共查询到20条相似文献,搜索用时 15 毫秒
1.
K. K. J. Hallfeldt A. W. Trupka J. Erhard H. Waldner L. Schweiberer 《Surgical endoscopy》1998,12(7):907-910
Background: Management strategies for abdominal stab wounds (ASW) in initially asymptomatic patients range from mandatory explorative
laparotomy (EL) to conservative approaches with observation alone. Emergency diagnostic laparoscopy (DL) may play a potential
role between these two extremes—hence lowering the rate of unnecessary laparotomies and keeping the rate of missed injuries
to a minimum.
Patients and Methods: At our institution mandatory EL was carried out in every patient with ASW until 1992. In a retrospective study the charts
of 43 patients with ASW were reviewed in terms of initial diagnostic procedures, intraabdominal injuries, and course and length
of hospital stay. Between 5/1993 and 4/1995 DL was performed in a prospective study in 15 patients with suspected peritoneal
penetration (PP) after ASW according to a standardized diagnostic and therapeutic algorithm.
Results: In 17 patients (40%) EL showed no PP; 15 (35%) had significant intraabdominal injuries, while 11 patients with PP didn't
have lacerations of intraabdominal organs, resulting in an overall rate of nontherapeutic laparotomy of 65%. Mortality was
6% (n= 3), average hospital stay 8 days. Primary DL could exclude PP in 10 out of 15 patients (66%). The remaining five patients
(33%) showed PP: In two patients with ASW to the right upper quadrant, intraabdominal injuries could be excluded by DL, and
in one patient a low-grade liver injury was treated laparoscopically, thus avoiding laparotomy in a total of 87% (n= 13). In two patients with PP laparoscopy was converted to laparotomy: no pathological finding in one case, splenectomy for
spleen laceration in the second patient, resulting in a rate of nontherapeutic laparotomies of 7%. All patients in this series
had an uneventful course; average hospital stay was 2.4 days.
Conclusions: DL offers an important diagnostic tool in excluding peritoneal penetration in ASW, hence lowering the rate of unnecessary
laparotomies. Given experience and skills, laparoscopy may be used therapeutically in selected cases of ASW.
Received: 24 February 1997/Accepted: 10 August 1997 相似文献
2.
腹腔镜诊治女性急性右下腹痛 总被引:1,自引:0,他引:1
目的 :探讨腹腔镜诊断和治疗不明原因女性急性右下腹痛的作用。方法 :回顾分析不明原因女性急性右下腹痛 1 1 5例的临床资料。结果 :1 1 5例不明原因女性急性右下腹痛均在腹腔镜下明确诊断 ,除 5例中转开腹外 ,其余病例均在腹腔镜下完成手术。所有病例经腹腔镜探查或治疗后均无严重并发症 ,术后 2~ 6d出院。结论 :腹腔镜诊断不明原因的女性急性右下腹痛准确率高 ,减少了患者的痛苦 ,缩短了住院时间。腹腔镜手术可作为诊治女性不明原因右下腹痛的首选方法。 相似文献
3.
Laparoscopy for chronic abdominal pain 总被引:3,自引:1,他引:2
Background: This purpose of this investigation was to evaluate the utility of laparoscopy in patients with chronic abdominal pain.
Methods: A retrospective review was performed of 34 patients who underwent laparoscopy for chronic abdominal pain. Average patient
age was 39 years. The majority were women. Most had undergone abdominal surgery in the past.
Results: All procedures were performed laparoscopically. A positive finding was made in 65% of patients. Fifty-six percent of patients
underwent adhesiolysis, but 26% required no operative intervention other than laparoscopic exploration. Notably, 73% of patients
reported improvement in pain postoperatively, whether or not a positive finding had been made on laparoscopy.
Conclusions: This retrospective study suggests laparoscopy can identify abnormal findings and improve outcome in a majority of selected
cases. Recommendations are provided for patient selection. Prior abdominal surgery is not an absolute contraindication to
laparoscopic exploration for chronic abdominal pain.
Received: 16 April 1996/Accepted: 30 May 1996 相似文献
4.
Background: Diaphragmatic rupture is one of the most commonly missed injuries in trauma cases. Traditionally, laparotomy or thoracotomy
has been the treatment of choice for this condition.
Methods: During the last 2 years, we treated three patients laparoscopically to address neglected diaphragmatic ruptures that caused
herniation of the intraabdominal contents.
Results: In all three cases, laparoscopy succeeded in identifying the diaphragmatic defect, so that the herniated viscera could be
released and the defect repaired primarily or with a prosthesis. The intraoperative and the postoperative courses were uneventful;
there were no significant complications.
Conclusion: Laparoscopy has an important role in the surgical treatment of missed diaphragmatic ruptures.
Received: 12 July 1999/Accepted: 21 October 1999/Online publication: 8 May 2000 相似文献
5.
Heath EI Kaufman HS Talamini MA Wu TT Wheeler J Heitmiller RF Kleinberg L Yang SC Olukayode K Forastiere AA 《Surgical endoscopy》2000,14(5):495-499
Background: Diagnostic laparoscopy has been used to determine resectability and to prevent unnecessary laparotomy in patients with advanced
esophageal cancer. The objective of this prospective study was to evaluate the role of laparoscopy in conjunction with computed
tomography (CT) scan in staging patients with esophageal cancer.
Methods: From March 1995 to October 1998, 59 patients with biopsy-proven esophageal cancer underwent diagnostic laparoscopy with concurrent
vascular access device and feeding jejunostomy tube placement.
Results: Laparoscopy changed the treatment plan in 10 of 59 patients (17%). Of the patients with normal-appearing regional or celiac
nodes, 78% were confirmed by biopsy to be tumor free, whereas 76% of patients with abnormal-appearing nodes were confirmed
by biopsy to have node-positive disease.
Conclusions: Diagnostic laparoscopy is useful for detecting and confirming nodal involvement and distant metastatic disease that potentially
would alter treatment and prognosis in patients with esophageal cancer.
Received: 16 May 1999/Accepted: 10 November 1999/Online publication: 24 March 2000 相似文献
6.
The role of laparoscopy in symptomatic Meckel's diverticulum 总被引:2,自引:0,他引:2
We report two cases of symptomatic Meckel's diverticulum in adults with recurrent abdominal pain and episodes of minor lower
gastrointestinal bleeding. In case 1, the diagnosis was suggested by 99mTc pertechnetate scan and confirmed by laparoscopy; whereas in case 2, only diagnostic laparoscopy was performed because of
suspected appendicitis. A segmental small bowel resection with attached diverticulum was performed extracorporeally after
exteriorization through the umbilical port site in both cases.
Received: 15 May 1998/Accepted: 7 April 1999 相似文献
7.
Most trocars currently used to place a cannula through the abdominal wall have a conical or pyramidal tip. Because the risk
of inadvertent injury along with removal of the cannula is probably related to (a) the force needed to traverse the abdominal
wall, (b) the force needed to remove the trocar, and (c) the defect in the abdominal wall, the optimum configuration of the
penetrating tip should be determined. The entry force needed to perforate the abdominal wall, the removal force necessary
to remove the trocar, and the defect in the abdominal wall were measured in a porcine model under standardized conditions
(general anesthesia, 12 mmHg pneumoperitoneum). Nineteen trocars (six disposable, seven reusable, six custom-made) have been
tested. They were divided into six groups according to the shape of the tip (conical, pyramidal, or a combination). The entry
force (F= 25.6, p < 0.0001) and the removal force (F= 5.1, p < 0.01) were related to the shape of the tip. Conical tips needed a higher force than purely pyramidal tips. The abdominal
defect was also different between groups (F= 6.5, p < 0.001). The trocar with a pyramidal shape caused a greater defect than conical tips. The defect in the abdominal wall was
inversely related to the entry force (r=−0.55, p < 0.001) and to the removal force (r=−0.57, p < 0.001). There is not an optimum configuration of a simple push-through trocar with a low entry force and a high removal
force. Some kind of a conical tip is recommended for insertion of trocars under direct view.
Received: 30 June 1998/Accepted: 11 March 1998 相似文献
8.
Background: This prospective study was conducted to evaluate the accuracy and the therapeutic relevance of staging laparoscopy.
Methods: Between June 1993 and February 1997 staging laparoscopy was performed in 389 patients with various neoplasms. Additionally,
144 selected patients of this group were examined with laparoscopic ultrasound using a semiflexible ultrasound probe (7.5
MHz).
Results: Compared to conventional imaging methods, laparoscopy and laparoscopic ultrasound improved the accuracy of staging in 158
of 389 patients (41%). Statistical subgroup analysis of 131 patients with gastric cancer showed that the accuracy of staging
laparoscopy in the detection of distant metastases (68%) was significantly higher (p < 0.01) than that of ultrasound (63%) or computed tomography (58%). In the whole group, laparoscopy alone disclosed intraabdominal
tumor dissemination or nonresectable disease in 111 patients. Laparoscopic ultrasound displayed additional metastases—i.e.,
liver metastases (n = 9), M1 lymph nodes (n = 15), or nonresectable tumors (n = 6) in 30 patients. Although metastastic disease
was suggested by preoperative imaging, benign lesions were found in five patients with laparoscopy and in a further 12 patients
with ultrasonography. The findings of staging laparoscopy changed the treatment strategy in 45% of the patients. Conversion
to open surgery was necessary in 5% of the cases, and complications related to laparoscopy occured in 4% of the patients.
Conclusions: Laparoscopy with laparoscopic ultrasound improves the staging of gastrointestinal tumors and has a significant impact on
a stage-adapted surgical therapy.
Received: 3 April 1997/Accepted: 26 September 1997 相似文献
9.
Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh 总被引:30,自引:12,他引:18
Carbajo MA Martín del Olmo JC Blanco JI de la Cuesta C Toledano M Martin F Vaquero C Inglada L 《Surgical endoscopy》1999,13(3):250-252
Background: Despite being one of the most exact indications, laparoscopic treatment of eventrations and ventral hernias is barely known
among the array of laparoscopic techniques.
Methods: A total of 60 patients were assigned at random over a 3-year period to two homogeneous groups to be operated on for major
ventral hernias with mesh. Half of them were operated upon laparoscopically and the rest with open surgery. Early and longer-term
complications were analyzed, as were operative time and postoperative hospital stays.
Results: The two groups were homogeneous in terms of demographic and clinical characteristics. The group that was operated on laparoscopically
presented a lower rate of postoperative and longer-term complications; similarly, surgery time was significantly lower (p < 0.05). Hospitalization time was also significantly lower than in the group undergoing conventional open surgery (p < 0.05).
Conclusions: Laparoscopic treatment of postoperative eventration and primary ventral hernia reduces complications and relapse rates, eliminates
reintervention through mesh infection, reduces operative time, and considerably shortens the hospital stay.
Received: 22 December 1997/Accepted: 18 August 1998 相似文献
10.
Cost analysis of diagnostic laparoscopy vs laparotomy in the evaluation of penetrating abdominal trauma 总被引:1,自引:0,他引:1
Background: Diagnostic laparoscopy for the evaluation of injuries in patients with penetrating abdominal trauma has been shown to decrease
the morbidity and mortality associated with mandatory laparotomy. The overall impact on patient care and hospital costs has
not been thoroughly investigated. The goal of this study was to determine the economic impact of laparoscopy as a diagnostic
tool in the management of patients following penetrating trauma to the abdomen or flank.
Methods: Retrospective chart review of all hemodynamically stable patients with penetrating trauma to the abdomen or flank, but without
other injuries requiring emergent intervention, admitted to a level I trauma center between January 1, 1992, and September
30, 1994. Those patients who underwent either laparoscopy (DL) or laparotomy (NL) or both (CONV) and who had no intraabdominal
organ injuries requiring surgical therapeutic intervention were included in the study. Age, operative time, operative findings,
length of hospitalization, Injury Severity Score (ISS), variable costs, and total costs were recorded for each patient.
Results: Fourteen patients underwent negative/nontherapeutic laparoscopy (DL), 19 patients underwent negative/nontherapeutic laparotomy
(NL), and four patients underwent both laparoscopy and laparotomy, a conversion procedure (CONV). There was no significant
difference in age, operative times, or ISS between the DL and NL groups. Mean ISS of CONV patients was significantly greater
than that of DL patients, 5.75 ± 1.97 vs 2.43 ± 0.63 (p < 0.05). Mean operative time for CONV patients was also significantly greater than both DL and NL patients, 106.5 ± 17.00
min vs 66.1 ± 6.55 and 47.3 ± 7.50 min, respectively (p < 0.05). The mean length of stay was significantly shorter in the DL group as compared to the NL or CONV groups, 1.43 ± 0.20
vs 4.26 ± 0.31 and 5.0 ± 0.82 (p < 0.0001). The variable costs for the DL group were significantly lower than those incurred by patients in the NL and CONV
groups, $2,917 ± 175 vs $3,384 ± 102 and $3,774 ± 286, (p < 0.05). Variable costs were not significantly different between the NL and CONV groups. Total costs were also significantly
lower in the DL group when compared to NL and CONV, $5,427 ± 394 vs $7,026 ± 251 and $7,855 ± 750 (p < 0.005), but again, they were not statistically different between the NL and CONV groups. The overall total costs for laparoscopy,
including the costs incurred by conversion patients, was significantly less than the total costs for laparotomy patients,
$5,664 ± 394 vs $7,028.47 ± 250 (p < 0.005). This resulted in an overall savings of $1,059.44 per laparoscopy performed. The overall negative/nontherapeutic
laparotomy rate during this study was 19.1%, which was significantly lower than the negative or nontherapeutic exploration
rate during the time period prior to the use of laparoscopy (p < 0.01, z = 2.550).
Conclusion: Variable and total costs and length of stay were significantly lower in our population of patients who underwent DL as compared
to NL. The rate of negative or nontherapeutic laparotomy was also significantly reduced when compared to the rate identified
during the era prior to the use of laparoscopy. Laparoscopy resulted in an overall savings of $1,059 per laparoscopy performed
when compared to laparotomy.
Received: 11 March 1996/Accepted: 5 July 1996 相似文献
11.
目的探讨腹腔镜在腹部外科病人诊断和治疗中的应用价值。方法回顾性分析自2013年3月至2014年5月共1 15例腹部外科病人行腹腔镜探查的临床资料。结果所有病人经腹腔镜探查及术后病理得以明确诊断,其中94例(81.7%)在腹腔镜下完成手术,44例肿瘤性病变在腹腔镜探查下明确,其中4例(9.1%)发现肿瘤已广泛转移或无法切除则选择关腹,所有病人术后都恢复良好。结论腹腔镜在腹部外科病人诊治中具有重要作用,值得在临床上推广应用。 相似文献
12.
Background: Removing the normal appendix when operating for suspected acute appendicitis is the standard of care. The use of laparoscopy
should not alter this practice.
Methods: Retrospective review of 72 patients found to have grossly normal appendices while undergoing laparoscopy for suspected appendicitis.
Twenty-eight patients underwent diagnostic laparoscopy (DL) alone while 44 patients underwent diagnostic laparoscopy with
incidental laparoscopic appendectomy (ILA).
Results: There was no difference in length of hospitalization (DL = 44 h, ILA = 43 h, p= 0.49) or morbidity (DL = 11%, ILA = 5%, p= 0.37). One patient required appendectomy 11 days after diagnostic laparoscopy for recurrent acute right lower quadrant abdominal
pain. Five percent of resected appendices (2/44) demonstrated acute inflammation upon pathologic review.
Conclusions: Laparoscopic removal of the normal appendix produces no added morbidity or increase in length of hospitalization as compared
to diagnostic laparoscopy. It demonstrates cost effectiveness by preventing missed and future appendicitis. Incidental laparoscopic
appendectomy is the preferred treatment option.
Received 3 April 1997/Accepted: 3 July 1997 相似文献
13.
Utility of transesophageal echocardiography and pulmonary artery catheterization during laparoscopic assisted abdominal aortic aneurysm repair 总被引:1,自引:1,他引:0
A. J. D'Angelo R. G. Kline M. H. M. Chen V. J. Halpern J. R. Cohen 《Surgical endoscopy》1997,11(11):1099-1101
Background: Advanced laparoscopic procedures are more commonly performed in elderly patients with cardiac disease. There has been limited
data on the use of pulmonary artery catheters (PAC) and transesophageal echocardiography (TEE) to monitor hemodynamic changes.
Methods: We prospectively studied eight patients undergoing laparoscopic assisted abdominal aortic aneurysm repair. All patients had
a PAC and all but one had an intraoperative TEE. Data included heart rate (HR), temperature (temp), pulmonary artery systolic
(PAS) and diastolic (PAD) pressures, mean arterial pressure (MAP), central venous pressure (CVP), pulmonary capillary wedge
pressure (PCWP), cardiac index (CI), mixed venous oxygen saturation (MVO2), and oxygen extraction ratio (O2Ex) and was obtained prior to induction, during insufflation, after desufflation, during aortic cross-clamp, and at the end
of the procedure. End diastolic area (EDA), a reflection of volume status, was measured on TEE. ANOVA was used for data analysis.
Results: No changes were noted in HR, temp, PAS, PCWP, CI, MVO2, and O2Ex. PAD and CVP were greater during insufflation compared with baseline and aortic cross-clamp without associated changes
in EDA. MAP was higher at baseline compared with all other times during the procedure.
Conclusions: Insufflation increased PAD and CVP. However, volume status as suggested by EDA and PCWP did not change. These data question
the reliability of hemodynamic measurements obtained from the PAC during pneumoperitoneum and suggest that TEE may be sufficient
for evaluation of volume status along with the added benefit of timely detection of ventricular wall motion abnormalities.
Received: 27 March 1997/Accepted: 5 July 1997 相似文献
14.
Totally laparoscopic abdominal aortic aneurysm repair 总被引:1,自引:0,他引:1
On the basis of our previous animal and clinical experience with laparoscopic intra-abdominal vascular reconstructions, and
due to the prevalence of abdominal aortic aneurysms (AAA), we have recently broadened our scope to tackle more difficult aortic
surgery laparoscopically. We present a case report of our first clinical experience with laparoscopic AAA repair using specialized
laparoscopic vascular instrumentation. The patient was an 84-year-old hypertensive male with a 7-cm asymptomatic infrarenal
abdominal aortic aneurysm that was discovered incidentally. He presented with postcoronary artery bypass grafting and had
moderate chronic obstructive pulmonary disease (COPD). A spiral computed tomograph (CT) angiogram revealed an adequate infrarenal
neck and aneurysmal involvement of the proximal iliac arteries. An eight-port transabdominal technique was used with the patient
in the supine position. Proximal and distal control was achieved without difficulty. The aneurysm was excluded using endoscopic
stapling devices, and an aortobiiliac reconstruction was performed with a 16 × 9-mm bifurcated dacron graft. Estimated blood
loss was 1000 ml, and the operative time was approximately 7 hours. The patient was ambulating without assistance on postoperative
day 3. Total hospitalization was 7 days (delayed secondarily to postoperative ileus). Minimal quantities of narcotics were
required for analgesia. At 6-months follow-up, the patient has palpable peripheral pulses and no complications related to
surgery. This case report shows that a completely laparoscopic approach to the abdominal aortic aneurysm is possible using
instrumentation specifically designed for laparoscopic vascular surgery. The exact role that laparoscopic techniques will
hold in vascular surgery remains to be determined because these procedures are time consuming and technically difficult.
Received: 2 December 1997/Accepted: 4 March 1998 相似文献
15.
Background: Diagnostic laparoscopy through the right lower abdominal incision following open appendectomy for suspected acute appendicitis
may help in making the correct diagnosis in the absence of pathology of the appendix.
Methods: Fourteen patients with a clinical diagnosis of acute appendicitis underwent diagnostic laparoscopy through the right lower
quadrant incision after open appendectomy to exclude further pathology in the case of a noninflamed appendix.
Results: In 10 of the 14 patients, laparoscopy helped to correct the diagnosis. In two patients, the etiology of the acute right lower
abdominal pain remained unclear. In two others, histological examination showed acute appendicitis despite a normal macroscopic
appearance.
Conclusions: Diagnostic laparoscopy through the right lower quadrant incision may help to correct the diagnosis in patients who are operated
on for clinically acute appendicitis but in whom no acute appendicitis or other pathological findings are seen.
Received: 10 September 1997/Accepted: 15 April 1998 相似文献
16.
Pain after laparoscopy 总被引:9,自引:1,他引:8
Background: In the context of the much-heralded advantages of laparoscopic surgery, it can be easy to overlook postlaparoscopy pain as
a serious problem, yet as many as 80% of patients will require opioid analgesia. It generally is accepted that pain after
laparoscopy is multifactorial, and the surgeon is in a unique position to influence many of the putative causes by relatively
minor changes in technique.
Methods: This article reviews the relevant literature concerning the topic of pain after laparoscopy.
Results: The following factors, in varying degrees, have been implicated in postlaparoscopy pain: distension-induced neuropraxia of
the phrenic nerves, acid intraperitoneal milieu during the operation, residual intra-abdominal gas after laparoscopy, humidity
of the insufflated gas, volume of the insufflated gas, wound size, presence of drains, anesthetic drugs and their postoperation
effects, and sociocultural and individual factors.
Conclusions: On the basis of the factors implicated in postlaparoscopy pain, the following recommendations can be made in an attempt to
reduce such pain: emphathically consider each patients' unique sociocultural and individual pain experience; inject port sites
with local anesthesia at the start of the operation; keep intra-abdominal pressure during pneumoperitoneum below 15 mmHg,
avoiding pressure peaks and prolonged insufflation; use humidified gas at body temperature if available; use nonsteroidal
anti-inflammatory drugs at the time of induction; attempt to evacuate all intraperitoneal gas at the end of the operation;
and use drains only when required, rather than as a routine.
Received: 26 May 1998/Accepted: 30 June 1998 相似文献
17.
J. C. Box T. Duncan B. Ramshaw J. G. Tucker E. M. Mason J. P. Wilson D. Melton G. W. Lucas 《Surgical endoscopy》1997,11(10):1026-1028
Background: The evaluation of AIDS patients with acute abdominal complaints (AAC) is quite difficult, and surgical intervention is associated
with a high complication rate. The intent of this study is to evaluate the application of laparoscopy in the diagnosis and
treatment of AIDS patients with AAC.
Methods: This is a retrospective analysis of 10 consecutive AIDS patients who presented with AAC. Each had evaluation by a surgical
team with subsequent laparoscopic intervention. The charts were reviewed for age, sex, time with AIDS, AIDS comorbidities,
evaluation modalities, findings, treatment modalities, and outcome.
Results: Laparoscopy resulted in the successful surgical treatment of four patients, diagnosis of medically treatable conditions in
four patients, and alteration of the incision site in the remaining two patients. Each patient thus received direct benefit
from laparoscopy. Two complications, in the converted patients, and no mortalities were encountered.
Conclusions: Laparoscopy is a safe and effective interventional modality in the diagnosis and treatment of AAC in the AIDS patient.
Received: 26 November 1997/Accepted: 7 May 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.
C. A. Jacobi J. Ordemann B. Böhm H. U. Zieren C. Liebenthal H. D. Volk J. M. Müller 《Surgical endoscopy》1997,11(6):618-621
Background: The effects of laparotomy and laparoscopy with different gases on subcutaneous and intraperitoneal tumor growth have not
been evaluated yet.
Methods: Tumor growth of colon adenocarcinoma DHD/K12/TRb was measured in rats after laparotomy, laparoscopy with CO2 or air, and in control group. Cell kinetics were determined after incubation with carbon dioxide or air in vitro and tumor
growth was measured subcutaneously and intraperitoneally after surgery in vivo.
Results: In vitro, tumor cell growth increased significantly after incubation with air and CO2. In vivo, intraperitoneal tumor weight was increased after laparotomy (1,203 ± 780 mg) and after laparoscopy with air (1,085
± 891 mg) and with CO2 (718 ± 690 mg) compared to control group (521 ± 221 mg) (p < 0.05). Subcutaneous tumor growth was promoted after laparotomy (71 ± 35 mg) and even more after laparoscopy with air (82
± 45 mg) and CO2 (99 ± 55 mg) compared to control group (36 ± 33 mg).
Conclusions: Insufflation of air and CO2 promote tumor growth in vitro. In vivo, intraperitoneal tumor growth seems to be promoted primarily by intraperitoneal air
and subcutaneous tumor growth by CO2.
Received: 7 November 1996/Accepted: 3 December 1996 相似文献
20.
Background: Endoscopy created a new epoch in gynecology and general surgery. After a decade of learning experiences and expansion of
laparoscopic surgery in a variety of areas, the need to further miniaturize the endosurgical approach surfaced. This, however,
requires a better knowledge about the tools that surgeons must or wish to employ in minimal access surgery. For miniaturization,
the quality of the image on the TV monitor is critical.
Methods: We examined two miniature optical systems: the quartz-fiber (2.0–2.2 mm) and the rod-lens (3.3-mm) relay technologies.
Results: The smaller quartz telescope image was found to be brighter but lacking in other important features that are important in
diagnosis and surgical manipulations.
Conclusions: Because the detail, clarity, and the color display affect decision making and the course taken, the brand of telescope has
to be selected according to the particular application. By following this guideline, a number of diagnostic and therapeutic
procedures can be performed using smaller instruments with the patient under local anesthesia with sedation or under general
anesthesia in an outpatient setting.
Received: 15 April 1998/Accepted: 10 November 1998 相似文献