胃十二指肠溃疡为临床较为常见疾病,而穿孔是其常见的并发症之一。胃十二指肠溃疡穿孔(perforation of gastroduodenal ulcer,PGDU)发病急、病情重、变化快[1,2],为普外科常见急腹症。当前对于PGDU一般行手术治疗,传统开腹修补手术患者...胃十二指肠溃疡为临床较为常见疾病,而穿孔是其常见的并发症之一。胃十二指肠溃疡穿孔(perforation of gastroduodenal ulcer,PGDU)发病急、病情重、变化快[1,2],为普外科常见急腹症。当前对于PGDU一般行手术治疗,传统开腹修补手术患者并发症较多、手术切口大、所承受痛苦多。展开更多
PURPOSE: The aim of this study was to evaluate whether laparoscopic colorectal surgery can modify the risk factors for the occurrence of postoperative morbidity. METHODS: A total of 384 consecutive patients with color...PURPOSE: The aim of this study was to evaluate whether laparoscopic colorectal surgery can modify the risk factors for the occurrence of postoperative morbidity. METHODS: A total of 384 consecutive patients with colorectal disease were randomized to laparoscopic resection (n = 190) or open resection (n = 194). On admission, demographics, comorbidity, and nutritional status were recorded. Operative variables, patient outcome, and length of stay were also recorded. Postoperative complications were registered by four members of staff not involved in the study. RESULTS: The overall morbidity rate was 27.1 percent, with the rate in the laparoscopic group (18.7 percent) being less than that in the open group (31.5 percent; P = 0.003). Patients who underwent laparoscopic resection had a faster recovery of bowel function (P = 0.0001) and a shorter length of stay (P = 0.0001). In the whole cohort of patients, multi variate analysis identified open surgery (P = 0.003), duration of surgery (P= 0.01), and homologous blood transfusion (P = 0.01) as risk factors for postoperative morbidity. In the open group, blood loss (P = 0.01), homologous blood transfusion (P = 0.01), duration of surgery (P = 0.009), weight loss (P = 0.06), and age (P = 0.08) were related to postoperative morbidity. In the laparoscopic group the only risk factor identified was duration of surgery (P = 0.005). CONCLUSION: In the laparoscopic group, both postoperative morbidity and length of stay were significantly reduced and most risk factors for postoperative morbidity disappeared.展开更多
The aim of this study was to compare laparoscopic and abdominal approach in the treatment of endometrial cancer in our department. Study design: From January 1999 to November 2002, 77 patients underwent surgery for st...The aim of this study was to compare laparoscopic and abdominal approach in the treatment of endometrial cancer in our department. Study design: From January 1999 to November 2002, 77 patients underwent surgery for stages I- Ⅲ endometrial cancer. The first group of 36 patients had abdominal hysterectomy as well as salpingo-oophorectomy, with or without lymphadenectomy. The remaining 41 patients received laparoscopic assisted vaginal hysterectomy as well as salpingo-oophorectomy,with or without lymphadenectomy. In this retrospective study, we have compared the surgical results, the short-and long-term morbidity and the outcome of the two patient groups. Results: Body mass index (BMI) was signifi-cantly higher in the laparoscopic group (27.3 versus 24.6; p = 0.009). The average time for surgery was significantly longer for the laparoscopic group (143.6 min versus 109.7 min; p = 0.0001), but lymphadenectomy was performed in more patients (63.4% versus 25% ; p = 0.001). Postoperative hospital stay was significantly longer in patients undergoing the abdominal approach (4.59 days versus 3.18 days; p < 0.0001). No blood transfusions were performed and the rates of complications were similar in the two groups. No differences were found in recurrence and survival rate. Conclusions: In our experience, laparoscopic and abdominal surgery can achieve similar results in the treatment of endometrial cancer. In our series, even with the BMI and the number of lymphadenectomies being higher in the laparoscopic group, the rates of complications were similar in the two groups.展开更多
PURPOSE: In the last ten years, several robotic systems have been developed to overcome the loss of the three-dimensional view and dexterity characteristic of laparoscopic surgery. The aim of this study was to compare...PURPOSE: In the last ten years, several robotic systems have been developed to overcome the loss of the three-dimensional view and dexterity characteristic of laparoscopic surgery. The aim of this study was to compare the traditional laparoscopic approach and robotic techniques in the treatment of colorectal diseases. METHODS: The study compares a consecutive series of patients treated surgically for colorectal disease from June 2001 to May 2003 with the da VinciTM robotic system (Intuitive Surgical) and a matched number of patients who underwent conventional laparoscopy during the same time interval. The factors analyzed were the time required to prepare the patient and the room, total time of surgery, length of specimens, number of lymph nodes retrieved, blood loss, complications, and postoperative results. RESULTS: The study included 106 patients (53 in each group). No differences were observed in total time of surgery (laparoscopic group, 222 ±77 minutes vs. robotic group, 240±61 minutes), specimen length (laparoscopic group, 29 ±11 cm vs. robotic group, 27 ±13 cm), or number of lymph nodes retrieved (laparoscopic group, 16 ±9 vs. robotic group, 17 ±10). It took significantly longer to prepare the operating room and patient in the robotic group (24 ±12 minutes) than in the laparoscopic group (18 ±7 minutes). There were three conversions to laparotomyin the laparoscopic group; in the robotic group, two cases were converted to laparoscopy and three to hand-assisted laparoscopy. No significant differences were observed between the two groups in terms of recovery of bowel function and postoperative hospital stay. CONCLUSIONS: Robot-assisted surgery proved to be as safe and effective as laparoscopic techniques in the treatment of colorectal diseases. Because of its dexterity and three-dimensional view, the da VinciTM system was particularly useful in specific stages of the procedure, e.g., takedown of the splenic flexure, dissection of a narrow pelvis, identification of nervous plexus, and handsewn anastomosis. The cost-effectiveness of the procedure still needs to be evaluated.展开更多
Objective: To determine whether fluid hysteroscopic directed biopsies , in pati ents with endometrial cancer upstages the tumor and worsens the prognosis. Study design: Between January 1996 and September 2001, a total...Objective: To determine whether fluid hysteroscopic directed biopsies , in pati ents with endometrial cancer upstages the tumor and worsens the prognosis. Study design: Between January 1996 and September 2001, a total of 62 consecutive pati ents with endometrial cancer, treated at our institution, were randomized 3 ∶2 to have or not to have a fluid hysteroscopic biopsy just prior to surgery. A tot al of 38 patients underwent a hysteroscopy after the induction of anesthesia. Al l patients had pelvic washings performed, followed by a hysterectomy, bilateral salpingooforectomy and pelvic +/-para-aortic lymph node dissections. Only sta ges I and II endometrioid type tumors or stage IIIa, secondary to positive pelvi c washings, were included in the study. Eight patients in the hysteroscopy group and four patients in the control group were excluded for various reasons. Patie nts received post-operative radiation therapy depending on the surgical-pathol ogical risk factors. The median follow up was 34 months. Fishers Exact Test wa s performed to compare differences between the hysteroscopic (n=30) and the cont rol (n=20) groups. Results: We found three patients (10%) with positive washing s in the hysteroscopic group compared to one (5%) among the controls (P=0.64), with a statistical power of < 20%. If the differences would persist, we would n eed 588 patients in each arm to obtain a power of 80%, and reach definitive con clusions. The Odds Ratio (OR) of performing a hysteroscopy and upstaging the tum or in this study was: 2.1 95%CI (0.20-21.09). Prognostic variables were compar ed between both groups and no differences were observed. All patients but one (d ead due to intercurrent disease), were alive and with no evidence of disease at the completion of the study. Conclusions: Fluid hysteroscopy and directed biopsi es may have a small risk of upstaging early endometrial cancers, but does not se em to influence prognosis.展开更多
文摘胃十二指肠溃疡为临床较为常见疾病,而穿孔是其常见的并发症之一。胃十二指肠溃疡穿孔(perforation of gastroduodenal ulcer,PGDU)发病急、病情重、变化快[1,2],为普外科常见急腹症。当前对于PGDU一般行手术治疗,传统开腹修补手术患者并发症较多、手术切口大、所承受痛苦多。
文摘目的腹腔镜辅助手术和多重管理方案（即加速康复程序,Enhanced Recovery Program,ERP）极大地改变了结直肠癌患者的围手术期管理,并改善了临床治疗结局。然而,腹腔镜手术尚未成为世界范围内结直肠癌手术治疗的标准,大量有着良好开腹手术技术的外科医生仍采用传统手术方式治疗。究竟传统开腹手术辅助ERP能否与腹腔镜辅助的微创治疗匹敌？这一问题还存在争议。EnROL（Enhanced Recovery Open versus Laparoscopic）多中心随机对照试验旨在解答上述问题。资料和方法该研究为Ⅲ期多中心随机对照临床试验,纳入可择期手术的成年结直肠癌患者（年龄≥18岁）,按1∶1随机分配至腹腔镜组或开腹组,两组均应用快速康复多重管理程序（ERP）进行围手术期管理。通过纳入中心、肿瘤部位（结肠或直肠）、年龄组（〈66/66~75/〉75岁）再进行分层分析。研究的主要结局指标为术后1个月的机体疲劳感（使用多维疲劳量表MFI-20评价）,次要结局指标包括：住院时间、术后并发症、患者其他不适情况及身体机能（简表SF-36）。术后7天或更早出院之前,受试患者和结局评估人员都不知晓治疗情况。手术质量及病理评估由中心负责人员进行盲评。该研究在英国临床伦理委员会南部牛津中心B注册,注册号为No.07/H0605/150。结果研究从2008年7月开始,至2012年4月结束,共在英国的12个中心纳入204例病人（其中腹腔镜组103人,开放结合ERP组101人）。腹腔组的切除范围[（6.8±3.7）vs.（18.4±7.5）cm]以及术中出血量[（115±152）vs.（257±290）ml]较开腹组减少,但手术时间[（182±69）vs.（135±54）min]相对延长,总体手术相关损伤评分[（31.2±6.0）vs.（31.8±6.0）]没有明显差别。两组病人术后1个月的机体疲劳感评分无显著差异[MFI-20（12.28,95%CI：11.3~13.1）vs.（12.05,95%CI：11.2~13.1）;P=0.93]。然而,腹腔镜组的中位住院时间较开腹组明显缩短（5 vs.7天;四分位点间距：4~9 vs.5~11天;P=0.033）。其他次要结局和病理报告质量均未见显著差异。结论虽然有经验的外科医生运用开腹手术结合加速康复程序可使结直肠癌患者术后疲乏感及其他不适情况降低至腹腔镜手术治疗相当的水平,但是住院时间会有明显的延长。在治疗结局无明显差别的前提下,腹腔镜辅助结直肠癌手术结合快速康复程序更应被推广使用。
文摘PURPOSE: The aim of this study was to evaluate whether laparoscopic colorectal surgery can modify the risk factors for the occurrence of postoperative morbidity. METHODS: A total of 384 consecutive patients with colorectal disease were randomized to laparoscopic resection (n = 190) or open resection (n = 194). On admission, demographics, comorbidity, and nutritional status were recorded. Operative variables, patient outcome, and length of stay were also recorded. Postoperative complications were registered by four members of staff not involved in the study. RESULTS: The overall morbidity rate was 27.1 percent, with the rate in the laparoscopic group (18.7 percent) being less than that in the open group (31.5 percent; P = 0.003). Patients who underwent laparoscopic resection had a faster recovery of bowel function (P = 0.0001) and a shorter length of stay (P = 0.0001). In the whole cohort of patients, multi variate analysis identified open surgery (P = 0.003), duration of surgery (P= 0.01), and homologous blood transfusion (P = 0.01) as risk factors for postoperative morbidity. In the open group, blood loss (P = 0.01), homologous blood transfusion (P = 0.01), duration of surgery (P = 0.009), weight loss (P = 0.06), and age (P = 0.08) were related to postoperative morbidity. In the laparoscopic group the only risk factor identified was duration of surgery (P = 0.005). CONCLUSION: In the laparoscopic group, both postoperative morbidity and length of stay were significantly reduced and most risk factors for postoperative morbidity disappeared.
文摘The aim of this study was to compare laparoscopic and abdominal approach in the treatment of endometrial cancer in our department. Study design: From January 1999 to November 2002, 77 patients underwent surgery for stages I- Ⅲ endometrial cancer. The first group of 36 patients had abdominal hysterectomy as well as salpingo-oophorectomy, with or without lymphadenectomy. The remaining 41 patients received laparoscopic assisted vaginal hysterectomy as well as salpingo-oophorectomy,with or without lymphadenectomy. In this retrospective study, we have compared the surgical results, the short-and long-term morbidity and the outcome of the two patient groups. Results: Body mass index (BMI) was signifi-cantly higher in the laparoscopic group (27.3 versus 24.6; p = 0.009). The average time for surgery was significantly longer for the laparoscopic group (143.6 min versus 109.7 min; p = 0.0001), but lymphadenectomy was performed in more patients (63.4% versus 25% ; p = 0.001). Postoperative hospital stay was significantly longer in patients undergoing the abdominal approach (4.59 days versus 3.18 days; p < 0.0001). No blood transfusions were performed and the rates of complications were similar in the two groups. No differences were found in recurrence and survival rate. Conclusions: In our experience, laparoscopic and abdominal surgery can achieve similar results in the treatment of endometrial cancer. In our series, even with the BMI and the number of lymphadenectomies being higher in the laparoscopic group, the rates of complications were similar in the two groups.
文摘PURPOSE: In the last ten years, several robotic systems have been developed to overcome the loss of the three-dimensional view and dexterity characteristic of laparoscopic surgery. The aim of this study was to compare the traditional laparoscopic approach and robotic techniques in the treatment of colorectal diseases. METHODS: The study compares a consecutive series of patients treated surgically for colorectal disease from June 2001 to May 2003 with the da VinciTM robotic system (Intuitive Surgical) and a matched number of patients who underwent conventional laparoscopy during the same time interval. The factors analyzed were the time required to prepare the patient and the room, total time of surgery, length of specimens, number of lymph nodes retrieved, blood loss, complications, and postoperative results. RESULTS: The study included 106 patients (53 in each group). No differences were observed in total time of surgery (laparoscopic group, 222 ±77 minutes vs. robotic group, 240±61 minutes), specimen length (laparoscopic group, 29 ±11 cm vs. robotic group, 27 ±13 cm), or number of lymph nodes retrieved (laparoscopic group, 16 ±9 vs. robotic group, 17 ±10). It took significantly longer to prepare the operating room and patient in the robotic group (24 ±12 minutes) than in the laparoscopic group (18 ±7 minutes). There were three conversions to laparotomyin the laparoscopic group; in the robotic group, two cases were converted to laparoscopy and three to hand-assisted laparoscopy. No significant differences were observed between the two groups in terms of recovery of bowel function and postoperative hospital stay. CONCLUSIONS: Robot-assisted surgery proved to be as safe and effective as laparoscopic techniques in the treatment of colorectal diseases. Because of its dexterity and three-dimensional view, the da VinciTM system was particularly useful in specific stages of the procedure, e.g., takedown of the splenic flexure, dissection of a narrow pelvis, identification of nervous plexus, and handsewn anastomosis. The cost-effectiveness of the procedure still needs to be evaluated.
文摘Objective: To determine whether fluid hysteroscopic directed biopsies , in pati ents with endometrial cancer upstages the tumor and worsens the prognosis. Study design: Between January 1996 and September 2001, a total of 62 consecutive pati ents with endometrial cancer, treated at our institution, were randomized 3 ∶2 to have or not to have a fluid hysteroscopic biopsy just prior to surgery. A tot al of 38 patients underwent a hysteroscopy after the induction of anesthesia. Al l patients had pelvic washings performed, followed by a hysterectomy, bilateral salpingooforectomy and pelvic +/-para-aortic lymph node dissections. Only sta ges I and II endometrioid type tumors or stage IIIa, secondary to positive pelvi c washings, were included in the study. Eight patients in the hysteroscopy group and four patients in the control group were excluded for various reasons. Patie nts received post-operative radiation therapy depending on the surgical-pathol ogical risk factors. The median follow up was 34 months. Fishers Exact Test wa s performed to compare differences between the hysteroscopic (n=30) and the cont rol (n=20) groups. Results: We found three patients (10%) with positive washing s in the hysteroscopic group compared to one (5%) among the controls (P=0.64), with a statistical power of < 20%. If the differences would persist, we would n eed 588 patients in each arm to obtain a power of 80%, and reach definitive con clusions. The Odds Ratio (OR) of performing a hysteroscopy and upstaging the tum or in this study was: 2.1 95%CI (0.20-21.09). Prognostic variables were compar ed between both groups and no differences were observed. All patients but one (d ead due to intercurrent disease), were alive and with no evidence of disease at the completion of the study. Conclusions: Fluid hysteroscopy and directed biopsi es may have a small risk of upstaging early endometrial cancers, but does not se em to influence prognosis.
