoperative period. The posterolateral approach provides
better visualization and control of branches of the splenic vein and artery in the splenic hilum. It also permits visualization
and control of surgical hemorrhage through the operating ports.
Received: 24 January 1997/Accepted: 28 October 1997 相似文献
9.
Totally endoscopic Ivor Lewis esophagectomy 总被引:8,自引:4,他引:4
Esophagectomy is associated with significant risks of perioperative morbidity and mortality, as well as prolonged convalescence
due to effects of the incisions used for conventional surgical access. Because the outcome of this procedure is palliative
in the majority of patients, it is possible that laparoscopic techniques could improve initial postoperative outcomes and
therefore make surgery more acceptable for patients with esophageal cancer. A new technique is described for Ivor Lewis esophagectomy,
which incorporates a hand-assisted laparoscopic approach for gastric mobilization and a thoracoscopic approach for esophageal
dissection and anastomosis. Initial experience in two patients has been encouraging, with postoperative hospital stay and
convalescence shortened.
Received: 17 December 1997/Accepted: 18 March 1998 相似文献
10.
Endoscopic axillary exploration and sentinel lymphadenectomy 总被引:12,自引:0,他引:12
T. N. Tsangaris K. Trad F. J. Brody L. K. Jacobs N. T. Tsangaris J. M. Sackier 《Surgical endoscopy》1999,13(1):43-47
Background: Minimally invasive approaches have changed the practice of surgery in several specialties. The purpose of this study was
to develop a reproducible endoscopic technique for the evaluation of the axilla in breast cancer patients.
Methods: A total of 23 patients with biopsy-proven breast carcinoma were enrolled. Patients were positioned in the supine position
with the ipsilateral arm abducted at 90°. A 1-cm skin incision was made at the superior aspect of the axilla. Dissection was
carried bluntly to the lateral border of the pectoralis major. A balloon distention device was inserted into the tract and
distended under endoscopic vision to create a working space. Insufflation was initiated up to a pressure of 8 mmHg. A 30°
laparoscope was introduced for visualization of axillary contents. One or two additional 5-mm cannulas were placed as needed
under direct visualization. Manipulation of axillary contents was performed, and in 19 patients a sentinel node identification
technique was applied.
Results: In all patients, using insufflation and minimal instrument dissection, the axillary vein, long thoracic, and thoracodorsal
nerves were found in their usual anatomical locations. Utilizing blunt and sharp dissection, the axilla was thoroughly inspected,
and individual lymph nodes were easily identified and extracted. In 11 of 19 patients, a sentinel node or blue dye was identified
using isosulfan blue. There was a procedure concordance of 84%, and there were no complications.
Conclusions: We describe a novel endoscopic technique for the evaluation of the axilla in breast cancer patients. This technique allows
(a) creation of a minimally invasive working space within the axilla, (b) recognition of key axillary anatomic landmarks,
and (c) instrument manipulation within the axilla to identify and extract lymph nodes, and apply the sentinel node technique.
This is the first report of a minimally invasive approach to axillary exploration to employ sentinel lymph node mapping.
Received: 22 April 1996/Accepted: 15 May 1998 相似文献
11.
C. J. Stanton 《Surgical endoscopy》1999,13(11):1083-1086
Background: Laparoscopic splenectomy (LS) has rapidly become the preferred surgical treatment for idiopathic thrombocytopenic purpura
(ITP), but its long-term efficacy for this disorder is unproved. This report documents the author's 5-year experience with,
and long-term follow-up of, LS for ITP.
Methods: Between September 1992 and September 1997, 30 patients with clinical ITP and intractable thrombocytopenia were referred as
surgical candidates. Two of them (7%) were converted to open, and the other 28 underwent successful LS. The operative approach
evolved from a supine lithotomy to right lateral decubitus position, and the harmonic scalpel became the primary dissection
tool in the later part of the study.
Results: The 28 successful LS patients constituted the study group. Accessory spleens were identified and resected in six patients
(21%). Surgical times and blood loss averaged 2.4 h and 170 cc, respectively. The typical hospital stay was 2 days. Initial
reversal of thrombocytopenia and ultimate cessation of oral steroids was achieved in 25 of 28 patients (89%). There were no
deaths, but two patients had major complications (bleeding and pneumonia). All but two patients experienced a return to full
activity and/or employment by 3 weeks post-LS. In the three cases that failed LS, none had residual splenic tissue on subsequent
radionuclide scan. Long-term follow-up (2–60 months) was obtained in 22 of 28 patients (79%). The only death (at 13 months)
resulted from oncologic disease. Twenty-one patients had lasting clinical remission of ITP. A positive preoperative response
to oral steroids was the best predictor of success.
Conclusions: This 5-year experience with LS supports its use for the surgical treatment of ITP. The procedure is safe and efficacious,
resulting in brief hospitalization, minimal recovery time, and excellent long-term results.
Received: 11 October 1998/Accepted: 19 February 1999 相似文献
12.
Esposito C Vallone G Settimi A Gonzalez Sabin MA Amici G Cusano T 《Surgical endoscopy》2000,14(7):658-660
Background: Several surgical procedures have been described for the management of nonpalpable testis. Following a vast experience with
a complete laparoscopic two-stage Fowler-Stephens procedure, we report our experience with laparoscopic orchiopexy performed
without dividing the spermatic vessels.
Methods: Over a 24-month period, 70 boys with nonpalpable testes (72 overall) underwent laparoscopic diagnostic exploration. Twenty
patients (27.8%) of this series who showed an intraabdominal testis underwent laparoscopic orchiopexy without sectioning the
spermatic vessels. In seven cases, the testis was just proximal to the internal inguinal ring; in 13, it was in the high intraabdominal
position. The technique consisted in sectioning the gubernaculum (when present), opening the peritoneum laterally to the spermatic
vessels, and mobilizing the testicular vessels and the vas deferens in a retroperitoneal position for 8–10 cm. The testis
was then brought down into the scrotum through the internal inguinal ring (11 cases), if this was open, or through a neo-inguinal
ring (nine cases) created medially to the epigastric vessels. In every case, we closed the inguinal ring at the end of the
operation using one or two detached sutures.
Results: Operating time ranged between 40 and 75 min (median, 55). All the testes were successfully brought down into the scrotum.
We had only one (5%) intraoperative complication. In the second patient treated with this procedure, there was an iatrogenic
rupture of the spermatic vessels due to excessive traction.
Conclusion: On the basis of our experience, we believe that laparoscopic orchiopexy without division of the spermatic vessels should
be the treatment of choice in the management of nonpalpable testes, because it does not affect normal testicular vascularization
and is minimally invasive. A blunt dissection and a delicate manipulation of the testis without excessive traction are the
best ways to avoid any kind of complication.
Received: 26 April 1999/Accepted: 22 November 1999/Online publication: 8 May 2000 相似文献
13.
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
14.
Pietrabissa A Cuschieri A Carobbi A Boggi U Vistoli F Mosca F 《Surgical endoscopy》1999,13(3):298-302
Endoscopic adrenalectomy has been recommended for the treatment of several benign adrenal diseases. The safety of this procedure
largely depends on a careful surgical dissection and appropriate hemostatic technique. An established slipknotting technique
was employed to control the main adrenal vein in a consecutive series of 14 patients undergoing endoscopic adrenalectomy.
The operative steps to ligate the adrenal pedicle are described. A Medline search also was conducted to identify all reported
bleeding episodes associated with this procedure. All attempted ligatures of the main adrenal vein were completed successfully
by the described technique, and none of our patients required perioperative blood transfusion. Twenty-eight episodes of bleeding
collected from the literature were analyzed. Hemorrhagic accidents related to dislodgement of clips were documented at least
in three patients. The cause of bleeding was unspecified in 10 patients. Extracorporeal ligation of the main adrenal vein
is feasible, safe, and advisable to prevent the occurrence of hemorrhage during endoscopic adrenalectomy.
Received: 16 February 1998/Accepted: 28 May 1998 相似文献
15.
Laparoscopic rectopexy according to Wells 总被引:4,自引:0,他引:4
Background: The laparoscopic approach usually reduces the morbidity of procedures performed by laparotomy. The aim of this study was
to demonstrate the usefulness of laparoscopic rectopexy.
Methods: A total of 37 patients were included in this prospective study. The indication was true rectal prolapse in all patients.
Incontinence was seen in 33% of the patients. A slightly modified Wells procedure was performed laparoscopically. Postoperatively,
the patients were evaluated for resolution of the prolapse and incontinence. They were also questioned about their satisfaction
with the procedure.
Results: Laparoscopy was successful in all but one case. Follow-up is available in 32 of 37 patients. Prolapse was cured in all patients,
and the incontinence resolved in 11 of 12. In addition, 38% of the patients experienced significant constipation preoperatively
versus 5% postoperatively.
Received: 22 January/Accepted: 7 May 1998 相似文献
16.
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
17.
Poddoubnyĭ IV Dronov AF Kovarskiĭ SL Korznikova IN Darenkov IA Zalikhin DV 《Surgical endoscopy》2000,14(12):1107-1109
Background: The technique of the laparoscopic treatment of varicocele in children is described, and its outcome is discussed.
Methods: A total of 180 patients from 6 to 14 years of age were studied. All of them had left-sided varicocele; 10 of them were recurrences
after treatment by other methods. Varicocele was diagnosed on physical examination and confirmed by Doppler ultrasonography.
The laparoscopic procedure included obligatory dissection and preservation of the spermatic artery and tinted lymphatic vessels,
followed by double ligation of the spermatic veins.
Results: There were no intraoperative or postoperative complications and only one case of recurrence (0.6%).
Conclusion: The suggested technique for laparoscopic varix ligation is a highly effective and reliable method for the treatment of pediatric
varicocele. It provides the minimal invasiveness of the approach, effective microsurgical quality of visualization, and dissection
with guaranteed preservation of the spermatic artery and lymphatic vessels, along with very low rates of complication and
recurrence.
Received: 2 February 1999/Accepted: 7 October 1999/Online publication: 29 August 2000 相似文献
18.
Background: Sentinel node biopsy is a promising technique that allows the axillary status of breast cancer patients to be predicted with
high accuracy. Reducing false negative results remains a major challenge for the improvement of this procedure. Furthermore,
new techniques are required to achieve axillary clearing with less morbidity in cases of unsuccessful mapping or multicentric
carcinoma. We analyzed whether axilloscopy and endoscopic sentinel node biopsy is a feasible procedure for visualization of
the axillary space and resection of the sentinel node using endoscopic techniques.
Methods: Following blue dye–guided lymphography and liposuction of the axillary fat, endoscopic axillary sentinel node biopsy was
performed in 35 breast cancer patients. We then assessed the exposure of anatomical landmarks, the detection rate of the sentinel
node, the false negative rate, and the accuracy of consecutive axillary clearing.
Results: In almost every case, an excellent anatomical orientation was achieved. The detection rate for the sentinel node was 83.3%.
In one case, the sentinel node did not reflect the status of the residual axilla. A mean number of 17.1 lymph nodes was harvested
at consecutive axillary clearing.
Conclusions: Axilloscopy and endoscopic sentinel node biopsy, following liposuction of the axillary fat, is a feasible procedure that
allows identification and minimally invasive resection of the sentinel node with high accuracy. The endoscopic approach might
help to minimize the pitfalls of sentinel node biopsy by visualizing the axillary space. In future, it may become a technique
that enables minimally invasive axillary clearing when complete lymphadenectomy is required.
Received: 7 April 1999/Accepted: 16 December 1999/Online publication: 17 April 2000 相似文献
19.
Hemodynamics in the prone jackknife position during surgery 总被引:1,自引:0,他引:1
T Hatada M Kusunoki T Sakiyama Y Sakanoue T Yamamura R Okutani K Kono H Ishida J Utsunomiya 《American journal of surgery》1991,162(1):55-58
We examined the hemodynamic changes occurring with prone jackknife positioning during colorectal surgery. The operative procedure was restorative proctocolectomy with ileal J-pouch anal anastomosis in five patients with adenomatosis coli and six patients with ulcerative colitis and anoabdominal resection of the rectum with colonic J-pouch anal anastomosis in eight patients with rectal cancer. Nineteen patients (10 men and 9 women aged 41 +/- 19 years) were monitored with arterial and Swan-Ganz catheters during positioning. Measurements were obtained in the supine and prone positions (1 minute, 3 minutes), and the jackknife position (1, 3, 5, and 10 minutes), as well as before and after adoption of the Lloyd-Davies position (1, 3, 5, and 10 minutes). Turning the patient from the supine position to the prone position resulted in a significant decrease in the cardiac index (CI). However, following head-down rotation, the CI increased and returned to the value seen in the supine position (p less than 0.05). Heart rate (HR) slowed and mean arterial pressure (MAP) increased in the prone jackknife position. We concluded that the extent of the changes in cardiac function presented no serious problems. 相似文献
20.
Operative technique for thoracoscopic thymectomy 总被引:2,自引:1,他引:1
In most cases, myasthenia gravis (MG) and thymoma require complete removal of the thymus gland and resection of the pericardial
fatty tissue. There is some debate however, over which surgical approach is best for thymectomy. We have developed a new technique
for complete thoracoscopic thymectomy. Between October 1994 and February 1998, we performed a prospective observational study
of thoracoscopic thymectomy in 19 patients. The results were analyzed with special reference to perioperative morbidity, short-
and intermediate-term improvement of MG, and quality of life. This study showed the feasibility of complete thoracoscopic
thymectomy. The procedure was successfully applied in 19 of 20 cases. Thoracoscopic thymectomy was accomplished with zero
mortality and a very low perioperative morbidity. While the short-term improvement of MG after this procedure was comparable
to that seen with conventional surgery, the short- and intermediate-term quality of life was much better. The preliminary
results of thoracoscopic thymectomy appear to be excellent for both patients and neurologists. A prospective randomized trial
has been designed to compare thoracoscopic thymectomy with the gold standard of median sternotomy for thymectomy.
Received: 9 March 1998/Accepted: 22 June 1998 相似文献