共查询到20条相似文献,搜索用时 15 毫秒
1.
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
2.
Alterations in hepatic function during laparoscopic surgery 总被引:15,自引:4,他引:11
Background: Very few studies have been done on the consequences of pneumoperitoneum on hepatic function. At present, there is no consensus
on the physiopathological hepatic implications of pneumoperitoneum. The purpose of this clinical study was to evaluate the
effects of pneumoperitoneum on hepatic function in 52 patients treated with laparoscopic procedures.
Methods: Thirty-two laparoscopic cholecystectomies and 20 nonhepatobiliary laparoscopic procedures were performed in 52 patients (12
men and 40 women) with a mean age of 44 years (range, 15–74). All patients had normal values on preoperative liver function
tests. The anesthesiologic protocol was uniform, with drugs at low hepatic metabolism. The 32 cholecystectomies were randomized
into 22 performed with pneumoperitoneum at 14 mmHg and 10 performed at 10 mmHg. All nonhepatobiliary laparoscopic procedures
were performed with a pneumoperitoneum of 14 mmHg. The postoperative serologic levels of AST, ALT, bilirubin, and prothrombin
time were measured at 6, 24, 48, and 72 h. The serologic changes were related to the procedure, the duration, and the level
of pneumoperitoneum.
Results: Mortality and morbidity were nil. All 52 patients had a postoperative increase in AST, ALT, bilirubin, and lengthening in
prothrombin time. Slow return to normality occurred 48 or 72 h after operation. The increase of AST and ALT was statistically
significant and correlated both to the level (10 versus 14 mmHg) and the duration of pneumoperitoneum.
Conclusions: The duration and level of intraabdominal pressure are responsible for changes of hepatic function during laparoscopic procedures.
Although no symptom appears in patients with normal hepatic function, patients with severe hepatic failure should probably
not be subjected to prolonged laparoscopic procedures.
Received: 23 May 1997/Accepted: 28 October 1997 相似文献
3.
Background: Removing the normal appendix when operating for suspected acute appendicitis is the standard of care. The use of laparoscopy
should not alter this practice.
Methods: Retrospective review of 72 patients found to have grossly normal appendices while undergoing laparoscopy for suspected appendicitis.
Twenty-eight patients underwent diagnostic laparoscopy (DL) alone while 44 patients underwent diagnostic laparoscopy with
incidental laparoscopic appendectomy (ILA).
Results: There was no difference in length of hospitalization (DL = 44 h, ILA = 43 h, p= 0.49) or morbidity (DL = 11%, ILA = 5%, p= 0.37). One patient required appendectomy 11 days after diagnostic laparoscopy for recurrent acute right lower quadrant abdominal
pain. Five percent of resected appendices (2/44) demonstrated acute inflammation upon pathologic review.
Conclusions: Laparoscopic removal of the normal appendix produces no added morbidity or increase in length of hospitalization as compared
to diagnostic laparoscopy. It demonstrates cost effectiveness by preventing missed and future appendicitis. Incidental laparoscopic
appendectomy is the preferred treatment option.
Received 3 April 1997/Accepted: 3 July 1997 相似文献
4.
The true incidence of epiphrenic esophageal diverticulum is unknown. Traditionally, diverticulectomy via a left thoracic
approach has represented the gold standard. Trans-hiatal esophageal dissection under laparoscopy is feasible, but has not,
to our knowledge, been applied before in the treatment of epiphrenic esophageal diverticulum.
Received: 2 April 1997/Accepted: 10 June 1997 相似文献
5.
A prospective multicenter study on laparoscopic treatment of gastroesophageal reflux disease in Italy 总被引:4,自引:0,他引:4
Background: A national survey was undertaken by the Italian Society for Laparoscopic Surgery to investigate the prevalence, indications,
conversion rate, mortality, morbidity, and early results of laparoscopic antireflux surgery.
Methods: Beginning on January 1, 1996, all of the centers taking part in this study were asked to complete a questionnaire on each
patient. The questionnaire was divided into four parts and covered such areas as indications for surgery and preoperative
workup, type of operation performed and certain aspects of the surgical technique, conversions and their causes, intraoperative
and postoperative complications (within 4 weeks), and details of the postoperative course. The last part of the questionnaire
focused on the follow-up period and was designed to gather data on recurrence of preoperative symptoms, postoperative symptoms
(dysphagia, gas bloat), and postoperative test findings.
Results: As of June 30 1998, 21 centers were taking part in the study and 621 patients were enrolled, with a median of 27 patients
per center (less than one patient/month). The most popular technique was the Nissen-Rossetti (52%), followed by the Nissen
(33%) and Toupet procedures (13%). Other techniques, such as the Dor and Lortat-Jacob, were used in the remainder of cases.
Patients who received a Toupet procedure had a higher incidence of defective peristalsis (p < 0.05). The conversion rate to open surgery was 2.9%. The most common causes of conversion were inability to reduce the
hiatus hernia or distal esophagus in the abdomen and adhesions from previous surgery. Perforation of the stomach and esophagus
occurred in <1% of patients. Mortality was nil. Postoperative complications were observed in 7.3% of cases. The most common
complication was acute dysphagia (19 patients), which required reoperation in 10 patients. No differences in the incidence
of acute dysphagia were found for the different surgical techniques employed. Follow-up data were obtained for 319 patients
(53%): 91.5% of the patients remained GERD symptom–free; severe esophagitis (grade 2–3) healed in 95% of the patients; lower
esophageal sphincter (LES) manometric characteristics (pressure, abdominal length, and overall length) improved significantly
after surgery (p < 0.005); and acid exposure of the distal esophagus decreased.
Conclusions: Laparoscopic antireflux surgery has no mortality and a low morbidity. Symptoms and esophagitis are resolved in >90% of patients.
Despite these favorable results, however, this type of surgery is not yet as widely employed in Italy as in other countries.
Received: 12 February 1999/Accepted: 8 June 1999 相似文献
6.
Needle and trocar injury during laparoscopic surgery in Japan 总被引:12,自引:3,他引:9
Background: With the growth and sophistication of laparoscopic surgery, increased attention is now being focused on safety and complications.
Methods: In an attempt to address questions regarding the safety of laparoscopic surgery, a retrospective study of the time period
from January 1991 to December 1995 was conducted by the Study Group of Endoscopic Surgery in Kyushu, Japan.
Results: The response rate was 84.4% (152 of 180 hospitals). During the last 5 years 17,626 patients underwent endoscopic operations
and 87.5% (15,422 patients) had laparoscopic surgery while 12.5% (2,204 patients) underwent thoracoscopic surgery. In 96.6%
of the hospitals a minimal open laparotomy was used. Among the various operations, a cholecystectomy was performed in the
largest number of patients (13,787). The total number of complications was 415 (2.7%), of which 156 (37.6%) were related to
needle or trocar insertion. Visceral injury was found in 22 patients (0.14%): major vessel injury in 10, gastrointestinal
tract injury in 11, and liver injury in one patient. Abdominal wall injury was seen in 79 patients (0.52%), bleeding in 70
(0.46%), and a hernia in 9 (0.06%). Extraperitoneal insufflation occurred in 55 patients (0.36%). There was no mortality.
The complication rate significantly decreased year by year after the use of laparoscopic surgery began.
Conclusions: The most common complications of laparoscopic surgery are related to needle and trocar insertion. These are preventable by
placement under direct vision with verification of the intraperitoneal location of the needle and trocar.
Received: 10 February 1997/Accepted: 22 May 1997 相似文献
7.
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
8.
A case of a coincidental finding of hepatic carcinoid micrometastases, barely visible to the eye, during routine laparoscopic
cholecystectomy is reported. The micrometastases were possibly recognized as a result of a beneficial aspect of laparoscopic
surgery, namely the >10× enlargement of tissue/pathologic structures.
Received: 16 August 1996/Accepted: 28 February 1997 相似文献
9.
Gallbladder cancer (GC) has been reported in 0.3–1.5% of cholecystectomies. Since the introduction of laparoscopic surgery,
cholecystectomies have increased and occult GC may therefore be more frequent. Herein we analyze our own experience to determine
whether there was an increase in GC. We also evaluate the risk factors for this outcome. Four patients with GC undiagnosed
before surgery (four of 602 cases, or 0.66%) were submitted to laparoscopic cholecystectomy. The percentage in patients who
underwent open surgery was 0.28% (two of 714 cases). Without reoperation, three patients died in the laparoscopic group and
one is alive at 12 months. Trocar site metastasis was not observed. Although the percentage of GC (0.28% versus 0.66%) increased,
the percentage is still in the referred average. Undiagnosed GC is on the increase. Examination of the gallbladder and a frozen
section, if necessary, are recommended. Calcified gallbladders, age >70 years, a long history of stones, and a thickened gallbladder
all represent significant risk factors.
Received: 30 July 1997/Accepted: 24 October 1997 相似文献
10.
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
11.
Background: In this paper, we explored a quick and inexpensive method to evaluate the improvement in laparoscopic skills gained by residents
after attending a formal training course in laparoscopy.
Methods: Surgical residents attending an endoscopic workshop were randomly selected to perform tasks in a training simulator. Each
was evaluated qualitatively and quantitatively before and after the workshop. A control group of six residents who did not
attend the workshop were selected to perform the same tasks twice in succession.
Results: The total mean time improvement for all tasks in the study group was 34.3% and in the control group 7.3% (p= 0.0001). When the data was separated for each task, statistically significant improvement was demonstrated in five of the
six tasks.
Conclusions: Residents who attend a formal workshop in endoscopy can gain significant improvement in skills. The methods described in
this study can be used to quantitatively measure this improvement throughout a resident's training.
Received: 4 March 1996/Accepted: 12 August 1996 相似文献
12.
Background: Peritonitis continues to be an important cause of morbidity and mortality and often an etiologic diagnosis is unclear. To
evaluate the efficacy and safety of laparoscopy the authors analyzed their 5-year experience with this modality of treatment.
Methods: A review was made of 107 consecutive nonselected laparoscopic procedures performed between October 1990 and November 1995.
The diagnosis was established by clinical, laboratory, and imaging findings and confirmed by laparoscopy and/or laparotomy.
Results: An etiologic diagnosis was unclear in 35% of the cases and was established in all by laparoscopy; 94 patients (87.9%) were
successfully treated by laparoscopy while 13 (12.1%) required conversion. Mortality was 4.6%; 14% had postoperative complications
and 7.4% had reoperations.
Conclusions: Laparoscopic surgery is safe and very efficient in the diagnosis and treatment of patients with peritonitis. In most instances
a definitive treatment can be carried out without conversion and has the additional and well-known advantages of minimally
invasive surgery.
Received: 15 March 1996/Accepted: 29 August 1996 相似文献
13.
P. M. Hewitt K. H. Kwong W. Y. Lau S. C. S. Chung A. K. C. Li 《Surgical endoscopy》1997,11(10):1032-1033
We report two cases of necrotizing fasciitis following laparoscopic surgery and discuss contributing factors, as well as
treatment of this rare complication.
Received: 26 August 1996/Accepted: 31 December 1996 相似文献
14.
Background: Laparoscopic surgery has not been widely established in developing countries due to the lack of access to training and lack
of money. We describe our experience using on-site training programs to efficiently teach and propagate laparoscopic surgery
in Leon, Nicaragua; La Paz, Bolivia; and Santa Cruz, Bolivia.
Methods: A group of well-trained and motivated local surgeons was identified in each country as the initial target for teaching. Participants
were taught basic and advanced laparoscopic surgery during on-site didactics, animal laboratories, and proctoring sessions.
Follow-up courses were held until the target group of surgeons was capable of independently teaching and supervising laparoscopic
surgery among other surgeons in each country.
Results: Multiple technical and logistic difficulties were encountered. In Leon, Nicaragua, and La Paz, Bolivia, a total of eight
surgeons were fully trained and proctored in laparoscopic cholecystectomy. In La Paz and Santa Cruz, Bolivia, a total of seven
surgeons were instructed in advanced laparoscopic procedures. To date, over 180 patients have undergone laparoscopic cholecystectomy
or advanced procedures with a morbidity similar to that reported in literature series in the United States.
Conclusions: Our experience demonstrates that in spite of numerous limitations, basic and laparoscopic surgery can be efficiently and
safely taught in developing countries. Many lessons were learned in how to safely and efficiently use laparoscopic equipment
and instruments within strict financial constraints.
Received: 20 March 1996/Accepted: 15 May 1996 相似文献
15.
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
16.
Background: Whether or not laparoscopic cholecystectomy may be performed safely as an outpatient procedure is controversial. In 1993,
a protocol for outpatient laparoscopic cholecystectomy was instituted to determine the benefits and safety of discharging
patients within several hours of surgery.
Methods: The initial 60 outpatient laparoscopic cholecystectomies performed by one surgeon in a hospital-based outpatient teaching
facility between February 1993 to June 1996 were prospectively studied.
Results: Fifty-eight (97%) patients were discharged successfully after an average stay in the recovery room of 3 h. There were no
deaths. Two patients required overnight observation and three patients required readmission. Two patients (3%) had cystic
duct leak. The average hospital stay for all patients undergoing laparoscopic cholecystectomy at the institution (inpatient
and outpatient) decreased from 3.2 to 1.5 days and the average hospital cost decreased from $7,800 to $4,600 during this period.
Conclusion: Laparoscopic cholecystectomy in an outpatient setting is safe and cost-effective in healthy patients.
Received: 3 April 1997/Accepted: 10 June 1997 相似文献
17.
Significance of ``hands-on training' in laparoscopic surgery 总被引:2,自引:2,他引:0
Background: The objective of this study is to investigate the role and significance of a hand-on program designed to teach laparoscopic
skills.
Methods: The course consisted of 3 half days. In vitro training in suturing and knot tying was covered on the 1st half day, and live
animal surgery on the 2nd and 3rd half days, respectively. In vitro suturing and knot tying of the 15 course participants
were video-recorded and analyzed four times during the course, basing on the time required to mount a needle in the needle
driver (M), driving the needle in a rubber glove (D), and knot tying (T).
Results: Laparoscopic skills which require two-hand coordination (M,T) were significantly improved by hands-on training. Needle driving
skill appeared to be essentially the same as that needed for open surgery.
Conclusion: Hands-on training is an effective format particularly for laparoscopic skills in which two-hand coordination is essential.
Received: 3 April 1997/Accepted: 3 July 1997 相似文献
18.
Background: The purpose of this study was to evaluate the results of 138 cases of gastroesophageal reflux disease resolved laparoscopically
with the Rossetti modification of the Nissen fundoplication and to compare them with findings from other studies in an effort
to evaluate the procedure's ability to transfer from an academic setting to a community hospital setting.
Methods: We performed laparoscopic Nissen fundoplication on 138 patients and followed them for up to 45 months. Measures included
postoperative reflux persistence, complications, operating time, length of hospital stay, and others. These findings were
compared, using the Fisher's exact test, chi-square test, and the two-sample t-test, with results from other studies using open and laparoscopic procedures.
Results: No patient undergoing laparoscopic fundoplication experienced gastroesophageal reflux after surgery. Complications, not statistically
significantly different from those in other studies, occurred in 15 (10.9%), and conversion to an open procedure was required
in two (1.5%). The most common postoperative complaint has been dysphagia (21.7%). Operative time averaged 70.6 min, decreasing
from an average of 236 min for the first 10 cases to 40.8 min for the last 10. This measure was statistically significantly
lower than all other operative times to which it was compared, except one to which it was almost identical (69.9 min). Length
of stay (LOS) averaged 2.3 days, ranging from a low of 7 h to a high of 9 days, which made it fall well within limits set
by other studies. Overall, LOS fell from a 3.0-day average for the first 20 cases to a 1.9-day average for the last 20 cases.
Conclusions: Laparoscopic Nissen fundoplication resolved gastroesophageal reflux in all 138 patients, and measures for complications,
operating time, and LOS were well within values reported by other studies, indicating the ability of this procedure to be
successfully transferred from academic medical centers to the community hospital setting.
Received: 7 October 1996/Accepted: 14 May 1997 相似文献
19.
Determinants of outcomes in laparoscopic colorectal surgery 总被引:3,自引:3,他引:0
20.
Background: The introduction of laparoscopic techniques—especially that of gastric banding—and the fact that conservative management
does not provide satisfactory long-term results in patients with morbid obesity has resulted in a marked increase in the demand
for bariatric surgery in our department since 1995. In this paper, we present our experience during the first 3 years with
this approach.
Methods: Data for all patients who had bariatric surgery at our institution were collected prospectively. They were analyzed for the
purpose of this study.
Results: A total of 150 patients were operated on between December 1995 and December 1998 (37 months). There were 130 women and 20
men, with a mean age of 37.5 years (range, 19–62). The mean initial excess body weight was 102.9% (range, 58–191%), and the
mean initial body mass index (BMI) was 44.6 kg/m2 (range, 35.1–64.1). A Lapband was used in 101 cases and a SAGB in 47 cases. In two patients in whom conversion was necessary,
we performed a vertical banded gastroplasty. Duration of surgery decreased over time from 210 min (first 20 cases) to 73 min
(last 20 cases). Six patients (4%) developed major complications, one of whom died. The median duration of postoperative hospital
stay was 3 days. The mean follow-up was 17 months. In all, 24 patients (16%) developed late complications, and 22 (14.6%)
required reoperation, mainly for band slippage and/or pouch dilatation (14 cases). An incorrect surgical technique used for
the first 30 patients (Lapband within the lesser sac) was responsible for more than half of these complications. The mean
excess weight loss was 34% at 6 months, 55% at 1 year, and 56% at 2 years. Compared to vertical banded gastroplasty (197 cases
between 1981 and 1995), postoperative morbidity was greatly decreased, late morbidity was similar, and weight loss was equivalent.
Conclusions: Laparoscopic gastric banding is followed by a weight reduction that is similar to that observed after vertical banded gastroplasty,
with a much lower postoperative morbidity, a shorter hospital stay, and an earlier resumption of normal activities. If these
results can be confirmed by long-term follow-up, laparoscopic gastric banding will be confirmed as the restrictive procedure
of choice for morbid obesity.
Received: 20 July 1999/Accepted: 16 December 1999/Online publication: 8 May 2000 相似文献