腹腔镜用于子宫内膜癌分期手术39例分析

Objective:The purpose of our study was to investigate the feasibility and short-term therapeutic effects of laparoscopic staging operation in women with endometrial carcinoma.Methods:We analyzed 86 patients with endometrial carcinoma in PLA general hospital between 2006 and 2009 retrospectively.Thirty-nine patients were performed laparoscopic modified radical hysterectomy plus systemic retroperitoneal lymphadenectomy.Forty-seven patients received traditional abdominal radical hysterectomy plus systemic retroperitoneal lymphadenectomy.We compared the operation time,blood loss,number of lymph nodes retrieved,time for restoration of gastrointestinal function,postoperative complications and morbidity,the incidence of wound infection,the length of hospital stay,and hospital charges.Results:There was no significant deviation between the two groups in age,clinical stage,and pathology.We found that there was no significant deviation between the two groups in the number of lymph nodes retrieved,postoperative complications,the rate of wound infection or hospital charge(P>0.05).The laparoscopic group had an advantage in blood loss,time for restoration of gastrointestinal function,time for postoperative hospital stay(P<0.05).Conclusion:Laparoscopic surgery,as a primary surgical intervention,seems to be a safe and feasible option especially in patients with early endometrial cancer.     

Laparoscopic surgery for early gastric cancer--its advantages and pitfalls]

We have successfully established two different laparoscopic procedures for early gastric cancer since March 1992, which are laparoscopic wedge resection of the stomach using a lesion-lifting method and laparoscopic intragastric mucosal resection. The indication is as follows; (A) mucosal cancer, (B) < 25 mm, if the lesion is elevated type, (C) < 15 mm and Ul (-), if the lesion is depressive type. The advantages of these methods are; 1) minimally invasiveness, 2) sufficient surgical margin, 3) feasibility of detailed histology, 4) feasivility of perigastric lymph node dissection. In contrast, there are several problems to be solved, which are; 1) preoperative diagnostic accuracy of the depth of cancer invasion, 2) possibility of reoperation because of sm invasion or lymphatic or venous invasion in final histology, 3) possibility of postoperative stenosis after laparoscopic intragastric mucosal resection for the lesion near the cardia, 4) incidence of metachronous multiple gastric cancer. In conclusion, if the indication is properly selected, these laparoscopic procedures are curative and minimally invasive treatment for early gastric cancer.     

Outcome after 'curative' surgery for carcinoma of the lower third of the rectum

BACKGROUND: Controversy exists about the optimal surgical resection for lower third rectal carcinoma. The aim of this retrospective study was to analyse whether the type of surgery is a significant predictor of outcome after curative surgery alone. METHODS: Eighty-two consecutive patients underwent abdominoperineal rectum excision (APRE, 41 patients) or sphincter-saving operation (SSO, 41 patients) for adenocarcinoma at 3.5-7.5 cm from the anal margin. Cox proportional hazards technique with univariate and corrected (multivariate) analyses and the Kaplan-Meier life-table method were used to evaluate the data. RESULTS: Tumour wall penetration and lymph node involvement, but not the tumour level or the type of surgery, were found to be significant predictors of outcome. The local recurrence rate at 1, 2 and 5 years was 10, 22 and 26 per cent respectively after APRE, and 5, 13 and 21 per cent after SSO. The disease-free survival rate at 1, 2 and 5 years was 85, 67 and 58 per cent respectively after APRE, and 88, 78 and 62 per cent after SSO. CONCLUSION: Tumour-related factors are significant predictors of outcome. The type of surgery (APRE or SSO) did not seem to be a significant variable in this non-randomized study.     

Ambulatory surgery. Laparoscopic surgery

Laparoscopic surgery procedures have increased over the past decade and newer uses are being investigated. The major reasons for increased use of laparoscopic procedures include decreased pain, smaller incisions, and decreased length of hospital stay. Although the cost of hospital stay is decreased, there are increased costs associated with longer surgery time, increased anesthesia time, and additional equipment. Other drawbacks to the procedure are miniaturized instruments, decreased field of vision, inability to palpate tissue and organs directly, and necessary hand-eye coordination.     

Laparoscopic colo-rectal surgery

Laparoscopic colorectal surgery was less invasive for patients although it was difficult to perform complete resection of colon combined with regional lymph node. The skillful manner of the laparoscopic surgery was required for the surgical team. The laparoscopic equipments, in order to perform curative dissection of mesenterium and intermediate lymph node, such as Ultrasonic-aspiration surgical unit (USU) or Harmonic scalpel laparoscopic coagulation shears (LCS), were useful for safer dissection of D2 regional lymph node. Meticulous manner of grasping forceps and special dissectors was made sufficient lymph node dissection. The reconstruction of extracorporeal anastomotic technique by hand or valtrac (biofragmentable anastomosis ring) were safer manner for anastomosis after resection of the right side colon. Reconstruction by double stapling technique of linear stapler and circular stapler was admired for anastomosis for left side colonic and rectal surgery. We had safely performed locar resection in 3, partial resection with Do dissection in 2, with D1 dissection in 14, with D2 dissection in 21 and right and left hemicolectomy in 1 each.     

Laparoscopic antireflux surgery

Gastroesophageal reflux disease is very common, and there continues to be a need for gastroesophageal reflux surgery despite improved medical therapy. With the relatively new option of laparoscopic antireflux surgery, many more of these procedures are now being performed. In order to perform these well, one must select patients carefully, evaluate them fully, and adhere to the technical principles required to achieve consistently good results.     

Laparoscopic surgery in Crohn's disease

In a prospective study the feasibility and safety of laparoscopic-assisted ileocaecal resection for Crohn's disease was studied and compared with 16 patients who had open ileocaecal resection, and the value of laparoscopic stoma surgery was assessed. From January to November 1995 laparoscopic-assisted ileocaecal resection for Crohn's disease was undertaken in 7 patients, laparoscopic-assisted stoma formation in 10 patients. In 1 patient laparoscopic ileocaecal resection was converted to open surgery due to an unrecognised ileocolic fistula. Operating time in laparoscopic-assisted ileocaecal resections was longer than in open ileocaecal resection (150 vs. 127 min, P = 0.7). Blood loss (386 vs. 445 ml, P = 0.7), first bowel movement (3.5 vs. 4.9 postoperative days, P = 0.07) and postoperative time to discharge (5.2 vs. 9.9 days, P < 0.01) in patients who had a laparoscopic-assisted ileocaecal resection were less than in patients who had open surgery. In all 10 patients laparoscopic formation of a stoma was possible. Operating time was 62 min. Oral solids were restored on the 1.5 postoperative day. Mean postoperative stay was 8.8 days, prolonged due to time needed for stoma-care training. These preliminary results indicate that laparoscopic-assisted ileocaecal resection and stoma surgery for Crohn's disease are feasible and safe. Both procedures are characterised by rapid recovery and superior cosmetic results.     

Laparoscopic assisted spine surgery

A neonate presented with atrial flutter complicating acute Coxsackie B2 myocarditis. The tachyarrhythmia was successfully terminated with electrocardioversion followed by digoxin administration. The infant survived with no long-term cardiac sequelae. Atrial flutter is an unusual complication of Coxsackie myocarditis that has not previously been reported.     

Laparoscopic surgery in esophageal achalasia--initial results

The authors present their initial results of laparoscopic operations on account of achalasia of the oesophagus. The first oesophagocardiomyotomy was performed at the author s department by the laparoscopic approach in September 1994. In the course of one year 20 of these operations were performed. The mean period of complaints before surgery was 5.9 years with a range of 1 to 40 years. Only six patients were operated during the stage of compensated achalasia, the remainder already in the stage of decompensation. As to peroperative complications twice perforation of the oesophagus occurred, in one instance treated laparoscopically and once during conversion by the classical approach. In one instance the a. epigastrica was injured and haemoperitoneum developed and subsequent revision was urgent. All patients were relieved of their dysphagic complaints, one female patient developed minor pyrosis.     

Laparoscopic surgery in children and adolescents

Laparoscopic surgery is a rapidly developing field in general surgery. The advantages of laparoscopic procedures are short postoperative courses, fewer wound-related complications, possible reduction in rate of late postoperative adhesions and better cosmetic results. Laparoscopic procedures are indicated in well-defined clinical settings, after enough experience has been acquired and technical problems solved. Children and adolescents may also benefit from laparoscopic procedures. The technique is suitable for cholecystectomies, appendectomies in selected cases, splenectomies, anti-reflux procedures, bowel resections, and diagnostic procedures, among others. In the past 3 years we have performed 65 laparoscopic procedures in patients younger than 17 years, including 10 cholecystectomies, 31 appendectomies and 7 Nissen fundoplications.     

Laparoscopic surgery for infertility therapy

During cold exposure, the expression of insulin-like growth factor I (IGF-I) mRNA in rat brown adipose tissue (BAT) increased significantly with the increase in the BAT weight. In addition, the blood plasma from cold-acclimated (CA) rats enhanced the proliferation of brown adipocyte precursor cells in primary culture and the expression of IGF-I mRNA in them compared to those from warm-acclimated rats. The cell proliferation was considerably inhibited by anti-growth hormone (GH) antibody. These results suggest that IGF-I produced by brown adipocytes may play a role in BAT enlargement during cold acclimation. It is probable that some factors (including GH) concerned with the proliferation of brown adipocyte precursor cells are involved in the blood plasma from CA rats.     

Laparoscopic colorectal surgery and cancer

Review article of the actual level of knowledge about laparoscopic colorectal surgery and laparoscopic-assisted procedures. At present time laparoscopy for the cure of colorectal neoplasia should only be performed within prospective randomized trials. In the meantime it is perfectly appropriate to perform laparoscopy for palliation of metastatic disease. Patients with benign colorectal neoplasms can achieve better outcome if treated by laparoscopy rather than laparotomy. Other areas in which laparoscopy may be useful include enterolysis and possibly, treatment of rectal prolapse. Laparoscopy can be appropriately applied for the treatment of terminal ileal Crohn's disease, sigmoid diverticulitis, reversal of Hartmann's pouches and the construction of stomas.     

Laparoscopic surgery for cancer patients

Laparoscopy is an effective tool for diagnosis and staging of malignancies. Laparoscopic resection of abdominal tumors has been performed rarely, with two exceptions: laparoscopic adrenalectomy and laparoscopic resection of colorectal cancer. One of the best applications of minimally invasive surgery is the use of laparoscopic techniques for palliation of abdominal cancer. Requiring thorough training and preparation of surgeons and mandating their strict credentialing will reduce the risk of complications from laparoscopic surgery.     

Laparoscopic sigmoid resection in diverticulitis]

Between September 1992 and May 1997 in the Department of Surgery at the Medical University of Lübeck 240 colorectal procedures were performed by laparoscopic techniques. Fifty-seven patients underwent laparoscopic colectomy for diverticulitis. In 52 cases sigmoid resections were performed laparoscopically, including 4 cases with simultaneous laparoscopic rectopexy. Anterior resections were necessary in 3 patients, whereas 2 patients with extended localization of diverticula required left hemicolectomies. Using atraumatic instruments and an ultrasound dissector, laparoscopic resection involved tubular dissection and preperitoneal anastomosis. The mean operative time was 234 min. In 8 cases (14%) conversion to an open procedure was necessary. Complications occurred in 6 patients (10.5%). One patient died because of an anastomotic leakage. In conclusion, with increasing experience laparoscopic resection for diverticulitis can be performed without additional morbidity in comparison to open colectomy. In particular, the benefits of the minimally invasive method are quicker reconvalescence with reduced postoperative pain and improved cosmesis.