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1.
Background: Diagnostic laparoscopy plays a significant role in the evaluation of acute and chronic abdominal pain in the era of therapeutic
laparoscopic surgery.
Methods: We referred to our personal series of laparoscopy for both acute and chronic abdominal pain. This is a retrospective review
of data accumulated prospectively between 1979 and the present.
Results: In our series, 387 consecutive patients underwent laparoscopy because of abdominal pain. In a group of 121 patients with
acute abdominal pain, a definitive diagnosis was made in 119 cases (98%). Two patients needed laparotomy to confirm the diagnosis;
both had a disease process that did not require laparotomy to treat. A definitive therapeutic laparoscopic procedure was performed
in 53 cases 944%). In 45 patients (38%), a diagnosis was made that did not require therapeutic laparoscopy or laparotomy to
treat. In the remaining 21 patients (17.5%), exploratory laparotomy was needed to treat the condition. In a chronic abdominal
pain group of 265 patients, the etiology was established laparoscopically in 201 cases (76%). A definitive therapeutic laparoscopic
procedure was performed in 128 patients (48%). There was a normal laparoscopic examination in 64 patients (24%). There was
one false negative laparoscopy that required laparotomy to treat 1 month later.
Conclusions: Laparoscopy is an accurate modality for the diagnosis of both acute and chronic abdominal pain syndromes. These data support
the use of laparoscopy as the primary invasive intervention in patients with acute and chronic abdominal pain.
Received: 24 March 1997/Accepted: 4 September 1997 相似文献
2.
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
3.
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
4.
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
5.
C. A. Jacobi J. Ordemann B. Böhm H. U. Zieren H. D. Volk W. Lorenz E. Halle J. M. Müller 《Surgical endoscopy》1997,11(3):235-238
Background: Laparoscopy is increasingly used in patients with intraabdominal bacterial infection although pneumoperitoneum may increase
bacteremia by elevated intraabdominal pressure.
Methods: The influence of laparotomy and laparoscopy on bacteremia, endotoxemia, and postoperative abscess formation was investigated
in a rat model. Rats received intraperitoneally a standardized fecal inoculum and underwent laparotomy (n= 20), or laparoscopy (n= 20), or no further manipulation in the control group (n= 20).
Results: Bacteremia and endotoxemia were higher after laparotomy and laparoscopy compared to the control group (p= 0.01) 1 h after intervention. One hour after intervention, aerobic and anaerobic bacterial species were detected in the
laparotomy group while only anaerobic bacteria were found in the other two groups. Although bacteremia and endotoxemia did
not differ among the three groups after 1 week, the mean number of intraperitoneal abscesses was significantly higher (p < 0.05) after laparotomy (n= 10) compared with laparoscopy (n= 6) and control group (n= 5).
Conclusion: Laparoscopy does not increase bacteremia and intraperitoneal abscess formation compared to laparotomy in an animal model
of peritonitis.
Received: 28 May 1996/Accepted: 25 July 1996 相似文献
6.
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
7.
Mutter D Hajri A Tassetti V Solis-Caxaj C Aprahamian M Marescaux J 《Surgical endoscopy》1999,13(4):365-370
Background: The use of laparoscopy for assessment and treatment of malignant tumors remains controversial. The aim of this study was
to evaluate the impact of tumor manipulation during laparoscopy compared with that of conventional laparotomy on growth and
spread of an intraperitoneal tumor in the rat in a randomized, controlled trial.
Methods: Thirty 2-month-old male Lewis rats received a single-site intrapancreatic inoculation of a ductal adenocarcinoma. Fourteen
days after cancer implanting, two groups of six animals each underwent a laparotomy (30 min 6 mmHg CO2 pneumoperitoneum). The tumor was manipulated in the one group, and exclusively visualized in the other. In two other groups,
a midline laparotomy with (n = 6) or without (n = 6) tumor manipulation was performed. Animals in the control group (n = 6)
underwent no procedure. Tumor volume, tumor mass, local regional invasion incidence, lymph node involvement, and liver and
lung metastases were evaluated on 28-day tumors.
Results: No difference in tumor growth and spread was observed between laparoscopy and laparotomy when tumor manipulation was not
carried out. Tumor manipulation increased tumor growth significantly in the laparotomy group, but not in the laparoscopy one.
Tumor metastases were correlated to tumor growth and increased significantly after manipulation in both groups. There was
no port-site or conventional wound seeding in either the surgical procedure.
Conclusions: This study showed that manipulation is the main factor acting on tumor dissemination in both laparoscopy and laparotomy.
Laparoscopic surgery had a beneficial effect on local tumor growth compared with laparotomy in the case of tumor manipulation.
This beneficial effect of laparoscopic surgery may be related to a better preservation of immune function in the early postoperative
period.
Received: 16 August 1996/Accepted: 27 January 1997 相似文献
8.
L. C. Leung M. K. Yiu C. W. Man W. H. Chan K. W. Lee K. W. Lau 《Surgical endoscopy》1998,12(6):891-893
We describe a one-port laparoscopic technique for assisting in Tenchkoff catheter placement and salvaging obstructed ones
in patients requiring continuous ambulatory peritoneal dialysis (CAPD). This unique technique enables diagnostic laparoscopy,
adhesiolysis, repositioning of catheters, and omentectomy to be performed without laparotomy. Six patients were treated. Only
one 10-mm port was required, using an operating laparoscope and an instrument introduced through the working channel of the
laparoscope. Adhesiolysis was performed under laparoscopic vision; omentectomy and flushing of blocked catheters were carried
out extracorporeally. The catheters were then repositioned to the pelvic cavity under laparoscopic vision. All patients were
followed up for 6–10 months. No mechanical problem was noticed. Our one-port laparoscopic technique is a simple and effective
method for treating patients who have mechanical problems with their peritoneal dialysis catheters.
Received: 14 January 1997/Accepted: 14 April 1997 相似文献
9.
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
10.
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
11.
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
12.
Background: The aim of this study was to compare the significance of routine examinations prior to laparoscopic cholecystectomy (LC)
with intraoperative abdominal investigation. Preoperative evaluation becomes increasingly important when laparoscopic procedures
are performed for the removal of gallstones because other intraabdominal diseases may coexist in these patients, mimicking
biliary tract disease.
Methods: Over the last 6 years, we treated 816 patients with symptomatic cholecystolithiasis using LC. Prior to surgery, routine tests
such as upper abdominal ultrasonography, chest radiography, and standard laboratory blood tests were carried out.
Results: Despite these routine tests, coexisting colonic cancers escaped detection in four out of 816 cases. This indicates a risk
of more ``missed pathologies' during the course of laparoscopic operations compared to standard laparotomy.
Conclusion: The risk of missing coexisting diseases during laparoscopic operations has to be minimized by placing additional emphasis
on careful evaluation of anamnesis. Physical examination and additional laboratory tests—such as analysis of tumor markers
and blood in the stool—combined with complete abdominal ultrasonography, gastroscopy, and/or complete colonoscopy should be
performed prior to LC.
Received: 6 October 1996/Accepted: 19 February 1997 相似文献
13.
Laparoscopic pelvic lymphadenectomy in the surgical treatment of endometrial cancer: results of a multicenter study. 总被引:2,自引:0,他引:2
Zdenek Holub Antonin Jabor Pavel Bartos Josef Eim Lev Kliment 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2002,6(2):125-131
OBJECTIVE: To analyze the results and determine the contribution of laparoscopic pelvic lymphadenectomy in the surgical treatment of women with endometrial cancer and compare with the open technique. METHODS: A prospective multicenter study was carried out on 120 women who underwent laparoscopic surgery (96 women) and open procedures (24 women) for endometrial cancer between April 1996 and March 2000. RESULTS: Four patients whose laparoscopic surgery was completed by laparotomy were excluded from the study. The other 92 laparoscopic procedures were successfully completed. Laparoscopically assisted surgical staging (LASS) was performed based on the grade of the tumor and the depth of myometrial invasion. Sixty-seven of the patients underwent hysterectomy, bilateral salpingooophorectomy (BSO), and pelvic lymphadenectomy, and 25 women also had para-aortic lymph node sampling dissection. Eleven of these patients had positive pelvic or para-aortic nodes. The mean operating time for the laparoscopic procedure was significantly longer (173.8 min, P < 0.0001) than the time for the open procedure (135.0 min). The rate of complications was similar in both groups. The recovery time was significantly reduced (P < 0.0001). CONCLUSION: The laparoscopic approach to hysterectomy and lymphadenectomy for early stage endometrial carcinoma is an attractive alternative to the abdominal surgical approach. The advantages of laparoscopically assisted surgical staging are patient related. Because the abdominal incision is avoided, the recovery time is reduced. Laparoscopic pelvic lymph node dissection is a procedure that is appropriate, when applicable. 相似文献
14.
J. C. Box T. Duncan B. Ramshaw J. G. Tucker E. M. Mason J. P. Wilson D. Melton G. W. Lucas 《Surgical endoscopy》1997,11(10):1026-1028
Background: The evaluation of AIDS patients with acute abdominal complaints (AAC) is quite difficult, and surgical intervention is associated
with a high complication rate. The intent of this study is to evaluate the application of laparoscopy in the diagnosis and
treatment of AIDS patients with AAC.
Methods: This is a retrospective analysis of 10 consecutive AIDS patients who presented with AAC. Each had evaluation by a surgical
team with subsequent laparoscopic intervention. The charts were reviewed for age, sex, time with AIDS, AIDS comorbidities,
evaluation modalities, findings, treatment modalities, and outcome.
Results: Laparoscopy resulted in the successful surgical treatment of four patients, diagnosis of medically treatable conditions in
four patients, and alteration of the incision site in the remaining two patients. Each patient thus received direct benefit
from laparoscopy. Two complications, in the converted patients, and no mortalities were encountered.
Conclusions: Laparoscopy is a safe and effective interventional modality in the diagnosis and treatment of AAC in the AIDS patient.
Received: 26 November 1997/Accepted: 7 May 1997 相似文献
15.
Laparoscopic cholecystectomy and gallbladder cancer 总被引:2,自引:0,他引:2
Background: This study was designed to assess the treatment of patients in whom gallbladder cancer was diagnosed in the course of histological
examination of their gallbladders, which were removed during laparoscopic cholecystectomy.
Methods: Six (0.29%) cancers were found among 2,017 patients who underwent laparoscopic cholecystectomy. Four of these cancers (0.22%)
were in 1,831 gallbladders with normal walls, two (1.0%) were in 186 with thicker walls, and two (1.8%) were in 109 patients
in whom conversion was necessary because of extensive inflammation and thickening of gallbladder wall.
Results: In two cases, the cancer did not cross the muscular layer. In one of them, no further treatment was undertaken. In the second
case, liver resection and lymphadenectomy was performed. In the other four cases, dissemination was diagnosed during laparotomy,
precluding radical treatment.
Conclusions: Thickened and infiltrated gallbladder walls in patients without preoperative symptoms of cholecystitis should raise a suspicion
of cancer. The surgeon should be prepared to perform a conversion, an intraoperative histological examination, and an appropriate
radical operation, if necessary.
Received: 16 June 1998/Accepted: 17 November 1998 相似文献
16.
Heath EI Kaufman HS Talamini MA Wu TT Wheeler J Heitmiller RF Kleinberg L Yang SC Olukayode K Forastiere AA 《Surgical endoscopy》2000,14(5):495-499
Background: Diagnostic laparoscopy has been used to determine resectability and to prevent unnecessary laparotomy in patients with advanced
esophageal cancer. The objective of this prospective study was to evaluate the role of laparoscopy in conjunction with computed
tomography (CT) scan in staging patients with esophageal cancer.
Methods: From March 1995 to October 1998, 59 patients with biopsy-proven esophageal cancer underwent diagnostic laparoscopy with concurrent
vascular access device and feeding jejunostomy tube placement.
Results: Laparoscopy changed the treatment plan in 10 of 59 patients (17%). Of the patients with normal-appearing regional or celiac
nodes, 78% were confirmed by biopsy to be tumor free, whereas 76% of patients with abnormal-appearing nodes were confirmed
by biopsy to have node-positive disease.
Conclusions: Diagnostic laparoscopy is useful for detecting and confirming nodal involvement and distant metastatic disease that potentially
would alter treatment and prognosis in patients with esophageal cancer.
Received: 16 May 1999/Accepted: 10 November 1999/Online publication: 24 March 2000 相似文献
17.
M. A. Cuesta Q. A. J. Eijsbouts R. V. Gordijn P. J. Borgstein D. de Jong 《Surgical endoscopy》1998,12(7):915-917
Background: There are acute abdominal conditions in which it is difficult to establish an indicative diagnosis before laparotomy. A diagnosis
is important in planning the right abdominal incision or to avoid an unnecessary laparotomy. Diagnostic noninvasive procedures
such as X-ray studies do not always appear conclusive. Diagnostic laparoscopy is the only technique which can visualize the
abdomen and, by establishing an adequate diagnosis, permits the surgeon to plan the right abdominal approach.
Methods: In a prospective study, 65 patients with a generalized acute abdomen (no intestinal obstruction or perforation) underwent
a diagnostic laparoscopy under general anesthesia previous to the planned median laparotomy.
Results: In 46 patients (70%) diagnostic laparoscopy permitted the establishment of an adequate diagnosis, whereas in seven patients
(10%) no cause for the acute abdomen could be found and an explorative laparotomy was avoided. In another 12 patients (20%)
insufficient information was obtained during laparoscopy and an explorative laparotomy was performed.
Conclusions: A conclusive diagnosis was established in 53 patients. This information led to a change in the surgical approach in 38 patients
(e.g., limited, well-placed approach, laparoscopically, or avoidance of an unnecessary laparotomy). Diagnostic laparoscopy
in this category of patients is a useful technique with important therapeutic consequences.
Received: 5 May 1997/Accepted: 18 September 1997 相似文献
18.
Lee YS Lee TH Koo TB Cho YL Park I 《Journal of laparoendoscopic & advanced surgical techniques. Part A》2003,13(2):123-126
BACKGROUND: Radical abdominal surgery in patients who have previously undergone a hysterectomy is a surgical challenge. This type of surgery for invasive cervical cancer after a hysterectomy or for vaginal stump metastasis traditionally requires a major laparotomy; however, a minimal access approach is now being applied to this type of procedure. METHODS: A laparoscopic radical parametrectomy including a paraaortic and pelvic lymphadenectomy was performed on two patients with invasive cervical cancer diagnosed after a simple hysterectomy and one patient with recurrent endometrial cancer in the vaginal stump. RESULTS: All three patients had an excellent clinical outcome and made a rapid recovery, even though two cases involved a bladder laceration. CONCLUSION: A laparoscopic radical parametrectomy including a paraaortic and pelvic lymphadenectomy is a viable technique for women with invasive cervical cancer or recurrent endometrial vaginal cancer after a prior hysterectomy. 相似文献
19.
Morbidity in laparoscopic gynecological surgery 总被引:16,自引:0,他引:16
C. Mac Cordick F. Lécuru E. Rizk F. Robin V. Boucaya R. Taurelle 《Surgical endoscopy》1999,13(1):57-61
Background: We set out to investigate prospectively the morbidity rate for gynecological laparoscopy patients at a tertiary care center.
Methods: We prospectively recorded data on 743 laparoscopic procedures performed between January 1, 1992 and December 31, 1996. The
procedures included 36 diagnostic laparoscopies (4.8%), 115 laparoscopies carried out for minor surgical acts (15.4%), 523
for major surgical acts (70.4%), and 69 for advanced surgical acts (9.4%). A total of 127 patients had a history of prior
laparotomy (17%). All those procedures were performed by young senior surgeons. We defined a complication as an event that
had modified the usual course of the procedure or of the postoperative period. For statistical analysis, we used the chi-squared
test or Fisher's exact test.
Results: Complications occurred in 22 cases; the overall complication rate was 2.9% when all events were considered. One complication
(injury of the left primitive iliac artery) was related to insertion of the Veress needle (0.13%). A total of 2,578 trocars
were inserted, giving rise to 10 complications (1.3%). Three unintended laparotomies were required for bowel or bladder injuries
(0.4%). Finally, the introduction of the laparoscope was responsible for 11 complications (1.4%); this figure represents 50%
of all the complications of this series. Eight intraoperative complications (1%) occurred during the laparoscopic surgery
(seven severe bleedings and one ureter injury, but no intestinal lesions); laparotomy was required in six of these cases.
Three complications occurred during the postoperative stage: one granulomatous peritonitis after intraabdominal rupture of
a dermoid cyst, one incisional hernia, and a fast-resolving cardiac arrhythmia.
Conclusions: In our experience, operative gynecological laparoscopy is associated with an acceptable morbidity rate. Moreover, about half
of the complications occur during the installation of the laparoscopic procedure, underscoring the usefulness of safety rules.
Received: 25 November 1997/Accepted: 8 May 1998 相似文献
20.
F. Asencio J. Aguiló J. L. Salvador A. Villar E. De la Morena M. Ahamad J. Escrig J. Puche V. Viciano G. Sanmiguel J. Ruiz 《Surgical endoscopy》1997,11(12):1153-1158
Background: The high proportion of gastric carcinomas present in an unresectable stage, together with the emergence of multimodal treatments,
increases the usefulness of objective staging methods that avoid unnecessary laparotomies.
Methods: A prospective evaluation of the accuracy of laparoscopy in the staging of 71 patients with gastric adenocarcinoma is presented.
Serosal infiltration, retroperitoneal fixation, metastasis to lymph nodes, peritoneal and liver metastasis, and ascites were
determined in the staging workup. Sensitivity, specificity, and predictive values were calculated and compared with those
obtained with ultrasonography (US) and computed tomography (CT).
Results: The diagnostic accuracy of laparoscopy in the determination of resectability was 98.6%. Consequently, over 40% of patients
were spared unnecessary laparotomies. Laparoscopy yielded diagnostic indices superior to US and CT for all the tumoral attributes
studied. Our technique permits accurate assessment and pathologic verification of liver and the peritoneal and retroperitoneal
extent of tumor invasion in the majority of patients.
Conclusions: Laparoscopy in gastric adenocarcinoma is a reliable technique that provides accurate assessment of resectability and stage,
thus avoiding unnecessary laparotomies in patients in whom surgical palliation is not indicated. A stepwise diagnostic workup
combining imaging and minimally invasive techniques is proposed.
Received: 5 May 1996/Accepted: 10 March 1997 相似文献