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1.
Gluteus Augmentation with Fat Grafting 总被引:3,自引:0,他引:3
This study presents the authors' experience with gluteus augmentation with autologus fat grafts and liposuction methods,
having recorded the evolution of gluteus reshaping with autologus intramuscular fat graft injections for the past 5 years.
Preoperative shape is discussed and patient evaluations, operative techniques, postoperative management, and long-term results
are emphasized. 相似文献
2.
Lipocontouring the arm has a lower degree of patient satisfaction compared to other regions since untoward sequelae such
as sagging and wrinkled skin may result. Circumferential para-Axillary Superficial Tumescent (CAST) liposuction was offered as an alternative to traditional arm liposuction or brachioplasty to 59 patients.
Fifty-three of 59 patients (89.9%) were satisfied or very satisfied with the procedure; six patients (10.2%) requested secondary
procedures; four, further liposuction (6.8%); two, brachioplasty (3.4%). Although temporary untoward sequelae (15.3%) and
minor complications (8.5%) were not infrequent and more vigorous postoperative care necessary, the final aesthetic result
was rarely compromised and patient satisfaction was high. 相似文献
3.
Background: Between February 1995 and June 1998, 30 laparoscopic Duhamel pull-through procedures were performed in our department.
Methods: Our main aim was to prove the feasibility of the laparoscopic abdominal Duhamel procedure for different localizations of
Hirschsprung disease. We used one camera port and three working ports. The sigmoid colon and posterior rectum were mobilized
laparoscopically. A standard posterior colo-anal anastomosis was fashioned and a stapler was used for the anterior anastomosis.
The top of the rectum was then closed by endo stapler under laparoscopic vision.
Results: Thirty patients underwent laparoscopic surgery for this procedure. Three laparoscopic procedures were converted because of
technical difficulties. The operative time was 100–330 mn. Oral feeding was started at a mean postoperative time of 2.5 days.
Mean postoperative hospitalization was 9 days. Early postoperative complications included 1 anastomotic leak, 1 retrorectal
abscess, 2 urinary infections, and 1 evisceration (after conversion). No enterocolitis or enterocolitis-like symptoms were
noted. All patients now have daily spontaneous bowel movements.
Conclusion: The laparoscopic Duhamel procedure can be performed safely, giving good results.
Received: 6 November 1998/Accepted: 12 February 1999 相似文献
4.
Microlaparoscopic cholecystectomy 总被引:11,自引:4,他引:7
Background: We set out to compare a prospective evaluation of microlaparoscopic cholesystectomy (MLC) using 5-mm ports for the scope
and operating ports and two 2-mm ports for retracting to the historic results of standard laparoscopic cholecystectomy (SLC).
Methods: Fifty-six consecutive patients were operated electively for symptomatic gallstones between June 1997 and July 1998. Demographics,
history of prior abdominal surgery, operative time, resident level, need to convert, length of stay, and postoperative analgesia
were recorded for each case. In all, 43 women and 13 men aged 21 to 89 (average, 51 years) underwent MLC. Average weight was
78 kg (range, 48–119) and average height was 163 cm.
Results: Operative time for MLC was 72 ± 25 min (range, 35–140), somewhat less than the referenced standard of 79 ± 27 min (p= 0.1). The skin-to-trocar time (6 ± 2 vs 13 ± 77 min) and intraoperative cholangiogram time (9 ± 8 vs 11 ± 6 min) were significantly
shorter (p < 0.01 and p < 0.05, respectively) for MLC. Other partial times were not significantly different. PGY2 residents averaged 74 ± 21 min
(range, 44–118) compared to 75 ± 27 min (range, 35–140) for PGY3 and 53 ± 5 (range, 43–59) for PGY5. Patient weight influenced
time. Patients <65 kg averaged 56 ± 12 min; 66–80 kg, 72 ± 24 min; 81–95 kg, 78 ± 26 min; and >95 kg, 85 ± 22 min. Previous
abdominal surgery did not affect operative time. Nine patients (16%) required conversion from 2- to 5-mm ports because of
adhesions, wall thickening, or need for better retraction. Time in these patients was 95 ± 26 min vs 68 ± 21 min in other
patients (p < 0.01). No patient was converted to an open procedure. Three patients (5%) had a positive cholangiogram and common bile
duct exploration that required placement of an extra 5-mm trocar. Five patients (9%) required insertion of an additional 2-mm
port. All patients received patient-controlled analgesia (PCA). Morphine use was 0.21 ± 0.19 mg/kg (range, 0–0.8). Hospital
stay was 1.31 days (range, 0.5–4). Subjective satisfaction was excellent because of smaller incisions. No additional morbidity
was seen with MLC.
Conclusion: MLC is a feasible and safe approach that provides similar times to SLC with better cosmesis, a less painful recovery, and
possibly an earlier return to normal activity.
Received: 16 February 1999/Accepted: 8 October 1999 相似文献
5.
H. Spivak I. Nudelman V. Fuco M. Rubin P. Raz A. Peri S. Lelcuk L. A. Eidelman 《Surgical endoscopy》1999,13(10):1026-1029
Background: Laparoscopic repair of inguinal hernia is traditionally performed under general anesthesia mainly because of the adverse
effects that carbon dioxide pneumoperitoneum has on awake patients. Since a mandatory use of general anesthesia for all hernia
repairs is questionable, the feasibility of laparoscopic extraperitoneal herniorraphy using spinal anesthesia combined with
nitrous oxide insufflation was investigated.
Methods: Over a 4-month period, February to May 1998, we performed 35 consecutive total extraperitoneal inguinal hernia procedures
(24 unilateral, 11 bilateral) using spinal anesthesia and nitrous oxide extraperitoneal gas. Data on operative findings, self-reported
operative and postoperative pain and discomfort (visual analog pain scale), procedure-related hemodynamics, and complications
were collected prospectively.
Results: All 35 procedures were completed laparoscopically without the need to convert to general anesthesia. Mean operative time
was 39 ± 7 min for unilateral hernia and 65 ± 10 min for bilateral hernia. Incidental peritoneal tears occurred in 22 patients
(63%) resulting in nitrous oxide pneumoperitoneum, which was well tolerated. The patients remained hemodynamically stable
throughout the procedure, and operative conditions and visibility were excellent. Complications at a mean of 4 months after
the procedure included seven uninfected seromas (20%), three patients with transient testicular pain, and one (3%) recurrence.
Conclusions: Laparoscopic total extraperitoneal hernia repair can be safely and comfortably performed using spinal anesthesia with extraperitoneal
nitrous oxide insufflation gas. This method provides a good alternative to general anesthesia.
Received: 17 February 1999/Accepted: 1 July 1999 相似文献
6.
Laparoscopic gastric banding for morbid obesity 总被引:3,自引:1,他引:2
Background: Morbid obesity occurs in 2–5% of the population of Europe, Australia, and the United States and is becoming more common.
Open surgical techniques, such as vertical banded gastroplasty and other divisional procedures in the stomach, have led to
long-term weight reduction as well as an amelioration of the attendant medical problems in approximately two-thirds of patients.
Materials and methods: A total of 335 patients with a median age of 41 years underwent gastric banding. We emphasized the need for long-term maintenance
and follow-up. The indications for surgery comprised a body mass index >35, a stated desire to undergo the procedure, and
a full understanding of all possible complications.
Results: All patients have needed band adjustments of 1–4 ml over the course of their follow-up. No patient had increased his or her
weight during the follow-up, and only three patients have not enjoyed sustained weight loss.
Conclusions: Laparoscopic gastric banding has much to recommend it. Certainly in the short term, its results in terms of effectiveness
of weight loss are at least as good as those of any open procedure. Longer follow-up will show whether this weight loss is
maintainable. The procedure is technically demanding, and the major prerequisite of satisfactory performance of this surgery
is laparoscopic experience.
Received: 12 May 1998/Accepted: 12 February 1999 相似文献
7.
The aging female with excess arm fat and poor skin tone frequently refuses a brachioplasty scar due to permanent detectability.
Traditional deep liposuction localized to the posterolateral aspect of the arm frequently leaves sagging, wrinkled skin. Circumferential para-Axillary Superficial Tumescent (CAST) liposuction was developed to maximize skin retraction and create regional harmony by preparatory compartment
magnification with dilute lidocaine and epinephrine followed by circumferential treatment of the arm and adjacent areas utilizing
superficial and/or subdermal liposuction. Early CAST liposuction results in patients with moderate fat and excess skin revealed
excellent skin retraction. CAST liposuction was then offered as the first of two stages to patients with excess fat and poor
skin tone to avoid or shorten the brachioplasty scar. Twenty-six patients underwent CAST liposuction with 9–22 months follow
up. Only two patients (7.7%) eventually required brachioplasty. Although postoperative seromas were frequent (38.5%) and preexisting
skin wrinkling usually returned, the final result is acceptable to the vast majority of patients (84.6%) who refuse a brachioplasty
scar. 相似文献
8.
Background: During a 4-year period, 240 gastrostomy buttons were placed in children, as the initial surgical feeding tube, using laparoscopic
techniques.
Materials and methods: The technique requires the use of a minilaparoscope (1.6-mm) and a single 5-mm trocar placed at the exit site for the gastrostomy
button. It can also be performed in addition to a laparoscopic fundoplication using the same trocar sites. The technique requires
no special instrumentation or kits. When performed alone, operative times average 15 min. When performed with fundoplication,
it adds ∼5–10 min to the time for the procedure.
Results: There were no intraoperative complications and five (2.1%) postoperative complications.
Conclusions: This technique has proven to be simple and effective. It allows primary placement of a gastrostomy button that is cosmetically
and functionally superior to a gastrostomy tube.
Received: 11 February 1999/Accepted: 27 April 1999 相似文献
9.
Laparoscopic vs open colectomy for sigmoid diverticulitis 总被引:3,自引:0,他引:3
Tuech JJ Pessaux P Rouge C Regenet N Bergamaschi R Arnaud JP 《Surgical endoscopy》2000,14(11):1031-1033
Background: The aim of this prospective comparative study was to assess the outcome of laparoscopic and open colectomy for sigmoid diverticulitis
in patients aged ≥75 years.
Methods: From January 1993 to December 1998, all patients 75 years of age and older undergoing an elective colectomy for sigmoid diverticulitis
were included in the study. The patients were divided into the following two groups: group 1 (n= 22) consisted of patients who underwent a laparoscopic procedure; group 2 (n= 24) consisted of patients who underwent an open procedure.
Results: In group 1, there were 12 women and 10 men with a mean age of 77.2 years (range, 75–82); in group 2, there were 14 women
and 10 men with a mean age of 78 years (range, 76–84) (p= 0.37). There was no difference between the groups in ASA classification. The operative time was shorter in group 2 (136
vs 234 mins). The postoperative period during which parenteral analgesics were required (5.4 vs 8.2 days, p= 0.001), postoperative morbidity (18% vs 50%, p= 0.02), postoperative length of hospital stay (13.1 vs 20.2 days, p= 0.003), and the inpatient rehabilitation (6 vs 15 patients, p= 0.01) were significantly shorter for group 1 than for group 2. There were no perioperative deaths. The conversion rate was
9% in group 1.
Conclusion: The data from the present study suggest that laparoscopic colectomy for sigmoid diverticulitis can be applied safely to older
patients with fewer complication, less pain, shorter hospital stay, and a more rapid return to preoperative activity levels
than that seen with open colorectal resection.
Received: 22 November 2000/Accepted: 22 February 2000/Online publication: 7 September 2000 相似文献
10.
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
11.
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
12.
Laparoscopic Nissen fundoplication for the treatment of gastroesophageal reflux disease (GERD) 总被引:1,自引:0,他引:1
D. L. van der Peet E. C. Klinkenberg-Knol Q. A. J. Eijsbouts M. van den Berg L. M. de Brauw M. A. Cuesta 《Surgical endoscopy》1998,12(9):1159-1163
Background: A prospective study was conducted to evaluate the physiologic and clinical consequences of laparoscopic Nissen fundoplication
(LNF), using strict indications for surgery.
Methods: From 1992 to 1997, 50 patients underwent LNF. Indications for operative treatment were either failure of conservative treatment
or foresight to see long-term use of strong acid suppressive therapy. Patients were evaluated by barium esophagogastric study
(BES), esophagoscopy, 24-h pH monitoring (pHM), stationary esophageal manometry, gastric-emptying studies (GES), pancreatic
polypeptide stimulation test (PPT) and clinical evaluation using questionnaires.
Results: Perioperative complications necessitated conversion to laparatomy in two cases, and there was no mortality. Severe dysphagia
resulted in reoperation in two patients. The average maximum lower esophageal sphincter pressure (MLESP) increased from 6.1
mmHg to 12.7 mmHg. Endoscopy showed improved grading of the esophagitis, and the total percentage of pH less than 4 during
24 h decreased from a mean of 9.2 to 0.95. Three patients demonstrated impaired PPTs postoperatively; two had (mild) diarrhea.
The overall success rate after the operation was 90%.
Conclusions: The results of LNF in a limited number of patients with severe and/or resistant gastroesophageal reflux disease (GERD) receiving
continuous medical treatment with proton pump inhibitors (PPIs) on a maintenance base are comparable with LNF results in centers
with a more liberal policy concerning indications for LNF surgery.
Received: 15 September 1997/Accepted: 12 October 1997 相似文献
13.
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
14.
Laparoscopic renal surgery usually involves the use of five or six trocars. This report concerns the authors' technique for
performing such surgery through only three trocars. Semilateral patient positioning, along with additional table rotation,
is utilized to facilitate visceral rotation and optimize exposure of the kidney. Four laparoscopic renal procedures were performed:
one renal cyst decortication and three upper pole partial nephrectomies with ureterectomies for duplications of the collecting
system. Mean operative time was 148 min with no conversions; there were no intra- or postoperative complications. All patients
tolerated a liquid diet on postoperative day 1, and the median hospital stay was 2 days. In selected cases laparoscopic renal
surgery may be approached safety through three trocars.
Received: 29 March 1996/Accepted: 1 July 1996 相似文献
15.
Background: Experience with 94 resections in 88 patients with Crohn's disease using advanced laparoscopic techniques is reported. Records
of patients who underwent intestinal resection for Crohn's disease between August, 1993 and November, 1998 were reviewed.
Indications, operative findings, clinicopathologic, and postoperative data were recorded.
Methods: In this study, the mean age was 37 years (range, 16–70 years), and 55% of the participants were women. Indications for surgery
included obstruction (64 cases), pain (22 cases), peritonitis (1 case) and abscess (1 case). Seventy patients underwent ileocolic
resection, 28 of whom had a previous history of one or two ileocolic resections. Eight of these patients had additional procedures
including tubal ligation (1), sigmoidectomy (1), cholecystectomy (3 cases), and enterectomy (3 cases). Small bowel resection
(13 cases), right hemicolectomy (3 cases), subtotal colectomy (3 cases), anterior rectal resection (2 cases), and sigmoid
resection (3 cases) were performed in the remaining patients. All but one procedure were completed laparoscopically with extracorporeal
anastomosis. The average length of intestine resected was 33 cm (range, 10–92 cm). Forty-one patients had 58 fistulae between
ileum, jejunum, mesentery, colon, abdominal wall, skin, or bladder. Mean blood loss was 168 ml (range, 30–800 ml) and mean
operative time was 183 min (range, 96–400 min).
Results: More than 85% of the patients were tolerating a liquid diet on the first postoperative day. Average length of hospital stay
was 4.2 days (range, 3–11 days). Complications included anastomotic leak necessitating reoperation, stricture requiring endoscopic
dilation, hemorrhage treated expectantly, urinary tract infection, pulmonary embolus, line sepsis, and early postoperative
intestinal obstruction (7 cases) requiring reoperation in three cases.
Conclusions: Experience with both advanced laparoscopic techniques and conventional surgery for inflammatory bowel disease allowed successful
laparoscopic management of patients with complicated Crohn's disease.
Received: 29 August 1998/Accepted: 22 January 1999 相似文献
16.
Randomized comparison between low-pressure laparoscopic cholecystectomy and gasless laparoscopic cholecystectomy 总被引:5,自引:2,他引:3
A. Vezakis D. Davides J. S. Gibson M. R. Moore H. Shah M. Larvin M. J. McMahon 《Surgical endoscopy》1999,13(9):890-893
Background: Laparoscopic cholecystectomy using low-pressure pneumoperitoneum (8 mmHg) minimizes adverse hemodynamic effects, reduces
postoperative pain, and accelerates recovery. Similar claims are made for gasless laparoscopy using abdominal wall lifting.
The aim of this study was to compare gasless laparoscopic cholecystectomy to low-pressure cholecystectomy with respect to
postoperative pain and recovery.
Methods: Thirty-six patients were randomized to low-pressure or gasless laparoscopic cholecystectomy using a subcutaneous lifting
system (Laparotenser).
Results: The characteristics of the patients were similar in the two groups. The procedure was completed in all patients in the low-pressure
group, but two patients in the gasless group were converted to pneumoperitoneum. There were no significant differences in
postoperative pain and analgesic consumption, but patients in the gasless group developed shoulder pain more frequently (50%
vs 11%, p < 0.05). Gasless operation took longer to perform (95 vs 72.5 min, p= 0.01).
Conclusions: Gasless and low-pressure laparoscopic cholecystectomy were similar with respect to postoperative pain and recovery. The gasless
technique provided inferior exposure and the operation took longer, but the technique may still have value in high-risk patients
with cardiorespiratory disease.
Received: 10 August 1998/Accepted: 12 February 1999 相似文献
17.
Background
The laparoscopic management of tubo-ovarian abscesses (TOA) was evaluated. The study sought to answer the following question: Does operative laparoscopy with only incision of the abscess cavity and lavage (organpreserving treatment) improve intraoperative and postoperative safety and long-term prospects of fertility as compared with laparoscopic salpingectomy or salpingo-oophorectomy (ablative treatment)?Methods
A retrospective chart review of 60 patients with TOA undergoing laparoscopic treatment in combination with broad-spectrum antibiotics from 1994 to 1998 was performed. Patients not wishing to have children underwent salpingectomy or salpingo-oophorectomy, whereas patients wishing to remain fertile were treated by means of an organpreserving procedure. To investigate the operative and reproductive outcome, patients were interviewed by telephone.Results
Of 60 women with TOA, 25 were treated laparoscopically, preserving the internal genital organs, and 35 underwent ablative treatment. Apart from one postoperative readmission because of lower pelvic pain in the organpreserving group, there were no operative complications or serious systemic sequelae. In contrast, there was a significantly higher incidence of intraoperative and postoperative complications when ablative treatment was performed: one intestinal perforation requiring subsequent laparotomy, four serosal lesions, two lesions of the greater omentum, two lacerated collaterals of the internal iliac artery, one postoperative fever higher than 38°C for 2 days, two bowel obstructions, one thrombosis of the upper leg, and one thrombosis of the lower leg. There were no significant differences between the two patient groups in body mass index, duration of pelvic pain, laboratory findings at admission, ultrasonic assessment of abscess size, and the extent of the abscess at laparoscopy.Conclusions
When laparoscopic treatment of TOA is performed, organ-preserving treatment should be chosen irrespective of the patient’s age or desire to have children because of the risk of complications. 相似文献18.
Background: Ventriculoperitoneal (VP) shunting remains the preferred treatment for hydrocephalus. Laparoscopic techniques to aid in the
placement of the peritoneal portion of the catheter have been reported previously. We describe a minilaparoscopic VP shunt
(MLVPS) insertion technique that facilitates directed placement of the peritoneal portion of the catheter in most patients,
including those with obese abdomens previously subjected to surgery. In this study we review our experience with MLVPS placement.
Methods: All cases of MLVPS insertions at the University of Kentucky Medical Center and Lexington VA Hospital performed between February
1998 and March 1999 were reviewed retrospectively. A total of 27 patients (13 males and 14 females) ranging in age from 4
to 81 years (mean, 41 years) underwent VP shunting. The MLVPS insertion was performed via a 2-mm laparoscope and a separate
2-mm incision for catheter insertion using a venous introducer kit. In patients who had prior abdominal surgery, a 5-mm direct-view
trocar was used.
Results: The MLVPS procedure was successful in 27 patients (100%). The mean number of prior shunts was 2 (range, 0–28). Of the 27
patients, 16 (59%) had undergone previous abdominal surgery. The mean operative time was 76 min (range, 19–155 min). There
were no intra- or postoperative complications, and no mortalities. The follow-up period extended from 1 to 12 months.
Conclusions: Findings show MLVPS placement to be safe and feasible. It allows accurate, directed placement of the VP shunt with a 2-mm
laparoscope and a second 2-mm incision for shunt insertion. The procedure is associated with reduced trauma to the abdominal
wall and minimal postoperative ileus. Long-term follow-up assessment of shunt function is planned.
Received: 30 April 1999/Accepted: 27 October 1999/Online publication: 17 May 2000 相似文献
19.
Background: The abdominal route is the traditional method of performing hysterectomy with bilateral salpingo-oophorectomy. In a feasibility
study, we compared a nonconventional (vaginal) route for bilateral salpingo-oophorectomy at the time of vaginal hysterectomy
(VH + BSO) to similar forms of hysterectomy performed abdominally or with operative laparoscopy.
Methods: Fifty-nine patients were subject to either total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO; n= 19), or laparoscopic-assisted vaginal hysterectomy and bilateral salpingo-oophorectomy (LAVH + BSO; n= 19) or VH + BSO (n= 21).
Results: VH + BSO resulted in a shorter operating time compared to LAVH + BSO (p < 0.001), shorter hospital stay compared with TAH + BSO (p= 0.001), and quicker long-term recovery compared to the other two operations.
Conclusion: This preliminary but significant study shows that the vaginal route for salpingo-oophorectomy at the time of vaginal hysterectomy
is superior to other methods of hysterectomy. A randomized trial is needed to confirm these initial findings.
Received: 20 February 1998/Accepted: 18 August 1998 相似文献
20.
S. S. Rothenberg D. Bratton G. Larsen R. Deterding H. Milgrom S. Brugman M. Boguniewicz S. Copenhaver C. White J. Wagener L. Fan J. Chang T. Stathos 《Surgical endoscopy》1997,11(11):1088-1090
Background: The relationship between severe reactive airway disease (RAD) and gastroesophageal reflux disease (GERD) has been noted but
the relationship is poorly understood. This study reports our experience with laparoscopic fundoplication and it's effect
on the pulmonary status of children with severe steroid-dependent reactive airway disease.
Methods: Fifty-six patients with severe steroid-dependent RAD and medically refractory GERD underwent laparoscopic Nissen fundoplications.
Mean age was 7 years and mean weight was 20 kg. All patients had the procedure completed successfully laparoscopically with
an average operative time of 62 min. Average hospital stay was 1.6 days.
Results: Forty-eight of 56 patients noted significant improvement in their respiratory symptoms in the first week. Fifty of 56 patients
have been weaned off their oral steroids and four others have had a greater than 50% decrease in their dose. Sixteen patients
had a documented increase in their FEV1 in the initial postoperative period (avg. 26%).
Conclusion: Patients with steroid-dependent RAD and GERD refractory to medical management show improvement in their respiratory status
following fundoplication and the majority can be weaned off of their oral steroids. Laparoscopic techniques allow this procedure
to be performed safely even in this high-risk group of patients.
Received: 25 March 1997/Accepted: 5 July 1997 相似文献