共查询到20条相似文献,搜索用时 15 毫秒
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The surgical management of rectal cancer has evolved as techniques have improved and the use of preoperative multimodality therapy has gained acceptance as the standard of care. One of the most dynamic areas regarding surgical resection of rectal cancer has been the issue of an oncologically safe distal resection margin. Despite recommendations for the minimum acceptable distal margin shrinking from 5 cm to 2 cm and now to 1 cm over the past several decades, this question remains a topic of intense debate. Such discussion centering on the impact distal margins of resection can critically affect the ability to preserve the anal sphincter complex during rectal resection for cancer. In the present era of the surgical treatment of locally advanced rectal cancers with neoadjuvant chemoradiation, the literature has supported the potential safety of a 1-cm margin for sphincter preservation without a significant risk for unresected microscopic distal intramural spread. More recently, data has emerged demonstrating no statistical difference in oncologic outcomes in terms of local recurrence or overall survival when comparing shorter distal margins to those greater than 1 cm. This review examines the data in support of the 1-cm rule and discusses its validity in light of more recent reports in the modern multidisciplinary treatment era. 相似文献
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Tilney HS Constantinides VA Heriot AG Nicolaou M Athanasiou T Ziprin P Darzi AW Tekkis PP 《Surgical endoscopy》2006,20(7):1036-1044
Background The role of laparoscopic surgery for patients with ileocecal Crohn’s disease is a contentious issue. This metaanalysis aimed
to compare open resection with laparoscopically assisted resection for ileocecal Crohn’s disease.
Methods A literature search of the Medline, Ovid, Embase, and Cochrane databases was performed to identify comparative studies reporting
outcomes for both laparoscopic and open ileocecal resection. Metaanalytical techniques were applied to identify differences
in outcomes between the two groups. Sensitivity analysis was undertaken to evaluate the heterogeneity of the study.
Results Of 20 studies identified by literature review, 15 satisfied the criteria for inclusion in the study. These included outcomes
for 783 patients, 338 (43.2%) of whom had undergone laparoscopic resection, with an overall conversion rate to open surgery
of 6.8%. The operative time was significantly longer in the laparoscopic group, by 29.6 min (p = 0.002), although the blood loss and complications in the two groups were similar. In terms of postoperative recovery, the
laparoscopic patients had a significantly shorter time for recovery of their enteric function and a shorter hospital stay,
by 2.7 days (p < 0.001).
Conclusions For selected patients with noncomplicated ileocecal Crohn’s disease, laparoscopic resection offered substantial advantages
in terms of more rapid resolution of postoperative ileus and shortened hospital stay. There was no increase in complications,
as compared with open surgery. The contraindications to laparoscopic approaches for Crohn’s disease remain undefined. 相似文献
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Due to the significant increase in interest in placebos, biomedical scientists have incorporated placebo innovations into a modern methodological research scenario in order to increase the quality of clinical studies. Indeed, the randomised-controlled trial design has changed dramatically, and these changes have had an impact on manual therapy research as well. The present paper outlines the main difficulties that placebo-controlled trials pose for research in manual therapy, for example, designing ineffective sham protocols, the role of touch in triggering neurobiological responses, or the unique specificity of manual therapies. The paper then offers suggestions on how to overcome such challenges, for example by providing a definition of ‘specificity’ in the context of manual therapies, and specifically osteopathy, suggesting how to design adequate sham procedures, and by introducing the so-called ‘touch equality assumption'. 相似文献
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Linden AF Sekidde FS Galukande M Knowlton LM Chackungal S McQueen KA 《World journal of surgery》2012,36(5):1056-1065
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There are large disparities in access to surgical services due to a multitude of factors, including insufficient health human resources, infrastructure, medicines, equipment, financing, logistics, and information reporting. This study aimed to assess these important factors in Uganda’s government hospitals as part of a larger study examining surgical and anesthesia capacity in low-income countries in Africa. 相似文献18.
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