摘要:

Summary: Endoscopic mucosal resection (EMR) is a recently introduced therapeutic method based on the principles of the strip biopsy for resection of flat lesions of the gastrointestinal tract. Eleven asymptomatic patients (nine men, two women) with superficial carcinoma or high-grade dysplasia of the intrathoracic esophagus were treated by EMR during a 6-month period. The patients' mean age was 64 years (range, 49–78). The site of the lesions was the middle third of the esophagus in eight, upper third in two, and lower third in one patient. All patients in this series had a flat (II) type of superficial cancer. The procedure was carried out in all 11 patients without complication. Histopathological examination of the specimens revealed squamous cell carcinoma in nine patients. The remaining two patients were confirmed to have dysplasia only. Free margins measured greater than 5 mm in all cases. No recurrence was detected in a mean follow-up of 8 (5–10) months. For superficial flat lesions, EMR proved to be a safe and curative procedure that provided good quality of life following resection. However, larger trials are needed to confirm these results. Applying EMR to esophageal dysplasia could decrease the incidence of esophageal cancer.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Summary: The wide use of operative and diagnostic laparoscopy has led to a greater use of the laparoscopic ultrasound (LUS) as a complementary procedure. A preliminary study was performed to evaluate the efficacy of LUS using a linear array laparoscopic probe characterized by double frequency, mechanical flexibility, and availability of Doppler analysis. LUS was performed in 36 patients with gastrointestinal neoplasms and compared with preoperative sonography, computed tomography, and with laparoscopy alone. LUS identified liver metastases with a sensitivity of 100% versus 60% for preoperative diagnostic means and laparoscopy. Nodal metastases were identified with a sensitivity of 96.1% and a specificity of 66.6%. Therapeutic planning was modified as result of LUS in 8 of 35 cases (22.9%). In patients with abdominal malignancy, LUS improves staging (cancer spread, nodal metastases, liver metastases), modifying therapeutic decisions. LUS represents a complementary, indispensable diagnostic method during laparoscopic surgery.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Summary: We report two cases of marked hypercapnia of more than 60 mm Hg (PaCO2) and extensive subcutaneous emphysema noted during laparoscopic cholecystectomy. The first case, a 55-year-old man was diagnosed as having cholecystolithiasis and had hypercapnia up to 83.5 mm Hg (PaCO2) during laparoscopic cholecystectomy. The patient resumed spontaneous respiration under controlled ventilation accompanied by persistent bigeminal pulse. Soon after deflation, CO2returned to normal range, and extensive subcutaneous emphysema was detected in the recovery room. The second patient, a 53-year-old woman, had cholecystolithiasis and also underwent laparoscopic cholecystectomy. Both hypercapnia rising to 61.1 mm Hg (PaCO2) and extensive subcutaneous emphysema appeared just before completion of resection of the gallbladder. Mild hypercapnia during pneumoperitoneum of about 50 mm Hg (PaCO2) has been reported previously. As compared with cases in the literature, the present cases suggest that hypercapnia is due to extensive subcutaneous emphysema. The large absorption surface area in the subcutaneous tissue and the large difference in the partial pressure cause the extensive gaseous interchange of CO2between subcutaneous tissue and blood perfusing into it at the moment between peritoneal cavity and blood perfused the peritoneum.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Summary: The preoperative diagnosis of Choledocholithiasis simplifies the laparoscopic management of biliary tract disease. Slow infusion intravenous cholangiography (SI-IVC) may be an accurate and cost-effective screening test for Choledocholithiasis, and it is safer than traditional intravenous cholangiography. Forty-nine patients underwent SI-IVCs for suspected Choledocholithiasis. These patients subsequently had endoscopic retrograde cholangiograms (ERC) or intraoperative cholangiograms (IOC) during laparoscopic cholecystectomies. Sixteen SI-IVCs demonstrated Choledocholithiasis; 13 were confirmed by ERCs or by IOCs. The remaining 33 patients with negative SI-IVCs had negative ERCs or IOCs. The sensitivity, specificity, and accuracy of detecting Choledocholithiasis by SI-IVC were 100%, 92%, and 94%. Only one patient had a mild reaction to the contrast agent. In our hospital the cost of an SI-IVC is $324, the cost of an IOC is $393 (including operating room and anesthesia costs), and the cost of an ERC is $1,085. SI-IVC is an accurate method of preoperative screening for Choledocholithiasis. It is safe and cost-effective.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Summary: The anatomy of the retroperitoneum, including the high retroperitoneum, was studied as it appears with balloon dissecting techniques. We used fresh cadavers in this study. A relatively unknown fascia that is located between the lateral aspect of the perirenal fascia and the posterior parietal peritoneum, called the paraconal fascia, was a constant finding. This structure is important because it protects delicate retroperitoneal organs: the duodenum, pancreas, celiac axis, and superior mesenteric artery. Locating this fascia is an important step in the dissection of the high retroperitoneum, which is of interest in advanced videoendoscopic procedures involving retroperitoneal organs.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Summary: Obese patients treated by laparoscopic cholecystectomy currently appear to be the largest risk subgroup amenable to consistent scientific evaluation. Here we report our experience and compare the results in obese patients with those obtained in nonobese patients undergoing the laparoscopic procedure. Laparoscopic cholecystectomy in obese patients was technically more difficult with significantly longer operating time (p < 0.01), but intraoperative and postoperative technical complications were not significant in the groups analyzed. Obese patients present significant anesthesiological complications (p $$ 0.001). The results of this experience and the literature review indicate that the therapeutic advantages proved in nonobese patients can be extended to the obese population.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Summary: A method for creating the pneumoperitoneum for laparoscopic surgery in 200 patients used the Lazarus-Nelson technique. A needle half the diameter of the Veress needle was used. A guide wire followed by a catheter with multiple side ports allowed for rapid infusion of CO2. A technique used safely in hundreds of thousands of peritoneal lavages gives the surgeon a safe and rapid technique to create a pneumoperitoneum.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Summary: A laparoscopic distal gastrectomy with gastroduodenostomy (Billroth I) was performed on a patient with intractable gastric ulcer. The patient was a 56-year-old man, complaining of severe epigastralgia, who had a 10-year history of peptic ulcer. Gastroscopy had revealed a UL-IV gastric ulcer on the lesser curvature at the angle of the stomach and a deformity of the bulbus. A diagnosis of intractable gastric ulcer was made, and the patient underwent laparoscopic distal gastrectomy and gastroduodenostomy. On postoperative day 1, he was able to walk. On postoperative day 4, he started on a clear liquid diet and was discharged on postoperative day 14.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Summary: This case report describes a procedure-related small-bowel obstruction after laparoscopic inguinal hernia repair caused by a herniation through the peritoneal closure.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID