共查询到20条相似文献,搜索用时 46 毫秒
1.
Background: Advanced age with its concomitant comorbid conditions may be associated with increased postoperative laparoscsopic cholecystectomy
(LC) complications and more frequent conversion to open cholecystectomy (OC). The purpose of this study was to evaluate the
outcome of LC in patients age 65 and older.
Methods: Ninety consecutive patients were studied age 65 and older, of whom 39 (43%) were males and 51 (57%) were females, mean age
74 years (range 65–98), with 20 patients (22%) ≥ 80. Indications for surgery included biliary colic 55 (61%), acute cholecystitis
22 (24%), pancreatitis 10 (11%), and cholangitis 3 (4%). Seventeen patients (19%) had preoperative ERCP, 12 of which were
normal; five had sphincterotomy with stone extraction. Comorbid conditions included hypertension (44%), CAD (17%), cardiac
arrhythmias (18), CHF (9%), and COPD (7%).
Results: Operative time—mean 1 h 51 min ± SD 43 min. Conversion to OC—three patients (3%). Length of stay—mean 5 days (range 1–26).
Mortality—two patients (2%) >80 years old, one patient with septicemia and multiorgan failure whose comorbid diseases included
CAD, C.F., COPPED, and elevated BP, one patient with MI postsurgery, morbid diseases included DM and CAD. Complications—five
patients (5%): bile leak from cystic duct stump (one), postsurgery MI (two), incarcerated incisional hernia (one), septicemia
(one).
Conclusion: Morbidity rates for LC in the elderly population are not different from that reported for patients less than 65 years of
age. (5% vs 6%, Fried et al., Surg Clin North Am 1994;74 [2]: 375–387). Our 2% mortality rate is statistically different from previously reported in a series of patients
of all ages (0.6%, Fried et al.). The 3% rate of conversion to OC in this older population is not significantly different
from the patients in Fried et al. series (4%).
Received: 17 September 1996/Accepted: 14 October 1996 相似文献
2.
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
3.
Preoperative abdominal ultrasound may be misleading in risk stratification for presence of common bile duct abnormalities 总被引:2,自引:0,他引:2
Background: Following the advent of laparoscopic cholecystectomy (LC), the preoperative predictors of common bile duct (CBD) abnormalities
became more important in perioperative decision making. Preoperative transabdominal ultrasound (US) is used to assess the
preoperative risks associated with CBD abnormalities. This study attempts to determine the sensitivity and specificity of
US in determining CBD abnormalities in patients prior to LC.
Methods: US measurements of the CBD diameter and presence of stones were ascertained from radiology reports in 100 patients who had
LC with a routine intraoperative cholangiogram (IOC). The same information was obtained from the patients' IOC. A supraduodenal
CBD diameter of >8 mm was considered dilated.
Results: US demonstrated a sensitivity of 25% and a specificity of 70% for the detection of CBD dilatation compared to IOC. The sensitivity
of US for predicting CBD dilatation was 55% when the IOC-derived diameter was >10 mm and 100% when it was >15 mm. The overall
sensitivity of US for detection of stones was 10%; it improved to 17% in patients with a dilated CBD on US.
Conclusions: Preoperative ultrasound is neither sensitive nor specific for detecting CBD dilatation or presence of stones. A negative
preoperative US report may be misleading in risk stratification for the presence of these CBD abnormalities. In order to avoid
missing any CBD pathology, we recommend the routine use of intraoperative cholangiography.
Received: 30 July 1999/Accepted: 24 September 1999 相似文献
4.
D. Collet 《Surgical endoscopy》1997,11(1):56-63
Background: In 1996, laparoscopic cholecystectomy is the gold standard for symptomatic cholelithiasis. The results of this operation
as published so far include data on the learning curve of the method. The aim of this study is to evaluate the results of
laparoscopic cholecystectomy when performed by a large number of surgeons during the year 1994, not taking into account the
beginning years in which the technique was being used.
Methods: This study has been carried out prospectively and anonymously among members of SFCERO. All the patients who underwent a cholecystectomy
started laparoscopically during 1994 have been included.
Results: Some 4,624 cholecystectomies were performed by 150 surgeons. There were 3,310 females (42.5 ± 19.8 years old) and 1,314 males
(56.3 ± 1.61 years old). The conversion rate was 6.9%: 320 operations had to be converted into laparotomy (group II) while
4,261 were performed entirely by laparoscopy (group I). Morbidity was 5% (N= 230)—4.7% in group I (N= 203) and 8.4% in group II (N= 27). Mortality was 0.2% (N= 9)—namely four intraabdominal complications (three cases of peritonitis and one biliary reoperation), two cardiac failures,
and one brain infarction. The causes of death were not specified in two patients.
Conclusions: These results show that morbidity and mortality have not changed dramatically since the beginnings of this technique, whereas
the frequency of common bile duct (CBD) injuries has decreased. However, the conversion rate has increased slightly. These
results make it possible to calculate the risk of conversion and postoperative complication according to the age of the patient
and the biliary symptoms.
Received: 25 January 1996/Accepted: 10 April 1996 相似文献
5.
A prospective comparison of laparoscopic ultrasound vs intraoperative cholangiogram during laparoscopic cholecystectomy 总被引:5,自引:2,他引:3
R. A. Falcone Jr. E. J. Fegelman M. S. Nussbaum D. L. Brown T. M. Bebbe G. L. Merhar J. A. Johannigman F. A. Luchette K. Davis Jr. J. M. Hurst 《Surgical endoscopy》1999,13(8):784-788
Background: The laparoscopic ultrasound (US) probe provides a new modality for evaluating biliary anatomy during laparoscopic cholecystectomy
(LC).
Methods: We performed a laparoscopic US examination in 65 patients without suspected common bile duct (CBD) stones prior to the performance
of a laparoscopic cholangiogram (IOC). We then compared the cost, time required, surgeon's assessment of difficulty, and interpretations
of findings.
Results: There was a significant difference in the cost of US versus the cost of IOC ($362 ± 12 versus $665 ± 12; p < 0.05). Surgeons who had performed >10 US (EXP) were compared with those who had performed ≤10 (NOV). There were significant
differences between the EXP and NOV groups in ease of examination, visualization of biliary anatomy, and accuracy of measurement
of the CBD.
Conclusions: The use of laparoscopic US for the accurate evaluation of the CBD and biliary anatomy requires that the surgeon has surpassed
the learning curve, which we have defined as having performed >10 US exams.
Received: 1 May 1998/Accepted: 21 October 1998 相似文献
6.
S. H. Kim J. W. Milsom J. M. Church K. A. Ludwig A. Garcia-Ruiz J. Okuda V. W. Fazio 《Surgical endoscopy》1997,11(10):1013-1016
Background: Because of the inability to palpate colonic tumors during laparoscopy, their location must be precisely identified before
resection is undertaken.
Method: A retrospective study was performed of 58 patients in order to be able to describe our methods of tumor localization for
laparoscopic colorectal operations and to review their effectiveness.
Results: In all patients, the entire colon was examined preoperatively by colonoscopy. In one patient, preoperative colonoscopic localization
was inaccurate. In 31 patients, tumors were easily detectable at surgery. In five patients with the tumor in the right colon,
even though the lesion was not detectable at surgery, right colectomy was performed without marking because preoperative colonoscopy
reliably identified the lesion adjacent to the ileocecal valve. Twenty-two patients required some type of procedure to localize
the tumor. The procedures and their problems were as follows: preoperative tattoo (five)—tattoo not visualized (one); intraoperative
colonoscopy alone (six), combined with intraoperative tattoo (four) or clip (three)—poor operative exposure due to bowel distension
(nine), hard to see the clip (three), dislodged clip (two), inadequate resection margin (one); intraoperative proctoscopy
alone (two), combined with laparoscopic stitch (two)—no problems. In no patient was tumor present at a resection line and
in no patient was the wrong segment resected.
Conclusions: Reliable preoperative identification of the tumor adjacent to the ileocecal valve can permit right colectomy without marking.
Lesions in the upper rectum can be approached via intraoperative proctoscopy ± suture placement. If the surgeon anticipates
intraoperative localization may be difficult, lesions other than rectal or cecal ones should probably be marked by preoperative
tattooing. Further studies regarding the technique of tattooing are warranted.
Received: 18 July 1996/Accepted: 10 March 1997 相似文献
7.
A new surgical strategy for cirrhotic patients with hepatocellular carcinoma and hypersplenism 总被引:8,自引:0,他引:8
Background: Hepatectomy for cirrhotic patients with hypersplenism is a high-risk operative procedure. We report herein a new strategy
for high-risk patients with hepatocellular carcinoma (HCC).
Methods: Six cirrhotic patients with HCC and hypersplenism received a partial hepatectomy after first undergoing a laparoscopic splenectomy.
We then compared the variables for these patients before splenectomy and before hepatectomy.
Results: The platelet count and the white blood cell count were found to be significantly elevated before hepatectomy. The ammonia
value decreased significantly before hepatectomy. The albumin value tended to be elevated before hepatectomy. Furthermore,
the Child's classification of all patients improved significantly before hepatectomy. However, other variables—such as the
indocyanine green dye excretion test at 15 min and the bilirubin value—did not change after splenectomy. For hepatectomy patients
who first underwent a laparoscopic splenectomy, operation time ranged from 265 to 440 min (average time, 361 min), and blood
loss ranged from 500 to 2,200 ml (median volume, 1,300 ml). Four of six patients did not require any blood transfusion; furthermore,
no patient needed a platelet-rich plasma transfusion. All but one patient, who suffered postoperatively from an intractable
duodenal ulcer, had an uneventful postoperative course.
Conclusion: Partial hepatectomy after an initial laparoscopic splenectomy is a new and effective choice of treatment for cirrhotic patients
with HCC and hypersplenism.
Received: 1 May 1998/Accepted: 30 June 1999 相似文献
8.
Role of laparoscopic ultrasonography in intraoperative localization of pancreatic insulinoma 总被引:11,自引:3,他引:8
Background: A combination of digital palpation and ultrasonography plays an important role in locating insulinomas intraoperatively.
Laparoscopic resection of insulinomas has been described recently, but experience in locating insulinomas during laparoscopy
is lacking.
Methods: From January 1998 to January 1999, three patients with pancreatic insulinomas underwent laparoscopy and laparoscopic ultrasonography
aimed at intraoperative localization and potential resection. The role of laparoscopy and laparoscopic ultrasonography in
locating insulinomas is evaluated.
Results: Preoperative localization studies were routinely performed, and two patients had an occult tumor before laparoscopy. None
of the tumors was detected by laparoscopic examination, but laparoscopic ultrasonography identified solitary tumors located
at the body and tail of the pancreas. Conversion to laparotomy was performed in one patient as a planned procedure. One patient
underwent laparoscopic enucleation, whereas the other had a laparoscopic distal pancreatectomy.
Conclusions: Laparoscopic ultrasonography seems to be sensitive in locating insulinomas at the body and tail of the pancreas. It optimizes
and facilitates resection of insulinomas through a minimally invasive approach.
Received: 8 March 1999/Accepted: 10 August 1999/Online publication: 7 September 2000 相似文献
9.
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
10.
A comparison of surgeons' posture during laparoscopic and open surgical procedures 总被引:17,自引:11,他引:6
Background: There is increasing recognition of surgeons' physical fatigue in the new ergonomic environment of laparoscopic surgery. The
purpose of this study was to determine what the differences are in the movement of the surgeon's axial skeleton between laparoscopic
and open operations.
Methods: Surgeons' body positions were recorded on videotape during four laparoscopic (LAP) and six open (OP) operations. The percent
of time the head and back were in a normal, bent, or twisted position as well as the number of changes in head and back position
were tabulated using a computer program. A separate laboratory study was performed on four surgeons ``walking' a 0.5-inch
polyethylene tubing forward and backward using laparoscopic and open techniques. The movements of the surgeons' head, trunk,
and pelvis were measured using a three-camera kinematic system (Kin). The center of pressure was recorded using a floor-mounted
forceplate (Fp).
Results: In the operating room surgeons' head and back positions were more often straight in laparoscopic procedures and more often
bent in open operations. The number of changes in back position per minute were significantly decreased when the laparoscopic-only
part of surgery was analyzed. In the laboratory the subjects' head position was significantly (p= 0.02) more upright and the anteroposterior (AP) and rotational range of motion of the head was significantly reduced during
laparoscopy. Subjects' CP was more anterior and there was a significant reduction in the AP range of motion of the CP during
laparoscopy.
Conclusions: Our study suggests that surgeons exhibit decreased mobility of the head and back and less anteroposterior weight shifting
during laparoscopic manipulations despite a more upright posture. This more restricted posture during laparoscopic surgery
may induce fatigue by limiting the natural changes in body posture that occur during open surgery.
Received: 3 March 1996/Accepted: 2 July 1996 相似文献
11.
Minimally invasive surgery for posterior gastric stromal tumors 总被引:9,自引:3,他引:6
Background: Because involvement is extremely rare, surgery for gastric stromal tumors consists of local excision with clear resection
margins. The aim of this study was to report the results of a consecutive series of nine patients with posterior gastric stromal
tumors that were excised using a minimally invasive method.
Methods: Patients received a general anesthetic before placement of three laparoscopic ports— a 10-mm (umbilical) port for the telescope
and two working ports, a 12-mm port (left upper quadrant) and a 10-mm port (right upper quadrant). Grasping forceps were placed
through an anteriorly placed gastrotomy to deliver the tumor through the gastrotomy into the abdominal cavity, thus allowing
an endoscopic linear cutter to excise the tumor with a cuff of normal gastric tissue.
Results: Nine consecutive patients with a median age of 73 years (range, 47–83) were treated. In seven patients, laparoscopic removal
of the tumor was achieved. Two patients required conversion to an open operation because the tumor could not be delivered
into the abdominal cavity. The median length of postoperative stay for the seven patients in whom the procedure was completed
laparoscopically was 3 days (range, 2–6).
Conclusions: Posterior gastric stromal tumors can be removed safely using this minimally invasive method. Delivery of the tumor through
the gastrotomy is essential for success.
Received: 30 April 1999/Accepted: 12 July 1999 相似文献
12.
Intermittent pneumatic sequential compression (ISC) of the lower extremities prevents venous stasis during laparoscopic cholecystectomy 总被引:2,自引:1,他引:1
Background: Fifty patients were included in a prospective randomized trial to evaluate the efficacy of intermittent sequential compression
(ISC) of the lower extremities in preventing venous stasis during laparoscopic cholecystectomy.
Methods: We treated 25 patients with (+ISC) and 25 without (–ISC) intermittent sequential compression. Peak flow velocity (PFV) and
cross-sectional area (CSA) of the right femoral vein were measured by Doppler ultrasound before, during, and after capnopneumoperitoneum
with 14 mm Hg.
Results: PFV was 26.4 (8.4) cm/s and CSA was 1.03 (0.23) cm2 before pneumoperitoneum was induced. During abdominal insufflation, PFV decreased to 61% of the baseline value in the (–ISC)
group but remained unchanged in the (+ISC) group (t = 5.17, df = 42.8, p < 0.01). CSA was 1.06 (0.22) cm2 before insufflation. It increased to 118% of the baseline in the (–ISC) group and to 108% in the (+ISC) group (t =–1.55,
df = 47.1, p= 0.13). PFV and CSA returned to baseline values within 5 min after abdominal desufflation.
Conclusions: ISC effectively neutralizes venous stasis during laparoscopic surgery and may decrease the risk of postoperative thromboembolic
complication. Therefore, it is recommended for all prolonged laparoscopic procedures.
Received: 10 April 1996/Accepted: 24 April 1997 相似文献
13.
Cost-effectiveness of different diagnostic strategies in patients with nonresectable upper gastrointestinal tract malignancies 总被引:1,自引:0,他引:1
Mortensen MB Ainsworth AP Langkilde LK Scheel-Hincke JD Pless T Hovendal C 《Surgical endoscopy》2000,14(3):278-281
Background and methods: Using a simple model, this retrospective study evaluated the cost-effectiveness of different diagnostic strategies used for
pretherapeutic detection of patients with disseminated or locally nonresectable upper gastrointestinal tract malignancies
(UGIM). Of 162 consecutive UGIM patients referred for treatment, 73 (45%) had disseminated or locally nonresectable disease,
and these patients were eligible for evaluation.
Results: The noninvasive diagnostic strategies (computed tomography [CT] with ultrasonography [US] and endoscopic ultrasonography
[EUS]) had a low procedure cost, but a diagnostic strategy based on CT with US or CT with US and laparoscopy was not cost-effective.
The inclusion of endoscopic or laparoscopic ultrasonography seemed necessary to the provision of a cost-effective strategy
because both techniques had a high diagnostic accuracy combined with a low cost. A change in diagnostic strategy from CT with
US to CT with US and EUS resulted in a net saving regarding the cost of each additional nonresectable patient detected, but
this strategy still required up to 20% futile explorative laparotomies.
Conclusions: The combination of endoscopic and laparoscopic ultrasonography was cost-effective and had no complications in this study.
We use this strategy as our standard in the pretherapeutic evaluation of UGIM patients.
Received: 27 November 1998/Accepted: 12 July 1999 相似文献
14.
C. Bloechle D. Kluth A. F. Holstein A. Emmermann T. Strate C. Zornig J. R. Izbicki 《Surgical endoscopy》1999,13(7):683-688
Background: Minimal invasive surgery is increasingly used in conditions complicated by peritonitis—e.g., peptic ulcer perforation. This
study was devised to assess the effect of a pneumoperitoneum (PP) on the ultrastructural integrity of parietal peritoneum
in perforation-induced peritonitis.
Methods: Anesthetized rats were subjected either to standardized gastrotomy simulating gastric perforation (groups Ia–d; IIa–d) or
to sham perforation (groups IIIa–d, IVa–d). In group I (a–d) and III (a–d), CO2 was insufflated 12 h after gastrotomy for 60 min (Pia 4 mmHg). Glutaraldehyde was administered intraperitoneally at the end of the PP period while the abdominal wall was still
extended (group index a), as well as 30 sec (b), 2 h (c), and 12 h (d) after desufflation. Specimens were taken from the parietal
peritoneum of the left diaphragm for scanning electronic-microscopic (SEM) analysis. In groups II (a–d) and IV (a–d), simple
puncture of the abdominal cavity was performed, and specimens were taken at corresponding times.
Results: In group Ia (gastric perforation with PP), distortion of the mesothelial cell layer with concomittant opening of stomata
to the submesothelial tissue was already observed in specimens harvested while the abdominal wall was still extended. Concomitantly,
scarce microvilli, which appeared coarse and thickened, were lying flat on top of the mesothelial cells. After desufflation
(groups Ib–c), a rapid process of mesothelial disintegration with disruption from the submesothelial layer and vanishing of
microvilli occurred. At 12 h after PP (group Id), complete deterioration of mesothelial cell integrity was observed. In groups
IIa–c (gastric perforation without PP), microvilli appeared shrunk and coarse, while integrity of the mesothelial cell layer
remained intact up to 2 h after the abdominal puncture. At 12 h after abdominal puncture (group IId), the microvilli had nearly
completely vanished and the mesothelium was breaking apart into multiple soils.
Conclusions: In SEM analysis of parietal peritoneum, premature distortion, and disintegration of the mesothelial cell layer was observed
in animals exposed to increased abdominal pressure in addition to gastric perforation-induced peritonitis.
Received: 4 May 1998/Accepted: 17 November 1998 相似文献
15.
The 3-D monitor and head-mounted display 总被引:1,自引:0,他引:1
D. M. Herron J. C. Lantis II J. Maykel C. Basu S. D. Schwaitzberg 《Surgical endoscopy》1999,13(8):751-755
Background: Stereoscopic (3-D) monitors and head-mounted displays have promised to facilitate laparoscopic surgery by increasing positional
accuracy and decreasing operative time. To test this hypothesis, we evaluated the performance of subjects using these displays
to perform standardized laparoscopic dexterity drills.
Methods: Fifty laparoscopic novices worked within an abdominal cavity simulator using four videoscopic display configurations: (1)
standard (2-D) monitor; (2) 3-D monitor; (3) 2-D head-mounted display; and (4) 3-D head-mounted display. Subjects repeated
3 standardized training exercises 2 times. We measured time to complete each drill and number of errors committed.
Results: Mean total times to complete all 3 drills were 455, 459, 485, and 449 sec for configurations 1–4, respectively. Mean total
errors committed numbered 11.3, 10.4, 12.3, and 10.8, respectively. Neither comparison reached statistical significance (p < 0.05). When 3-D configurations were compared to 2-D configurations overall, a small but statistically significant reduction
in errors was noted for 1 drill only (4.3 vs 5.0, p= 0.018).
Conclusions: Three-dimensional imaging slightly reduced the number of errors committed by laparoscopic novices during one test drill;
this improvement, however, was not clinically significant. Neither the 3-D monitor nor the head-mounted display decreased
task performance time. Widespread adoption of this technology awaits future improvement in display resolution and ease of
use.
Received: 14 October 1998/Accepted: 22 January 1999 相似文献
16.
Laparoscopic ultrasonography during laparoscopic cholecystectomy 总被引:3,自引:0,他引:3
Background: This study assessed the effectiveness of laparoscopic ultrasonography in demonstrating biliary anatomy, confirming suspected
pathology, and detecting unsuspected pathology.
Methods: Laparoscopic ultrasonography was performed on 48 patients (17 M:31 M) who underwent laparoscopic cholecystectomy. An Aloka
7.5-MHz linear laparoscopic ultrasound transducer was used for scanning.
Results: Gallbladder stones were confirmed by laparoscopic ultrasonography in all patients and unsuspected pathology was found in
five patients. Two patients were found to have common bile duct stones by laparoscopic ultrasonography and this was confirmed
by laparoscopic cholangiography. Laparoscopic ultrasound was found to be helpful during dissection in four patients, particularly
in a patient with Mirizzi syndrome. The entire common bile duct was visualized by laparoscopic ultrasonography in 40 patients
but was poorly seen in eight patients. The mean time taken for the examination was 9 min (range 4–18 min).
Conclusion: Laparoscopic ultrasound is useful during laparoscopic cholecystectomy.
Received: 8 November 1995/Accepted: 5 May 1996 相似文献
17.
Long-term results after laparoscopic unroofing of solitary symptomatic congenital liver cysts 总被引:3,自引:0,他引:3
Background: Reports about laparoscopic management of symptomatic nonparasitic liver cysts are increasing, proving the procedure feasible
and safe. However, late results of endoscopic unroofing currently are not available. The primary aim of the study was to offer
long-term results with a follow-up of more than 5 years. Two diagnostic pitfalls are presented.
Methods: Preoperatively, diagnosis was established by sonography, computed tomography (CT) scan, echinococcus serology, and tumor-marker
measurement. The outcome of 12 laparoscopic fenestrations in 11 patients with symptomatic solitary liver cysts is presented.
Nine patients were reexamined after a median observation time of 3.1 years (range, 0.6–6.4 years) by clinical investigation
and ultrasonography, CT scan, or magnetic resonance imaging (MRI), respectively.
Results: All operations could be finished laparoscopically, and no death occurred. Simultaneous cholecystectomy was performed in six
cases. All patients experienced immediate relief of symptoms. Postoperatively, no complications were observed except one patient
with unilateral brachial vein thrombosis. Histologically, we discovered one hydatide cyst and one cystadenoma underlying the
cystic disorder leading to further therapy. At follow-up, one of the remaining seven patients (14.3%) suffered symptomatic
recurrence and successfully underwent reoperation endoscopically.
Conclusions: The results of this study confirm the outcome reported previously after short- and intermediate-term follow-up showing that
laparoscopic management of symptomatic solitary nonparasitic liver cysts is permanently successful in a large majority of
cases when diagnosis is correct.
Received: 16 July 1998/Accepted: 17 December 1998 相似文献
18.
Background: Most patients presenting with pancreatic cancer are irresectable at the time the diagnosis is made. Therefore, they are in
need of palliative treatment that can guarantee minimal morbidity, mortality, and hospital stay. To address this need, we
designed a study to test the feasibility of laparoscopic gastroenterostomy and hepaticojejunostomy and to compare their results
with those achieved with open techniques.
Methods: We performed a case control study of a new concept in laparoscopic palliation based on the findings of preoperative imaging
and diagnostic laparoscopy. Laparoscopic side-to-side gastroenterostomy and end-to-side hepaticojejunostomy (Roux-en-Y) were
done in irresectable cases. Of 14 patients who underwent laparoscopic palliation, three had a laparoscopic double bypass,
seven had a gastroenterostomy, and four underwent staging laparoscopy only. The results were compared with a population of
14 matched patients who had conventional palliative procedures.
Results: Postoperative morbidity was 7% vs 43% for laparoscopic and open palliation, respectively (p < 0.05). There were no mortalities in the laparoscopic group, as compared to 29% in the group who had open bypass surgery
(p < 0.05). Postoperative hospital stay averaged 9 days in the laparoscopic group and 21 days in the open group (p < 0.06). Operating time tended to be shorter in the laparoscopic group (p < 0.25). Morphine derivatives were necessary for a significantly shorter period after laparoscopic surgery (p < 0.03).
Conclusions: Our preliminary experience strongly suggests that laparoscopic palliation can reduce the three major drawbacks of open bypass
surgery—i.e., high morbidity, high mortality, and long hospital stay.
Received: 24 February 1999/Accepted: 13 May 1999 相似文献
19.
Laparoscopic insufflation of the abdomen reduces portal venous flow 总被引:31,自引:12,他引:19
Background: The adverse effects of sustained elevated intraperitoneal pressure (IPP) on cardiovascular, pulmonary and renal systems have
been well documented by several reported experimental and clinical studies. Alteration in the splanchnic circulation has also
been reported in animal experiments, but details of the exact hemodynamic changes in the flow to solid intraabdominal organs
brought on by a raised intraperitoneal pressure in the human are not available. The aim of the present study was to estimate
effect of increased IPP on the portal venous flow, using duplex Doppler ultrasonography in patients undergoing laparoscopic
cholecystectomy.
Methods: The studies were performed using the SSD 2000 Multiview Ultrasound Scanner and the UST 5536 7.0-MHz laparoscopic transducer
probe. Details of the measurements were standardized in according to preset protocol. Statistical evaluation of the data was
conducted by the two-way analysis of variance (ANOVA).
Results: The flow measurement data have demonstrated a significant (p < 0.001) decrease in the portal flow with increase in the intraperitoneal pressure. The mean portal flow fell from 990 ±
100 ml/min to 568 ± 81 ml/min (−37%) at an IPP of 7.0 mmHg and to 440 ± 56 mmHg (−53%) when the IPP reached 14 mmHg.
Conclusions: The increased intraperitoneal pressure necessary to perform laparoscopic operations reduces substantially the portal venous
flow. The extent of the volume flow reduction is related to the level of intraperitoneal pressure. This reduction of flow
may depress the hepatic reticular endothelial function (possibly enhancing tumor cell spread). In contrast, the reduced portal
flow may enhance cryo-ablative effect during laparoscopic cryosurgery for metastatic liver disease by diminishing the heat
sink effect. These findings suggest the need for a selective policy, low pressure or gas-less techniques to positive-pressure
interventions, during laparoscopic surgery in accordance with the disease and the therapeutic intent.
Received: 19 March 1996/Accepted: 4 July 1997 相似文献
20.
L. de Cannière L. Michel E. Hamoir G. Hubens M. Meurisse J. P. Squifflet P. Urbain L. Vereecken 《Surgical endoscopy》1997,11(11):1065-1067
Background: Adrenalectomy is not a frequent operation. Therefore the newly developed laparoscopic approach is sporadically performed
by surgeons dealing with endocrine disorders.
Methods: Some 54 videoendoscopic adrenalectomies performed on 52 patients by five surgical teams between October 1993 and December
1996 were prospectively evaluated.
Results: Indications for endoscopic adrenalectomy were pheochromocytoma (n= 17), primary hyperaldosteronism (n= 15), Cushing's adenoma or disease (n= 7), nonsecreting adenoma (n= 7), single metastasis from adenocarcinoma (n= 2), adenoma with dehydroepiandrostenedione (DHEAS) hypersecretion (n= 3), and ACTH-secreting metastases from a thymoma (n= 1). Of the 54 adrenalectomies performed, 31 were of the left gland, 19 of the right and two bilateral. Laparoscopic adrenalectomy
was successful in 50 patients (96%). Median tumor size was 4 cm (range 1.5–12), median operation duration was 80 min (range
59–360), and median postoperative stay was 4 days (range 2–13). One patient required blood transfusion.
Conclusions: Endoscopic adrenalectomy can safely be performed—even sporadically—by surgeons well versed in adrenalectomy techniques for endocrine disorders and trained in endoscopic surgery.
Received: 25 March 1997/Accepted: 16 May 1997 相似文献