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101.
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
102.
Background: Increasingly larger series of laparoscopic fundoplications (LF) are being reported. A well-documented advantage of the laparoscopic
approach is shortened hospital stay. Most centers report typical lengths of stay (LOS) for LF of 2–3 days. Our success with
LF with a LOS of 1 day led to an attempt at performing LF on an ambulatory basis.
Methods: Sixty-one consecutive patients with appropriate criteria for LF underwent surgery at our institution. Patients were counseled
by the authors as to the usual postop course and progression of diet. All patients received preemptive analgesia (PEA) consisting
of perioperative ketorolac and preincisional local infiltration with bupivicaine. Anesthetic management included induction
with propofol, high-dose inhalational anesthetics, minimizing administration of parenteral narcotics, and avoidance of reversal
of neuromuscular blockade. Immediate postop pain management included parenteral ketorolac and oral hydro- or oxycodone. All
patients were given oral fluids and soft solids after transfer from the recovery room to the postoperative observation unit.
Two patients were excluded from ambulatory consideration due to excessive driving distance from our hospital. Another two
were hospitalized for observation after experiencing intraoperative technical problems.
Results: Of 57 patients in whom same-day discharge was attempted, there were three failures requiring overnight hospitalization: All
were due to pain and nausea; one patient also suffered transient urinary retention. There were no adverse outcomes related
to early discharge, and there were no readmissions. One patient returned to the emergency room after delayed development of
urinary retention. Median time from conclusion of operation to discharge was less than 5 h. No patients expressed dissatisfaction
with early discharge on follow-up interview.
Conclusions: LF can be safely performed as an ambulatory procedure. Analgesic and anesthetic management should be tailored to minimize
nausea and provide adequate pain control.
Received: 1 April 1996/Accepted: 29 May 1997 相似文献
103.
104.
105.
106.
P. J. Donald 《European archives of oto-rhino-laryngology》2007,264(7):713-717
The purpose of this paper is to detail the contraindications for surgery, with curative intent for those patients who suffer
from a head and neck malignancy that invades the intracranial space. This is based on a 30-year experience of over 250 patients.
The most important contraindications are anatomical. Surgery is not done if the following structures are invaded: brain stem,
eloquent portions of the cerebrum, superior sagittal sinus, both internal carotid arteries, both cavernous sinuses and certain
vital bridging veins. Certain tumor factors are absolute but are occasionally relative contraindications: such as distant
metastatic disease especially if multiple and at multiple anatomic sites. Some tumors that behave in a particularly virulent
fashion that defy complete resection but are often difficult to predict preoperatively. Lack of patient medical fitness or
absence of patient commitment to the operative procedure is make-up two serious contraindications to surgery.
Presented at the 77th Annual Meeting of the German Society for Oto-Rhino-Laryngology, Head and Neck Surgery, 24–28 May 2006,
Mannheim, Germany. 相似文献
107.
Twenty women diagnosed with functional urinary incoordination were randomly assigned to one of two treatment groups: biofeedback or progressive muscle relaxation. Ten subjects who were placed on a waiting list prior to treatment allocation served as a comparison group. The biofeedback intervention focused specifically on retraining of pelvic floor musculature (PFM). Patients were assessed pretreatment, posttreatment, and at 2-month follow-up. Outcome measures included self-reported symptomatology, psychological functioning, psychophysiological assessment of the PFM, and urologist ratings of problem severity and treatment efficacy. Both treatment approaches proved effective in improving symptomatology and psychological state. Subjects on the waiting list demonstrated no change in urological difficulties. No differences were found between the two treatment groups on any of the outcome measures. Theoretical and practical implications of the results are discussed. 相似文献
108.
Intra-articular fractures of the proximal tibia present a wide spectrum of injury patterns with associated soft tissue injury. The last two decades have seen the techniques of management evolve from extensive open reduction and rigid internal fixation to arthroscopy-assisted minimal invasive surgery (MIS) and biologically benign internal fixation. The ultimate aim is to prevent the occurrence of late degenerative arthritis. This could be achieved in selected patients using minimal invasive surgery, which offers the advantages of better visualisation and management of intra-articular soft tissue injuries, confirmation of fracture reduction viewed from the joint surface, faster rehabilitation and fewer wound complications. 相似文献
109.
姜桂芳 《安徽卫生职业技术学院学报》2007,6(4):65-66
目的:为帮助腹腔镜胆囊手术病人掌握健康教育的知识.方法:开展了由腹腔镜手术后的病人向术前病人介绍手术感受.结果:促进术前病人对有关的健康教育知识的掌握,并能延长其术前1d晚的睡眠时间.结论:使病人更好地掌握健康宣教知识,有利于病人的治疗. 相似文献
110.
目的:探讨甲状腺微小癌的诊断和外科治疗经验。方法:36例甲状腺微小癌患者,10例行患侧腺叶切除术,20例行患侧腺叶加峡部切除术,3例行甲状腺次全切除术,加局部淋巴结清扫术1例,加功能性颈淋巴结清扫术2例,术后均服用甲状腺素片80~120mg/d,服药时间维持手术后1~3年,定期复查甲状腺激素水平,以"轻度甲亢"症状为用药标准调整服药用量。2例术后做同位素治疗。结果:术后2例曾出现短暂声音嘶哑,后逐渐恢复,1例出现短期的低钙抽搐。34例术后随访3~10年,平均随访5年,除1例混合型癌伴发肝转移者死亡外,其余无复发和死亡。结论:甲状腺微小癌女性发病较多,以单发癌结节为主,B超、细针穿刺细胞学检查(FNAC)、术中快速冰冻病理检查等方法综合运用能提高甲状腺微小癌的检出率,甲状腺微小癌手术治疗的预后较好。 相似文献