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1.
V. Laopodis E. Kritikos L. Rizzoti P. Stefanidis P. Klonaris P. Tzardis 《Surgical endoscopy》1998,12(7):944-947
Background: Splenectomy is indicated in patients with thalassemia major when they develop hypersplenism with subsequent need for increased
transfusions. Extreme splenomegaly is considered a restrictive factor for laparoscopic splenectomy in these patients.
Methods: Laparoscopic splenectomy was undertaken in 12 β-thalassemia major patients with massive splenomegaly. The devascularization
of the organ was performed with serial ligations of the splenic vessels starting from the lower pole of the organ. The spleen
was extracted from the abdominal cavity through a 5-cm incision in the left iliac fossa, which incorporated two port sites.
Results: The procedure was concluded laparoscopically in 10 cases, while two patients were converted due to difficulty in controlling
bleeding from branches of the splenic vein. The patients tolerated the procedure well and had a postoperative hospital stay
of 3–6 days.
Conclusions: From our limited initial experience it seems that laparoscopic splenectomy in the difficult setting of thalassemia major
patients is feasible, but extreme care is required in order to avoid hemorrhagic complications.
Received: 21 March 1997/Accepted: 10 August 1997 相似文献
2.
Background: The purpose of this study was to evaluate the outcome of patients undergoing laparoscopic splenectomy (LS) at the University
of California, San Francisco.
Methods: The medical records of the initial 52 unselected patients undergoing LS were reviewed and compared to 28 concurrently treated
open splenectomy patients (OS).
Results: Patients did not differ with regard to age, gender, body, or splenic weights. The operative time was longer in the LS patients
(mean 196 vs 156 min), but the length of stay and duration of ileus were shorter in the LS group. For adult patients admitted
exclusively for splenectomy, operative times did not differ between LS and OS and total hospital cost was less in the LS group
(mean $8,939 vs $14,022). Six patients required conversion to OS, four occurring in the first 11 patients treated (overall
conversion rate of 11%). Three patients died from complications related to their underlying disease. Two other major complications
occurred. Complication rates and transfusion requirements did not differ between OS and LS patients.
Conclusions: Laparoscopic splenectomy is a safe and effective alternative to open splenectomy for treatment of hematologic diseases in
patients of all ages.
Received: 16 April 1996/Accepted: 5 July 1996 相似文献
3.
Hand-assisted laparoscopic splenectomy for hydatid cyst 总被引:1,自引:1,他引:0
K. E. W. Ballaux J. M. Himpens G. Leman M. R. P. Van den Bossche 《Surgical endoscopy》1997,11(9):942-943
Splenic hydatidosis is a rare condition. We performed a hand-assisted laparoscopic splenectomy for a large hydatid cyst localized
in the center of the spleen. We discuss the advantages of the ``helping hand.'
Received: 27 September 1996/Accepted: 19 November 1996 相似文献
4.
A. Valeri F. Venneri L. Presenti F. Nardi A. Grossi D. Borrelli 《Surgical endoscopy》1998,12(9):1173-1176
Portal thrombosis is a rare complication of splenectomy. We performed 12 laparoscopic splenectomies and observed this complication
only in one patient with idiopathic thrombocytopenia (ITP). The right branch of the portal vein presented a partial thrombosis,
while the left branch was completely obstructed by thrombi. Abdominal ultrasonography and an ultrasound doppler exam allowed
us to diagnose this event and a retrograde angiography performed afterward confirmed our diagnosis. A 48-h intravenous heparin
treatment was promptly begun, followed by anticoagulant drugs (dicumarol). The patient was dismissed 5 days afterward, presenting
a steady-state ultrasound doppler pattern and a complete normalization of liver parameters. An ultrasound doppler exam performed
1 month after anticoagulant therapy showed a complete resolution of portal thrombosis. We believe that early diagnosis of
this rare complication, prompt beginning of anticoagulant therapy, and care in surgical procedures may reduce patient life-threatening
risks and assure complete remission.
Received: 18 March 1997/Accepted: 18 September 1997 相似文献
5.
Background: Since 1994, 27 patients at our institution have undergone laparoscopic splenectomy for immune thrombocytopenic purpura (ITP).
Laparoscopic splenectomy was completed in 22 of these patients. We sought to identify factors that precluded successful laparoscopic
splenectomy in the remaining 5 patients.
Methods: Retrospective review of 27 patients with ITP undergoing laparoscopic splenectomy was performed at Duke University Medical
Center from August, 1994 to September, 1997.
Results: Laparoscopic splenectomy was performed in 16 women and 11 men with a mean age of 47.2 years. Five (18%) of these procedures
were converted to open splenectomy. There was no significant difference in age, ASA score, gender, weight, height, or splenic
size between the converted and laparoscopic groups. However, preoperative and postoperative platelet counts were significantly
higher in the laparoscopic group than in the converted group (p < 0.001). Operative times also were significantly longer for the laparoscopic group than for the converted group (p < 0.001). Adherent adjacent structures, associated comorbidities, and technical errors prohibited laparoscopic completion
in five patients. Technical errors with subsequent bleeding required conversion in two patients. A thickened greater omentum
blanketing the splenic capsule and a densely adherent pancreatic tail extending well into the splenic hilum prevented laparoscopic
completion in two patients. Increased peak airway pressures greater than 60 mmHg after pneumoperitoneum necessitated conversion
in the remaining patient, who had a previous history of pulmonary insufficiency. Regardless of surgical approach, all patients
achieved a therapeutic response after splenectomy. Splenectomies completed laparoscopically resulted in a significantly shorter
length of hospital stay (p < 0.01).
Conclusions: Densely adherent adjacent structures, technical errors, and cardiopulmonary instability may preclude successful completion
of laparoscopic splenectomies. Thorough preoperative evaluation with an emphasis on the cardiopulmonary system may elicit
a cohort of individuals with ITP who are unlikely to undergo laparoscopic splenectomy successfully. This cohort also may include
individuals with preoperative platelet counts less than 35,000 mm−3.
Received: 15 April 1998/Received: 15 January 1999 相似文献
6.
Background: Laparoscopic splenectomy of normal-sized spleens is performed with increasing frequency. By using a handport, which allows
the intraperitoneal introduction of one surgeon's hand, massively enlarged spleens may also be extirpated via a laparopscopy-assisted
technique.
Methods: Seven patients (54–80 years) with massive splenomegaly (3.5–5.8 kg) underwent handport-assisted laparoscopic splenectomy.
All patients had spleens that extended beyond the umbilicus, hypersplenism, and discomfort in the upper left quadrant due
to intractable hematological malignancy.
Results: Both the operation and recovery were uneventful in five of the patients, but one patient had to be converted to an open procedure
due to splenic damage and bleeding, and another was reoperated for hemorrhage from a trocar. The handport allowed splenic
protection while the trocars were introduced and instruments changed. It also enabled splenic mobilization, particularly prior
to stapling of the hilar structures and dissection of the upper splenic pole.
Conclusions: Handport-assisted laparoscopic splenectomy seems to be a viable alternative for massive splenomegaly, but it requires further
evaluation with respect to safety, efficacy, and indication.
Received: 7 September 1999/Accepted: 12 March 2000/Online publication: 20 July 2000 相似文献
7.
C. J. Stanton 《Surgical endoscopy》1999,13(11):1083-1086
Background: Laparoscopic splenectomy (LS) has rapidly become the preferred surgical treatment for idiopathic thrombocytopenic purpura
(ITP), but its long-term efficacy for this disorder is unproved. This report documents the author's 5-year experience with,
and long-term follow-up of, LS for ITP.
Methods: Between September 1992 and September 1997, 30 patients with clinical ITP and intractable thrombocytopenia were referred as
surgical candidates. Two of them (7%) were converted to open, and the other 28 underwent successful LS. The operative approach
evolved from a supine lithotomy to right lateral decubitus position, and the harmonic scalpel became the primary dissection
tool in the later part of the study.
Results: The 28 successful LS patients constituted the study group. Accessory spleens were identified and resected in six patients
(21%). Surgical times and blood loss averaged 2.4 h and 170 cc, respectively. The typical hospital stay was 2 days. Initial
reversal of thrombocytopenia and ultimate cessation of oral steroids was achieved in 25 of 28 patients (89%). There were no
deaths, but two patients had major complications (bleeding and pneumonia). All but two patients experienced a return to full
activity and/or employment by 3 weeks post-LS. In the three cases that failed LS, none had residual splenic tissue on subsequent
radionuclide scan. Long-term follow-up (2–60 months) was obtained in 22 of 28 patients (79%). The only death (at 13 months)
resulted from oncologic disease. Twenty-one patients had lasting clinical remission of ITP. A positive preoperative response
to oral steroids was the best predictor of success.
Conclusions: This 5-year experience with LS supports its use for the surgical treatment of ITP. The procedure is safe and efficacious,
resulting in brief hospitalization, minimal recovery time, and excellent long-term results.
Received: 11 October 1998/Accepted: 19 February 1999 相似文献
8.
Background: Ventriculoperitoneal shunts have been used for the treatment of hydrocephalus for years. In the past, the abdominal portion
of this technique has required mini-laparotomy. We present a series of 10 consecutive patients in which ventriculoperitoneal
(VP) shunts were placed with laparoscopic assistance.
Materials and methods: At Lankenau Medical Center for July 1996 to January 1998, 10 patients (aged 22–81) with normopressure hydrocephalus underwent
laparoscopic VP shunt placement. The neurologic portion of the procedure is begun simultaneously with the abdominal procedure.
After pneumoperitoneum is established using a miniport disposable 2-mm introducer at the umbilicus, a 2-mm camera is introduced
into the peritoneal cavity through the same port. A needle is introduced into the peritoneal cavity under direct visualization.
Once the catheter is placed ventricularly, it is tunneled subcutaneously to the abdomen. Using the Seldinger technique, the
VP catheter is introduced under direct visualization through a sheath into the peritoneal cavity toward the pelvis. Positioning
and function are also confirmed under direct visualization.
Results: All patients tolerated this procedure well, and there were no complications. The benefits of this procedure include direct
visualization of catheter placement and smaller incisions than necessary for an open procedure.
Conclusion: We recommend laparoscopic-assisted placement of the VP shunt in normopressure hydrocephalus patients as a good alternative
to the open technique.
Received: 30 June 1998/Accepted: 25 November 1998 相似文献
9.
Background: There is a certain amount of controversy regarding the need to divide the short gastric vessels (SGV) in laparoscopic fundoplication
for treatment of gastroesophageal reflux disease (GERD). In addition, there is often difficulty in identifying the crural
fibers when encircling the lower esophagus.
Methods: We determine whether it is necessary to divide the SGV by trying to appose the gastric fundus to the anterior abdominal wall
intraoperatively. If this could be done easily, the SGV are preserved. When their division is required, a posterior gastric
approach is employed. We have also found that the injection of methylene blue into the left crural fibers anterior to the
esophagus is helpful in identifying the left side when dissection posterior to the gastroesophageal junction is difficult.
Results: Between 1992 and 1995 we performed 20 laparoscopic fundoplications for GERD. All patients had at least grade 3 esophagitis
(Savary-Miller scale), increased esophageal exposure to acid (median DeMeester score of 195), and decreased lower esophageal
sphincter (LES) pressure. The median operative time was 175 min. There were no conversions to open surgery, and there was
no mortality. Three patients developed transient postoperative dysphagia and one patient had pneumonia. The median hospital
stay was 3 days; all patients were free of reflux symptoms at follow-up ranging from 7 to 42 months.
Conclusion: We conclude that the techniques described by us aid in intraoperative decision making and allow laparoscopic fundoplication
to be both simple and effective.
Received: 29 March 1996/Accepted: 28 May 1996 相似文献
10.
Laparoscopic splenectomy using a wall-lifting procedure 总被引:1,自引:1,他引:0
T. Nishizaki I. Takahashi T. Onohara K. Wakasugi T. Matsusaka K. Kume 《Surgical endoscopy》1999,13(10):1055-1056
A laparoscopic splenectomy using a hanger wall-lifting procedure is herein described. The patient is placed in the right
lateral position. The left lower chest and left abdominal wall are then lifted by three wires in two directions, left laterally
and vertical to the abdominal wall. The view of the operative field thus obtained is excellent. The lifting wires and bars
do not hinder the movement of the forceps, since the angles of the instruments to approach the spleen are different from those
of the wires. A laparoscopic splenectomy using this wall-lifting procedure avoids the usual complications associated with
pneumoperitoneum while still being technically comparable to a procedure with pneumoperitoneum.
Received: 7 October 1998/Accepted: 22 February 1999 相似文献
11.
Pediatric laparoscopic splenectomy 总被引:6,自引:1,他引:5
Background: Lateral laparoscopic splenectomy in adults, first reported in 1991, was begun with children in 1993.
Methods: The authors reviewed records of 59 patients 2 to 17 years old who underwent laparoscopic splenectomy by the lateral approach
between 1994 and 1998 at four medical centers. Patients received prophylactic penicillin or vaccinations preoperatively.
Results: Of the 59 patients, 51 required splenectomy for one of the following conditions: idiopathic thrombocytopenic purpura, hereditary
spherocytosis, or sickle-cell disease. Splenomegaly was found in 86% of the patients, and ten accessory spleens were resected.
No deaths or infection occurred, and only three patients had perioperative complications: acute chest crisis, small diaphragmatic
injury, and intraoperative hemorrhage. One operation was converted to a minilaparatomy because of difficulty with specimen
extraction.
Conclusions: Pediatric laparoscopic splenectomy is safe and effective, resulting in little blood loss, rapid recovery, and a good cosmetic
outcome.
Received: 12 February 1999/Accepted: 24 September 1999/Online publication: 8 May 2000 相似文献
12.
Laparoscopic splenectomy for ITP 总被引:6,自引:0,他引:6
R. L. Friedman M. J. Fallas B. J. Carroll J. R. Hiatt E. H. Phillips 《Surgical endoscopy》1996,10(10):991-995
Background: A comparison of safety, efficacy, and cost of laparoscopic splenectomy (LS) vs open splenectomy (OS) for idiopathic thrombocytopenic
purpura (ITP) was performed.
Methods: The records of 49 consecutive patients who underwent splenectomy for ITP (31 LS and 18 OS) at a large metropolitan teaching
hospital between 3/91 and 8/95 were reviewed. Morbidity, mortality, hospital stay, operative time, blood loss, time to oral
fluid intake, direct costs, and operating room (OR) costs were analyzed.
Results: Age, sex, comorbidity, and spleen size were similar in both groups. LS was successful in 94% of patients in whom it was attempted.
Operative times showed a learning curve for LS, with average times for the last ten cases (94 ± 35 min) significantly shorter
than for the first ten (p= 0.01) and also shorter than for OS (103 ± 45 min). Postsurgical hospital stay was 2.9 ± 1.3 days for LS and 6.9 ± 3.0 days
for OS (p < 0.001). Patients tolerated an oral diet 1.2 ± 0.5 days after LS and 3.2 + 0.7 days after OS (p < 0.001). Direct hospital cost was $5,509 ± 3,636 for LS and $9,031 ± 12,752 for OS. In the LS group, six patients (21%)
had accessory spleens identified and removed, compared with two patients (11%) in the OS group. Platelet counts did not respond
in two (7%) patients in the LS group, but no accessory spleens were identified by nuclear scan. One major complication occurred
in the LS group. There were no cases of splenosis or mortality in either group.
Conclusions: LS is a safe and effective treatment for ITP, with significantly shorter postoperative hospital stay than OS.
Received: 26 March 1996/Accepted: 11 May 1996 相似文献
13.
S. Gentilli M. Velardocchia A. Ferrero S. Martelli F. Donadio 《Surgical endoscopy》1998,12(11):1345-1347
Background: With the evolution of laparoscopic surgery comes the need for specific instruments that apply traction to parenchymal tissue,
like the spleen, without exposing the organ to the associated high risk of bleeding. To meet this need, we designed and developed
a suction-cup grasper that allows easy grasping and manipulation of the spleen. Some of the difficulties usually encountered
during laparoscopic splenectomy may be overcome by using this device.
Materials: The instrument consists of a cone-shaped, silicone rubber suction cup designed with an antislip internal surface. The cup
is connected to a support arm with a flexible distal end that can be rotated. Traction is exerted with a commonly available
suction system. The device is inserted through a 12-mm-diameter guide sheath.
Results: The two interventions performed with the atraumatic device were completed with laparoscopic technique. No complications arose
during or after the operations. The average operating time was 110 min. The patients were discharged after 4 and 5 days postoperative,
respectively.
Conclusions: As a device specifically designed for grasping parenchymal organs, the atraumatic suction grasper affords the operator a
faster and safer technique in laparoscopic splenectomy.
Received: 18 October 1996/Accepted: 16 May 1997 相似文献
14.
J. L. Bouillot K. Aouad A. Badawy B. Alamowitch J. H. Alexandre 《Surgical endoscopy》1998,12(12):1393-1396
Background: Although several recent reports described the different methods utilized for laparoscopic colon resection, only a few of
them questioned whether the procedure is appropriate for the surgical treatment of diverticular disease. To assess this question,
we performed a retrospective study of 50 consecutive patients operated using laparoscopic assistance to remove the sigmoid
colon for diverticular disease.
Method: The surgical technique was a laparoscopically assisted procedure that included mobilization of the left colon and vascular
ligation laparoscopically and then, via a small abdominal incision, division of the colon, removal of the specimen, and hand-sewn
anastomosis.
Results: The surgical goal was achieved in 46 cases, with a conversion rate of 8%. The mean operative time was 195 min (range 150–280
min). There was no mortality, and the morbidity rate was 14%. There were no complications directly related to the laparoscopic
technique. The mean return of regular bowel habits was 3.2 days, and the median postoperative stay was 10 days.
Conclusions: These preliminary results suggest that laparoscopic-assisted sigmoidectomy can be used safely for the surgical treatment
of diverticular disease.
Received: 30 July 1997/Accepted: 21 January 1998 相似文献
15.
W. W. Roberts T. A. Dinkel P. G. Schulam L. Bonnell L. R. Kavoussi 《Surgical endoscopy》1997,11(12):1221-1223
A system was developed to determine the potential role of infrared imaging as a tool for localizing anatomic structures and
assessing tissue viability during laparoscopic surgical procedures. A camera system sensitive to emitted energy in the midinfrared
range (3–5 μm) was incorporated into a two-channel visible laparoscope. Laparoscopic cholecystectomy, dissection of the ureter,
and assessment of bowel perfusion were performed in a porcine model with the aid of this infrared imaging system. Inexperienced
laparoscopists were asked to localize and differentiate structures before dissection using the visible system and then using
the infrared system. Assessment of bowel perfusion was also conducted using each system. Infrared imaging proved to be useful
in differentiating between blood vessels and other anatomic structures. Differentiation of the cystic duct and arteries and
transperitoneal localization of the ureter were successful in all instances using the infrared system when use of the visible
system had failed. This system also permitted assessment of bowel perfusion during laparoscopic occlusion of mesenteric vessels.
These initial studies demonstrate that infrared imaging may improve the differentiation and localization of anatomic structures
and allow assessment of physiologic parameters such as perfusion not previously attainable with visible laparoscopic techniques.
It may thus potentially be a powerful adjunct to laparoscopic surgery.
Received: 23 August 1996/Accepted: 14 October 1996 相似文献
16.
This article reports our early experience using laparoscopic instruments and techniques when performing radical retropubic
prostatectomy through an entirely extraperitoneal endoscopic approach. Two patients with localized adenocarcinoma of the prostate
underwent endoscopic radical retropubic prostatectomy through an entirely extraperitoneal approach (EERRP). The procedure
was evaluated for its efficacy in removing prostate and seminal vesicles and in effecting complete vesicourethral anastomosis.
Operative time, blood loss, hospital stay, and pathology were also evaluated. Complete endoscopic removal of the prostate
and seminal vesicles was achieved in both patients. Endoscopic reconstruction of the bladder neck with watertight anastamosis
was successful in both. Operative time and estimated blood loss improved from 5 h and 45 min and 600 cc, respectively, in
patient 1 to 4 h and 400 cc in patient 2. Hospital stay was 2.5 days for both. The early experience for EERRP is encouraging.
Further evaluation to standardize technique and determine its efficacy and role in treating prostate cancer is in order.
Received: 21 July 1997/Accepted: 11 November 1997 相似文献
17.
Pain after laparoscopy 总被引:9,自引:1,他引:8
Background: In the context of the much-heralded advantages of laparoscopic surgery, it can be easy to overlook postlaparoscopy pain as
a serious problem, yet as many as 80% of patients will require opioid analgesia. It generally is accepted that pain after
laparoscopy is multifactorial, and the surgeon is in a unique position to influence many of the putative causes by relatively
minor changes in technique.
Methods: This article reviews the relevant literature concerning the topic of pain after laparoscopy.
Results: The following factors, in varying degrees, have been implicated in postlaparoscopy pain: distension-induced neuropraxia of
the phrenic nerves, acid intraperitoneal milieu during the operation, residual intra-abdominal gas after laparoscopy, humidity
of the insufflated gas, volume of the insufflated gas, wound size, presence of drains, anesthetic drugs and their postoperation
effects, and sociocultural and individual factors.
Conclusions: On the basis of the factors implicated in postlaparoscopy pain, the following recommendations can be made in an attempt to
reduce such pain: emphathically consider each patients' unique sociocultural and individual pain experience; inject port sites
with local anesthesia at the start of the operation; keep intra-abdominal pressure during pneumoperitoneum below 15 mmHg,
avoiding pressure peaks and prolonged insufflation; use humidified gas at body temperature if available; use nonsteroidal
anti-inflammatory drugs at the time of induction; attempt to evacuate all intraperitoneal gas at the end of the operation;
and use drains only when required, rather than as a routine.
Received: 26 May 1998/Accepted: 30 June 1998 相似文献
18.
An ergonomic comparison of in-line vs pistol-grip handle configuration in a laparoscopic grasper 总被引:4,自引:3,他引:1
Background: Laparoscopic instruments incorporate both in-line and pistol-grip handle configurations, yet it is unclear which design is
most advantageous for surgeons, particularly when operating at angles perpendicular to the surgeon's position. We present
a detailed electromyographic (EMG) comparison of these handle configurations under different force and angle conditions.
Methods: Nine general surgeons used a Microsurge grasper with the handle in an in-line (MS-IL) and pistol (MS-PS) configuration, as
well as a standard hemostat (HE), to grasp and close two spring-loaded metal plates. The task was performed randomly by each
subject with the three instrument configurations at two forces levels (0.7 N, 4.2 N) and at three angles to the surgeons'
body (0, 45, and 90°). Surface EMG was measured from the flexor carpi ulnaris (FCU), flexor digitorum profundus (FDP), flexor
digitorum superficialis (FDS), extensor carpi ulnaris (ECU), extensor digitorum comunis (EDC), and thenar compartment (TH).
The peak root mean squared (RMS) EMG voltage was calculated for each instrument, force, and angle condition. Statistical comparison
was carried out by ANOVA.
Results: Both laparoscopic handle configurations required significantly higher contractions of all muscle groups compared to the hemostat
at the high force level. TH was not affected by laparoscopic handle configuration. MS-IL required higher FCU, ECU, and EDC
contractions at 45° compared to MS-PS. However, MS-IL decreased the flexor compartment muscle contractions (FDP, FDS, FCU)
at 90° compared to MS-PS.
Conclusions: Laparoscopic grasping requires higher forearm and thumb muscle contractions compared to the use of a hemostat. The in-line
handle configuration is no better than the pistol configuration except when grasping at 90° to the surgeon, where rotation
of the handle and wrist back toward the surgeon significantly decreases forearm flexor compartment muscle contractions.
Received: 3 April 1997/Accepted: 10 August 1997 相似文献
19.
Incidence and significance of pneumomediastinum after laparoscopic esophageal surgery 总被引:1,自引:0,他引:1
Clements RH Reddy S Holzman MD Sharp KW Olsen D Holcomb GW Richards WO 《Surgical endoscopy》2000,14(6):553-555
Background: Pneumomediastinum can be a sign of esophageal perforation. During laparoscopic esophageal surgery, the mediastinum is exposed
to carbon dioxide gas under pressure that can cause pneumomediastinum.
Methods: Forty-five patients undergoing laparoscopic esophageal procedures had erect, inspiratory, single-view chest radiographs (CXR)
performed in the recovery room (RR). Patients with extraabdominal gas underwent daily erect, inspiratory, single-view CXR
until resorption of the gas or discharge from the hospital. Insufflation time and pressure were recorded, and morbidity was
evaluated. Results are expressed as mean ± SEM.
Results: Twenty-five mens (56%)and 20 women (44%) aged 33.0 ± 2.9 years underwent 10 Heller myotomies (22.2%), 27 Nissen fundoplications
(60.0%), six Toupet fundoplications (13.3%), and two paraesophageal hernia repairs (4.4%). Twenty-four patients (53.3%) had
normal CXR in RR, and 21 (46.7%) had extraabdominal gas. Eighteen (85.7%) of the 21 had pneumomediastinum, three (14.3%) had
pneumothorax, and 12 (57.1%) had subcutaneous emphysema in RR. Sixteen of these 21 remained hospitalized and had repeat CXR
on postoperative day 1. Of these 16, five (31.3%) had normal CXR, 11 (68.8%) had pneumomediastinum, and seven (43.8%) had
subcutaneous emphysema. There were no esophageal perforations and no chest tube insertions, and there was no morbidity related
to pneumomediastinum.
Conclusion: Pneumomediastinum is observed frequently following laparoscopic esophageal operations and often persists past 24 h. After
these operations, pneumomediastinum is not necessarily indicative of esophageal perforation. In this group, it caused no clinically
significant events that altered the course of the patients.
Received: 30 April 1999/Accepted: 24 February 2000/Online publication: 8 May 2000 相似文献
20.
Ergonomic problems associated with laparoscopic surgery 总被引:6,自引:16,他引:6
Background: The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Task Force on Ergonomics conducted a subjective and objective assessment of ergonomic problems associated with laparoscopic instrument use. The goal was to assess the prevalence, causes, and consequences of operational difficulties associated with the use of laparoscopic instruments. Methods: A questionnaire was distributed asking respondents to rate the frequency with which they experienced pain, stiffness, or numbness in several body areas after laparoscopic operations. An ergonomics station was assembled to quantify forearm and thumb muscle workload. Processed electromyogram (EMG) signals were acquired from 27 volunteer surgeon subjects while they completed simulated surgical tasks using a hemostat and an Ethicon® laparoscopic grasper, with the aid of an endoscopic trainer and video monitoring system. Results: Of 149 surgeons responding to the questionnaire, 8% to 12% reported frequent pain in the neck and upper extremities associated with laparoscopic surgery. The ergonomics station demonstrated that the peak and total muscle effort of forearm and thumb muscles were significantly greater (p < 0.01) when the grasping task was performed using the laparoscopic instrument rather than the hemostat. Conclusion: These findings indicate that laparoscopic surgical technique is more taxing on the surgeon. 相似文献