共查询到20条相似文献,搜索用时 31 毫秒
1.
Is laparoscopic resection of colorectal polyps beneficial? 总被引:6,自引:0,他引:6
Background: We set out to compare the results of laparoscopic and open resections of colorectal polyps.
Methods: Forty-five consecutive patients who underwent operation by a single surgeon for endoscopically irretrievable colonic polyps
between April 1992 and March 1996 were classified into the following two groups: group I, laparoscopic procedures for colonic
polyps (n= 23); and group II, open procedures for colonic polyps (n= 22).
Results: No significant differences were seen between the groups relative to age [71.7 ± 10.7 versus 70.6 ± 13.7 years], gender [male:female
= 10:13 versus 13:9], history of previous abdominal operation (eight of 23 [34.8%] versus 10 of 22 [45.5%]), type of pathology
(villous: seven of 23 [30.4%] versus four of 22 [18.1%], tubulovillous: nine of 23 [39.1%] versus six of 22 [27.2%], tubular:
three of 23 [13.0%] versus seven of 22 [31.8%]), size of polyps (2.6 ± 1.7 cm versus 2.7 ± 1.5 cm), or type of procedures
(right hemicolectomy: 15 of 23 [65.2%] versus 11 of 22 [50%], sigmoid colectomy: five of 23 [21.7%] versus six of 22 [27.3%],
left hemicolectomy: two of 23 [8.7%] versus two of 22 [9.1%]). There was no mortality and no difference in the incidence of
postoperative complications (four of 23 [17.4%] versus seven of 22 [31.8%]), blood loss (167 cc versus 243 cc), number of
retrieved lymph nodes (7.1 ± 5 versus 6.6 ± 4), incidence of carcinoma in polyps (two of 23 [13.0%] versus four of 22 [18.2%]),
or medical cost ($22,840 versus $18,420), respectively, between the two groups. There were statistically significant differences
in length of ileus (3.5 ± 1.0 days versus 5.5 ± 1.8 days), postoperative pain (2.3 ± 1.4 versus 3.7 ± 1.9 on postoperative
day 1 [patient pain rating scale 1–10]), length of hospital stay (6.5 ± 2.0 days versus 9.4 ± 2.7 days), and return to normal
activity (5.2 ± 4.2 weeks versus 9.3 ± 12.1 weeks) in group I compared to group II, respectively. However, patients in group
II had a longer mean specimen length (18.5 ± 6.4 cm versus 29.1 ± 22.7 cm) and a shorter mean operative time (177.6 ± 52.7
min versus 143 ± 51.4 min) than patients in group I.
Conclusions: Laparoscopic colectomy for colonic polyps has definite advantages over traditional open surgery, including less postoperative
pain, earlier return of bowel function, and earlier return to normal activity. Conversely, its disadvantages include longer
operative time and a shorter specimen.
Received: 27 January 1997/Accepted: 2 February 1998 相似文献
2.
Early experience with laparoscopic abdominoperineal resection 总被引:4,自引:0,他引:4
Background: Laparoscopic abdominoperineal resection (LAPR) has not been fully evaluated as a technique in the treatment of rectal and
anal cancer or inflammatory bowel disease. The purpose of our study was to evaluate the early experience with laparoscopic
abdominoperineal resection at Washington University Medical Center.
Methods: A prospective analysis was performed on the first 21 patients undergoing the procedure at Washington University Medical Center.
Indications for surgery included rectal cancer (14 patients), anal squamous cell cancer (four patients), inflammatory bowel
disease (two patients), and anal melanoma (one patient).
Results: The procedure was converted to open procedure in four patients (19%). The mean (±SEM) operative time and blood loss for completed
and converted LAPR were 239 ± 11 min and 424 ± 43 ml, respectively. Postoperative hematocrit dropped a mean of 8.3% ± 1.2%
SEM; five patients required blood transfusion (24%). Wound complication occurred in four patients (19%; three perineal, one
trocar site). Bowel function returned after a mean of 3 days, and mean postoperative hospital stay for the completed LAPR
group was 5 days. Mild pain was experienced by 81% of patients (17/21) while 19% (4/21) noted moderate pain, usually of the
perineal wound. The mean duration of patient-controlled analgesia use was 2 days. During the 1–44-month follow-up, six patients
(29%) died from cancer (stage III or IV at operation) and only one patient developed local recurrence in the pelvis (5%).
There were no trocar-site implants of cancer. Furthermore, there was no relationship between prior abdominal operations, the
amount of blood loss, postoperative drop of hematocrit, or blood transfusion requirement and the length of hospitalization
or complication rates.
Conclusion: Laparoscopic abdominoperineal resection is a feasible alternative to the conventional open technique in both cancer and colitis
patients.
Received: 23 April 1996/Accepted: 8 July 1996 相似文献
3.
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
4.
Video-assisted thoracic surgery as a primary therapy for primary spontaneous pneumothorax 总被引:1,自引:0,他引:1
Jhingook Kim Kwhanmien Kim Young M. Shim Woo I. Chang Kay-Hyun Park Tae-Gook Jun Pyo W. Park Hurn Chae Kyung S. Lee 《Surgical endoscopy》1998,12(11):1290-1293
Background: Because blebs are confirmed in most of the patients undergoing thoracotomy, identification of blebs by high-resolution computed
tomography (HRCT) can be proposed as a surgical indication in primary spontaneous pneumothorax (PSP). If an apical bleb is
identified, we treat the patient by video-assisted thoracic surgery (VATS).
Methods: From May 1995 to September 1997, 61 patients (21.9 ± 4.6 years) were seen for initial episodes of PSP. Only seven showed
bullae on simple chest radiography. However, by HRCT, 48 had sizable blebs (>5 mm), and 45 were treated surgically by VATS.
Results: The mean duration of chest tube use after surgery was 3.2 ± 1.9 days, and the mean hospital stay was 4.5 ± 1.9 days. Only
one recurrence developed 5 weeks after VATS.
Conclusions: Our protocol is effective in controlling an initial episode of PSP. It shortens the observation time before definitive surgical
treatment, shortens the hospital stay, and decreases the likelihood of recurrence.
Received: 25 June 1997/Accepted 18 February 1998 相似文献
5.
Thoracoscopic splanchnicectomy for pain control in patients with unresectable carcinoma of the pancreas 总被引:2,自引:0,他引:2
Saenz A Kuriansky J Salvador L Astudillo E Cardona V Shabtai M Fernandez-Cruz L 《Surgical endoscopy》2000,14(8):717-720
Background: Intractable pain is the most distressing symptom in patients suffering from unresectable pancreatic carcinoma. Palliative
interventions are justified to relieve the clinical symptoms with as little interference as possible in the quality of life.
The purpose of this study was to examine the efficacy and safety of thoracoscopic splanchnicectomy for pain control in patients
with unresectable carcinoma of the pancreas.
Methods: Between May 1995 and April 1998, 24 patients (14 men and 10 women) with a mean age of 65 years (range, 30–85) suffering from
intractable pain due to unresectable carcinoma of the pancreas underwent 35 thoracoscopic splanchnicectomies. All patients
were opiate-dependent and unable to perform normal daily activities. Subjective evaluation of pain was measured before and
after the procedure by a visual analogue score. The following parameters were also evaluated: procedure-related morbidity
and mortality, operative time, and length of hospital stay.
Results: All procedures were completed thoracoscopically, and no intraoperative complications occurred. The mean operative time was
58 ± 22 min for unilateral left splanchnicectomy and 93.5 ± 15.6 min for bilateral splanchnicectomies. The median value of
preoperative pain intensity reported by patients on a visual analogue score was 8.5 (range, 8–10). Postoperatively, pain was
totally relieved in all patients, as measured by reduced analgesic use. However, four patients experienced intercostal pain
after bilateral procedures, even though their abdominal pain had disappeared. Complete pain relief until death was achieved
in 20 patients (84%). Morbidity consisted of persistent pleural effusion in one patient and residual pneumothorax in another.
The mean hospital stay was 3 days (range, 2–5).
Conclusions: We found thoracoscopic splanchnicectomy to be a safe and effective procedure of treating malignant intractable pancreatic
pain. It eliminates the need for progressive doses of analgesics, with their side effects, and allows recovery of daily activity.
The efficacy of this procedure is of major importance since life expectancy in these patients is very short.
Received: 23 December 1999/Accepted: 6 January 2000/Online publication: 12 July 2000 相似文献
6.
Laparoscopic vs conventional bowel resection in the rat 总被引:2,自引:0,他引:2
N. D. Bouvy R. L. Marquet L. N. L. Tseng E. W. Steyerberg S. W. J. Lamberts H. Jeekel H. J. Bonjer 《Surgical endoscopy》1998,12(5):412-415
Background: The role of laparoscopic surgery in the treatment of colorectal disease is still controversial. To assess the metabolic consequences
of laparoscopic and open bowel surgery, we studied serum levels of insulin-like growth factor 1 (IGF-1), an anabolic and mitogeneic
peptide, in rats.
Materials and methods: In experiment 1, the serum IGF-1 levels of 10 rats undergoing laparoscopic small bowel resections (group I) and 10 rats undergoing
conventional small bowel resections (group II) were determined before surgery and on days 1, 2, and 7. Experiment 2 compared
five rats that had CO2 pneumoperitoneum (group III), five rats that underwent laparotomy (group IV), and five rats that received anesthesia only
(group V). Differences in IGF-1 levels were tested with analysis of covariance.
Results: In experiment 1, preoperative IGF-1 levels were similar in groups I and II (87.9 ± 6.1 nmol/L versus 90.5 ± 8.1 nmol/L).
One day after surgery IGF-1 was 54.6 ± 10.5 in group I versus 41.6 ± 8.3 in group II (p= 0.006). Two days after surgery, IGF-1 was 79.4 ± 9.2 in group I versus 59.0 ± 10.5 in group II (p < 0.001). Seven days after both types of surgery, IGF-1 levels had returned to almost normal levels. In experiment 2, no
significant differences were found between the rats with CO2 pneumoperitoneum (group III) and those with laparotomy only (group IV). Rats that had anaesthesia only showed a significant
decrease in IGF-1 levels between days 0 and 1 (p < 0.018).
Conclusion: Our study indicates that laparoscopic bowel surgery is associated with a better postoperative anabolic state (i.e., less
catabolism) than conventional surgery. This finding reflects a potential benefit of laparoscopy in bowel surgery.
Received: 22 May 1996/Accepted: 10 July 1997 相似文献
7.
Background: Unlike sliding hiatal hernias, paraesophageal hiatal hernias (PEH) present a risk of catastrophic complications and should
be repaired. To assess laparoscopic repair of PEH, we prospectively evaluated the outcome of 38 consecutive patients with
type II (20 patients) or III (18 patients) PEH treated laparoscopically.
Methods: With the use of 5 or 6 ports, laparoscopic PEH reduction and repair was attempted. One patient (3%) was converted to an open
procedure. In the first 12 patients, the hiatus was closed using varying techniques including the placement of prothestic
mesh in 6 patients, and the hernia sac was not routinely excised. In the next 25 patients, the hernia sac always was excised
and the hiatus routinely sutured posteriorly to the esophagus. Twenty-nine patients also underwent either a Nissen (n= 27) or Toupet (n= 2) fundoplication, which is now performed routinely. Sutured anterior gastropexy was performed selectively in 10 of the
first 20 patients, then routinely, using T-fasteners in the last 17 patients. Barium swallow studies were performed on all
patients at 3 to 5 months postoperatively.
Results: Mean ± standard error of the mean (SEM) age was 67 ± 2 year (range, 39–92 years; 11 men, 27 women), and the American Society
of Anesthesia (ASA) score was 2.5 ± 0.1. The operating time was 195 ± 10 min: 244 ± 15 min in the first 12 patients and 170
± 11 min in the last 25 patients (p < 0.001). There were three (8%) intraoperation complications, which were treated without sequelae, and four (11%) grade II
postoperation morbidities. Median discharge was 3 days, and return to full activity was 14 days. Two patients (5%) died of
cardiovascular disease after discharge. Barium swallow revealed 2/35 (6%) PEH recurrences (1 reoperated), 3 (9%) intrathoracic
wraps, and 3 (9%) small sliding hiatal hernias. At follow-up of 1 year or more, 6/28 (21%) patients noted mild symptoms of
reflux or bloating, but only 1 patient (4%) required medication for these symptoms.
Conclusions: Laparoscopic PEH repair offers a reasonable alternative to traditional surgery, especially for high-risk patients. Rapid
recovery is achieved with acceptable morbidity and early outcome. Barium x-rays revealed hiatal abnormalities in a significant
fraction of patients, many of whom were asymptomatic. Longer follow-up will be required to determine the ideal strategy for
management of these patients.
Received: 4 April 1998/Accepted: 9 December 1998 相似文献
8.
Laparoscopic splenectomy for ITP 总被引:6,自引:0,他引:6
R. L. Friedman M. J. Fallas B. J. Carroll J. R. Hiatt E. H. Phillips 《Surgical endoscopy》1996,10(10):991-995
Background: A comparison of safety, efficacy, and cost of laparoscopic splenectomy (LS) vs open splenectomy (OS) for idiopathic thrombocytopenic
purpura (ITP) was performed.
Methods: The records of 49 consecutive patients who underwent splenectomy for ITP (31 LS and 18 OS) at a large metropolitan teaching
hospital between 3/91 and 8/95 were reviewed. Morbidity, mortality, hospital stay, operative time, blood loss, time to oral
fluid intake, direct costs, and operating room (OR) costs were analyzed.
Results: Age, sex, comorbidity, and spleen size were similar in both groups. LS was successful in 94% of patients in whom it was attempted.
Operative times showed a learning curve for LS, with average times for the last ten cases (94 ± 35 min) significantly shorter
than for the first ten (p= 0.01) and also shorter than for OS (103 ± 45 min). Postsurgical hospital stay was 2.9 ± 1.3 days for LS and 6.9 ± 3.0 days
for OS (p < 0.001). Patients tolerated an oral diet 1.2 ± 0.5 days after LS and 3.2 + 0.7 days after OS (p < 0.001). Direct hospital cost was $5,509 ± 3,636 for LS and $9,031 ± 12,752 for OS. In the LS group, six patients (21%)
had accessory spleens identified and removed, compared with two patients (11%) in the OS group. Platelet counts did not respond
in two (7%) patients in the LS group, but no accessory spleens were identified by nuclear scan. One major complication occurred
in the LS group. There were no cases of splenosis or mortality in either group.
Conclusions: LS is a safe and effective treatment for ITP, with significantly shorter postoperative hospital stay than OS.
Received: 26 March 1996/Accepted: 11 May 1996 相似文献
9.
Microlaparoscopic cholecystectomy 总被引:11,自引:4,他引:7
Background: We set out to compare a prospective evaluation of microlaparoscopic cholesystectomy (MLC) using 5-mm ports for the scope
and operating ports and two 2-mm ports for retracting to the historic results of standard laparoscopic cholecystectomy (SLC).
Methods: Fifty-six consecutive patients were operated electively for symptomatic gallstones between June 1997 and July 1998. Demographics,
history of prior abdominal surgery, operative time, resident level, need to convert, length of stay, and postoperative analgesia
were recorded for each case. In all, 43 women and 13 men aged 21 to 89 (average, 51 years) underwent MLC. Average weight was
78 kg (range, 48–119) and average height was 163 cm.
Results: Operative time for MLC was 72 ± 25 min (range, 35–140), somewhat less than the referenced standard of 79 ± 27 min (p= 0.1). The skin-to-trocar time (6 ± 2 vs 13 ± 77 min) and intraoperative cholangiogram time (9 ± 8 vs 11 ± 6 min) were significantly
shorter (p < 0.01 and p < 0.05, respectively) for MLC. Other partial times were not significantly different. PGY2 residents averaged 74 ± 21 min
(range, 44–118) compared to 75 ± 27 min (range, 35–140) for PGY3 and 53 ± 5 (range, 43–59) for PGY5. Patient weight influenced
time. Patients <65 kg averaged 56 ± 12 min; 66–80 kg, 72 ± 24 min; 81–95 kg, 78 ± 26 min; and >95 kg, 85 ± 22 min. Previous
abdominal surgery did not affect operative time. Nine patients (16%) required conversion from 2- to 5-mm ports because of
adhesions, wall thickening, or need for better retraction. Time in these patients was 95 ± 26 min vs 68 ± 21 min in other
patients (p < 0.01). No patient was converted to an open procedure. Three patients (5%) had a positive cholangiogram and common bile
duct exploration that required placement of an extra 5-mm trocar. Five patients (9%) required insertion of an additional 2-mm
port. All patients received patient-controlled analgesia (PCA). Morphine use was 0.21 ± 0.19 mg/kg (range, 0–0.8). Hospital
stay was 1.31 days (range, 0.5–4). Subjective satisfaction was excellent because of smaller incisions. No additional morbidity
was seen with MLC.
Conclusion: MLC is a feasible and safe approach that provides similar times to SLC with better cosmesis, a less painful recovery, and
possibly an earlier return to normal activity.
Received: 16 February 1999/Accepted: 8 October 1999 相似文献
10.
P. J. Klingler G. Wetscher K. Glaser J. Tschmelitsch T. Schmid R. A. Hinder 《Surgical endoscopy》1999,13(11):1129-1134
Background: Rectus sheath hematoma (RSH) is a rare entity that can mimic an acute abdomen. Therefore, we designed a study to analyze
the etiology, frequency, diagnosis using ultrasound, and treatment of RSH.
Methods: A total of 1,257 patients admitted for abdominal ultrasound for acute abdominal pain or unclear acute abdominal disorders
were evaluated.
Results: In 23 (1.8%) patients, an RSH was diagnosed; three of them were not diagnosed preoperatively by ultrasound. Of 13 men and
10 women (mean age, 57 ± 23 years), 13 developed RSH after local trauma, three after severe coughing, two after defecation,
and five spontaneously. Fifteen had nonsurgical therapy, and eight underwent surgery. The use of anticoagulants was accompanied
by a larger diameter of the RSH (p < .012), and surgical therapy was more frequently required in these patients. In the surgically treated group, more intraabdominal
free fluid could be detected by ultrasound (p < .0005), patients required less analgesics (p < .001), and the mean hospital stay was shorter (p < .001).
Conclusions: RSH is a rare condition that is usually associated with abdominal trauma and/or anticoagulation therapy. Ultrasound is a
good screening technique. Nonsurgical therapy is appropriate but leads to a greater need for analgesics. Surgery should be
restricted to cases with a large hematoma or free intraabdominal rupture.
Received: 29 June 1998/Accepted: 19 December 1998 相似文献
11.
Background: The elderly have prevalence rates and clinical features of gastroesophageal reflux disease (GERD) similar to those in younger
individuals, but the role of laparoscopic antireflux surgery (LARS) in the elderly has not been clearly established. The purpose
of this study was to determine if the results of LARS in the elderly are comparable with those in younger patients.
Methods: All patients undergoing LARS for GERD at the Washington University Medical Center were entered prospectively into a computerized
database. Between May 1992 and June 1998, 339 patients underwent LARS and were divided into two groups based on age: nonelderly
(ages, 18–64 years; n= 303) and elderly (age, ≥65 years; n = 36). Data were expressed as mean ± standard deviation (SD) and statistical analysis
was performed.
Results: Elderly patients had a higher American Society of Anesthesiology (ASA) score (2.3 ± 1.5) and a longer hospital stay (2.1
± 0.2 days) than the younger group (ASA, 1.9 ± 0.5; hospital stay, 1.6 ± 0.9 days; p < 0.001). Operation times averaged 154 ± 68 min in the elderly compared with 134 ± 49 min in the nonelderly (p= NS). Grade I complications occurred significantly more frequently in the elderly (13.9%) than in the nonelderly (2.6%),
but the incidence of grade II complications was similar between the groups (elderly 2.8% vs nonelderly 2.7%). There were no
grade III complications in either group, but there was one death in the nonelderly group. At follow-up ranging to 81 months
(median, 27 months), the two groups had similar low incidences of heartburn and dysphagia. Anatomic failures of LARS developed
in 19 nonelderly patients (6.2%) compared with 2 elderly patients (5.5%; p= NS).
Conclusions: As shown in this study, LARS is safe and effective in elderly patients with GERD. Age older than 65 years should not be a
contraindication to laparoscopic antireflux surgery in properly selected patients.
Received: 3 March 1999/Accepted: 2 April 1999 相似文献
12.
Laparoscopic closure of perforated duodenal ulcer 总被引:4,自引:2,他引:2
Background: Medical treatment of peptic ulcer is highly successful, and the eradication of Helicobacter pylori (H. pylori) reduces ulcer recurrence. However, the incidence of perforated duodenal ulcer and its associated mortality have not been
reduced by modern methods of therapy. Laparoscopic simple closure and omental plug by suturing, fibrin glue, and stapler have
been successful.
Methods: Over a 1-year period (1996–97), 21 patients with perforated duodenal ulcer were operated on in our hospital by laparoscopic
simple closure and omental patch. The mean age was 36.4 ± 11.8 years (range, 18–61). Twenty patients were male (93.7%). The
mean duration of pain was 9.1 ± 11.7 hs (range, 2–48). Three patients had a previous history of duodenal ulcer (14.3%), and
another three (14.3%) patients had a history of nonsteroidal antiinflammatory drug (NSAID) intake. Erect chest radiograph
showed that 19 patients had air under the diaphragm (90.5%). Sixteen patients (76.2%) had frank pus in the abdomen, and five
patients had a minimal peritoneal reaction (23.8%).
Results: The mean operative time was 71.6 ± 24.6 mins (range, 40–120), and the mean hospital stay was 5.2 ± 1.6 days (range, 3–9).
The mean time to resume oral fluids was 3.1 ± 0.8 days (range, 2–4). Only one patient was reoperated due to leakage identified
by gastrographin swallow.
Conclusions: This procedure is safe and efficient; however, further study of its long-term effectiveness and comparability to existing
therapy is still needed.
Received: 28 May 1998/Accepted: 17 November 1998 相似文献
13.
Endoscopic photodynamic therapy for obstructing esophageal cancer: 77 cases over a 2-year period 总被引:14,自引:0,他引:14
Luketich JD Christie NA Buenaventura PO Weigel TL Keenan RJ Nguyen NT 《Surgical endoscopy》2000,14(7):653-657
rid="id="<e5>Correspondence to:</e5> J. D. Luketich, 200 Lothrop Street, C-800, Presbyterian Hospital, Pittsburgh, PA 15213,
USA
Background: Photodynamic therapy (PDT) is an alternative treatment option for the palliation of obstructive esophageal cancer. We report
our experience with PDT for patients presenting with inoperable, obstructing, or bleeding esophageal cancer.
Methods: Seventy-seven patients with inoperable, obstructing esophageal cancer were treated with PDT from November 1996 to July 1998.
Photofrin (1.5–2.0 mg/kg) was administered, followed by endoscopic light treatment (630 nm red dye laser) at 48 h. Dysphagia
score (1 for no dysphagia to 5 for complete obstruction), dysphagia-free interval, and patient survival were assessed.
Results: Seventy-seven patients underwent 125 PDT courses. The mean dysphagia score at 4 weeks after PDT in 90.8% of the patients
improved from 3.2 ± 0.7 to 1.9 ± 0.8 (p < 0.05). PDT adequately controlled bleeding in all six patients who had bleeding. The most common complications after the
125 PDT courses were esophageal stricture (4.8%), Candida esophagitis (3.2%), symptomatic pleural effusion (3.2%), and sunburn (10.0%). Twenty-nine patients (38%) required more than
one PDT course, and seven patients required placement of an expandable metal stent for recurrent dysphagia. The mean dysphagia-free
interval was 80.3 ± 58.2 days. The median survival was 5.9 months.
Conclusions: Photodynamic therapy is a safe and effective treatment for the palliation of obstructing and bleeding esophagus cancer.
Received: 8 May 1999/Accepted: 24 September 1999/Online publication: 15 May 2000 相似文献
14.
Immediately recognizable benefits and drawbacks after laparoscopic colon resection for benign disease 总被引:3,自引:0,他引:3
Background: A prospective assessment of the impact of laparoscopic colon resection (LCR) was carried out in order to quantify immediately
recognizable benefits and limitations of this approach.
Methods: Elective LCR was attempted in 95 selected patients (mean age 64 years, range 39–81 years) presenting with benign disease
of the colon. A completely intracorporeal approach was adopted. Results were compared with a control group of 90 patients
who had previously undergone open colectomy (OC) by the same surgeons at the same institution.
Results: There were no perioperative deaths. Intraoperative complications included difficult extraction of accidentally detached anvil
(n= 1), air leak at colonoscopy (n= 2), and conversion to OC (n= 1). Operating time was significantly longer after LCR compared with OC (180 ± 10.3 vs 116 ± 97, p < 0.001). Passage of flatus (3.5 ± 1.2 days vs 4.4 ± 1.4, p < 0.5) and morbidity (4 vs 3, p= 0.48) were not significantly different in the two groups. Hospital stay was significantly shorter after LCR (5.2 ± 1.3 days
vs 12.2 ± 1.9 days, p < 0.001). Theater and ward costs were, respectively, significantly increased ($ 2,829.6 ± 340 vs $ 1,422 ± 318, p < 0.001) and decreased ($ 2,600 ± 366 vs $ 6,022 ± 916, p < 0.001) in LCR patients compared with the OC group. There was no significant difference in total hospital costs ($ 10,929
± 369 vs $ 9,944 ± 1,014).
Conclusions: LCR does not appear to offer any immediately recognizable advantages.
Received: 15 October 1996/Accepted: 13 December 1996 相似文献
15.
Early laparoscopic cholecystectomy for acute cholecystitis 总被引:4,自引:0,他引:4
Background: The timing of laparoscopic cholecystectomy for acute cholecystitis remains controversial.
Methods: One hundred ninety-four patients with acute cholecystitis were reviewed. The conversion rates for the various number of days
of symptoms before surgery were analyzed. The conversion rate dramatically increased from 3.6% for those patients with 4 days
of symptoms to 26% for those patients with 5 days of symptoms. The mean number of days of symptoms prior to surgery in those
patients who underwent successful laparoscopic cholecystectomy was 4.1 as compared to 8.0 in those patients who required open
cholecystectomy (p < 0.0001). Based on this data the patients were divided into two groups. Group 1 consisted of 109 patients who underwent
laparoscopic cholecystectomy within 4 days of onset of symptoms and group 2 consisted of 85 patients who underwent laparoscopic
cholecystectomy after more than 4 days following onset of symptoms.
Results: The conversion rate from laparoscopic to open cholecystectomy was 15%. The conversion rate for group 1 was 1.8% as compared
to 31.7% for group 2 (p < 0.0001). Indications for conversion were inability to identify the anatomy secondary to inflammatory adhesions (68%), cholecystoduodenal
fistula (18%), and bleeding (14%). The major complication rate for group 1 was 2.7% as compared to 13% for group 2 (p= 0.007). The mortality rate for all patients with attempted laparoscopic cholecystectomy for acute cholecystitis was 1.5%.
The average procedure time for group 1 was 100 ± 37 min vs 120 ± 55 min in group 2. The average number of postoperative hospital
days in group 1 was 5.5 ± 2.7 days as compared to 10.8 ± 2.7 days in group 2.
Conclusions: We advocate early laparoscopic cholecystectomy within 4 days of onset of symptoms to decrease major complications and conversion
rates. This decreased conversion rate results in decreased length of procedure and hospital stay.
Received: 28 March 1996/Accepted: 12 September 1996 相似文献
16.
The clinical impact of warmed insufflation carbon dioxide gas for laparoscopic cholecystectomy 总被引:2,自引:0,他引:2
Background: Reports suggest that the insufflation of cold gas to produce a pneumoperitoneum for laparoscopic surgery can lead to an intraoperative
decrease in core body temperature and increased postoperative pain.
Methods: In a randomized controlled trial with 20 patients undergoing laparoscopic cholecystectomy, the effect of insufflation using
carbon dioxide gas warmed to 37°C (group W) was compared with insufflation using room-temperature cold (21°C) gas (group C).
Intraoperative body core and intra-abdominal temperatures were determined at the beginning and end of surgery. Postoperative
pain intensity was evaluated using a visual analog scale and recording the consumption of analgesics.
Results: There were no significant group-specific differences during the operation, neither in body temperature (group W: 36.1 ± 0.4°C
vs group C: 35.7 ± 0.6°C) nor in intra-abdominal temperature (group W: 35.9 ± 0.3°C vs group C: 35.6 ± 0.6°C). Postoperatively,
the two groups did not differ in pain susceptibility and need of analgesics.
Conclusion: The use of carbon dioxide gas warmed to body temperature to produce a pneumoperitoneum during short-term laparoscopic surgery
has no clinically important effect.
Received: 13 August 1999/Accepted: 24 September 1999/Online publication: 9 August 2000 相似文献
17.
Background: We report our initial experience using operative esophageal manometry as an adjunct to endoscopy to determine the completeness
of esophagogastric high-pressure zone (HPZ) obliteration during laparoscopic Heller myotomy.
Methods: Between July 1997 and October 1998, we performed laparoscopic Heller myotomies in 20 patients (eight male, 12 female; median
age, 41 years). Mean duration of symptoms was 3.2 ± 2.6 years (r= 0.5–11), and 45% of the patients had received prior dilation or toxin injection. A 16-channel esophageal manometry catheter
was placed prior to anesthesia, with sites crossing the lower esophageal sphincter (LES). An endoscope was passed intraoperatively
to localize the squamocolumnar junction, and the myotomy was performed. While the translucency was imaged in the area of the
incision, we determined the adequacy of myotomy by visual assessment of LES and gastric cardia opening in response to endoscopic
air insufflation. Manometry was then performed to detect any potential residual high pressure at the myotomized esophagogastric
junction (EGJ). If it was found, the locus of persistent pressure was identified by probing along the myotomy, and residual
muscle fibers were cut to yield a minimum pressure at the EGJ.
Results: A persistent HPZ was identified after the initial myotomy in 10 of 20 patients (50%). A Dor fundoplasty completed the operation.
The mean operating time was 2.6 ± 0.5 h (median, 2.5; r= 2–3.5 h), and the mean hospital stay was 1.6 ± 1 days (median, 1, r= 1–5 days). The mean LES pressure was 2 ± 3 mmHg immediately postmyotomy (p < 0.001 compared with preoperative value). Of 20 patients, only two have reported recurrence of dysphagia (10%). One had
a recurrent HPZ on manometry, and one developed esophagitis, which resolved with omeprazole.
Conclusions: Our initial experience suggests that operative esophageal manometry is a useful adjunct to upper endoscopy during laparoscopic
Heller myotomy, quantitatively assuring obliteration of the nonrelaxing LES and HPZ.
Received: 1 March 1999/Accepted: 30 June 1999 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.
R. Rosati U. Fumagalli S. Bona L. Bonavina M. Pagani A. Peracchia 《Surgical endoscopy》1998,12(3):270-273
Background: Extramucosal myotomy of the lower esophagus and cardia, combined with anterior fundoplication, is, in our opinion, the procedure
of choice to treat stage I–III esophageal achalasia.
Methods: After a successful experience with open surgery in over 280 patients, from January 1992 through February 1997, 61 patients
underwent laparoscopic Heller-Dor for stage I–III achalasia. Conversion to laparotomy was done in three cases. All procedures
were performed under intraoperative endoscopic control. Intraoperative complications were seven mucosal tears, which were
sutured laparoscopically in five cases. The sole postoperative complication was bleeding from an acute gastric ulcer (conservative
treatment).
Results: Follow-up consisted of clinical and radiographic study 1 month after surgery, and endoscopy and manometry within 1 year.
After a mean follow-up (F.U.) of 21 months (1–62), clinical results range from excellent to good in 98.2%. One patient (1.7%)
complaining of recurrent dysphagia improved after endoscopic dilation. Esophageal diameter reduced from 52 to 27 mm. LES pressure
reduced from 30.3 ± 12.4 to 10.7 ± 3.5 mmHg (basal) and from 14.8 ± 9.3 to 2.9 ± 2.1 mmHg (residual).
Conclusions: Laparoscopic Heller-Dor operation is feasible, safe, and effective. Special care should be taken in patients with previous
endoscopic dilations.
Received: 3 April 1997/Accepted: 28 July 1997 相似文献
20.
Production and systemic absorption of toxic byproducts of tissue combustion during laparoscopic surgery 总被引:3,自引:0,他引:3
Background: Among the potential hazards of laparoscopic surgery using electrocautery is the intraperitoneal release and subsequent absorption
of byproducts of tissue combustion. In a porcine model of laparoscopic surgery with smoke production, our aims were to assess
(1) the relationship between levels of intraperitoneal carbon monoxide (CO) and systemic carboxyhemoglobin (COHb) and methemoglobin
(MetHb), and (2) intraperitoneal concentrations of other noxious gases, including hydrogen cyanide (HCN), acrylonitrile (Acr),
and benzene (Bzn).
Methods: Seven pigs underwent laparoscopic resection of three hepatic wedges using monopolar electrocautery in a CO2 pneumoperitoneum. Sequential arterial samples were drawn to measure [COHb] and [MetHb] perioperatively, while gaseous intraabdominal
[CO], [HCN], [Acr], and [Bzn] were assayed intraoperatively.
Results: The mean ± SEM duration of operation was 90 ± 2 min, and electrocautery was used for 68 ± 4 min. Intraabdominal [CO] rose
from 0 to 814 ± 200 ppm (p < 0.01) while [COHb] increased from 2.9 ± 0.1% to 3.5 ± 0.1% (p < 0.001). Systemic [MetHb] remained unchanged intra- and postoperatively, ranging from 0.3 to 0.7%. Intraperitoneal [HCN]
rose from 0 to 5.7 ± 0.7 ppm (p < 0.001). [Acr], however, did not change significantly from preoperative values, ranging from 0 to 1.6 ± 1.0 ppm, and [Bzn]
was undetectable.
Conclusions: Laparoscopic tissue combustion increases intraabdominal [CO] to ``hazardous' levels leading to minimal, yet significant,
elevations of [COHb]. Systemic [MetHb] and intraabdominal [HCN], [Acr], and [Bzn] are not elevated to toxic levels. Production
of intraperitoneal smoke during laparoscopic electrosurgery therefore may not pose a significant threat to the patient.
Received: 3 April 1997/Accepted: 22 May 1997 相似文献