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1.
Kohei Takei Satoki Abe Naoyuki Yamanaka Shinya Sejiyama Takahiro Narimatsu 《Minimally invasive therapy & allied technologies》2018,27(3):153-159
Purpose: The purpose of this study is to assess the efficacy of laparoendoscopic single-site (LESS) nephrectomy in hemodialysis patients, we compared outcomes between LESS nephrectomy and conventional laparoendoscopic nephrectomy in hemodialysis patients with dialysis-related renal tumors.Material and methods: A total of 16 hemodialysis patients who underwent LESS nephrectomy (LESS-N; n?=?8) or conventional laparoendoscopic nephrectomy (C-N; n?=?8) between November 2003 and July 2012 were retrospectively evaluated. Outcomes were compared between the two groups.Results: Patient and tumor characteristics were similar between the LESS-N and C-N groups. The mean operative duration was longer in the LESS-N than in the C-N group (231.0?±?26.7?min versus 188.6?±?36.4?min; p?=?.025). The mean estimated blood loss was lower in the LESS-N compared with the C-N group (26.4?±?14.4?ml versus 65.6?±?45.2?ml; p?=?.047). Postoperative complications were observed in three cases, comprising one case of retroperitoneal hematoma in the LESS-N group and one case each of peritoneal hematoma and retroperitoneal abscess in the C-N group. Surgical scarring was minimal in the LESS-N group.Conclusions: Although there is a little extension of the operating time, LESS nephrectomy in hemodialysis patients is a feasible procedure compared with the conventional method. 相似文献
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Y. ‐J. Boo W. ‐B. Kim J. Kim T. ‐J. Song S. ‐Y. Choi Y. ‐C. Kim 《Scandinavian journal of clinical and laboratory investigation》2013,73(2):207-214
Objective. Laparoscopic surgery is thought to reduce the postoperative immunologic effects of surgical trauma. The aim of this study is to evaluate the influence of surgical trauma on systemic inflammation and the immune response in acute cholecystitis. Material and methods. Thirty‐three patients with acute calculous cholecystitis were assigned to laparoscopic cholecystectomy (LC, n = 18) or open cholecystectomy (OC, n = 15). Blood samples were obtained preoperatively and on postoperative day 1 (24?h after surgery) and day 3 (72?h after surgery), and blood concentration of C‐reactive protein (CRP), leukocyte subpopulations, as well as levels of tumor necrosis factor‐α (TNF‐α) ex vivo secretion by peripheral blood mononuclear cells (PBMCs) were measured in both groups. Results. Hospitalization was significantly shorter in the LC group than in the OC group (LC group: 3.7±1.2 days versus OC group: 6.3±2.7 days, p = 0.010). There was no postoperative morbidity in the LC group, but two patients in the OC group had postoperative complications. Postoperative TNF‐α ex vivo secretion by PBMCs and PBMC counts in the OC group were significantly lower than those in the LC group (p = 0.002). The CRP level declined by postoperative day 3, but was significantly less in the OC group than in the LC group (p<0.001). Postoperative monocyte counts significantly decreased in the OC group compared with those in the LC group (p = 0.001). Conclusions. A laparoscopic approach appears to cause less surgical trauma and immunosuppression than open surgery in patients with acute cholecystitis. 相似文献
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《Journal of Medical Imaging and Radiation Sciences》2020,51(1):137-144
IntroductionComputed tomography (CT) measurements of hepatic steatosis can be performed using unenhanced CT images. The purpose of this study was to assess the occurrence of hepatic steatosis using unenhanced CT images for patients undergoing cholecystectomy or having cholelithiasis.MethodsA total of 143 unenhanced CT cases from a single centre were retrospectively examined. The CT number of liver, ratio of CT number of liver to spleen, and CT number of liver minus CT number of spleen were measured in three groups: (1) patients undergoing cholecystectomy, (2) patients having cholelithiasis, and (3) control group. Abdominal circumference, anterior subcutaneous fat tissue thickness, and body mass index were obtained.ResultsMean CT number of liver was significantly different between the group of patients with cholecystectomy and cholelithiasis and the control group (P < .001) and also between cases of cholecystectomy and cholelithiasis (P = .041), with the lowest CT number of liver in the cholecystectomy group. The mean CT number of liver minus CT number of spleen and mean CT number (liver/spleen) ratios, evaluated separately for both lobes, were not different comparing the cholelithiasis and cholecystectomy groups. The mean CT number of liver minus CT number of spleen and mean CT number (liver/spleen) ratios differed significantly between the control group and both patient groups (P < .001). Positive correlations were identified between abdominal circumference, subcutaneous fat depth, body mass index, and liver size and hepatic steatosis.ConclusionThere was an increased occurrence of hepatic steatosis in patients who have undergone a cholecystectomy compared with patients treated for cholelithiasis and the control group. 相似文献
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【摘要】目的:探讨经脐单孔腹腔镜胆囊切除术 ( transumbilical single port laparoscopic cholecystectomy, TUSPLC) 的手术可行性和经验体会。方法:回顾性分析我院2020 年3月~2021年11月开展TUSPLC 51例患者及三孔法LC 51例患者的临床资料。结果:TUSPLC组手术时间显著长于三孔法LC组[(49.4±13.3)min Vs (31.2±11.51)min],TUSPLC组增加戳孔的例数显著多于三孔法LC组[(5(9.8%)]Vs [1(1.96%))],差异均有统计学意义(P<0.05);但TUSPLC组较三孔法LC组,术后止痛剂使用例数更少[4(7.85%)Vs[17(33.3%)],术后腹壁疤痕满意度评分更高[(3.88±0.11)分 Vs (2.75±0.31)分],差异均有统计学意义(P<0.05);TUSPLC组的手术出血量、术后并发症及住院天数与三孔法LC组比较没有差异(P>0.05)。 结论:TUSPLC在有丰富的二孔LC经验的基础上是安全可行的,也是现阶段最能体现NOTES理念的手术,选择合适的患者可做推广。 相似文献
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《Minimally invasive therapy & allied technologies》2013,22(4):353-357
SummaryLaparoscopic cholecystectomy offers many advantages, yet patients with a history of cardiopulmonary problems are at an increased risk because of the hemodynamic and respiratory effects of pneumoperitoneum. Between June 1990 and November 1997, a laparoscopic cholecystectomy was performed on 31 high risk patients [American Society of Anesthesiology (ASA) IV] and 40 conventional cholecystectomies were performed on patients with the same operative risk (ASA IV). In total, 15.5% (n = 11) of these patients experienced intraoperative cardiopulmonary complications, occurring with approximately the same frequency in both groups. General post-operative complications were seen in 28.2% (n=20) of all cases, the conventionally operated patients were more often affected [37.5% (n=15) versus 16.1 % (n=5) (p<0.05)]. The hospital stay was longer for patients with an open cholecystectomy, at 13.9±8.7 days, in comparison to those with a laparoscopic cholecystectomy, at 7.8±5 days (p<0.001). In high risk patients there is an increased rate of perioperative complications; this study shows the intraoperative risk is the same, but the post-operative complication rate is lower for laparoscopic cholecystectomy. 相似文献
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目的 探讨导丝进入胰管的困难性胆管插管策略应用于内镜逆行胰胆管造影术(ERCP)中的临床效果。方法 回顾性分析该院63例导丝进入胰管的困难性胆管插管患者的临床资料。依次采用双导丝法、胰管预切开法和胰管支架法选择性胆管插管,根据不同胆管插管方法分为双导丝组、胰管预切开组和胰管支架组。分析各组的插管成功率、插管时间及ERCP术后并发症之间的差异。结果 3组总体插管成功率为96.8%。双导丝组、胰管预切开组及胰管支架组的插管时间分别为(70.7±28.6)、(116.6±43.2)和(129.1±88.2)s,组间比较,差异有统计学意义(P < 0.05)。ERCP术后高淀粉酶血症总体发生率为39.3%,胰管预切开组明显高于其他两组(P < 0.05)。ERCP术后胰腺炎(PEP)总发生率为21.3%,胰管预切开组明显高于其他两组(P < 0.05)。ERCP出血发生率为6.6%。未发生重症胰腺炎和十二指肠穿孔病例。结论 导丝进入胰管后依次采用双导丝法、胰管预切开法和胰管支架法选择性胆管插管,上述方法插管成功率高,手术安全可行。 相似文献
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《Annals of medicine》2013,45(1):40-46
AbstractBackground. The red cell distribution width (RDW) in ICU patients has never been investigated. Methods. A total of 602 consecutive patients were prospectively enrolled. We collected each patient's base-line characteristics including the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, RDW, and C-reactive protein (CRP). The primary outcome for this analysis was ICU mortality, and secondary outcome was the total length of stay in hospital (TLSH). Potential predictors were analyzed for possible association with outcomes. Results. There was a significantly graded increase in APACHE-II score (tertile I = 10.7 ± 6.5 versus tertile II = 13.3 ± 6.2 versus tertile III = 15.8 ± 7.2; all P < 0.001) and ICU mortality rate (tertile I = 11.2% versus tertile II = 18.8% versus tertile III = 33.8%; all P < 0.001) across increasing of RDW tertile. As compared with APACHE-II score, combination of RDW and APACHE-II score increased the area under the curve (AUC) for predicting ICU mortality from 0.832 ± 0.020 to 0.885 ± 0.017 (P < 0.05). Multivariate analysis demonstrated that RDW, APACHE-II score, and CRP were independent predictors of ICU mortality (P < 0.05). RDW was also independently associated with TLSH in patients alive (P < 0.05). Conclusion. We found a graded independent relation between higher RDW and adverse outcomes in ICU patients. RDW has the potentially clinical utility to predict outcome in ICU patients. 相似文献
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目的 对比分析经阴道自然腔道内镜手术(V-NOTES)与经脐单孔腹腔镜在子宫肌瘤切除术中的优缺点。方法 选取2019年1月-2019年10月因子宫前壁单发肌瘤住院行经阴道自然腔道子宫肌瘤切除术的患者23例(观察组)、经脐单孔腹腔镜子宫肌瘤切除术的患者44例(对照组),对比分析两组患者手术时间、术中出血量、术后肛门排气时间、术后第1天疼痛情况[数字评分法(NRS)]、术后住院时间、术后平均峰值体温和住院费用。结果 观察组术后肛门排气时间(25.52±4.17)h较对照组(32.72±3.06)h短(P < 0.05),观察组术后第1天NRS疼痛评分(2.65±0.98)分低于对照组(4.50±1.00)分(P < 0.05);两组患者手术时间、术中出血量、住院时间、术后平均峰值体温和住院费用比较,差异均无统计学意义(P > 0.05)。结论 V-NOTES用于子宫前壁单发肌瘤切除是可行的,患者术后肛门排气时间更短、疼痛程度更轻。 相似文献
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目的 探讨经腋窝入路无充气腔镜下手术对早期甲状腺肿瘤患者免疫功能及美容效果的影响。方法 选取2019年5月-2021年6月该院收治的98例早期甲状腺肿瘤患者为研究对象,随机分为观察组和对照组,观察组(n=49)给予经腋窝入路无充气腔镜手术,对照组(n=49)给予开放性甲状腺肿瘤切除术。对比两组患者手术相关指标、淋巴结清除效果、免疫功能、并发症发生率及术后3个月美容效果。结果 观察组术中出血量为(12.27±4.53) mL,术后引流量为(78.25±19.36) mL,明显少于对照组的(23.71±6.86)和(136.24±45.28) m L (均P <0.05)。观察组手术时间为(110.16±11.57) min,明显长于对照组的(61.34±6.27) min (P <0.05)。观察组淋巴结清扫数目为(2.02±1.03)枚,与对照组的(1.98±1.05)枚比较,差异无统计学意义(P> 0.05)。术后1周,观察组CD3+为(56.84±5.06)%,CD4+为(33.72±4.08)%,明显高于对照组的(50... 相似文献
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Introduction: Single‐port laparoscopic cholecystectomy (LC) has been recently introduced to achieve clinical benefits over standard LC. However, surgical outcomes of this operation have been poorly described compared with current techniques. The purpose of this study is to evaluate the surgical outcomes of single‐port LC compared with needlescopic and conventional LC. Methods: We reviewed the surgical outcomes of consecutive patients with symptomatic gallbladder stone disease who underwent single‐port LC (31 cases), needlescopic LC (26 cases) and conventional LC (32 cases) from March 2009 to January 2010. Operation time, hospital stay, conversion, complications, and postoperative pain using visual analog scale were analyzed. In addition, patients were interviewed for overall satisfaction and cosmetic results. Results: BMI in the single‐port group was significantly lower than in the conventional group (26.0 ± 4.0 vs 30.8 ± 7.3 kg/m2, P=0.0017). Operation time in the single‐port group was significantly longer than in the conventional group (65.1 ± 20.1 minutes vs 52.2 ± 19.6 minutes, P=0.012). There was one conversion in the single‐port group. In nine cases in the single‐port group (29%), a Kirschner wire or a suture retractor helped visualization. There was one complication in the single‐port group (wound infection) and one in the needlescopic group (bile leak, requiring laparoscopy). Hospital stay, visual analog scale scores, and overall satisfaction did not vary among these groups. Greater cosmetic satisfaction was shown in the single‐port group compared with the conventional group (P=0.039). Conclusion: Single‐port LC is feasible and secure, with better cosmetic results than conventional LC. Further prospective randomized studies are still required to show its superiority over current LC techniques. 相似文献
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Effects of Inspiratory Oxygen Concentration on Endtidal Carbon Monoxide Concentration 总被引:1,自引:1,他引:0
Objective. Carbon monoxide (CO) is eliminated mainly via the lungs so that exhaled carbon monoxide concentration reflects endogenous
production. In this context, we studied the effects of inspiratory oxygen concentration and endotracheal intubation on endtidal
CO concentrations. Methods. In patients undergoing general anaesthesia, endtidal CO concentrations were measured while breathing room air, oxygen as
well as after induction of general anaesthesia and endotracheal intubation. To exclude time-dependent effects, patients were
assigned to two groups. Patients in group 1 (n = 20) were preoxygenated for 5 minutes, whereas patients in group 2 (n = 20) were preoxygenated for 10 minutes. We also studied the effects of different inspiratory oxygen concentrations in volunteers
(n = 20) breathing room air, 50% and 100% oxygen. Results. Breathing oxygen for 5 minutes increased endtidal carbon monoxide concentrations in all patients (in group 1 from 7.6±4.9
to 12.6± 5.0 ppm, p < 0.001; in group 2 from 7.1±6.1 to 16.4 ± 8.6 ppm, p < 0.001). No further change of CO concentration was detected after 10 minutes of preoxygenation (16.4 ± 9.0 vs. 16.4 ± 8.6
ppm, p > 0.05). Endtidal CO values however significantly increased with induction of anaesthesia and endotracheal intubation (in
group 1 to 21.5 ± 6.3 ppm, p < 0.001, in group 2 to 26.1 ± 13.1 ppm, p < 0.001). In volunteers, mean endtidal CO values increased from 10.7 ±5.9 to 14.8±7.3 ppm after breathing 50% oxygen for
3 minutes (p < 0.001). Breathing pure oxygen had no additional effect on endtidal CO values (16.0 ± 6.0 ppm, p > 0.05). Conclusions. Endtidal carbon monoxide levels are influenced by inspiratory oxygen concentrations. Induction of anaesthesia and endotracheal
intubation further increases endtidal CO concentrations beyond the effects attributable to preoxygenation alone. 相似文献
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目的 分析右美托咪定与酮咯酸氨丁三醇联合应用于腹腔镜胆囊切除术(LC)的麻醉效果。方法 选取2018年1月-2020年1月该院行LC的患者120例,随机分为对照组(60例)和观察组(60例)。手术过程中,对照组给予酮咯酸氨丁三醇超前镇痛,观察组给予右美托咪定联合酮咯酸氨丁三醇超前镇痛。比较两组患者不同时间点心率(HR)、平均动脉压(MAP)、镇痛评分、镇静评分、氧化应激情况及不良反应。结果 切胆时(T2),两组患者HR和MAP水平均明显低于术前(T1)(P < 0.05),观察组HR和MAP水平明显高于对照组(P < 0.05);气管拔管时(T3),对照组HR和MAP水平明显高于T1时点(P < 0.05),观察组HR和MAP水平明显低于对照组(P < 0.05)。术后6 h(T5)和12 h(T6),两组患者Ramsay评分均明显高于术后1 h(T4)(P < 0.05);T4、T5和T6时点,观察组Ramsay评分明显高于对照组(P < 0.05),数字分级评分(NRS)的动态评分明显低于对照组(P < 0.05)。T5时点,两组患者血清丙二醛(MDA)和超氧化物歧化酶(SOD)水平均明显高于T1时点(P < 0.05),总抗氧化能力(T-AOC)水平明显低于T1时点(P < 0.05),且观察组SOD和T-AOC水平明显高于对照组(P < 0.05),MDA水平明显低于对照组(P < 0.05)。两组患者不良反应发生率比较,差异无统计学意义(P = 0.648)。结论 在酮咯酸氨丁三醇基础上辅以右美托咪定超前镇痛,有助于提高镇痛镇静效果,纠正LC患者机体血流动力学紊乱,控制机体氧化应激反应,且安全性较高。 相似文献
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目的 探究偏好食物刺激联合口香糖咀嚼与下肢功能锻炼操对妇科腹腔镜手术患者术后胃肠功能的影响。方法 按随机数表法将患者分为食物刺激联合口香糖咀嚼与下肢锻炼组(FCL组)和口香糖咀嚼与下肢锻炼组(CL组),每组60例。患者均行妇科腹腔镜手术,FCL组在术后采用食物刺激联合口香糖咀嚼与下肢锻炼法改善胃肠功能,CL组在术后采用口香糖咀嚼与下肢锻炼法改善胃肠功能。比较两组患者血浆胃泌素水平、第一次排气及排便时间、数字分级评分法(NRS)、不良反应发生情况的差异性。结果 手术后72 h,FCL组血浆胃泌素水平为(350.75±27.46)pmol/L,明显高于CL组的(269.63±14.96)pmol/L(P < 0.05);CL组第一次排气及排便时间为(25.56±2.46)和(48.74±5.97)h,FCL组为(16.74±2.01)和(34.95±4.92)h,FCL组明显短于CL组(P < 0.05);手术后24 h,CL组NRS评分为(5.83±1.46)分,FCL组为(3.17±1.02)分,手术后72 h,CL组NRS评分为(4.74±1.75)分,FCL组为(2.13±0.89)分,FCL组明显低于CL组(P < 0.05);FCL组不良反应情况发生率为6.67%,明显低于CL组的25.00%(P < 0.05)。结论 偏好食物刺激联合口香糖咀嚼与下肢功能锻炼对妇科腹腔镜手术患者术后胃肠功能的改善效果明显优于口香糖咀嚼与下肢功能锻炼。 相似文献
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《Expert opinion on biological therapy》2013,13(4):469-473
Introduction: Treatment of nail psoriasis can be challenging and unsatisfactory. The aim of this study was to compare the efficacy of three different anti-TNF-α agents on nail psoriasis in patients affected by psoriasis. Materials and methods: Seventy-two patients with nail psoriasis were evaluated in this open, 24 weeks, prospective study. Patients were enrolled in three groups of treatment: adalimumab, etanercept or infliximab. Severity of nail psoriasis was assessed by the Nail Psoriasis Severity Index (NAPSI) at baseline, week 14, and 24. Results: Sixty patients were included in the study. The mean NAPSI was 33.77. In the adalimumab group, the mean NAPSI score was 33.1 (± 14.9) at baseline, 21 (± 8.91) at week 14 and 11.4 (± 4.6) at week 24 (p < 0.0002). In the etanercept group, the mean NAPSI was 34.8 (± 12.38) at baseline, 23.6 (± 10.43) at week 14, and 10.6 (± 5.25) at week 24 (p < 0.0016). In the infliximab group, the mean NAPSI was 33.3 (± 9.76) at baseline, 14.9 (± 4.20) at week 14 (p < 0.001) and 3.1 (± 3.27) at week 24 (p < 0.00001). At week 14 efficacy was higher in infliximab group compared to adalimumab and etanercept groups (p < 0.05). Conclusions: Among the three agents, in the infliximab group a significant improvement in nail psoriasis was observed as early as week 14 of therapy whereas in the adalimumab and etanercept groups at week 24. 相似文献
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Jakeb D. Riggle Emily E. Miller Bernadette McCrory Alex Meitl Eric Lim M. Susan Hallbeck 《Minimally invasive therapy & allied technologies》2015,24(2):68-76
Background: Single-site surgery improves cosmesis but increases procedural difficulty. Enhanced instruments could improve procedural efficiency leading to better patient outcomes. Material and methods: One pair of non-articulating (straight) and two different pairs of articulating laparoscopic instruments were evaluated using a peg-transfer surgical task simulator by premedical college students. The instruments were comparatively tested using task performance measures, ergonomic measures, and participant questionnaires. Results: The straight instrument produced significantly higher task performance scores and lower task times compared to both articulating instruments (p < 0.05). The straight instrument required less muscle activation and less wrist deviation than the articulating instruments to perform the same task. Participants rated the straight instrument significantly easier to use and less difficult to complete the task than with either articulating instrument (p < 0.05 for both). Conclusions: This exploratory study suggests that novices have difficulty using articulating instruments and perform better using straight laparoscopic instruments when first attempting LESS surgical tasks. Although a study with post-graduate medical trainees is needed to confirm these results, trainees should initially practice LESS with non-articulating instruments to gain proficiency at basic laparoscopic tasks. Additionally, redesigning articulating instruments to specifically address the spatial constraints and learning curve of LESS may also improve trainee performance and instrument usability. 相似文献
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Uterus banding with the Osada method effectively reduces intraoperative blood loss during myomectomy
Grzegorz Raba Jan Kotarski Kamil Szczupak Beata Obloza Magdalena Fudali-Walczak 《Minimally invasive therapy & allied technologies》2016,25(1):43-47
Introduction: The surgery of fibroid removal and reconstruction of the uterus is associated with increased blood loss. That is a significant limitation of surgical myomectomy. There are many methods to decrease blood loss during myomectomy. However, in women planning to conceive their reversibility is important. The procedure of uterus banding with the Osada method meets this condition. The objective of this study was a comparison of intraoperative blood loss during the myomectomy with banding according to the Osada technique with blood loss during a classic myomectomy with the Martin method. Material and methods: The study group consisted of 140 women with myomatous uterus. In 70 patients myomectomy was performed with the Osada uterus banding method, for the remaining 70 patients the Martin method was applied. Results: Myomectomy with banding according to the Osada method versus myomectomy with the Martin method: intraoperative blood loss (ml): 56 ± 23 vs 378 ± 186, p < 0.05; a drop in hematocrit levels over 24 hours postoperatively (%): 0.32 ± 0.12 vs 3.42 ± 2.54, p < 0.05; a drop in hemoglobin concentration over 24 hours postoperatively (g/dl): 0.13 ± 0.04 vs 0.79 ± 0.38, p < 0.05. the need for blood transfusion (% of women): 0 vs 4.28, p < 0.05. Conclusion: Myomectomy performed according to the Osada method of uterus banding is associated with less intraoperative blood loss. 相似文献