Laparoscopic appendectomy versus open appendectomy in children

This study compares the benefits, advantages and complications of laparoscopic Appendicectomy (LA) versus Open Appendectomy (OA) in children's in Dublin Ireland. Total 200 patients were studied. Hundred of LA and 100 for OA. Out of 100 LA 58 were male, 42 were female aged between 4-15 yr. and out of 100 OA 58 were male, 42 were female aged between 4-14 yr. The mean operative time of LA was 35.8 minutes and the Anaesthetic time was 46.6 minutes. Patients having LA had less post-op pain with early start of feed at 16.7 hrs, and had significantly less post-op hospital stay of 1.6 days. Post op complications rate was 3%. The patient started the normal life activities at 10.8th post op day. Wound infection rate was 3% with Re-admission rate of 2%. The mean operative time of OA was 45.66 minutes and the Anaesthetic time was 56.75 minutes. Patients having OA had post-op pain hospital stay of 2.55 days with start of feed at 24.7 hrs. Post op complications rate was 2%. The patient started the normal life activities at 15.78th post op day. Wound infection rate was 3% with Re-admission rate of 1%. Laparoscopic appendectomy is safe alternative to conventional open appendectomy, leading to early ambulation, decreased hospital stay, and better exploration of abdominal cavity.     

腹腔镜与开腹胆囊切除术的护理及卫生资源利用情况的对比分析

目的比较腹腔镜胆囊切除术(laparoscopiccholecystectomy,LC)与开腹胆囊切除术(opencholecystectomy,OC)的护理及卫生资源节约情况。方法回顾分析97例胆囊切除术病例,将其分成腹腔镜组和开腹组,比较两组住院日、术前住院日、术后住院日、术中出血量、手术时间、身体恢复时间、并发症等。结果腹腔镜组和开腹组住院日、术后住院日分别为(11.4±3.0)d和(15.±4.2)d(P<0.01)、(6.1±0.9)d和(10.7±2.4)d(P<0.01);腹腔镜组与开腹组术中出血量、手术时间相比差异有显著性(P<0.05),身体恢复时间相比差异有显著性(P<0.01)。结论LC卫生资源利用率较OC高,围手术期临床护理观察周期较短。     

腹腔镜和开腹手术治疗化脓性阑尾炎的对比研究

目的探讨腹腔镜阑尾切除术治疗化脓性阑尾炎的临床应用价值。方法回顾分析113例化脓性阑尾炎的手术治疗病例,其中行腹腔镜阑尾切除术61例（LA组）,行开腹阑尾切除术52例（OA组）。比较两组的手术时间、术中出血量、术后肛门排气时间、术后疼痛程度、术后住院时间、切口感染率和住院费用。结果 LA组中有4例中转开腹。LA组的住院费用和术中出血量高于OA组（P〈0.05）,术后疼痛程度和切口感染率较OA组低（P〈0.05）。两组患者在手术时间、术后住院时间和术后肛门排气时间的差异无统计学意义（P〉0.05）。结论腹腔镜和开腹手术治疗化脓性阑尾炎各有优势,临床工作中应根据患者具体病情和医师的手术经验合理选用。     

腹腔镜阑尾切除术几种阑尾残端处理的方式比较

目的总结腹腔镜阑尾切除术（LA）阑尾残端处理的几种方法带来的不同后果,探讨LA阑尾残端处理方法的优劣性。方法 LA治疗阑尾炎共163例,阑尾残端处理方式有：直接缝扎（A组）43例、套扎线套扎（B组）42例、＂威克夹＂结扎（C组）38例、钛夹结扎（D组）40例。比较各组的术中、术后并发症,痊愈出院时间,远期效果,并进行统计学处理。结果 A、B、C组残端处理的并发症发生率分别为6.98%、2.38%、2.63%,三组比较差异无统计学意义（P〉0.05）;D组为25.00%,与A、B、C三组比较差异均有统计学意义（P〈0.05）。且A、B、C三组病人的住院时间、远期效果、平均费用方面差异无统计学意义（P〉0.05）,D组与A、B、C三组比较差异则有统计学意义（P〈0.05）。结论 LA时阑尾残端直接缝扎、套扎线套扎和＂威克夹＂结扎均是可靠的选择。     

腹腔镜与开腹手术对直肠癌患者术后性功能及膀胱功能影响的系统评价

背景：腹腔镜手术治疗直肠癌在安全性及有效方面均达到或优于传统开腹手术,但可能引起性功能及膀胱功能障碍,而传统开腹术后性功能及膀胱功能障碍发生报道也存在争议。 目的：比较腹腔镜手术与开腹手术对直肠癌患者术后性功能及膀胱功能的影响。 方法：计算机检索PubMed,EMbase,Cochrane library,中国生物医学文献数据库、万方数据库、中国期刊全文数据库、中文科技期刊全文数据库,收集腹腔镜手术对比开腹手术治疗直肠癌患者的随机对照试验。由2名研究者独立按照纳入标准筛选文献、提取资料并交叉核对,采用Cochrane系统评价员手册4.2.6文献质量评价标准评价纳入研究质量,用RevMan 5.0软件进行 Meta分析。 结果与结论：共纳入3个研究,共计347例患者。结果显示与开腹手术比较,腹腔镜术后无论是男性患者或女性患者总在性功能障碍、膀胱功能障碍方面无显著性差异,但尚需要多中心大样本的随机对照试验进一步证实。     

进展期胃癌腹腔镜辅助与开腹D2根治术中淋巴结清扫效果的对照研究

目的 探讨进展期胃癌腹腔镜辅助与开腹D2根治术两种术式中对淋巴结清扫的临床效果。方法 选取平煤神马集团总医院肿瘤科2013年3月—2016年3月行根治术的98例进展期胃癌患者资料进行回顾性研究。根据手术方式分为两组:腹腔镜组50例,其中男23例、女27例,年龄32~56岁;开腹组48例,男22例、女26例,年龄33~56岁;分别行腹腔镜辅助和开腹进展期胃癌D2根治术。比较两组患者手术时间、术中出血量、淋巴结清扫数目,术后排气、恢复进食和住院时间。结果 与开腹组比较,腹腔镜组患者手术时间长,术中出血量少,术后排气时间、进食时间、住院时间均短,差异均有统计学意义(P值均＜0.01)。腹腔镜组和开腹组淋巴结清扫总数分别为(19.32±1.42)枚和(20.01±3.22)枚,第一站淋巴结清扫数量分别为(15.82±8.23)枚和(16.93±9.12)枚,第二站淋巴结清扫数量分别为(4.83±0.23)枚和(4.92±0.63)枚,差异均无统计学意义(P值均＞0.05)。结论 腹腔镜辅助与开腹进展期胃癌D2根治术,两种术式的腹腔淋巴结清扫效果基本无差异;但腹腔镜辅助手术损伤小,患者术后恢复更快,值得临床推广应用。     

Intraoperative fluid management in open gastrointestinal surgery: goal-directed versus restrictive

OBJECTIVE:

The optimal strategy for fluid management during gastrointestinal surgery remains unclear. Minimizing the variation in arterial pulse pressure, which is induced by mechanical ventilation, is a potential strategy to improve postoperative outcomes. We tested this hypothesis in a prospective, randomized study with lactated Ringer''s solution and 6% hydroxyethyl starch solution.

METHOD:

A total of 60 patients who were undergoing gastrointestinal surgery were randomized into a restrictive lactated Ringer''s group (n = 20), a goal-directed lactated Ringer''s group (n = 20) and a goal-directed hydroxyethyl starch group (n = 20). The goal-directed fluid treatment was guided by pulse pressure variation, which was recorded during surgery using a simple manual method with a Datex Ohmeda S/5 Monitor and minimized to 11% or less by volume loading with either lactated Ringer''s solution or 6% hydroxyethyl starch solution (130/0.4). The postoperative flatus time, the length of hospital stay and the incidence of complications were recorded as endpoints.

RESULTS:

The goal-directed lactated Ringer''s group received the greatest amount of total operative fluid compared with the two other groups. The flatus time and the length of hospital stay in the goal-directed hydroxyethyl starch group were shorter than those in the goal-directed lactated Ringer''s group and the restrictive lactated Ringer''s group. No significant differences were found in the postoperative complications among the three groups.

CONCLUSION:

Monitoring and minimizing pulse pressure variation by 6% hydroxyethyl starch solution (130/0.4) loading during gastrointestinal surgery improves postoperative outcomes and decreases the discharge time of patients who are graded American Society of Anesthesiologists physical status I/II.     

Laparoscopic myomectomy: predicting the risk of conversion to an open procedure

BACKGROUND: Laparoscopic myomectomy (LM) has some advantages over laparotomy; however, it is reputed to be technically difficult, and the risk of conversion to laparotomy might be an obstacle in using this procedure. The aim of this study was to identify the pre-operative factors affecting the risk of conversion to an open procedure (either laparoscopic assisted myomectomy or laparotomy), and to develop a simple prediction model based on available pre-operative data with the use of multiple logistic regression. METHODS: A total of 426 women presenting with a subserous or intramural myoma measuring 20 mm or more underwent LM between March 1989 and October 1999. Of these patients, 378 had successful LM. Forty eight patients [11.3%, 95% confidence interval (CI) 8.3--14.3] had a conversion to an open procedure. A total of 265 women had adequate pre-operative ultrasonography (US) and were used for the analysis. RESULTS: The best prediction model included four pre-operative factors that were found to be independently related to the risk of conversion: size > or = 50 mm at US (adjusted OR = 10.3; 95% CI = 2.8--37.9), intramural type (adjusted OR = 4.3; 95% CI = 1.3--14.5), anterior location (adjusted OR = 3.4; 95% CI = 1.3-9.0) and pre-operative use of gonadotrophin-releasing hormone (GnRH) agonists (adjusted OR = 5.4; 95% CI = 2.0--14.2). The regression coefficients were then scaled and rounded to integers to provide an estimate of the risk for conversion. For a given patient with selected characteristics the predicted risk varied from 0--73%. CONCLUSIONS: This prediction model provides a useful tool that enables multiple criteria to be taken into account simultaneously to help select cases for LM. GnRH agonists should been used only in selected cases. US evaluation is essential before performing LM.     

腹腔镜治疗小儿先天性肠旋转不良——附41例病例分析

目的回顾性分析小儿先天性肠旋转不良腹腔镜Ladd’s与传统开腹手术治疗的治疗效果,探讨腹腔镜Ladd’s手术与传统开腹手术比较的优势。方法选取临床工作中患先天性肠旋转不良患儿41例,其中男性24例,女性17例;年龄2个月~6岁7个月,平均年龄4岁3个月。经腹腔镜手术治疗病例18例,经传统开腹手术治疗的病例23例。比较其手术时间、术后排气时间、排便时间、进食时间、有无体温升高等指标。结果经腹腔镜治疗的病例恢复顺利,各项观察指标均优于开腹手术患儿。结论腹腔镜治疗肠旋转不良术中、术后效果确切,可广泛应用于临床。     

Abdominal aortic aneurysm repair: long-term follow-up of endovascular versus open repair

Introduction

To compare early and long-term outcomes of endovascular abdominal aortic aneurysm repair (EVAR) versus open repair (OPEN). Design: Prospective observational, per protocol, non-randomized, with retrospective analyses.

Material and methods

Between 2000 and 2005, a total of 311 patients having EVAR or OPEN repair of infrarenal abdominal aortic aneurysms were identified and included in this prospective single-center observational study. A propensity score-based optimal-matching algorithm was employed, and 138 patients undergoing EVAR procedures were matched (1: 1) to OPEN repair.

Results

Open repair showed higher hospital mortality (17% vs. 6%, p = 0.004), respiratory failure (p < 0.026), transfusion requirement (p < 0.001), and intensive care unit admission (27% vs. 7%, p < 0.001), and longer hospitalization (p < 0.001). Median follow-up was 70 months (25^th to 75^th percentile, 24 to 101). Actuarial survival estimates at 1, 5 and 10 years were 93%, 74%, 49% for the OPEN group compared to 89%, 69%, 59% for the EVAR group (p = 0.465). A significant difference between groups was observed in younger patients (< 75 years) only (p < 0.044). Late complication and re-intervention rates were significantly higher in EVAR patients (p < 0.001 and p = 0.002, respectively). Freedom from late complications at 1, 5 and 10 years was 96%, 92%, 86%, and 84%, 70%, 64% for OPEN and EVAR procedures, respectively.

Conclusions

Our experience confirms the excellent results of the EVAR procedures, offering excellent early and long-term results in terms of safety and reduction of mortality. Patients < 75 years seem to benefit from EVAR not only in the immediate postoperative period but even in a long-term perspective.     

Cerebral Oxygenation during Laparoscopic Surgery: Jugular Bulb versus Regional Cerebral Oxygen Saturation

Purpose

We hypothesized that regional cerebral oxygen saturation (rSO₂) could replace jugular bulb oxygen saturation (SjvO₂) in the steep Trendelenburg position under pneumoperitoneum. Therefore, we evaluated the relationship between SjvO₂ and rSO₂ during laparoscopic surgery.

Materials and Methods

After induction of anesthesia, mechanical ventilation was controlled to increase PaCO₂ from 35 to 45 mm Hg in the supine position, and the changes in SjvO₂ and rSO₂ were measured. Then, after establishment of pneumoperitoneum and Trendelenburg position, ventilation was controlled to maintain a PaCO₂ at 35 mm Hg and the CO₂ step and measurements were repeated. The changes in SjvO₂ (rSO₂) -CO₂ reactivity were compared in the supine position and Trendelenburg-pneumoperitoneum condition, respectively.

Results

There was little correlation between SjvO₂ and rSO₂ in the supine position (concordance correlation coefficient=0.2819). Bland-Altman plots showed a mean bias of 8.4% with a limit of agreement of 21.6% and -4.7%. SjvO₂ and rSO₂ were not correlated during Trendelenburg-pneumoperitoneum condition (concordance correlation coefficient=0.3657). Bland-Altman plots showed a mean bias of 10.6% with a limit of agreement of 23.6% and -2.4%. The SjvO₂-CO₂ reactivity was higher than rSO₂-CO₂ reactivity in the supine position and Trendelenburg-pneumoperitoneum condition, respectively (0.9±1.1 vs. 0.4±1.2% mm Hg^-1, p=0.04; 1.7±1.3 vs. 0.5±1.1% mm Hg^-1, p<0.001).

Conclusion

There is little correlation between SjvO₂ and rSO₂ in the supine position and Trendelenburg-pneumoperitoneum condition during laparoscopic surgery.     

Memory for actions in children with autism: self versus other

In order to ask whether autism is associated with difficulty in self-monitoring we gave a group of children and adolescents with autism a task in which they themselves had to remember whether they or another person had performed certain actions. In our first experiment, three groups of participants had to recall whether placements of picture cards had been made by themselves or by the experimenter. The participants with autism performed at a much lower level than the two comparison groups and, unlike the comparison groups, were not better at recalling their own placements. A second experiment tested the prediction arising from the monitoring-deficit account that the children with autism would be unimpaired when the placement of the items did not alternate between self and other. This prediction was confirmed moderately well. Additionally, in contrast to that of the comparison groups, the performance of the participants with autism was unaffected by whether self or other displaced the items. This is consistent with the existence of a monitoring deficit.