共查询到20条相似文献,搜索用时 140 毫秒
1.
E. Eypasch E. Neugebauer F. Fischer H. Troidl A. L. Blum D. Collet A. Cuschieri B. Dallemagne H. Feussner K.-H. Fuchs H. Glise C. K. Kum T. Lerut L. Lundell H. E. Myrvold A. Peracchia H. Petersen J. J. B. van Lanschot 《Surgical endoscopy》1997,11(5):413-426
Background: Laparoscopic antireflux surgery is currently a growing field in endoscopic surgery. The purpose of the Consensus Development
Conference was to summarize the state of the art of laparoscopic antireflux operations in June 1996.
Methods: Thirteen internationally known experts in gastroesophageal reflux disease were contacted by the conference organization team
and asked to participate in a Consensus Development Conference. Selection of the experts was based on clinical expertise,
academic activity, community influence, and geographical location. According to the criteria for technology assessment, the
experts had to weigh the current evidence on the basis of published results in the literature. A preconsensus document was
prepared and distributed by the conference organization team. During the E.A.E.S. conference, a consensus document was prepared
in three phases: closed discussion in the expert group, public discussion during the conference, and final closed discussion
by the experts.
Results: Consensus statements were achieved on various aspects of gastroesophageal reflux disease and current laparoscopic treatment
with respect to indication for operation, technical details of laparoscopic procedures, failure of operative treatment, and
complete postoperative follow-up evaluation. The strength of evidence in favor of laparoscopic antireflux procedures was based
mainly on type II studies. A majority of the experts (6/10) concluded in an overall assessment that laparoscopic antireflux
procedures were better than open procedures.
Conclusions: Further detailed studies in the future with careful outcome assessment are necessary to underline the consensus that laparoscopic
antireflux operations can be recommended.
Received: 29 November 1996/Accepted: 14 December 1996 相似文献
2.
Aim The role of laparoscopic surgery in the management of patients with diverticular disease is still not universally accepted. The aim of our study was to evaluate the results of laparoscopic surgery for diverticular disease in a centre with a specialist interest in minimally invasive surgery. Method All diverticular resections carried out between 2006 and 2010 were reviewed. Data recorded included baseline demographics, indication for surgery, operative details, length of hospital stay and complications. Complicated diverticular disease was defined as diverticulitis with associated abscess, phlegmon, fistula, stricture, obstruction, bleeding or perforation. Results One hundred and two patients (58 men) who had surgery for diverticular disease were identified (median age 59 years, range 49–70 years). Sixty‐four patients (64%) had surgery for complicated diverticular disease. The indications were recurrent acute diverticulitis (37%), colovesical fistula (21%), stricture formation (17%) and colonic perforation (16%). Sixty‐nine cases (88%) were completed by elective laparoscopy. Postoperative mortality was 0%. For elective cases there was no difference in morbidity rates between patients with complicated and uncomplicated diverticular disease. The overall anastomotic leakage rate was 1% and the wound infection rate 7%. There was a nonsignificant trend to higher conversion to open surgery in the elective group in complicated (11.4%) compared with uncomplicated patients (5.2%) (P = 0.67). Electively, the rate of stoma formation was higher in the complicated (31.6%) than the uncomplicated group (5.2%) (P < 0.02). Conclusion Laparoscopic surgery for both complicated and uncomplicated diverticular disease is associated with low rates of postoperative morbidity and relatively low conversion rates. Laparoscopic surgery is now the standard of care for complicated and uncomplicated diverticular disease in our institution. 相似文献
3.
Laparoscopic surgery for diverticulitis 总被引:11,自引:3,他引:8
M. E. Sher F. Agachan M. Bortul J. J. Nogueras E. G. Weiss S. D. Wexner 《Surgical endoscopy》1997,11(3):264-267
Background: Resection of diverticular disease may be quite challenging; the acute inflammatory process, thick sigmoid mesentery, and
any associated fistula or abscess can make this procedure technically demanding. The aim of this study was to compare the
results between laparoscopic and laparotomy-type resections stratified by disease severity and thereby predict outcome and
possibly a subset of patients who may benefit from a laparoscopic approach.
Methods: From August 1991 to December 1995, all patients with diverticular disease were classified according to a modified Hinchey
classification system. The laparoscopic group included 18 patients who underwent a laparoscopic assisted colectomy, one with
a loop ileostomy. The identical procedures were performed in 18 patients by laparotomy. The mean age of the two groups were
62.8 and 67.1 years, respectively (p= NS).
Results: Seven of 18 patients in whom laparoscopy was attempted (38.9%) had conversion to laparotomy. Six of seven (85.7%) conversions
were directly related to the intense inflammatory process. Laparoscopic treated patients with Hinchey IIa or IIb disease had
a morbidity rate of 33.3% and a conversion rate of 50% while all patients with Hinchey I disease were successfully completed
without morbidity or conversions to laparotomy. However, after the first four cases, the intraoperative morbidity and postoperative
morbidity rates were zero and 14.3% and after ten cases they were zero and zero, respectively. Furthermore, the median length
of hospitalization for Hinchey I patients after laparoscopy was 5.0 days vs 7 days after laparotomy (p < 0.05). In Hinchey IIa and IIb patients, the median length of hospitalization was almost 50% shorter with a laparoscopic
approach (6 days vs 10 days, p < 0.05).
Conclusion: In conclusion, laparoscopic resection of diverticulitis can be performed without additional morbidity particularly in Hinchey
I patients and with a reduced length of hospitalization in patients with class I or II disease. Patients with class I disease,
and after initial experience even those with class II disease, can benefit from the reduced morbidity and length of hospitalization
associated with laparoscopic treatment.
Received: 25 March 1996/Accepted: 17 July 1996 相似文献
4.
J. L. Bouillot K. Aouad A. Badawy B. Alamowitch J. H. Alexandre 《Surgical endoscopy》1998,12(12):1393-1396
Background: Although several recent reports described the different methods utilized for laparoscopic colon resection, only a few of
them questioned whether the procedure is appropriate for the surgical treatment of diverticular disease. To assess this question,
we performed a retrospective study of 50 consecutive patients operated using laparoscopic assistance to remove the sigmoid
colon for diverticular disease.
Method: The surgical technique was a laparoscopically assisted procedure that included mobilization of the left colon and vascular
ligation laparoscopically and then, via a small abdominal incision, division of the colon, removal of the specimen, and hand-sewn
anastomosis.
Results: The surgical goal was achieved in 46 cases, with a conversion rate of 8%. The mean operative time was 195 min (range 150–280
min). There was no mortality, and the morbidity rate was 14%. There were no complications directly related to the laparoscopic
technique. The mean return of regular bowel habits was 3.2 days, and the median postoperative stay was 10 days.
Conclusions: These preliminary results suggest that laparoscopic-assisted sigmoidectomy can be used safely for the surgical treatment
of diverticular disease.
Received: 30 July 1997/Accepted: 21 January 1998 相似文献
5.
M. Schäfer C. Suter Ch. Klaiber H. Wehrli E. Frei L. Krähenbühl 《Surgical endoscopy》1998,12(4):305-309
Background: Spilled gallstones after laparoscopic cholecystectomy may cause abscess formation, but the exact extent of this problem remains
unclear.
Method: The data (collected by the Swiss Association of Laparoscopic and Thoracoscopic Surgery) on 10,174 patients undergoing laparoscopic
cholecystectomy at 82 surgical institutions in Switzerland between January 1992 and April 1995 were retrospectively analyzed
with special interest in spilled gallstones and their complications.
Results: In 581 cases (5.7%) spillage of gallstones occurred; 34 of these cases were primarily converted to an open procedure for
stone retrieval. Of the remaining 547 cases only eight patients (0.08%) developed postoperatively abscess formation requiring
reoperation.
Conclusions: Spillage of gallstones after laparoscopic cholecystectomy is fairly common and occurs in about 6% of patients. However, abscess
formation with subsequent surgical therapy remains a minor problem. Removal of spilled gallstones is therefore not recommended
for all patients, but an attempt at removal should be performed whenever possible.
Received: 4 April 1997/Accepted: 9 July 1997 相似文献
6.
Background: Laparoscopic adrenalectomy has been shown to be a safe and effective therapy for benign adrenal lesions. We review our experience
with this procedure, including the use of laparoscopic ultrasound.
Methods: We retrospectively reviewed our experience with 36 patients who underwent resection of 42 adrenal glands. Data gathered included
preoperative evaluation and diagnosis, operative time, blood loss, complications, and follow-up status. Laparoscopic ultrasound
was used to guide dissection and characterize a variety of adrenal lesions.
Results: Thirty-five of 36 patients underwent successful laparoscopic adrenalectomy. There was one conversion to the open procedure
in a patient with bilateral adrenal metastases from an endometrial cancer. For the bilateral laparoscopic procedure, the operative
time averaged 262 mins, blood loss was 160 cc, and hospital stay was 3.0 days. For unilateral cases, operative time averaged
193 min, blood loss was 108 cc, and hospitalization was 1.1 days. Six patients experienced perioperative complications, most
of which were minor and transient. Laparoscopic ultrasound was useful to define anatomy and to identify the adrenal vein,
especially on the left side.
Conclusions: Laparoscopic adrenalectomy is the procedure of choice for benign adrenal disease. Laparoscopic ultrasound is useful to localize
and aid in the dissection of the left adrenal vein.
Received: 24 December 1998/Accepted: 12 February 1999 相似文献
7.
Laparoscopic cholecystectomy and interventional endoscopy for gallstone complications during pregnancy 总被引:6,自引:3,他引:3
Sungler P Heinerman PM Steiner H Waclawiczek HW Holzinger J Mayer F Heuberger A Boeckl O 《Surgical endoscopy》2000,14(3):267-271
Background: Symptomatic or complicated gallstone disease is the most common reason for nongynecological operations during pregnancy.
Gallstones are present in 12% of all pregnancies, and more than one-third of patients fail medical treatment and therefore
require surgical endoscopy or laparoscopy. Gallstone pancreatitis and jaundice during pregnancy is associated with a high
recurrence rate, exposing both fetus and mother to an increased risk of morbidity and mortality.
Methods: During a 4-year period, all pregnant patients (n= 37) with symptomatic or complicated gallstone disease were studied prospectively at the Landeskrankenhaus in Salzburg, Austria.
Five patients had an endoscopic retrograde cholangiopancreatogram (ERCP) for biliary pancreatitis or jaundice; two of these
underwent subsequent laparoscopic cholecystectomy. Another seven patients required laparoscopic cholecystectomy for severe
pain or cholecystitis; all were in their 13th–32nd gestational week. Access was established by Veress needle in all cases.
Insufflation pressure was 8–10 mmHg, and mean operative time was 62 min.
Results: All patients delivered full-term, healthy babies. There were no postendoscopic or postoperative complications. All patients
enjoyed full relief from their symptoms; there were no recurrences of pancreatitis or jaundice.
Conclusions: The combination of ERCP and laparoscopic cholecystectomy offers a safe and effective option for the definitive treatment
of complicated gallstone disease and intractable pain during pregnancy, and there is sufficient access for the combined treatment
to be employed.
Received: 7 September 1998/Accepted: 2 June 1999 相似文献
8.
Background: Although the laparoscopic-assisted approach to colorectal cancer remains controversial, its use for benign diseases can have
important advantages. The purpose of this study is to determine the feasibility of this approach for the treatment of elective
diverticular disease and to identify preoperative and perioperative factors which can help to select the best procedure for
each patient: either assisted laparoscopic resection (ALR) or dissection-facilitated laparoscopic resection (DLR).
Methods: From November 1991 to the present, we conducted a prospective study of 41 patients approached electively for diverticular
disease.
Results: Twenty-nine patients underwent an ALR, seven were approached by DLR, and another five patients were converted to laparotomy
(15%). Morbidity was 17.5% and there was no mortality in this series. The mean hospital stay after operation was 6.5 days.
Conclusions: Because of the complexity of this inflammatory process, choice of either an assisted or a more invasive laparoscopic facilitated
approach is necessary. The decision is based on the technical difficulty as determined by data collected both preoperatively
and during laparoscopy.
Received: 26 August 1996/Accepted: 26 November 1996 相似文献
9.
Background: Advocates of the Toupet partial fundoplication claim that the procedure has a lower rate of the side effects of dysphagia
and gas bloat than a complete Nissen fundoplication. However, there is increasing recognition that reflux control is not always
as good with the Toupet procedure as with the Nissen. Therefore, we set out to evaluate the factors contributing to success
and failure in patients who underwent laparoscopic modified Toupet fundoplication (LTF).
Methods: A total of 143 patients undergoing LTF for documented gastroesophageal reflux disease (GERD) were evaluated prospectively
in regard to their outcomes over a 4-year period. All patients had preoperative esophagogastroduodenoscopy (EGD) and manometry;
24-h pH testing was used selectively. Esophageal manometry was requested of all patients 6 weeks postoperatively. Clinical
follow-up was by office visit or questionnaire every 6 months after surgery; patients with significant problems were investigated
further. Failure was defined as the development of recurrent reflux documented by endoscopy, 24-h pH test, or wrap disruption
on barium swallow, or severe dysphagia persisting >3 months and requiring surgical revision.
Results: At a mean follow-up of 30 months (range, 3–51), 21 of 143 patients failed LTF; two had dysphagia and 19 had recurrent reflux.
Failure was associated with preoperative findings of a defective lower esophageal sphincter (LES) (14/21), complicated esophagitis
(13/21), and failure to divide short gastric vessels (12/19) (chi-square p < 0.05). Defective esophageal body peristalsis, present in 14 patients, resulted in failure in six cases. Presence of either
complicated esophagitis or a defective LES was associated with a 3-year 50% success rate, whereas presence of mild esophagitis
and a normal LES was reflected in a 96% 3-year success rate.
Conclusion: Laparoscopic Toupet fundoplication should be reserved for milder cases of GERD, as assessed by manometry and endoscopy.
Received: 29 June 1998/Accepted: 2 July 1999 相似文献
10.
Laparoscopic partial adrenalectomy 总被引:2,自引:0,他引:2
Imai T Tanaka Y Kikumori T Ohiwa M Matsuura N Mase T Funahashi H 《Surgical endoscopy》1999,13(4):343-345
Background: Most laparoscopic adrenalectomies involve total removal of the whole adrenal gland, and reports of laparoscopic partial adrenalectomies
have been very few. The criteria for performing a laparoscopic partial adrenalectomy have not been described.
Methods: (a) Patients with functioning adrenal tumors smaller than 3 cm in diameter were selected. (b) The solitary adrenal tumors
were evaluated by preoperative thin-slice computed tomography (CT) scan. (c) Solitary lesions were reconfirmed with intraoperative
ultrasonography. (d) Partial adrenalectomy was performed with at least a 5-mm margin using a vascular stapler.
Results: Laparoscopic partial adrenalectomy was performed in five patients using the vascular stapler. Hemostasis was perfect in all
five patients. The tumor was located in the inferior part of the right adrenal gland in three cases and in the upper pole
of the left adrenal gland in two cases. The postoperation pathologic diagnosis was adrenocortical adenoma in all five patients,
and excessive hormonal levels or symptoms all disappeared.
Conclusions: Laparoscopic partial adrenalectomy can be performed safely using a vascular stapler.
Received: 26 May 1998/Accepted: 30 June 1998 相似文献
11.
Micropuncture laparoscopic cholecystectomy 总被引:1,自引:1,他引:0
Background: Laparoscopic cholecystectomy (LC) significantly reduces the discomfort and disability typically associated with open cholecystectomy,
but there is still room for improvement.
Methods: In order to further reduce the trauma of access, we have introduced a technique of micropuncture laparoscopic cholecystectomy
(MPLC) that utilizes three 3-mm cannulae in addition to the standard 10-mm cannula at the umbilicus. MPLC was performed in
25 patients (median age, 52 years; m/f, three of 22) with symptomatic cholelithiasis.
Results: The operation was completed in all patients. The median duration of surgery was 75 min (range, 45–180). Sixteen patients
were discharged the same day and nine patients the next day. All the patients had an uncomplicated recovery. Only eight patients
requested postoperative analgesia while in hospital. Micropuncture exploration of the bile duct was carried out in one patient.
Conclusions: MPLC is a feasible and safe technique that appears to improve on the benefits of LC; it makes the operation even more feasible
as a day-surgery procedure.
Received: 28 January 1998/Accepted: 7 May 1998 相似文献
12.
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
13.
Laparoscopic liver surgery 总被引:7,自引:0,他引:7
Background: An effort was made to evaluate the indications, safety, and therapeutic efficacy of laparoscopic liver surgery.
Methods: Between 1989 and 1996, 28 patients, 23 to 88 years old were operated upon laparoscopically. Pathology consisted of simple
cyst (ten), polycystic liver disease (seven), hydatid cyst (three, two of them calcified), abscess (one), focal nodular hyperplasia
(six), and metastatic breast cancer (one).
Results: Operations included 17 fenestrations, three pericystectomies, and eight resections (two lateral lobes). Operative time was
45 to 525 min with only four cases longer than 4 h. There was a 21% morbidity rate. There were no mortalities. Follow-up was
1–67 months with one asymptomatic recurrence.
Conclusions: Laparoscopic hepatic surgery can be performed safely with good results by surgeons with hepatic and laparoscopic experience
when careful selection criteria are followed. We advocate the ``four-hands technique' for simultaneous dissection and control
of bleeding and bile ducts during resections.
Received: 10 May 1996/Accepted: 26 July 1996 相似文献
14.
Is laparoscopic sonography a reliable and sensitive procedure for staging colorectal cancer? 总被引:2,自引:2,他引:0
O. Goletti G. Celona C. Galatioto B. Viaggi P. V. Lippolis L. Pieri E. Cavina 《Surgical endoscopy》1998,12(10):1236-1241
Background: Laparoscopic colectomy has developed rapidly with the explosion of technology. In most cases, laparoscopic resection is performed
for colorectal cancer. Intraoperative staging during laparoscopic procedure is limited. Laparoscopic ultrasonography (LUS)
represents the only real alternative to manual palpation during laparoscopic surgery.
Methods: We evaluated the diagnostic accuracy of LUS in comparison with preoperative staging and laparoscopy in 33 patients with colorectal
cancer. Preoperative staging included abdominal US, CT, and endoscopic US (for rectal cancer). Laparoscopy and LUS were performed
in all cases. Pre- and intraoperative staging were related to definitive histology. Staging was done according to the TNM
classification.
Results: LUS obtained good results in the evaluation of hepatic metastases, with a sensitivity of 100% versus 62.5% and 75% by preoperative
diagnostic means and laparoscopy, respectively. Nodal metastases were diagnosed with a sensitivity of 94% versus 18% with
preoperative staging and 6% with laparoscopy, but the method had a low specificity (53%). The therapeutic program was changed
thanks to laparoscopy and LUS in 11 cases (33%). In four cases (12%), the planned therapeutic approach was changed after LUS
alone.
Conclusions: The results obtained in this study demonstrate that LUS is an accurate and highly sensitive procedure in staging colorectal
cancer, providing a useful and reliable diagnostic tool complementary to laparoscopy.
Received: 2 May 1997/Accepted: 11 February 1998 相似文献
15.
Laparoscopic common bile duct exploration by choledochotomy 总被引:2,自引:2,他引:0
Background: Management of cholelithiasis and choledocholithiasis usually requires two separate teams—the gastroenterologist/surgical
endoscopist and the laparoscopic surgical team. This requires two separate procedures that potentially increase the overall
morbidity and cost. Laparoscopic common bile duct exploration by choledochotomy (LCBDE-C) averts this problem with a single
approach.
Methods: In 1990–1991, unsuspected stones found at laparoscopy with intraoperative cholangiogram done routinely underwent postoperative
ERCP. Residual stones had been found after ERCP in 16 of 22 preoperative ERCP patients and we began to seek an alternative
technique. Laparoscopic common bile duct exploration by choledochotomy has achieved a high rate of success.
Results: Technically successful LCBDE-C has been accomplished in 143 of 148 patients (96.6%). Retained bile duct stones have been
found on postoperative cholangiogram in three patients (2.0%), all of which have been successfully removed by postoperative
ERCP. Thus 140 or 148 patients had their bile duct successfully cleaned by the one-step technique alone (94.6%).
Conclusions: We believe that most laparoscopic surgeons who have acquired the skills of intracorporeal suturing can be successful at laparoscopic
common bile duct exploration by choledochotomy. The disadvantage of T-tube presence will likely be eliminated by future developments
with intraoperative antegrade sphincterotomy-like procedures, but the ability to see both proximal and distal biliary tree
with the choledochotomy in all cases seems to offer more than adequate results at this point in the evolution of the laparoscopic
approach to calculus biliary tract disease.
Received: 3 April 1997/Accepted: 18 September 1997 相似文献
16.
Background: The use of minimally invasive techniques in the surgical treatment of pheochromocytoma is controversial because of possible
intraoperative excessive hormone release resulting in cardiovascular instabilities.
Methods: Laparoscopic adrenalectomy was performed in nine patients with a total of 10 pheochromocytomas. Conversion was required in
two cases. The relevant data were prospectively documented and compared with a historical group of nine patients who had undergone
conventional transabdominal adrenalectomy for unilateral pheochromocytoma.
Results: The laparoscopic operations lasted significantly longer than the conventional procedures (median 243 min vs. 100 min, p < 0.01). Intraoperative cardiovascular instabilities (tachycardia, hypertension) occurred in seven laparoscopically and eight
conventionally treated patients. All were easily controlled. Blood transfusions were necessary in four patients in the conventional
and one patient in the laparoscopic group. Postoperative hospital stay and duration of analgetic treatment were significantly
shorter after laparoscopic adrenalectomy.
Conclusions: Laparoscopic adrenalectomy is a safe procedure for patients with pheochromocytoma.
Received: 11 May 1997/Accepted: 20 March 1998 相似文献
17.
Background: Antireflux operations have been recommended for infants and children suffering from complications related to gastroesophageal
reflux (GER). In recent years, the laparoscopic approach has been used increasingly for antireflux surgery in adult patients.
This is our initial experience with Nissen fundoplication in infants and children under 2 years of age.
Patients: We operated on 11 patients weighing between 3.0 and 10.0 kg. The main indications for surgery were GER-induced aspiration
pneumonia and failure to thrive, in spite of intensive conservative treatment. All patients except one had an associated neurological
abnormality, including six patients with familial dysautonomia.
Results: All attempted operations were completed successfully laparoscopically, with only a few postoperative complications and acceptable
short-term results. The clinical considerations and technical aspects unique to this specific group of patients are discussed.
Conclusion: Laparoscopic Nissen fundoplication is feasible, safe, and effective, even in very small babies.
Received: 16 April 1997/Accepted: 30 June 1997 相似文献
18.
S. S. Rothenberg D. Bratton G. Larsen R. Deterding H. Milgrom S. Brugman M. Boguniewicz S. Copenhaver C. White J. Wagener L. Fan J. Chang T. Stathos 《Surgical endoscopy》1997,11(11):1088-1090
Background: The relationship between severe reactive airway disease (RAD) and gastroesophageal reflux disease (GERD) has been noted but
the relationship is poorly understood. This study reports our experience with laparoscopic fundoplication and it's effect
on the pulmonary status of children with severe steroid-dependent reactive airway disease.
Methods: Fifty-six patients with severe steroid-dependent RAD and medically refractory GERD underwent laparoscopic Nissen fundoplications.
Mean age was 7 years and mean weight was 20 kg. All patients had the procedure completed successfully laparoscopically with
an average operative time of 62 min. Average hospital stay was 1.6 days.
Results: Forty-eight of 56 patients noted significant improvement in their respiratory symptoms in the first week. Fifty of 56 patients
have been weaned off their oral steroids and four others have had a greater than 50% decrease in their dose. Sixteen patients
had a documented increase in their FEV1 in the initial postoperative period (avg. 26%).
Conclusion: Patients with steroid-dependent RAD and GERD refractory to medical management show improvement in their respiratory status
following fundoplication and the majority can be weaned off of their oral steroids. Laparoscopic techniques allow this procedure
to be performed safely even in this high-risk group of patients.
Received: 25 March 1997/Accepted: 5 July 1997 相似文献
19.
Follow-up of 161 unselected consecutive patients treated laparoscopically for common bile duct stones 总被引:9,自引:6,他引:3
Background: Aim was to study the incidence of recurrent ductal stones and of biliary strictures at follow-up after laparoscopic treatment
of gallstones and common bile duct stones and to update the short-term results.
Methods: Ductal stones were proven in 161 patients of 1,975 (8.1%) undergoing laparoscopic cholecystectomy. Laparoscopic transcystic
CBD exploration was the method of choice. If this was unsuccessful, laparoscopic choledochotomy was performed. After treatment,
all patients were enrolled in a continued, ongoing follow-up study.
Results: Laparoscopic CBD exploration was completed in 157 cases (transcystic 107, choledochotomy 50). Retained stones occurred in
eight patients (5%) and major complications (cystic duct leakage, hemoperitoneum) in six (3.8%); mortality occurred in one
high-risk patient (0.6%). Follow-up available in 154 patients (two unrelated deaths) for a period of up to 62 months showed
the occurrence of recurrent ductal stones in five cases (3.2%) and no signs of bile stasis, suggestive of ductal stricture,
on the basis of clinical and laboratory findings.
Conclusions: This prospective, ongoing follow-up study demonstrates that laparoscopic treatment of gallstones and common bile duct stones
in unselected patients is feasible and safe.
Received: 21 May 1996/Accepted: 10 March 1997 相似文献
20.
Background: This prospective study was conducted to evaluate the accuracy and the therapeutic relevance of staging laparoscopy.
Methods: Between June 1993 and February 1997 staging laparoscopy was performed in 389 patients with various neoplasms. Additionally,
144 selected patients of this group were examined with laparoscopic ultrasound using a semiflexible ultrasound probe (7.5
MHz).
Results: Compared to conventional imaging methods, laparoscopy and laparoscopic ultrasound improved the accuracy of staging in 158
of 389 patients (41%). Statistical subgroup analysis of 131 patients with gastric cancer showed that the accuracy of staging
laparoscopy in the detection of distant metastases (68%) was significantly higher (p < 0.01) than that of ultrasound (63%) or computed tomography (58%). In the whole group, laparoscopy alone disclosed intraabdominal
tumor dissemination or nonresectable disease in 111 patients. Laparoscopic ultrasound displayed additional metastases—i.e.,
liver metastases (n = 9), M1 lymph nodes (n = 15), or nonresectable tumors (n = 6) in 30 patients. Although metastastic disease
was suggested by preoperative imaging, benign lesions were found in five patients with laparoscopy and in a further 12 patients
with ultrasonography. The findings of staging laparoscopy changed the treatment strategy in 45% of the patients. Conversion
to open surgery was necessary in 5% of the cases, and complications related to laparoscopy occured in 4% of the patients.
Conclusions: Laparoscopy with laparoscopic ultrasound improves the staging of gastrointestinal tumors and has a significant impact on
a stage-adapted surgical therapy.
Received: 3 April 1997/Accepted: 26 September 1997 相似文献