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1.
Laparoscopic vs open repair of gastric perforation and abdominal lavage of associated peritonitis in pigs 总被引:3,自引:2,他引:1
C. Bloechle A. Emmermann T. Strate U. J. Scheurlen C. Schneider E. Achilles M. Wolf D. Mack C. Zornig C. E. Broelsch 《Surgical endoscopy》1998,12(3):212-218
Background: Laparoscopy is increasingly used in conditions complicated by peritonitis, e.g., peptic ulcer perforation. Of some theoretical
concern is the capnoperitoneum, which may aggravate peritonitis and induce septic shock due to increased intraabdominal pressure
and distension of the peritoneum. This animal study was devised to analyze the effectiveness of laparoscopic versus traditional
open repair of gastric perforation and abdominal lavage for associated peritonitis.
Methods: To simulate gastric perforation, female Duroc pigs were subjects to standardized gastrotomy. Either 6 or 12 h after gastric
perforation, the animals underwent either traditional open or laparoscopic repair of the gastric defect and peritoneal lavage.
The subjects were divided into the following four groups: peritonitis for 6 h and open surgery (group I) or laparoscopic surgery
(group II); peritonitis for 12 h and open surgery (group III) or laparoscopic surgery (group IV). After an observation period
of 6 days, the surviving animals were killed. The main outcome criteria were survival, perioperative changes of hemodynamics
suggestive for septic shock, bacteremia, and endotoxemia.
Results: There were no significant differences between group I and II. Mortality was 22% in group III, as compared to 78% in group
IV (p= 0.045). In group IV, the incidence of perioperative bacteremia and plasma endotoxin concentrations were significantly higher
than in group III. Concomitantly, decreased mean arterial pressure and systemic vascular resistance, and increased cardiac
output suggested a higher incidence of septic shock in group IV.
Conclusion: Critical appraisal of laparoscopic surgery is warranted in conditions associated with severe, longstanding peritonitis.
Received: 28 February 1997/Accepted: 1 July 1997 相似文献
2.
C. Balagué E. M. Targarona M. Pujol X. Filella J. J. Espert M. Trias 《Surgical endoscopy》1999,13(8):792-796
Background: Laparoscopic surgery has a lower incidence of surgical infection than open surgery. Differential factors that may modify
the bacterial biology and explain this finding to some extent include CO2 atmosphere, less desiccation of intraabdominal structures, fewer temperature changes, and a better preserved peritoneal and
systemic immune response. Previous data suggest that the immune response and acute phase response are better preserved after
laparoscopy. Therefore, we designed a study to evaluate the early peritoneal response to sepsis in an experimental peritonitis
model comparing open surgery with CO2 and abdominal wall lift laparoscopy.
Methods: The study subjects comprised 360 mice distributed into the following four groups: group 1, n= 72 (controls); group 2, n= 96 (open surgery), 2–3 cm laparotomy, with abdominal cavity exposed to the air for 30 min; group 3, n= 96, CO2 laparoscopy (5 mmHg pneumoperitoneum) for 30 min; group 4, n= 96, wall lift laparoscopy for 30 min. Intraabdominal contamination in the four groups was induced with 1 ml of E. coli suspension (1 × 104 CFU/ml) 10 min before abdomen closure. Peritoneal fluid and blood samples were obtained 1.5, 3, 24, and 72 h after surgery,
and TNF, IL-1, and IL-6 were measured (via ELISA), as well as quantitative culture.
Results: The number of CFU (colony-forming units) obtained in peritoneal fluid and positive blood culture rates were significantly
lower in the laparoscopic groups than in the open group. IL-1 peritoneal levels were significantly lower after 24 h and 72
h in the laparoscopy groups. IL-6 levels decreased sharply in the laparoscopy groups at 24 h and 72 h. There were no differences
between the two types of laparoscopy models (CO2 and wall lift).
Conclusions: Peritoneal response to sepsis is better preserved after laparoscopy than after open surgery. CO2 does not seem to influence bacterial growth. According to these findings, laparoscopy entails less local trauma and better
preserved intraabdominal conditions.
Received: 29 June 1998/Accepted: 25 August 1998 相似文献
3.
Effect of CO2 insufflation on bacteremia and bacterial translocation in an animal model of peritonitis 总被引:4,自引:0,他引:4
Background: The widespread adoption of the laparoscopic approach has created some concern over the potential for increased risk of bacteremia
and sepsis due to increased intraabdominal pressure in patients with intraabdominal infection and peritonitis. This study
examines the effect of the CO2 pneumoperitoneum on bacteremia and bacterial translocation.
Methods: New Zealand white rabbits were assigned into three groups of 10 animals. In group 1, 100 ml of sterile saline was infused
into the peritoneal cavity under 10 mmHg CO2 insufflation for 1 h. Group 2 received 100 ml of saline containing 109 CFU/ml (colony-forming units) E. coli strain 0163 and 10 mmHg CO2 insufflation for 1 h. Group 3 received an identical bacterial inoculum, followed by a 10-cm midline laparotomy. Blood samples
were taken for culture by cardiac puncture at various intervals during the experiment. At 6 h after being subjected to the
experimental procedures, the rabbits were killed and their organs were cultured quantitatively for translocating bacteria.
Results: In group 1, neither blood nor organ cultures were positive, whereas in group 2 all blood cultures became positive in 1 h,
and intraperitoneally infused bacteria translocated to the lung and kidney in all rabbits. In group 3, blood cultures became
positive in 1 h, all but two of the rabbits had translocated bacteria in their lungs, and kidney samples from two of the rabbits
were culture-positive.
Conclusions: Our results indicate that both CO2 pneumoperitoneum and laparotomy increase the incidence of bacterial translocation from the peritoneal cavity into the bloodstream.
Thus, the risk of translocation to extraperitoneal organs such as lung and kidney is increased significantly by laparoscopy.
Therefore, laparoscopic surgery should be avoided or used cautiously in the setting of acute peritonitis. 相似文献
4.
Background: In order to better investigate the effects of laparoscopic surgery, it is necessary to establish reliable, reproducible,
and economical animal models of laparoscopic intervention. Here we describe a mouse model of laparoscopic-assisted colon resection.
Methods: After successful induction of anesthesia the mouse is placed in Trendelenburg position and the peritoneal cavity is insufflated
with carbon dioxide gas through an angiocatheter placed in the right upper quadrant. A 4-mm rigid scope with camera attachment
is then inserted through a midline port created just caudal to the xiphoid. A second port is then created in the right lower
quadrant to allow introduction of laparoscopic forceps into the peritoneal cavity. The cecum, which extends 1.5 cm beyond
the ileocecal valve, is grasped with forceps and exteriorized through the operative port. Extracorporeally, the cecum is ligated
and resected before the cecal stump is returned to the peritoneal cavity. The abdominal wall defects are then stapled closed.
Results: This simple model can be mastered by individuals with very limited surgical experience. This laparoscopic model has been
used successfully in our laboratory in a number of experiments with an intraoperative complication rate of 3.2% (3/94), which
was similar to the open surgery group rate of 2.1% (2/95, p= 0.99 by chi square). We observed no postoperative leaks in either group. The only postoperative death occurred in the open
resection group due to dehiscence of the laparotomy wound.
Conclusions: We propose that this model may be useful for comparing the effects of open to laparoscopic surgery.
Received: 19 June 1996/Accepted: 2 November 1996 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.
Laparoscopic repair of perforated duodenal ulcer 总被引:5,自引:2,他引:3
M. L. Druart R. Van Hee J. Etienne G. B. Cadière J. F. Gigot M. Legrand J. M. Limbosch B. Navez M. Tugilimana E. Van Vyve L. Vereecken E. Wibin J. P. Yvergneaux 《Surgical endoscopy》1997,11(10):1017-1020
Background: A series of 100 consecutive patients with perforated peptic ulcer were prospectively evaluated in a multicenter study. The
feasibility of the laparoscopic repair was evaluated.
Methods: All patients had peritonitis, 20% were in septic shock, and 57% had delayed perforation. Conversion to laparotomy was necessary
in eight patients. The morbidity rate was 9% and mortality rate 5%.
Results: The mean delay of postoperative gastric aspiration (mean 3.4 days) and resumed food intake (mean 4.4 days) as well as the
mean postoperative hospital stay (mean 9.3 days) were comparable to conventional surgery, but postoperative comfort was subjectively
increased by laparoscopy and noticed by all laparoscopic surgeons participating in this study.
Conclusions: Laparoscopic repair of perforated peptic ulcer proves to be technically feasable and carries an acceptable morbidity and
mortality rate, compared with conventional surgery.
Received: 16 August 1996/Accepted: 1 April 1997 相似文献
7.
Background: The gut is a central organ in the postoperative stress reaction. We previously reported that measuring gut-mucosal cytokines
may more accurately reflect the response to operative stress. Additionally, we have shown that the gut demonstrates a blunted
cytokine response after laparoscopy as compared with laparotomy.
Methods: To further investigate whether this differential response is caused by exposure of the peritoneal cavity to general atmospheric
air during laparotomy, 80 A/J mice were randomized equally into four groups: CD (carbon dioxide [CO2] pneumoperitoneum), RA (room air pneumoperitoneum), AP (anesthesia and port insertion only), and PC (pure control, no intervention).
Pneumoperitoneum was established and maintained at 3 mmHg for 60 min. All the mice were killed 4 h after the intervention.
Jejunal mucosa and serum samples were collected and analyzed for interleukin-6 (IL-6) levels. Results were analyzed by analysis
of variance (ANOVA).
Results: Gut-mucosal IL-6 in the RA group was significantly higher than in all other groups: RA, 1,354.5 ± 117.9* vs. CD, 964.3 ±
114.0 vs. AP, 960.2 ± 86.2 vs. PC, 908.0 ± 83.6; *p < 0.05. The CD group did not show a significant increase in gut-mucosal IL-6 as compared with the AP and PC groups. Similarly,
RA resulted in significant increases in serum IL-6 as compared with AP and PC, whereas CD showed no significant difference:
RA, 161.3 ± 66.2* vs. 95.1 ± 1 vs. AP, 10.6 ± 5.3 vs. PC, undetectable; *p < 0.05. There was no difference in serum IL-6 level between CD or any of the other groups.
Conclusions: Exposure of the peritoneal cavity to atmospheric air, independently of the trauma of abdominal access, causes an exaggerated
serum and gut mucosal IL-6 response 4 h after intervention. The beneficial effect of CO2 laparoscopy may be caused by the exclusion of general atmospheric air from the peritoneal cavity.
Received: 29 June 1998/Accepted: 1 November 1998 相似文献
8.
Characteristic alterations of the peritoneum after carbon dioxide pneumoperitoneum 总被引:19,自引:4,他引:15
Objective: Any route of entry into the abdomen contributes to alterations of the intraperitoneal organs with different clinical consequences.
Characteristic alterations of the peritoneum after CO2 pneumoperitoneum used in laparoscopic surgery is examined.
Methods: A CO2 pneumoperitoneum with an intraperitoneal pressure of 6 mmHg was applied for 30 min in 32 nude mice. In the course of 4 days,
the animals were killed and the peritoneal surface of the abdominal wall was studied by means of scanning electron microscopy.
Results: Already 2 h after release of the pneumoperitoneum, mesothelial cells were bulging up. The intercellular clefts thereby increased
in size, and the underlying basal lamina became visible. This reaction peaked after 12 h. Subsequently, peritoneal macrophages
and lymphocytes filled all gaps, thereby recovering the basal lamina.
Conclusion: The morphologic integrity of the peritoneum is temporarily disturbed by a CO2 pneumoperitoneum.
Received: 9 March 1998/Accepted: 24 July 1998 相似文献
9.
Background: The purpose of the study was to discover whether ultrasonography can be used in diagnosing ureteral complications during
surgery.
Methods: The study consisted of an animal experiment with five pigs, that underwent laparotomy. The right ureter was electrocauterized
and transsected, and the left ureter was ligated. The type and frequency of peristaltic waves and the diameter of the ureter
were recorded by perioperative ultrasonography. Four patients with ureteral trauma during gynecologic surgery were also examined.
Results: In the animal study six out of nine ureters dilated after the procedure. In seven ureters the contraction segment became
smaller, and the lumen did not close properly during the peristaltic wave. The frequency of peristalsis diminished in all
cases after ligation. Human ureters showed similar changes when examined 1.5–48 h after surgical trauma.
Conclusions: Perioperative ultrasonography has great diagnostic potential as a method for noninvasive evaluation of ureteral conditions
during both laparoscopy and laparotomy.
Received: 16 June 1997/Accepted: 4 December 1997 相似文献
10.
Laparoscopic surgery in newborn infants 总被引:14,自引:1,他引:13
Background: Thanks to various technical innovations and advances in instrumentation, laparoscopic surgical intervention is now possible
for certain congenital anomalies in children. To test the applicability of laparoscopic surgery in neonates, we reviewed our
personal experience of neonatal laparoscopic surgery, focusing on cardiopulmonary function, surgical procedures, problems
with devices, and degree of associated surgical stress.
Methods: We performed 65 laparoscopic procedures in neonates. Their ages ranged from 2 to 30 days old, and their body weights ranged
from 1,980 to 4,780 g. All 65 laparoscopic procedures were carried out without mortality or serious morbidity.
Results: As complications, we encountered four cases of hypothermia due to rapid insufflation of carbon dioxide (CO2). We also found that relative hypercapnea (increase in end-tidal CO2 as high as 61 mmHg) developed unless hyperventilation and a relatively high peak insufflation pressure were maintained during
pneumoperitoneum. No cardiac depression developed at this insufflation pressure. Fluid and electrolyte balance during our
cases of newborn laparoscopic surgery, as well as the doses and volumes of fluid and electrolytes administered, were identical
to those required for open surgery. Interleukin-6 (IL-6) was measured serially to estimate the degree of associated surgical
stress and was found to be significantly lower in neonates who had received laparoscopic procedures than in those who had
received open procedures.
Conclusion: Laparoscopic surgery can be carried out safely even in neonates.
Received: 9 June 1998/Accepted: 22 September 1998 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.
Effect of carbon dioxide pneumoperitoneum on bacteremia and severity of peritonitis in an experimental model 总被引:3,自引:3,他引:0
Background: Laparoscopy is increasingly used in conditions complicated by peritonitis. A theoretical concern is that carbon dioxide pneumoperitoneum
may increase bacteremia.
Method: In 60 rats peritonitis was induced by cecostomy. Animals were randomly allocated to pneumoperitoneum (PP) and control groups.
Blood cultures and intraabdominal swabs were assessed. A peritonitis severity score (PSS) was computed based on histology
from peritoneal biopsy.
Results: One hour after cecostomy neither in abdominal swabs nor in blood samples bacteria were reproduced in PP and control groups.
Three hours after cecostomy the frequency of positive blood cultures was 80% and 20% in PP and control groups, respectively
(p < 0.0001). Six hours after cecostomy the frequency of positive blood cultures was 100% in each group (p > 0.05). One hour after cecostomy the mean peritoneal severity score was significantly higher in the PP group than in the
control group, but there was not any significant difference between groups 3 and 6 h after cecostomy. The mean peritoneal
severity scores were found to be significantly increased with time when the PP groups compared with each other.
Conclusion: In rats, pneumoperitoneum can't cause a more severe peritonitis but it does induce an increase in the rate of bacteremia
within the early 6-h period of peritonitis.
Received: 14 April 1997/Received: 18 September 1997 相似文献
13.
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
14.
X. Sala-Blanch J. Fontanals G. Martínez-Palli P. Taurá S. Delgado J. Bosch A. M. Lacy J. Visa 《Surgical endoscopy》1998,12(9):1121-1125
Background: Elevated intraabdominal pressure due to gas insufflation for laparoscopic surgery may result in regional blood flow changes.
Impairments of hepatic, splanchnic, and renal blood flow during peritoneal insufflation have been reported. Therefore we set
out to investigate the effects of peritoneal insufflation with helium (He) and carbon dioxide (CO2) on hepatic blood flow in a porcine model.
Methods: Twelve pigs were anesthetized and mechanically ventilated with a fixed tidal volume after the stabilization period. Peritoneal
cavity was insufflated with CO2 (n= 6) or He (n= 6) to a maximum intraabdominal pressure of 15 mmHg. Hemodynamic parameters, gas exchange, and oxygen content were studied
at baseline, 90 mm and 150 min after pneumoperitoneum, and 30 min after desufflation. Determination of hepatic blood flow
with indocyanine green was made at all measured points by a one-compartment method using hepatic vein catheterization.
Results: A similar decrease in cardiac output was observed during insufflation with both gases. Hepatic vein oxygen content decreased
with respect to the baseline during He pneumoperitoneum (p < 0.05), but it did not change during CO2 insufflation. Hepatic blood flow was significantly reduced in both the He and CO2 pneumoperitoneums at 90 min following insufflation (63% and 24% decrease with respect to the baseline; p < 0.001 and p < 0.05, respectively) being this decrease marker in the He group (p= 0.02).
Conclusions: These findings suggest that helium intraperitoneal insufflation results in a greater impairment on hepatic blood flow than
CO2 insufflation.
Received: 27 March 1996/Accepted: 19 January 1997 相似文献
15.
M. R. Evasovich T. C. Clark M. C. Horattas S. Holda L. Treen 《Surgical endoscopy》1996,10(12):1176-1179
Background: To evaluate the impact of laparoscopy in the presence of peritonitis, this study was designed to assess bacteremia caused
by E. coli–induced peritonitis with a carbon dioxide pneumoperitoneum in a rat model.
Methods: Sixty Sprague-Dawley rats were divided into inoculum groups (no E. coli, 106 colony-forming units [CFU] E. coli, and 108 CFU E. coli), followed by induction of a carbon dioxide pneumoperitoneum or no pneumoperitoneum. Fifteen-minute-interval blood cultures
were obtained to determine time of bacteremia development. Statistical assessment to determine significant differences among
groups was done using ANOVA and t-test analysis.
Results: A total of 20 animals with E. coli introduced into the peritoneum and a carbon-dioxide-induced pneumoperitoneum had more frequent positive blood cultures at
all time intervals compared to identical inoculum subgroups without a pneumoperitoneum. ANOVA revealed a significant difference
in bacteremia within the same concentration inoculum groups in animals receiving a pneumoperitoneum vs none (p < 0.01). Bacteremia increased significantly as inoculum concentrations increased (25% with 106
E. coli inoculum vs 80% with 108
E. coli), especially among the insufflated subgroups (45% with 106
E. coli vs 100% with 108
E. coli) over 180 min (p < 0.01).
Conclusion: Carbon dioxide pneumoperitoneum increases the incidence of E. coli bacterial translocation from the peritoneum into the bloodstream in this rat model.
Received: 30 April 1996/Accepted: 5 July 1996 相似文献
16.
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
17.
Background: We describe a technique of laparoscopic cecal ligation and puncture (CLP) in the rat analogous to open CLP which may facilitate
the study of minimally invasive surgery (MIS) and peritonitis.
Methods: Forty-four rats were randomized to either laparoscopic or open CLP and their 3-day mortality was recorded. Autopsies were
performed for peritoneal fluid cultures, measurement of the length of ligated cecum, and scoring of the degree of cecal necrosis.
Results: Laparoscopic CLP required slightly longer operating times compared to open CLP (average 15.6 vs 13.1 min, p= 0.002). Three-day postoperative mortality was 36.4% and 22.7% for open and laparoscopic CLP, respectively (p= NS). There were no differences in the length of ligated cecum or the cecal necrosis score between the open and laparoscopic
CLP groups.
Conclusion: Laparoscopic CLP is feasible and produces a fecal peritonitis with similar characteristics to those of traditional open CLP.
Received: 3 July 1996/Accepted: 7 January 1997 相似文献
18.
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
19.
Mendoza-Sagaon M Hanly EJ Talamini MA Kutka MF Gitzelmann CA Herreman-Suquet K Poulose BF Paidas CN De Maio A 《Surgical endoscopy》2000,14(12):1136-1141
Background: We designed a prospective controlled animal study to compare the stress response induced after laparoscopic and open cholecystectomy.
Methods: Twelve female pigs (20–25 kg body weight) were anesthetized with ketamine, pentobarbital, and fentanyl. The animals were
randomized into the following four groups: control (C), pneumoperitoneum with CO2 at 14–15 mmHg (P), laparoscopic cholecystectomy (LC), and open cholecystectomy (OC). The average duration of the procedure
in each group was 35 min.
Results: Central venous pressure, mean arterial pressure, pulmonary capillary wedge pressure, and cardiac output were monitored. Measurements
were recorded when animals were anesthetized (baseline), immediately before and after surgery, and thereafter every 30 min
for a maximum of 3 h. White blood cell count (WBC) was determined from blood samples taken before and after 3 h of surgery.
Ultrasound-guided liver biopsies were done preoperatively and after 3 h of surgery. Total RNA was isolated from the liver
biopsy specimens. Steady-state mRNA levels of β-fibrinogen (β-fib), α 1-chymotrypsin inhibitor (α1-CTI), metallothionein (MT),
heat shock protein 70 (Hsp70), and polyubiquitin (Ub) were detected by Northern blot/hybridization. There were no statistical
differences in the hemodynamic parameters among the groups. The number of circulating neutrophils and monocytes decreased
only after LC. Expression of Hsp70 was not induced after any surgical procedure, and the mRNA levels of Ub did not change
after surgery. The expression of α1-CTI and β-fib (acute phase genes) were similarly increased after LC and OC. Steady-state
mRNA levels of MT were slightly increased after P and LC but not after OC.
Conclusion: These data indicate that there are no significant differences between LC and OC in terms of induction of the stress response.
Received: 19 March 1999/Accepted: 2 July 1999/Online publication: 20 September 2000 相似文献
20.
Background: Early diagnosis and treatment of intra-abdominal pathology in critically ill intensive care unit (ICU) patients remains a
clinical challenge. The objective of this study is to assess the feasibility of portable, bedside diagnostic laparoscopy (DL)
in the ICU for patients suspected of intra-abdominal pathology, and to contrast its accuracy with diagnostic peritoneal lavage
(DPL).
Methods: All adult ICU patients for whom a general surgery consultation was requested were eligible. Patients with a recent laparotomy
or obvious peritonitis were excluded. All procedures were performed in the ICU.
Results: Over a consecutive 16-month period, 12 patients underwent DPL/DL. Ages ranged from 28 to 88 (mean, 72) years. Causative findings
were disclosed by DL in five patients, (42%) including intestinal ischemia in two. Perforated diverticulitis, thickened terminal
ileum, and nonpurulent peritonitis were found in one patient each. All patients with findings by DL had a positive DPL (WBC
> 200 cells/mm3), and one negative laparoscopy was positive by lavage. The average length of time to perform DPL was 14 min, and to complete
DL 19 min. One patient underwent laparotomy based on DPL/DL and survived along with three others with negative DPL/DL. Eight
patients died (67%), four from their surgically untreated intra-abdominal pathology. One patient sustained a procedure-related
complication of bradycardia and high ventilatory airway pressures. Peak airway pressures increased an average of 8 mmHg and
were significantly higher (p < 0.001) than pre-DL pressures without any significant change in end-tidal CO2 or pCO2. There were no statistically significant hemodynamic changes based on mean arterial pressure (MAP), central venous pressure
(CVP), or pulmonary artery diastolic pressure (PADP).
Conclusions: Bedside laparoscopy can be performed rapidly and safely in the ICU. In predicting the need for laparotomy, DL was more accurate
than DPL.
Received: 18 July 1995/Accepted: 19 December 1995 相似文献