大脑外侧裂开放并蛛网膜撕裂治疗外伤性顽固性硬膜下积液

目的探讨大脑外侧裂开放并蛛网膜撕裂治疗外伤性顽固性硬膜下积液的效果。方法 56例外伤性顽固性硬膜下积液患者,行大脑外侧裂开放并蛛网膜撕裂术,术后随访患者的硬膜下积液复发情况。结果本组56例经手术治疗临床症状消失,术后复查CT示积液完全消失。术后随访,55例无复发,有效率达98.2%。结论大脑外侧裂开放并蛛网膜撕裂是治疗外伤性顽固性硬膜下积液的最佳方法。     

Laparoscopic transgastric esophageal mucosal resection: 4-year minimum follow-up

Background

The management of high-grade esophageal dysplasia has included surveillance, endoscopic ablative techniques, and esophagectomy. Herein we describe an alternative treatment, laparoscopic transgastric esophageal mucosal resection.

Methods

Laparoscopic transgastric esophageal mucosal resection was accomplished through an anterior gastrotomy. The mucosa was stripped from the Z-line to the proximal extent of the abnormal epithelium. The gastrotomy then was closed with a linear stapler, and a Nissen fundoplication was performed.

Results

Six patients with high-grade dysplasia of the distal esophagus underwent mucosal resection. After 4 to 7 years of endoscopic surveillance, all patients have regenerated squamous epithelium. One patient developed nondysplastic Barrett's esophagus after 2 years and was treated medically. Two strictures were treated successfully with dilatation.

Conclusions

Laparoscopic transgastric esophageal mucosal resection was a reasonable treatment for high-grade dysplasia in this small sample of patients. This technique is a potential alternative treatment for high-grade dysplasia of the esophagus.     

Outcomes of Robot-Assisted Pancreaticoduodenectomy in Patients Older Than 70 Years: A Comparative Study

Background

Minimally invasive pancreaticoduodenectomy (PD) remains one of the most challenging abdominal procedures and its application in the elderly population is poorly reported in the literature so far. The goal of this study was to demonstrate that robot-assisted PD can be safely performed in patients aged 70 years and older.

Methods

Forty-one consecutive robot-assisted PD performed between April 2007 and January 2010 were prospectively entered in a dedicated database. Patients were stratified into two groups: group 1, aged ≥70 years (n = 15, 36.6%); and group 2, aged <70 years (n = 26, 63.4%). The data were reviewed retrospectively.

Results

Indications for surgery and patient characteristics were the same in both groups, with the exception of age. There was no statistical difference in terms of operative time (P = 0.376), blood loss (P = 0.989), conversion rate (P = 0.52), mortality (P = 0.36), or overall morbidity rate (P = 0.74). The mean hospital stay was 14.3 days in group 1 and 11.2 days in group 2. This was not statistically significant (P = 0.136).

Conclusions

Robot-assisted pancreaticoduodenectomy can be performed safely in elderly patients with comparable mortality, morbidity, and outcomes compared with a younger population. Age alone should not be a contraindication for robotic pancreatic resection.     

Evaluation of acute fixation strength of absorbable and nonabsorbable barrier coated mesh secured with fibrin sealant

Introduction  

The purpose of this study was to evaluate the acute fixation strength of fibrin sealant as an alternative fixation method for laparoscopic ventral hernia repair (LVHR) when utilized with absorbable and nonabsorbable barrier meshes.     

Comprehensive interview assessment of eating behavior 18–35 months after gastric bypass surgery for morbid obesity

BackgroundWeight loss surgery induces a marked change in eating behavior. However, not much work has been done characterizing the eating behavior after weight loss surgery. We conducted a detailed analysis of patients' eating behavior 18–35 months after Roux-en-Y gastric bypass surgery, determined whether preoperative eating disorders might be associated with non-normative postoperative eating, and examined the association of such eating behaviors with weight loss and psychopathology.MethodsA sample of 59 patients who had undergone Roux-en-Y gastric bypass was interviewed in person after surgery about a range of eating behaviors, including binge eating, chewing and spitting out food, picking at and nibbling food, and nocturnal eating and compensatory behaviors such as vomiting and laxative and diuretic misuse. An established semistructured interview was used. The prevalence of preoperative eating disorders was assessed retrospectively. The eating-related and general psychopathology and quality of life were assessed using self-report questionnaires before and after surgery.ResultsSubjective bulimic episodes were reported by 25% and vomiting for weight and shape reasons by 12% of the participants, on average, 2 years after surgery. Subjective bulimic episodes were significantly associated with a preoperative binge eating disorder, with more eating-related and general psychopathology after surgery, and with less weight loss.ConclusionA substantial subgroup of patients with a preoperative eating disorder will develop binge eating after surgery that might be associated with less weight loss. A subsample will start vomiting for weight and shape reasons after bariatric surgery. Clinicians must probe carefully for these behaviors postoperatively to identify patients in need of treatment of pathological eating behaviors.     

显微内窥镜下椎管减压椎间融合治疗腰椎失稳症的近期疗效观察

目的:探讨显微内窥镜下椎管减压、椎间植骨融合治疗腰椎失稳症的临床疗效。方法:2006年7月～2008年12月共收治退变性腰椎失稳症患者48例,患者均有持续性腰痛,伴有双侧臀部、双侧或一侧下肢疼痛、麻木,均有间歇性跛行、腰部屈伸活动受限。腰椎动力位X线片示均为单节段失稳,椎间水平移位≥4mm或椎间角度变化≥11°,但滑移不超过Ⅰ度。均采用显微内窥镜下经椎板间隙入路椎管减压、经椎间孔入路椎体间自体骨粒、椎间融合器置入椎体间融合术。术后2周(出院时)拍腰椎正侧位X线片,术后每3个月复查X线片。按照Macnab标准评价疗效,随访观察近期治疗效果。结果:手术时间70～150min,平均95min;出血量110～210ml,平均150ml。随访6～18个月,平均12个月。术后症状及体征均有不同程度缓解,术中、术后均无任何并发症发生。末次随访时按照Macnab标准,优24例,良20例,可4例。X线检查未见cage移位、下沉,37例随访超过9个月的患者均见椎间隙变模糊,过伸过屈侧位X线片示椎体间无移位,但所有患者均未观察到椎间隙消失和骨小梁完全通过椎体间上下终板。结论:显微内窥镜下椎管减压及椎间融合术治疗退变性椎间失稳症具有创伤小、早期疗效满意等优点,长期疗效及融合情况需进一步随访观察。     

Laparoscopic management of vaginal clear cell adenocarcinoma arising in pelvic endometriosis: case report and literature review

Vaginal clear cell adenocarcinoma arising from pelvic endometriosis has not been reported in the literature. We report a case of a 50-year-old woman with stage I clear cell adenocarcinoma of the vagina who was found to have endometriosis adjacent to the vaginal tumor. She was treated with neoadjuvant chemoradiation, laparoscopically assisted radical vaginal hysterectomy, radical upper vaginectomy, and pelvic lymphadenectomy followed by combination chemotherapy.     

Uterine fibroid embolization versus myomectomy in women wishing to preserve fertility: preliminary results of a randomized controlled trial

Objective: To compare the clinical results of surgical and endovascular treatment of uterine myomas in young women.     

Laparoscopic Diagnosis of Annular Pancreas in a Patient with Mucinous Cystoadenoma of the Body of the Pancreas

Introduction  

Annular pancreas (AP) is a rare anomaly due to malrotation of the pancreatic ventral bud during embryologic development. AP has been extensively described in the pediatric population; however, in adults, the incidence has been reported to be only 1 in 22,000 patients with only a few cases presenting with simultaneous mucinous cystadenoma described in the recent literature.