腹腔镜手术在妇科急诊中的应用

目的 探讨腹腔镜手术在妇科急诊中的应用。方法 回顾分析我院1997年5月～2001年8月145例妇科急诊腹腔镜手术，并将145例中100例输卵管妊娠腹腔镜手术(腹腔镜组)与我院19994年1月～1997年4月89例开腹输卵管妊娠手术(开腹组)进行比较。结果 145例妇科急诊腹腔镜手术中，139例(95．9％)顺利完成手术，6例中转开腹。腹腔镜组输卵管开窗术与开腹组相比较，手术时间明显延长(t＝3．9，P＝0．000)，术中出血量明显增量(t＝5．81，P＝0．000)。结论腹腔镜手术在妇科急诊中有诊断和治疗双重作用，是一种安全、可靠的治疗方法，但是急诊腹腔镜手术最好选择输卵管切除。     

Deep venous thrombosis after emergency gastrointestinal operations: a pilot study.

In a prospective pilot study, 30 patients over 50 years of age undergoing major emergency gastrointestinal surgery were examined with the 125I-fibrinogen uptake test for postoperative deep venous thrombosis (DVT). Prophylaxis against thrombosis was at that time not used routinely for the emergency patients. The surgeon decided for each patient whether and when prophylaxis with low-dose heparin, 5,000 units twice daily, should be given. DVT was diagnosed in 11 patients (37%; 95% confidence interval 20 to 56%), in five of them bilaterally. No thrombi occurred within seven days in the patients who received low-dose heparin from the day of surgery. Major emergency gastrointestinal surgery carries a high risk of postoperative DVT.     

Relaparotomies: Why is Mortality Higher?

Background:   

Relaparotomy is sometimes required for complications that develop after abdominal surgery, but it is associated with high mortality. We aimed to investigate the independent risk factors related to mortality in patients that undergo relaparotomies.     

Benefit of emergency haemorrhoidectomy: a comparison with results after elective operations.

OBJECTIVE: To compare the outcome of emergency and elective haemorrhoidectomy. DESIGN: Retrospective study. SETTING: Teaching hospital, Belgium. SUBJECT: 104 patients who had haemorrhoidectomy for acutely ulcerated or strangulated haemorrhoids, and 545 who had elective haemorrhoidectomy. RESULTS: Early complications (26/104, 25%), reoperation (7/104, 7%) and late anal stenosis (7/104, 7%) were more common after emergency than elective haemorrhoidectomy, for which the corresponding figures were 74/545 (3.6%), 9 (1.7%) and 1/545 (0.2%). Late outcome was similar for the two groups. CONCLUSIONS: Emergency haemorrhoidectomy is indicated for the treatment of the acute complications of haemorrhoids.     

Laparoscopic operations in emergency surgery]

582 laparoscopic operations for various urgent diseases of the organs of abdominal cavity were made. 190 of them were performed for acute appendicitis, 266--for acute cholecystitis and its complications, 33--for pancreonecrosis, 39--for perforated gastro-duodenal ulcers, 32--for acute bowel obstruction and 22--for other pathological conditions. The necessity of conversion to conventional open surgery has arose in 41 (7.0%) patients. Intraoperative complications were detected in 7 (1.3%) patients. Postoperative complications developed in 18 (3.3%) patients. 2 patients (0.4%) died. The obtained results of treatment made it possible to recommend laparoscopic operations in acute abdominal diseases.     

Implications of emergency operations on the colon

The records of 137 patients undergoing elective colonic operations and 45 patients requiring emergency large bowel operations were reviewed. The mortality rate was 37.8 percent after emergency operations compared with 5.1 percent after elective operations (p less than 0.001). Patient age was not a significant prognostic variable although physiologic status of the patient had a high correlation with both morbidity and mortality. Complications followed 86.7 percent of the emergency operations and 57.7 percent of the elective operations (p less than 0.001). Respiratory failure, renal and hepatic dysfunction, and cardiac events more frequently followed emergency colonic operations. Intraabdominal complications developed after 57.8 percent of the emergency operations compared with 29.9 percent of the elective operations (p less than 0.005). Colonic resection and primary anastomosis in the elective setting was associated with a 7.9 percent mortality rate. A large bowel anastomosis during an emergency operation resulted in a 70 percent mortality rate (p less than 0.001). When emergency colonic operation included creation of a colostomy the mortality rate was 34.4 percent. Although this mortality rate was substantial, it was significantly better than the 70 percent rate that followed attempted anastomosis under unfavorable circumstances (p less than 0.02).     

Combined simultaneous operations in emergency surgery and gynecology

Results of 927 simultaneous urgent operations performed on account of associated surgical and gynaecological pathology were analyzed. Urgent combined operations on account of acute gastrointestinal diseases and concomitant gynaecological pathology, independently of a primary cause, are advisable and justified. Non-eliminated concomitant disease or deferred second operation can lead to complications. The V (extreme) stage of operative risk can be the contraindication to the simultaneous combined surgery.     

Use of central analgesia in emergency abdominal operations

In 48 patients urgent operative interventions on organs of the abdominal cavity were performed against the background of the adequate central analgesia by phentanyl (0,02 mg/kg). The authors think the method to be inexpedient in operative interventions shorter than 60 min.     

APACHE II in emergency operations for perforated ulcers

Most reports concerning the management of patients with perforated peptic ulcers suffer from inadequate documentation of the severity of illness and the operative risk of these patients. This study attempts to evaluate the prognostic value of the APACHE II scoring system in a homogeneous group of patients with perforated peptide ulcers, to assess it as a potential clinical and research tool for future studies, and to examine its usefulness in stratifying these patients according to their surgical risk. Our results confirm the prognostic value of the APACHE II scoring system, measured either retrospectively or prospectively, in patients who undergo emergency operations for perforated ulcers. When measured preoperatively, it accurately stratifies these patients to various risk groups and should therefore be used in future trials examining various treatment aspects of this condition. Our data, evaluating the results of various procedures in subgroups of patients stratified by the APACHE II, failed to support the superiority of one approach over another.     

Secondary operations after replantations

Summary 77 Secondary operations after 72 replantations of completely amputated parts of the body in 54 patients are analysed. These operations have been carried out over a period of five years from 1974 to 1979 at the Department of Plastic and Reconstructive Surgery of the 2^nd Surgical University Hospital of Vienna. In assessing the distribution of secondary operations after replantations a distinction between early and late secondary operations is of considerable value. This paper presents a survey of the operations performed as well as two significant cases with several secondary surgical interventions.Paper presented at the 15th Annual Meeting of the Swiss Society of Plastic and Reconstructive Surgery held jointly with the 17th Meeting of the Austrian Society of Plastic and Reconstructive Surgery in Lucerne, Switzerland