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1.
M. Anselmino G. Zaninotto M. Costantini M. Rossi C. Boccu' D. Molena E. Ancona 《Surgical endoscopy》1997,11(1):3-7
Background: The Heller-Dor operation has recently been proposed for the treatment of esophageal achalasia even via a laparoscopic approach.
Methods: To measure the medium-term effectiveness of this new minimally invasive technique, an evaluation of pre- and postoperative
symptoms, esophagogram, endoscopic findings, esophageal manometry, and pH monitoring was prospectively designed in 43 patients
with primary esophageal achalasia. The mean clinical follow-up for all the patients is 12 months (range 3–43), while the mean
radiological follow-up is 11 months (range 1–23). Endoscopic data 1 year after surgery are currently available for 27 patients
(63%), whereas a 12-month (range 1–26) functional follow-up (including manometric and pH-monitoring studies of the esophagus)
is currently available for 35 patients (81.4%).
Results: No dysphagia was reported in 38 cases (88.4%); two (4.6%) complained of occasional swallowing discomfort which regressed
spontaneously; two (4.6%) had persistent dysphagia which regressed with pneumatic dilatation. One patient (2.8%) reported
mild occasional dysphagia after a 1-year asymptomatic period. Preoperatively, esophagograms showed an average maximum diameter
of 40.6 ± 9.1 mm which decreased to 24.1 ± 6.0 mm after operation. Mean lower esophageal sphincter (LES) resting and residual
pressures decreased significantly from 28.6 ± 10.7 mmHg to 8.8 ± 4.1 mmHg and from 17.0 ± 9.7 mmHg to 4.7 ± 4.0 mmHg, respectively
(p < 0.0001). These effects on esophageal diameter and LES function seem to persist over time. The complete absence of any peristaltic
contractions recorded preoperatively in all cases remained unchanged after surgery in all but four patients. However, this
rare recovery of peristalsis proved to be transient, and patients revealed a manometric impairment of their esophageal body
function, but without complaining of dysphagia. Twenty-four-hour pH monitoring showed abnormal gastroesophageal reflux episodes
in two (5.7%) of the 35 patients who were monitored: one was asymptomatic; the other had heartburn and endoscopically demonstrated
grade II esophagitis.
Conclusions: Laparoscopic Heller-Dor operation achieves excellent medium-term results which, together with the already-demonstrated advantages
of a minimal surgical trauma and rapid convalescence, validate the use of such a minimally invasive approach to treat patients
with primary achalasia of the esophagus.
Received: 19 March 1996/Accepted: 15 May 1996 相似文献
2.
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
3.
The laparoscopic management of post-transplant lymphocele 总被引:2,自引:0,他引:2
W. S. Melvin G. L. Bumgardner E. A. Davies E. A. Elkhammas M. L. Henry R. M. Ferguson 《Surgical endoscopy》1997,11(3):245-248
Background: The management of lymphocele in patients following kidney (KT) and kidney pancreas (KPT) transplants is evolving. Open surgery
has been the traditional treatment, but some authors have advocated laparoscopic drainage in selected patients.
Methods: We retrospectively reviewed our results in lymphocele treatment since developing a laparoscopic program at our institution.
Results: Between May 1994 and June 1995, 186 KTs and 48 KPTs were performed, and 1,354 patients are currently being followed. Eight
patients developed symptomatic lymphoceles an average of 26 months (range 4–59) following 6 KTs and 2 KPTs. All patients diagnosed
were successfully drained laparoscopically, with no conversions to open surgery. Laparoscopic ultrasound was used to help
with localization of the fluid collection. Operative time averaged 59 min, median hospital stay was 1 day (range 1–4), and
there were no perioperative complications. Follow-up imaging was obtained on six patients, 3–16 months following their procedures,
and no recurrences were noted. A review of the literature demonstrates a 5.3% rate of major complications and a 7% incidence
of lymphocele recurrence.
Conclusions: Intraoperative laparoscopic ultrasound can help localize fluid collections and prevent organ injuries. Laparoscopic drainage
of lymphocele following transplantation results in minimal disability and an acceptable complication rate, although it is
higher than with open drainage. Therefore, laparoscopic drainage should be considered as primary treatment for all patients
with symptomatic post-transplant lymphocele.
Received: 15 March 1996/Accepted: 3 July 1996 相似文献
4.
Laparoscopic fundoplication in infants and children 总被引:2,自引:0,他引:2
Background: Laparoscopic fundoplication is a new method for treating gastroesophageal reflux in children. We present 160 children with
gastroesophageal reflux treated by laparoscopic fundoplication.
Methods: Patients underwent either a laparoscopic Nissen or Toupet fundoplication. Many patients also required gastrostomies and gastric
outlet procedures.
Results: Twelve patients (7.5%) were converted to open fundoplication. Laparoscopic gastrostomies were placed in 112 patients (75.7%)
and laparoscopic gastric outlet procedures in 62 patients (41.9%). Feedings were initiated by postoperative day 2 in 126 children
(85.7%). Sixty-four percent were discharged by postoperative day 3. Complications occurred in 11 of 148 fundoplications (7.4%),
in nine of 112 gastrostomies (8.0%), and in three of 62 gastric outlet procedures (4.8%). One patient died as a result of
a surgical error in placing a gastrostomy (0.7%).
Conclusion: Laparoscopic fundoplication appears to foster a more rapid recovery and decreased hospital stay while maintaining complication
rates similar to or better than open fundoplication.
Received: 22 March 1996/Accepted: 12 June 1996 相似文献
5.
Laparoscopic vs conventional Nissen fundoplication 总被引:18,自引:6,他引:12
Background: Laparoscopic Nissen fundoplication has gained wide acceptance among surgeons, but the results of the laparoscopic procedure
have not been compared to the results of an open fundoplication in a randomized study.
Methods: Some 110 consecutive patients with prolonged symptoms of grade II–IV esophagitis were randomized, 55 to laparoscopic (LAP)
and 55 to an open (OPEN) Nissen fundoplication. Postoperative recovery, complications, and outcome at 3- and 12-month follow-up
were compared in the two groups.
Results: Five LAP operations were converted to open laparotomy due to esophageal perforation (two), technical difficulties (two),
and bleeding (one). In the OPEN group (two) patients underwent splenectomy. There was no mortality. The mean hospital stay
was 3.2 days in the LAP group and 6.4 in the OPEN group. Dysphagia and gas bloating were the most common complaints 3 months
after the operation in both groups. These symptoms had disappeared at the 12-month follow-up examination. All patients in
the LAP group and 86% in the OPEN group were satisfied with the result.
Conclusions: Laparoscopic Nissen fundoplication is a safe and feasible procedure. Complications are few and functional results are good
if not better than those of conventional open surgery.
Received: 15 May 1996/Accepted: 10 September 1996 相似文献
6.
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
7.
Background: During a 4-year period, 240 gastrostomy buttons were placed in children, as the initial surgical feeding tube, using laparoscopic
techniques.
Materials and methods: The technique requires the use of a minilaparoscope (1.6-mm) and a single 5-mm trocar placed at the exit site for the gastrostomy
button. It can also be performed in addition to a laparoscopic fundoplication using the same trocar sites. The technique requires
no special instrumentation or kits. When performed alone, operative times average 15 min. When performed with fundoplication,
it adds ∼5–10 min to the time for the procedure.
Results: There were no intraoperative complications and five (2.1%) postoperative complications.
Conclusions: This technique has proven to be simple and effective. It allows primary placement of a gastrostomy button that is cosmetically
and functionally superior to a gastrostomy tube.
Received: 11 February 1999/Accepted: 27 April 1999 相似文献
8.
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
9.
F. K. Toy R. W. Bailey S. Carey C. W. Chappuis M. Gagner L. G. Josephs E. C. Mangiante A. E. Park A. Pomp R. T. Smoot Jr. J. F. Uddo Jr. G. R. Voeller 《Surgical endoscopy》1998,12(7):955-959
Background: A standard technique for laparoscopic ventral hernioplasty (peritoneal onlay using an expanded polytetrafluoroethylene [ePTFE]
patch for hernias ≥4 cm2) is being used in a prospective, multicenter, long-term study.
Methods: Demographic, operative, and postoperative data were collected and analyzed. Follow-up clinical evaluations were conducted
7–10 days, 4 weeks, 6 months, 1 year, and then annually after surgery in all patients.
Results: In the first 2 years of the study, 144 patients were enrolled; nine were lost to follow-up. The mean operating time was 120
min. The mean follow-up was 222 days (range 5–731). Postoperative complications were five infections, three cases of prolonged
ileus, one bowel obstruction, 23 seromas (15 resolved without intervention), and six hernia recurrences. Hospital discharge
occurred a mean of 2.3 days after surgery and return to normal activity a mean of 15 days postoperatively.
Conclusions: Laparoscopic prosthetic ventral hernioplasty avoids the large wound required in open repairs, with attendant complications
and recurrences, and appears safe, especially if an ePTFE mesh is used. Compared with conventional open ventral hernioplasty,
the laparoscopic technique may also allow shorter hospitalization and a quicker return to normal activities after surgery.
Received: 3 April 1997/Accepted: 10 August 1997 相似文献
10.
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
11.
Background: The aim of this study was to assess the impact of an intracorporeal double-stapled colorectal anastomosis upon the outcome
of laparoscopic left colon resection.
Methods: Fifty-four selected patients underwent elective laparoscopic left colon resection for benign disease. Once resection was
completed, a 33-mm suprapubic port allowed insertion of the anvil of a circular stapler into the colon, which was closed by
a handsewn purse-string suture using the T-needle technique. The circular stapler was passed transanally to perform a double-stapled
anastomosis. Specimens were delivered in a plastic bag via the suprapubic port.
Results: There were no deaths. Minor intraoperative and postoperative complications occurred in 3.7% and 9.2% of the patients, respectively.
Median operating time was 125 min (range 80–210 min). Complete proximal and distal doughnuts were obtained in all patients
and anastomoses were all methylene blue tight. Median hospital stay was 4 (range 3–7) days.
Conclusions: Fashioning double-stapled colorectal anastomoses intracorporeally is feasable and safe.
Received: 26 March 1996/Accepted: 9 September 1996 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.
Background: Colic ischemia is a serious complication that can occur after abdominal aortic surgery. It has been described in two patients
after laparoscopic aortic surgery. The goal of the current experiment was to determine the feasibility of inferior mesenteric
artery (IMA) reimplantation during laparoscopic aortobifemoral bypass (LAFB).
Methods: Six piglets were submitted to the laparoscopic approach according to the ``apron' technique previously described. The infrarenal
aorta was clamped and an LAFB was performed using a dacron graft. The IMA was reimplanted in the body of the graft with a
running 5-0 polypropylene suture.
Results: Mean operation and dissection times were 282.5 min (range, 270–310 min) and 123 min (range, 110–140 min), respectively, with
a mean blood loss of 108 ml (range, 80–150 ml). Aortic clamping and anastomotic times were 123 min (range, 110–135 min) and
33 min (range, 24–45 min), respectively. The IMA reimplantation took 55 min (range, 45–70 min). At autopsy, all anastomoses
were patent with no stenosis nor leak.
Conclusion: Laparoscopic IMA reimplantation during laparoscopic aortobifemoral bypass is feasible.
Received: 10 July 1998/Accepted: 15 November 1998 相似文献
14.
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
15.
Background: Laparoscopic nephrectomy in the adult population is reported with increased frequency. We present our initial experience
with laparoscopic nephrectomy in children.
Methods: Over a 2-year period, 11 nephrectomies were performed in nine children aged 16 months to 16 years (mean, 6.5 years). All
patients were referred due to complications of a nonfunctioning kidney. Seven patients had recurrent urinary tract infections,
and two had refractory hypertension. Two patients underwent bilateral laparoscopic nephrectomy. The operation was performed
using four access ports measuring 3.5 to 10 mm.
Results: All kidneys were removed successfully using a laparoscopic technique. The average length of the operation was 163 min per
kidney (range, 90–420). The estimated blood loss was <10–150 ml (mean, 45). No patient required transfusion. Seven patients
were discharged home by postoperative day 2. The two patients with the longest operating times were discharged home on postoperative
days 4 and 5 due to delay in return of bowel function. Narcotic use was minimal, and all patients enjoyed a rapid return to
full activity.
Conclusion: Laparoscopic nephrectomy is a viable alternative to open nephrectomy in children. Further experience with this technique
is required to establish its efficacy and reduce the operating time
Received: 29 April 1999/Accepted: 29 August 1999/Online publication: 17 April 2000 相似文献
16.
Background: Laparoscopic appendectomy was first described in the early 1980s and is currently widely used for the treatment of acute
appendicitis. The application of laparoscopic techniques to interval appendectomy and the value of this procedure as compared
to open elective interval appendectomy remains uncertain. Therefore, we set out to assess the usefulness of interval laparoscopic
appendectomy following periappendicular abscess.
Methods: This study analyzes the data for 10 patients who underwent interval laparoscopic appendectomy 8–10 weeks following documented
periappendicular abscess in the period between January 1996 and June 1998.
Results: Laparoscopic appendectomy was completed successfully in all 10 patients. Nine patients were discharged 1 day after the operation;
one patient was discharged on the evening of the operative day. There were no complications and no wound infections.
Conclusion: We conclude that the laparoscopic approach is the preferable treatment for interval appendectomy. It is associated with minimal
or no morbidity and a very short hospital stay.
Received: 13 May 1999/Accepted: 9 December 1999/Online publication: 12 July 2000 相似文献
17.
Laparoscopic colectomy 总被引:4,自引:1,他引:3
G. A. Fielding J. Lumley L. Nathanson P. Hewitt M. Rhodes R. Stitz 《Surgical endoscopy》1997,11(7):745-749
Background: Laparoscopic colectomy has developed with the explosion of technology that has followed laparoscopic cholecystectomy. Accumulation
of skills in general laparoscopic surgery has made complex surgery, such as colectomy, feasible.
Methods: Three hundred fifty-nine laparoscopic cases were prospectively studied. Data has been kept on benign and malignant cases,
operative results, hospital stay, and morbidity. Special care has been taken to follow malignant cases, looking for recurrence
of disease.
Results: There were 359 cases (206 females, 153 male) average age 58.8 years (18–94), and 149 patients had malignancy. All types of
resections were performed, including 151 anterior resections, 66 right hemicolectomies (RHC), 36 total colectomies, and 22
rectopexies. Operating times fell with experience—the last 20 cases of anterior resection took 150 min (110–240) and of RHC
took 130 min (65–210). Twenty-six (7%) cases were converted to open surgery. Hospital stays for anterior resection lasted
5–7 days (2–33); in the last 20 cases the average stay was 4 days. Morbidity included seven leaks (2.7%), four strictures
(1.2%), 12 wound infections (3.3%), and nine ileus (2.5%). There were six deaths within 30 days—sepsis, myocardial infarction,
aspiration pneumonia, and disseminated liver metastases. One hundred forty-nine cancer cases have had ten recurrences: one
pelvic recurrence, six liver metastases, two para-aortic nodal, and one case of disseminated disease. Average time of recurrence
was 33 months (15–46 months).
Conclusions: Laparoscopy in the hands of experienced laparoscopic surgeons is a safe, efficient procedure. All types of procedures are
possible. Early results in 149 malignancies are encouraging and recurrence rates are low. Prospective studies, now that skills
are developed to a level comparable to that of open surgery, are now being performed to further assess laparoscopy's possible
role in treating cancer.
Received: 26 March 1996/Accepted: 15 October 1996 相似文献
18.
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
19.
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
20.
Laparoscopic treatment of hydatid cysts of the liver and spleen 总被引:2,自引:0,他引:2
Background: The short-term results from laparoscopic treatment of hydatid cysts of the liver and spleen were reported previously. The
procedure was shown to be feasible and safe, offering the advantages of laparoscopic surgery. This is the first report on
the long-term follow-up of this operation in a large group of patients.
Methods: In this study, 108 hydatid cysts of the liver and spleen in 83 consecutive patients (43 males [52%] and 40 females [48%])
were approached laparoscopically. The mean age of the patients was 40 years (range, 13–85 years). There were 104 liver cysts
and 4 spleen cysts. The liver cysts were located in the right lobe in 42 patients (53%), in the left lobe in 21 patients (26%)
and in both lobes in 16 patients (21%). Of the 104 cysts, 44 (42%) were uniloculated and 60 (58%) were multiloculated.
Results: All cysts were approached laparoscopically. The mean operative time was 80 min (range, 40–180 min). The conversion rate was
3%. The mean hospital stay was 3 days (range, 2–7 days). There were no mortalities, and complications occurred in nine patients
(11%). All were managed conservatively except one patient in whom a laparotomy was needed. All patients were followed up for
a mean period of 30 months (range, 4–54 months) with serological testing and ultrasonography if needed. In three patients
(3.6%) recurrence of the disease developed.
Conclusion: The laparoscopic approach to uncomplicated hydatid cysts of the liver and spleen is a safe and effective option with favorable
long-term results.
Received: 27 August 1998/Accepted: 13 July 1999 相似文献