共查询到20条相似文献,搜索用时 31 毫秒
1.
T. Tomonaga S. G. Houghton C. J. Filipi R. A. Hinder J. Hunter B. Dallemagne N. Katkhouda R. Kozarek T. R. DeMeester R. Deeik Y. Shiino Z. T. Awad R. E. Marsh 《Surgical endoscopy》1999,13(8):738-741
Background: Intraluminal gastric surgery provides a new treatment option for various disease processes. This study assesses the safety
of a new large-diameter percutaneous endoscopic gastrostomy (PEG) for intraluminal surgery.
Methods: Investigators at six institutions were asked to complete a standard questionnaire to assess the difficulties associated with
the assembly and introduction of the PEG, plus intraoperative and postoperative problems related to placement of the device.
Results: In terms of assembly; 1.9% of respondents reported difficulty obtaining complete vacuum of the balloon tip, and 3.8% had
difficulty fitting the graduated dilator to the balloon-tipped cannula. Difficulties associated with introduction of the PEG
included disengagement of the dilator from the balloon-tipped cannula (0%), extraction of the dilator-port assembly (0%),
difficult PEG pullout (1.9%), abdominal wall bleeding (0%), and difficult PEG dilator separation (7.5%). Intraoperatively,
7.5% of respondents reported inadequate skin bolster fitting, 1.9% had CO2 leakage into the peritoneal cavity, 0% had inadvertent PEG extraction, and 0% reported injury to the esophagus, colon, or
small intestine. Postoperatively, there was a 9.4% rate of wound infection, a 1.9% rate of gastrocutaneous fistula, and a
1.9% rate of esophageal, colon, or small intestine injury.
Conclusions: The large-diameter PEG is safe and effective for endo-organ surgery. Additional preventive measures for PEG site infection
should be investigated.
Received: 15 September 1998/Accepted: 15 February 1999 相似文献
2.
Laparoscopic treatment of gastric stromal tumors 总被引:9,自引:4,他引:5
Basso N Rosato P De Leo A Picconi T Trentino P Fantini A Silecchia G 《Surgical endoscopy》2000,14(6):524-526
Background: The laparoscopic resection of gastric stromal tumors (GST) is being performed with increased frequency.
Methods: Between November 1993 and October 1998, nine consecutive patients with benign and low-grade gastric stromal tumors underwent
laparoscopic resection using intraoperative endoscopy. For lesions located on the anterior wall (three cases), a direct approach
was utilized. Lesions located on the posterior wall were resected via a transgastric approach (four cases) or through a small
opening on the omentum or on the gastrocolic ligament (two cases). Excision of the lesions was performed manually by means
of electrocautery and scissors in eight cases; the gastric incisions were closed by manual running suture. An endoscopic stapler
device was used in one case only.
Results: All patients were successfully treated laparoscopically; there were no conversions to open surgery. Operative time ranged
from 75 to 120 min. There was one bleeding from the suture line of the gastric wall postoperatively that was treated conservatively.
The average postoperative hospital stay was 4 days (range, 2–6).
Conclusions: In light of the results reported in the literature and on the basis of the present work, it seems that laparoscopic resection
of GST should be considered as the treatment of choice. Wedge resection of anterior wall lesions is generally performed. The
treatment of posterior wall lesions is still controversial. In our opinion the direct approach should be reserved for lesions
located on the posterior wall of the body, which can be easily reached through the greater omentum, while the transgastric
approach should be preferred for lesions located on the fundus and antrum. Manual excision allows a tailored operation; hand-sewn
sutures are always feasible, and they are cheaper than stapled ones.
Received: 30 April 1999/Accepted: 7 October 1999/Online publication: 10 April 2000 相似文献
3.
Background: Laparoscopic surgery has been successfully applied to several gastrointestinal procedures. Although the totally laparoscopic
gastrectomy is feasible, tactile sensation and manipulation of the organ as well as the lesion are decreased when compared
to open surgery. The Dexterity Pneumo Sleeve is a new device which allows the surgeon to insert a hand into the abdominal
cavity while preserving the pneumoperitoneum. This device was used for patients who underwent laparoscopic gastric surgery.
Methods: The first patient presented with a non-Hodgkin's lymphoma of the stomach. A laparoscopically assisted distal gastrectomy
was performed with Roux-en-Y reconstruction. The second patient had a 5-cm leiomyoma involving the greater curve of the stomach,
and this device was used for manipulation of the tumor. The last patient suffered from morbid obesity with its associated
medical complications and a ventral hernia. The Sleeve was applied at the hernia site and a laparoscopically assisted gastric
bypass was performed.
Results: The Pneumo Sleeve was useful in these cases for tactile localization of the tumor and for retraction and manipulation of
the stomach and surrounding upper abdominal organs.
Conclusions: The utilization of this device resulted in a more easily performed dissection, resection, and anastomosis and was felt to
decrease operation time.
Received: 18 September 1996/Accepted: 26 December 1996 相似文献
4.
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
5.
Laparoscopic resection of posterior gastric leiomyoma 总被引:4,自引:0,他引:4
Laparoscopic gastric surgery is gaining momentum, especially in the treatment of benign disease. Simultaneous endoscopy and
laparoscopy allow precise localization of lesions. Because of the stomach's size, mobility, and distensibility, relatively
large lesions can be safely excised. Wedge resection for anterior lesions and a transgastric or intragastric approach for
posterior lesions are feasible laparoscopically. Two cases of posterior gastric leiomyomas successfully resected laparoscopically
are presented. The use of stapling devices greatly facilitates this procedure.
Received: 17 February 1995/Accepted: 7 September 1995 相似文献
6.
Iatrogenic thoracic migration of the stomach complicating laparoscopic Nissen fundoplication 总被引:1,自引:0,他引:1
Background: Intrathoracic gastric herniation after laparoscopic Nissen fundoplication is an uncommon but potentially life-threatening
complication that may present in the early or late postoperative period.
Methods: A retrospective analysis was performed on all patients undergoing antireflux surgery from December 1991 to June 1999.
Results: Nine cases of gastric herniation occurred after 511 operations (0.17%). Patients presented with the condition 4 days to 29
months after surgery. Eight of these nine patients (89%) had reported vomiting in the immediate postoperative period. Seven
patients (78%) reported persistent odynophagia. A factor common to all patients was that posterior crural repair had not been
performed.
Conclusions: Measures should be undertaken to prevent postoperative vomiting after laparoscopic Nissen fundoplication. Posterior crural
repair is essential after surgery in all cases.
Received: 12 July 1999/Accepted: 22 November 1999/Online publication: 8 May 2000 相似文献
7.
Taniguchi E Ohashi S Takiguchi S Yumiba T Itoh T Matsuda H Nakajima K 《Surgical endoscopy》2000,14(5):505-507
Laparoscopic intragastric surgery (LIGS) has become more widely established in Japan as a therapy for early gastric cancers
and some types of submucosal gastric tumors. However, there have been some technical difficulties with the original method
of LIGS. Certain complicated procedures to access the gastric lumen are required, along with repair of the gastric wall after
endoluminal procedures. Using a 5-mm radially expandable sleeve (RES) for the working ports in LIGS, it becomes easier to
establish access to the gastric lumen, and repair of the port sites on the gastric wall is not required. Using RES makes LIGS
a simpler, less invasive procedure.
Received: 15 July 1999/Accepted: 24 September 1999/Online publication: 17 April 2000 相似文献
8.
P. R. Reardon A. Preciado T. Scarborough B. Matthews J. L. Marti 《Surgical endoscopy》1999,13(11):1139-1142
Background: For a long time it has been known that sympathectomy is an effective treatment for hyperhidrosis and other conditions. The
surgical options available until recently usually have required thoracotomy or large posterior incisions, and physicians generally
have been reluctant to recommend surgery for most patients with ``benign' disorders. Recently, thoracoscopic techniques have
allowed surgeons to offer these patients a permanent solution with minimal surgical trauma.
Methods: In 20 patients, 30 endoscopic thoracic sympathectomies (ETS) were performed for several indications. Nine patients had bilateral
sympathectomies. The procedures were performed on the day of admission, with the patient under general anesthesia using double
lumen endotracheal intubation and hand temperature monitoring. Each lung was reinflated on completion of the sympathectomy,
and residual pneumothorax aspirated before closure of the incisions. No placement of chest tubes was performed in the operating
room.
Results: All sympathectomies were completed thoracoscopically. There were no major complications, and 90% of the patients were discharged
within 24 hours of admission. The average operative time was 69 min.
Conclusions: Findings from this study show that ETS is a safe and effective procedure that can be performed routinely on an outpatient
basis. The use of miniendoscopic (2-mm) instrumentation is safe and effective in most patients and a helpful adjunct in providing
these patients with minimally traumatic surgery. Long-term results should be evaluated on the basis of specific indications
for sympathectomy.
Received: 1 March 1999/Accepted: 1 July 1999 相似文献
9.
Laparoscopy has added a new perspective to the diagnosis and treatment of abdominopelvic disease. A wide variety of gastric
procedures have been completed with laparoscopy in the past several years. The authors here present successful resection of
a submucosal gastric leiomyoma laparoscopically with the combined use of intraoperative gastroscopy for localization. A 2.5
× 2.0 cm submucosal gastric nodule is resected with ample margins laparoscopically. Intraoperative endoscopy is used for accurate
localization because the lesion was not visible to the laparoscope on the serosal surface of the organ. Laparoscopic surgery
can be applied to the traditional surgical principles with equal efficacy in selected patients.
Received: 15 December 1995/Accepted: 22 April 1996 相似文献
10.
Lobectomy with extended lymph node dissection by video-assisted thoracic surgery for lung cancer 总被引:5,自引:0,他引:5
Background: Between September 1992 and September 1996, we performed 88 VATS (video-assisted thoracic surgery) lobectomies and two VATS
pneumonectomies.
Methods: The indications for surgery were 68 cases of lung cancer, nine cases of bronchiectasis, six cases of tuberculosis, and seven
cases of benign lesions. Of the 68 cases of lung cancer, 36 were treated by VATS lobectomy with extended lymph node dissection
for clinical stage I lung cancer, making full use of recently developed devices for thoracoscopic surgery, such as roticulating
endoscissors, miniretractors, endoclips, and harmonic scalpels.
Results: Twenty-four lymph nodes were resected on average (range, 10 to 51) by VATS. This number was comparable to lymph nodes resected
in open thoracotomy during the same period. Among the 36 patients who underwent extended lymph node dissection, 20 showed
no lymph node metastasis postoperatively (stage I), while 16 had N1 or N2 cancer. All patients with stage I cancer have survived
4 to 36 months (median: 17 months) with no signs of recurrence.
Conclusions: This survival of stage I lung cancer after VATS is comparable to that of open thoracotomy. We thus believe that VATS lobectomy
with extended lymph node dissection can be an alternative to standard posterolateral thoracotomy for stage I lung cancer.
Received: 10 May 1996/Accepted: 19 November 1996 相似文献
11.
Early international results of laparoscopic gastrectomies 总被引:9,自引:4,他引:5
Background: The first totally laparoscopic Billroth II gastrectomy was performed in 1992. To date, laparoscopic gastrectomy has been
performed by a small number of surgeons around the world and the laparoscopic approach has been extended to Billroth I and
total gastrectomy. The aim of this study is to review the state of laparoscopically performed gastrectomies in the international
scene.
Methods: Questionnaires were prepared and sent to every surgeon in the world known by the authors or their contacts to have performed
a laparoscopic gastrectomy. A questionnaire survey was started in July 1994 and completed by November 1994. Data collected
included age, sex, type of gastric resection, technique of reconstruction after resection, average duration of surgery, time
to liquid and solid intake, postoperative hospital stay, complications, and opinions of the surgeons.
Results: Sixteen surgeons contributed to this study. A total number of 118 cases of laparoscopic gastrectomies, comprising Billroth
I (11), Billroth II (87), vagotomy and antrectomy (10), and total gastrectomy (10) had been performed. The indications were
gastric and/or duodenal ulcers and benign and malignant gastric tumors.
Conclusions: Laparoscopic gastrectomy was found to be superior to the open technique by 10 of 16 surgeons because of faster recovery,
less pain, and better cosmesis. The procedure was an expensive and long operation according to four. Two surgeons were uncertain
of any benefit because of limited experience.
Received: 7 August 1996/Accepted: 28 October 1996 相似文献
12.
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
13.
In endoscopic surgery, the ability to guide the instrument is significantly decreased compared with open surgery. Rigid laparoscopic
instruments offer only four of the six degrees of freedom required for the free handling of objects in space. Robotics technology
can be used to restore full mobility of the endoscopic instrument. Therefore, we designed a master-slave manipulator system
(ARTEMIS) for laparoscopic surgery as a prototype. The system consists of two robotic arms holding two steerable laparoscopic
instruments. These two work units are controlled from a console equipped with two master arms operated by the surgeon. The
systems and its components were evaluated experimentally. Laparoscopic manipulations were feasible with the ARTEMIS system.
The placement of ligatures and sutures and the handling of catheters were possible in phantom models. The surgical practicability
of the system was demonstrated in animal experiments. We conclude that robotic manipulators are feasible for experimental
endoscopic surgery. Their clinical application requires further technical development.
Received: 25 February 1998/Accepted: 20 April 1999 相似文献
14.
Simultaneous laparoscopic biliary and retrocolic gastric bypass in patients with unresectable carcinoma of the pancreas 总被引:11,自引:1,他引:10
Background: A substantial number of patients with unresectable pancreatic cancer eventually develop biliary or gastric outlet obstruction.
In some cases, they present initially with both complications. These conditions contribute markedly to their discomfort and
certainly justify palliative intervention. The purpose of this study was to examine the feasibility and safety of simultaneous
laparoscopic biliary and gastric bypass in patients with unresectable carcinoma of the pancreas.
Methods: Between August 1995 and July 1998, simultaneous laparoscopic biliary and retrocolic gastric bypass was performed successfully
in 12 consecutive patients with unresectable carcinoma of the pancreas. There were eight men and four women. Their median
age was 72 years (range, 50–82). In all patients, the indications for gastrointestinal bypass were gastric outlet obstruction
and obstructive jaundice. The following parameters were evaluated for each patient: procedure-related morbidity and mortality,
operative time, length of hospital stay, overall survival, and ability to sustain oral nutrition during the survival period.
Results: All procedures were completed laparoscopically. The mean operative time was 89 ± 29.56 min. There were no intraoperative
complications. Postoperative morbidity consisted of wound infection in two patients and pneumonia in one patient. One patient
died of multiorgan failure on postoperative day 2. The mean hospital stay was 6.4 ± 1.5 days (range, 5–17). The mean survival
time until death from underlying disease was 85 ± 32.46 days (range, 31–260). None of the patients had recurrent jaundice,
and all of them were able to maintain oral nutrition.
Conclusion: Simultaneous laparoscopic biliary and retrocolic gastric bypass is a safe and effective technique for the treatment of biliary
and gastroduodenal obstruction in patients with unresectable pancreatic cancer.
Received: 17 December 1998/Accepted: 13 May 1999 相似文献
15.
F. Köckerling J. Rose C. Schneider H. Scheidbach H. Scheuerlein M. A. Reymond Th. Reck J. Konradt H. P. Bruch C. Zornig E. Bärlehner A. Kuthe G. Szinicz H. A. Richter W. Hohenberger 《Surgical endoscopy》1999,13(7):639-644
Background: We report on a prospective observational multicenter study of more than 1,000 consecutive patients undergoing laparoscopic
colorectal procedures. The aim of the current study was to investigate the safety of laparoscopic colorectal surgery as reflected
by the anastomotic insufficiency rates in the various sections of the bowel, and to compare these rates with those of open
colorectal surgery.
Methods: The study was begun on August 1, 1995. Twenty-four centers in Germany, Austria, and Switzerland participated in this prospective
multicenter study. All patients undergoing laparoscopic colorectal surgery were included in the study. No selection criteria
were applied, which means that every operation begun as a laparoscopic procedure was included. Data on patient demographics,
surgical indications, surgical course, and patient outcome were recorded prospectively in a computer database. All data were
rendered anonymous.
Results: Between August 1995 and February 1998, the 24 participating centers treated 1,143 patients (male/female ratio, 1:1.36; mean
age, 60.7 years). In all, 626 operations were performed for benign indications and 517 for cancer. Most procedures involved
the sigmoid colon and rectum (80.9%). An anastomosis was performed in 83% of the operations. Most of the anastomoses were
laparoscopically assisted using the stapling technique. We observed an overall leakage rate of 4.25% (colon 2.9%; rectum 12.7%),
and surgical reintervention was required in 1% of the cases. The rate of conversion to open surgery was 5.6%. Intraoperative
complications occurred in 5.9%, and reoperation was necessary in 4.1% of the cases. The overall morbidity rate was 22.3%,
and the 30-day mortality rate was 1.57%.
Conclusions: The feasibility and safety of the laparoscopic colorectal approach is demonstrated clearly. The current study shows that
the laparoscopic or laparoscopically assisted approach to colorectal surgery is not associated with a higher risk of anastomotic
leaks. Morbidity and mortality rates with this method approximate those seen with conventional colorectal surgery.
Received: 24 August 1998/Accepted: 25 November 1998 相似文献
16.
Background: Between November 1991 and May 1995, a series of laparoscopic colectomies were performed in our hospital.
Methods: Our main aim was to define more specifically the indications for laparoscopic colectomy.
Results: A total of 69 patients underwent laparoscopic surgery for benign polypoid colorectal disease (n = 10), inflammatory bowel
disease (n = 24), and colorectal malignancy (n = 35). Of the latter group, four patients underwent a palliative procedure.
The conversion rate of the whole group was 29%. The main reason to convert was infiltrative growth in inflammatory disease
or cancer. Respectively, seven (10%) and 12 (17%) patients sustained complications in the perioperative and early postoperative
phase. Two patients died perioperatively (3%). The mean hospital stay was 12 days. On follow-up, 11 patients had developed
a stenotic anastomosis, which was successfully dilated in all cases. After 3 years, the survival rate according to Kaplan-Meier
is 86%, 66%, 68%, and 0% for Dukes' A, B, C, and D color carcinoma, respectively. In one patient with a Dukes B carcinoma,
port site metastases were found.
Conclusions: Justifiable indications for laparoscopic colorectal surgery include (a) a benign polyp 20–50 cm from the anal ring; (b) mobile,
inflammatory large bowel disease; (c) palliation in case of malignant disease, preferably of the left hemicolon. It remains
to be proven that laparoscopic colectomy is superior and not just equivalent to open colectomy. This is especially true for
resections of colorectal carcinoma with curative intent. Therefore a cost/benefit analysis should be performed in a prospective,
randomized setting.
Received: 1 November 1996/Accepted: 1 July 1997 相似文献
17.
Trias M Targarona EM Espert JJ Cerdan G Bombuy E Vidal O Artigas V 《Surgical endoscopy》2000,14(6):556-560
Background: Laparoscopic splenectomy (LS) is now regarded as the treatment of choice for autoimmune thrombopenia (ITP). However, there
have been few reports describing the application of LS to other splenic diseases, such as malignant entities and conditions
associated with splenomegaly. Hematological diseases have specific clinical features that can influence immediate outcome
after LS. Although the long-term effects of LS are unknown, a risk of splenosis has been suggested. Therefore, we designed
a study to analyze the impact of primary hematological disease on immediate and late outcome in a prospective series of LS
patients.
Methods: We performed a prospective analysis of 111 LS done between February 1993 and March 1999. The patients were classified by
hematological indications into the following four groups: (a) group 1, low platelet count. This group was further subdivided
into group 1A, idiopathic thrombocytopenic purpura (ITP) (n= 48) and group 1B, HIV-related ITP (n= 8); (b) group 2, anemia. This group was further subdivided into group 2A, autoimmune hemolytic anemia (n= 8), and group 2B, spherocytosis (n= 11); (c) group 3, malignancy (n= 28); and (d) group 4, others (n= 8). Immediate outcomes were recorded prospectively. Hematological status and late complications were reviewed after a mean
follow-up of 24 ± 18 months.
Results: There were no significant differences between the groups in terms of conversion, transfusion requirements, and morbidity,
although transfusion and morbidity were slightly higher in group 3. However, hospital stay was significantly longer in groups
3 and 4 than in groups 1 and 2. Long-term follow-up showed satisfactory hematological results in ≥75% of patients (group 1A,
82%; group 1B, 88%; group 2A, 88%; group 2B, 100%; group 3, 75%; group 4, 88%). Overall, late morbidity was 8.3% and mortality
was 6.2%, mainly due to deaths in group 4 (six of 22 patients).
Conclusion: LS is a safe and reproducible procedure for most hematological indications, with a similar immediate outcome for benign diseases
and a long-term hematological response comparable to the standard results that have been observed in open series.
Received: 1 April 1999/Accepted: 22 November 1999/Online publication: 8 May 2000 相似文献
18.
Postoperative complications of laparoscopic-assisted colectomy 总被引:4,自引:2,他引:2
A. M. Lacy J. C. García-Valdecasas S. Delgado L. Grande J. Fuster J. Tabet C. Ramos J. M. Piqué A. Cifuentes J. Visa 《Surgical endoscopy》1997,11(2):119-122
Background: This study was performed to prospectively assess the complications of 118 consecutive patients who underwent laparoscopic
assisted colorectal resections.
Methods: The variables included were: indication for surgery, type of resection, duration of operation, duration of postoperative
ileus, length of hospital stay, port-site recurrence, and complications in relation to the laparoscopic technique.
Results: 118 Laparoscopic-assisted procedures were performed between July 1992 and October 1995. Surgical indications were: 106 patients
for colonic malignancy, six for diverticulitis, two for Crohn's disease, two for benign polyps, one for endometriosis, and
one for ischemic colitis. Fifteen patients required conversion to open techniques for completion of the operations (12.7%).
The mean operating time was 168.8 min. The amount of operative blood loss was 98 ml. The mean time for passing flatus was
36 ± 16 h. Mean postoperative stay was 5.4 (range 3–13) days. Eight patients (6.8%) sustained complications: four unrelated
to laparoscopy (three wound infection, one anastomotic leak); and four complications related to the laparoscopic approach:
one small-bowel obstruction, one trocar injury, one rotation of the anastomosis, and one misdiagnosed synchronous adenocarcinoma.
Conclusions: We suggest that with the development of improved technical devices and more experience, the indications for laparoscopic
colectomy should continue to expand. The low incidence of infectious complications suggests an important role for the laparoscopic
approach to colorectal surgery.
Received: 25 March 1996/Accepted: 8 July 1996 相似文献
19.
Complications of laparoscopic antireflux surgery in childhood 总被引:6,自引:2,他引:4
Background: The aim of this study was to assess the complications associated with the laparoscopic treatment of gastroesophageal reflux
disease (GERD) in children.
Methods: From March 1992 to March 1998, we used the laparoscopic approach to treat 289 children affected by gastroesophageal reflux
disease. The patients' ages ranged between 4 months and 17 years (median, 4.3 years), and their body weight ranged between
5 and 52 kg. In 148 children (51.3%), we adopted a Nissen-Rossetti procedure and in 141 (48.7%) a Toupet technique.
Results: The duration of surgery ranged between 40 and 180 min (median, 70). There were no deaths and no anesthesiological complications
in our series. We recorded 15 (5.1%) intraoperative complications: six pleural perforations, four lesions of the posterior
vagus nerve, two esophageal perforations, two gastric perforations, and one pericardiac perforation. Conversion to open surgery
was necessary in only four cases (1.3%). We recorded 10 (3.4%) postoperative complications: one peritonitis due to an esophageal
perforation not detected during the intervention that required a reoperation, five cases of herniation of the epiploon through
a trocar orifice, three cases of dysphagia that disappeared spontaneously after a few months, and one case of delayed gastric
emptying that subsequently required a pyloroplasty. We had six recurrences of GERD (2.1%). In two cases, a new fundoplication
was performed using the laparoscopic approach; in the other four, the GERD was controlled with medical therapy.
Conclusion: Our results show that laparoscopic fundoplication is an adequate treatment for children with GERD that has a low rate of
complications. When severe complications do occur, they can be treated effectively via the laparoscopic approach.
Received: 16 November 1999/Accepted: 16 December 1999/Online publication: 5 June 2000 相似文献
20.
We performed a hand-assisted laparoscopic resection of the distal stomach for treatment of gastric cancer with use of an
abdominal wall-lift method. The surgeon's left hand, which was inserted through a right lower quadrant incision, was extremely
useful in accomplishing D2 lymph node dissection, application of a pursestring instrument, and approximation of a circular
stapler to carry out a Billroth I anastomosis. Abdominal wall-lift enabled us to perform the gastrectomy without any concern
about gas leakage. The combination of the wall-lift method and hand assistance seems to further enlarge the possibilities
of laparoscopic procedures, especially in gastrointestinal surgery.
Received: 22 July 1998/Accepted: 17 March 1999 相似文献