ISSN:0007-1323    

DOI:10.1002/bjs.1800831102

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800831103

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800831104

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractClinical desmoid disease affects approximately 10 per cent of patients with familial adenomatous polyposis (FAP); the subclinical rate is unknown. Desmoids are probably neoplastic rather than regenerative in origin and may arise in association with germline or somatic mutations at or beyond codon 1444 of theAPCgene. Intra‐abdominal desmoids behave unpredictably but are an important cause of death in those with FAP. Signal intensity on magnetic resonance imaging reflects tumour cellularity, which in part determines progression, and this may help management. Surgical treatment of advanced desmoids is hazardous, but medical treatments have limited success. Chemotherapy with doxorubicin and dacarbazine is currently under evaluatio

ISSN:0007-1323    

DOI:10.1002/bjs.1800831105

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractThe reported mortality rate associated with abdominal wounds sustained in war varies considerably because of the heterogeneity of wounds and the different circumstances under which figures have been collected rather than different treatment strategies. This review draws together a personal experience, reports from ten wars, and information from a database for war wounded into an analysis of abdominal wounds. The analysis attempts to bring understanding to why people die with abdominal wounds in war and so clarifies logistic and treatment issues.

ISSN:0007-1323    

DOI:10.1002/bjs.1800831106

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractThe routine use of intraoperative cholangiography during cholecystectomy has been debated extensively. Intraoperative ultrasonography was a quick, efficient alternative in open cholecystectomy. A prospective controlled trial to evaluate its usefulness in laparoscopic cholecystectomy is reported. Two groups of 100 patients each were examined during operation with laparoscopic ultrasonography and intraoperative cholangiography. In the first group an adapted urethral probe was used and in the second group a new specialized laparoscopic probe. Intraoperative cholangiography followed immediately after laparoscopic ultrasonography in each patient. In group 1 bile duct stones (n= 4) were detected with a sensitivity of 100 and 75 per cent, a specificity of 98 and 99 per cent, and an overall accuracy of 98 per cent for both ultrasonography and cholangiography. In group 2, 11 patients demonstrated common duct calculi. The sensitivity, specificity and overall accuracy for laparoscopic ultrasonography and intraoperative cholangiography were 91 and 64 per cent, 100 and 100 per cent, and 99 and 96 per cent respectively. The differences between groups 1 and 2 and between ultrasonography and cholangiography were not significant. Variations in the anatomy of the bile duct were observed in 21 patients in group 1 by laparoscopic ultrasonography and in 20 by intraoperative cholangiography. In group 2, 64 variations were demonstrated in 50 individuals by ultrasonography and 61 variations in 47 patients by cholangiography. Vascular variations were seen with ultrasonography in 22 and 24 patients in groups 1 and 2 respectively. In conclusion, laparoscopic ultrasonography (with either probe) proved as accurate as intraoperative cholangiography in detecting bile duct stones, and the specialized probe detected significantly more variations of the bile duct than the adapted probe.

ISSN:0007-1323    

DOI:10.1002/bjs.1800831107

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractThe aim of this retrospective study was to analyse outcome in 31 European patients operated on for peripheral cholangiocarcinoma between 1988 and 1995 (hilar cholangiocarcinoma was excluded). Before 1992, in addition to conventional resection, patients with irresectable tumour and with no extrahepatic metastasis underwent total hepatectomy with liver transplantation. Mild abdominal pain was the most frequent presenting clinical sign (11 of 31 patients) and jaundice was present in only four patients. Preoperative histological findings were available for 20 patients but the diagnosis was correct in only eight of these. Nineteen patients had curative surgery: 17 underwent conventional resection and two had total hepatectomy with liver transplantation. Major hepatectomy was performed in 12 of 17 cases, extended to the caudate lobe in five, to the bile duct confluence in four and to the retrohepatic vena cava in one. Postoperative mortality and morbidity rates were three and seven of 19 patients respectively, median survival was 15 months, and actuarial 1‐, 2‐ and 5‐year survival rates were 67, 40 and 32 per cent respectively. Twelve patients had only exploratory laparotomy because of the presence of extrahepatic metastasis or irresectable tumour. The invasive nature of peripheral cholangiocarcinoma can explain the limited number of resectable cases and the particularly unfavourable prognosis. Total hepatectomy does not provide survival benefit. Conventional surgery remains the only effective treatment, even for patients with advanced stage tu

ISSN:0007-1323    

DOI:10.1002/bjs.1800831108

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractFive patients with primary liver cancer presented with obstructive jaundice due to extension of tumour thrombus into the biliary ducts. Three patients had hepatocellular carcinoma, two of whom had alcoholic cirrhosis, and the other two had a peripheral cholangiocarcinoma. Preoperative diagnosis of biliary thrombus was best achieved by ultrasonography and computed tomography which showed peripheral hepatic tumour with dilated bile ducts containing dense material. All patients underwent liver resection associated with biliary exploration, clearance and T‐tube drainage. Major hepatectomy was required in four cases. There were no postoperative deaths; one patient developed a subphrenic collection of bile which was drained percutaneously. All patients survived more than a year; median survival was 29 months. There are two long‐term survivors without recurrence at 29 and 80 months. Patients with primary liver cancer and jaundice due to migrated tumour fragments in the common bile duct may benefit from surgical resection which can result in long‐term resolution of symptoms and occasional

ISSN:0007-1323    

DOI:10.1002/bjs.1800831109

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractA technique of hepatic resection is described and the results of 150 resections are reviewed. Hepatic transection was performed, under intermittent portal inflow occlusion, using ultrasonic aspiration to skeletonize portal branches and venous tributaries. Control of venous haemorrhage during resection was optimized by argon beam coagulation and lowering central venous pressure to between 0 and 4 cm H2O by extradural blockade and systemic nitroglycerine infusion. One patient with jaundice died in hospital, giving a mortality rate of 0·7 per cent. There were no deaths in patients without jaundice and cirrhosis. Fifteen patients (10.0 per cent) had significant complications, nine medical and six surgical, including three bile leaks (2.0 per cent). Mean blood loss was 814 ml for the whole study but only 434 ml in the last 4 years. During this latter period mean blood transfusion in hospital was 0·5 units and mean postoperative haemoglobin value fell by 0·7 g per 100 ml. Hepatic resection can be performed with the same degree of confidence and similar low morbidity as any other major surgical procedu

ISSN:0007-1323    

DOI:10.1002/bjs.1800831110

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY

摘要:

AbstractChildren who are too ill to await a liver graft of suitable size may be transplanted with a relatively oversized graft by leaving the abdominal wound partially open, the defect being bridged with polypropylene mesh and the mesh reduced in stages until it can be removed and the wound directly closed. This technique has been used in seven children who received nine grafts (five reduced and four full size). Their mean age was 7·3 (range 0·5–11) months and mean weight 5·8 (range 2·3–7·2) kg. Progressive reduction in the size of the transplanted liver made primary closure possible in survivors in up to four stages. Over a follow‐up period of 3 to 58 months, five of the nine grafts and five of the seven patients survived. No significant complications attributable to the technique were encountered. The technique of delayed primary abdominal wall closure may be of benefit in children at risk of graft failure because of a size‐mism

ISSN:0007-1323    

DOI:10.1002/bjs.1800831111

出版商:John Wiley&Sons, Ltd.    

年代:1996

数据来源: WILEY