ISSN:0007-1323    

DOI:10.1002/bjs.1800820302

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800820303

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800820304

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractLaparoscopic surgery is excellent for treating benign disease of the colon and rectum, and for palliative operations for malignancy. Its application for cure of colorectal malignancy, however, must be approached with caution. Port site recurrence of tumour is a particular, and increasingly recognized, drawback. This review discusses the evidence to date to support prospective randomized trials of laparoscopic colectomy for cure of carcinoma.

ISSN:0007-1323    

DOI:10.1002/bjs.1800820305

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractNeoplasms occur in 0–5 percent of appendices. Ultrasonography or computed tomography is beneficial, but preoperative detection is rare. At operation, the diagnosis is considered in under half of cases. Mucocele, localized pseudomyxoma peritonei, benign tumours and most appendiceal carcinoids are cured by appendicectomy alone. Right hemicolectomy is indicated for: (1) invasive adenocarcinoma; (2) tumours close to the caecum; (3) lesions larger than 2 cm; (4) mucin production; (5) invasion of the lymphatics, serosa or mesoappendix; and (6) cellular pleomorphism with a high mitotic rate. Tumours of 1–2 cm, small mucinous carcinoids, adenocarcinoma confined to the mucosa, and tumours in children may be treated by appendicectomy alone at the surgeon's discretion. The 5‐year survival rate associated with classical carcinoid is more than 90 percent. The prognosis of mucinous carcinoid is intermediate between that of classical carcinoid and well differentiated adenocarcinoma. The prognosis of adenocarcinoma is determined by Dukes' stage and is similar, stage for stage, to that of colorectal carc

ISSN:0007-1323    

DOI:10.1002/bjs.1800820306

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800820307

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractThe introduction of laparoscopic cholecystectomy has been associated with an increased incidence of bile duct injury. This review presents the incidence of bile duct injury in reported series and examines the role of the learning curve and other contributing factors. There is good evidence to suggest that, with adequate training and experience, the incidence of biliary injury can be reduced to a level comparable to that of open cholecystectomy. Continued audit is required to ensure that the low complication rates achieved in selected centres with wide experience are reproduced by the surgical community in general.

ISSN:0007-1323    

DOI:10.1002/bjs.1800820308

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractRectopexy is advocated as treatment for solitary rectal ulcer syndrome despite variable outcome. Sixteen patients with this condition, who remained symptomatic after surgery, were examined before and after operation by evacuation proctography and compared with a matched group of seven patients whose symptoms had been relieved, to investigate the effect of rectopexy on rectal configuration or emptying, or both, and to identify any preoperative factor associated with a good outcome. Rectal prolapse, demonstrated in 19 of 23 patients before operation (internal in 12, external in seven), was seen in only one patient after surgery. The rectal axis became more vertical at rest (median 44° before operationversus35° after surgery,P= 0.006) and on evacuation (median 38°versus31°,P= 0.023). Preoperative evacuation time was increased in patients with poor outcome (median (range) 22 (8–60) sversus10 (5–15) s,P= 0.008). Rectopexy successfully treats rectal prolapse in patients with solitary rectal ulcer syndrome and alters rectal configuration. These features, however, are unrelated to outcome. Prolonged preoperative evacuation time, suggesting a defaecatory disorder, may predict poor symptomatic

ISSN:0007-1323    

DOI:10.1002/bjs.1800820309

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractColonoscopy is the established method of surveillance of subjects at high risk of developing colorectal neoplasia but the procedure is expensive, time consuming and occasionally hazardous. Faecal occult blood tests can be prepared at home and are cheap, simple and safe. Hemeselect is an immunological faecal occult blood test that is more sensitive for colorectal cancer than Haemoccult. The aim of this study was to determine the sensitivity of the Hemeselect test for asymptomatic colorectal neoplasia in subjects at high risk of the disease who were undergoing colonoscopy, thus assessing its suitability as an alternative means of screening high‐risk groups. A total of 919 asymptomatic subjects were asked to complete Hemeselect tests. These were completed satisfactorily by 808 individuals (compliance rate 88 per cent) and were positive in 164 patients (20 per cent). At colonoscopy 11 cancers were detected in ten patients (seven Hemeselect positive) and 36 (16 Hemeselect positive) had at least one adenoma 1 cm or more in diameter. The test sensitivities of Hemeselect for carcinoma and large (1 cm or more) adenomas were 70 and 44 per cent respectively. In a subset of 417 subjects who also completed Haemoccult tests, the sensitivities were 33 and 18 per cent. Hemeselect specificity is 88 per cent compared with 98 per cent for Haemoccult. While the sensitivity of Hemeselect is higher than that of Haemoccult, it is still insufficient to replace colonoscopy in high‐risk gro

ISSN:0007-1323    

DOI:10.1002/bjs.1800820310

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractOf 905 patients with colorectal cancer admitted to a single district general hospital, 272 (30 per cent) were admitted as emergencies. Emergency patients had more advanced tumours (Dukes stage B and C 96 per centversus88 per cent of those admitted electively,P<0·006), a shorter history (median 3versus11 weeks,P<0·001), were less likely to be fully ambulatory (44versus80 per cent,P<0·0001) and more likely to have abdominal pain (74versus51 per cent,P<0·001) and vomiting (40versus10 per cent,P<0·0001). More emergency patients were given stomas (56 versus 35 per cent,P<0·0001) and died in hospital (19versus8 per cent,P<0·0001). Of those who survived to be discharged, patients admitted as an emergency spent longer in hospital (median stay 16versus13 days,P<0·0001) and had a poorer overall 5‐year survival rate (29versus39 per cent,P= 0·0001). Emergency patients were significantly older (median 74versus72 years,P= 0·04) and much more likely to be widowed (41versus27 per cent,P= 0·0002) than those admitted for elective surgery. If the personal and resource disaster of emergency colorectal cancer admission is to be reduced, screening strategies targeted by demographic characteristics require i

ISSN:0007-1323    

DOI:10.1002/bjs.1800820311

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY