共查询到20条相似文献,搜索用时 78 毫秒
1.
A prospective randomized controlled trial of sclerotherapy vs ligation in the prophylactic treatment of high-risk esophageal varices 总被引:4,自引:0,他引:4
Background: Endoscopic ligation (EVL) and endoscopic sclerotherapy (EIS) are both effective in the treatment of bleeding esophageal varices,
but the efficacy of the two techniques in the prophylaxis of first variceal bleeding has not been investigated. The aim of
this study was to investigate the frequency of first variceal bleeding, the recurrence of varices, and survival after treatment
with the two techniques, as compared to a nontreated control group.
Methods: A total of 157 patients with liver cirrhosis and advanced esophageal varices with no previous history of upper gastrointestinal
bleeding were randomly assigned to either an EIS group (n= 55), an EVL group (n= 52), or a nontreated control group (n= 50). After the eradication of esophageal varices in the EIS and in EVL groups and in all control patients, the endoscopic
examination was performed at 3-month intervals.
Results: There were no significant differences between EIS and EVL in the eradication rate of esophageal varices (85% in the EIS group
versus 81% in the EVL group). The mean number of sessions required to obtain eradication was lower in the EVL group than in
the EIS group (4.8 ± 1.8 versus 6.2 ± 2.0; p= 0.0003), but the recurrence of esophageal varices was higher in the EVL group (31% versus 11%; p= 0.01). Total mortality was significantly lower in the EIS patients than in the controls (20% versus 38%; p= 0.04). It was also lower, but not significantly, in the EVL patients than in the controls (23% versus 38%; p= 0.10). A significant decrease in variceal bleeding was observed both in sclerotherapy cases (20%) and controls (54%; p= 0.0005) and in ligation cases and controls (29%; p= 0.01). No significant difference in bleeding episodes was observed between the sclerotherapy and ligation cases (p= 0.29). No serious complications were observed either in the EIS or EVL groups.
Conclusions: EIS and EVL are similarly effective in the prevention of first variceal bleeding. The choice between EIS and EVL depends
on the skill of the endoscopic unit. For highly experienced surgeons facing no complications, sclerotherapy seems to be preferable;
for all others, it is technically easier to perform ligation.
Received: 29 June 1998/Accepted: 18 September 1998 相似文献
2.
Background: The therapeutic schedule in bleeding esophageal varices is today established: emergency endoscopy with sclerotherapy or ligation
combined with somatostatin and decreasing portal pressure drug followed by repetitive sclerotherapy or ligation. But the approach
to varices that do not bleed is not clear.
Methods: The authors submit the results of a 6-year sclerotherapeutic program. Since January 1989 they have treated 421 patients with
varices and have together performed 4,115 endoscopic sclerotherapeutic procedures. Among the 421 patients 95 were treated
during acute bleeding and 254 were treated after first bleeding; in 72 patients prophylactic sclerotherapy (PSG) was performed.
Results: The procedure was indicated, when grade III or IV varices or high-risk signs and/or hepatic venous pressure gradient (HVPG)
> 15 in grade II varices were observed. Prophylactic therapy (not-treated group—NTG) refused next 31 selected patients. The
mean follow-up time was 32 months in the PS group and 28 months in NTG (n.s.). Fifteen PSG patients died (21%), while the
mortality among the NTG patients (13 = 42% patients) was significantly higher (P < 0.02).
Conclusions: We recommend prophylactic sclerotherapy with 1% polidocanol in patients with advanced varices in liver cirrhosis of varied
etiology. We emphasize the need to perform these procedures in a department with adequate experience, where at least 100–200
sclerotherapies per year are performed.
Received: 31 July 1995/Accepted: 28 December 1995 相似文献
3.
Oberg S Peters JH DeMeester TR Lord RV Johansson J Crookes PF Bremner CG 《Surgical endoscopy》1999,13(12):1184-1188
Background: It has been suggested that endoscopic grading of the gastroesophageal flap valve is a good predictor of the reflux status.
Methods: To test this hypothesis, 268 symptomatic patients underwent endoscopic grading of the gastroesophageal valve using Hill's
classification, with grades I through IV. Esophageal acid exposure, lower esophageal sphincter characteristics, and the degree
of esophageal mucosal injury were compared among the groups.
Results: The prevalence of a mechanically defective sphincter, abnormal esophageal acid exposure, erosive esophagitis, and Barrett's
esophagus increased with increasing alteration of the gastroesophageal valve. The presence of a grade IV valve indicated increased
esophageal acid exposure in 75% of patients. As a predictor, this is similar to lower esophageal sphincter pressure but not
as good as the presence of esophageal mucosal injury.
Conclusions: Endoscopic grading of the gastroesophageal valve provides useful information about the reflux status but is less useful as
an indicator of gastroesophageal reflux disease (GERD) than the presence of esophageal mucosal injury.
Received: 28 April 1999/Accepted: 23 June 1999 相似文献
4.
Summary Sclerotherapy of esophageal varices is an effective hemostatic treatment and may also prevent bleeding. In our study, we examined
the effects of prophylactic sclerotherapy on esophageal motility in 15 patients with Child's A cirrhosis of the liver. All
the patients underwent three manometric measurements, performed respectively before the sclerotherapy, I week after the eradication
of varices, and 3 months later. The results of our study show that prophylactic sclerotherapy of esophageal varices does not
significantly change the resting pressure and length of the lower esophageal sphincter. Neither the amplitude nor the duration
of the postswallowing esophageal peristaltic waves is significantly influenced by sclerotherapy. However, sclerotherapy produces
a significant increase in tertiary contractions in the distal esophagus, which could explain the onset of dysphagia among
patients in whom postsclerotherapy stricture is not evident. 相似文献
5.
Background: The short esophagus increases the difficulty and limits the effectiveness of laparoscopic Nissen fundoplication. In our experience,
∼20–25% of esophagi judged by preoperative criteria to be foreshortened will, after dissection, be insufficiently long to
allow 2 cm of esophagus to reside below the diaphragm without inferior distraction (i.e., tension free). Collis gastroplasty
combined with Nissen fundoplication has become the standard approach for the creation of an intraabdominal neoesophagus and
fundic wrap.
Methods: After developing methods of performing totally laparoscopic stapled gastroplasty in the cadaver lab in 1994, we started applying
the technique clinically in 1996. We performed 220 laparoscopic antireflux procedures between January 1996 and July 1997.
Of these 220 patients, 26% were suspected to have esophageal foreshortening based on preoperative barium studies and/or endoscopy.
Results: After hiatal dissection, nine patients, or 16% of those suspected to have esophageal foreshortening and 4% of the entire
population, required the laparoscopic Collis-Nissen procedure. There was symptomatic improvement in all patients as assessed
by patient-initiated symptom scores.
Conclusions: The management of patients with esophageal foreshortening is a complex problem. We believe that our technique of laparoscopic
Collis-Nissen provides an effective means of achieving intraabdominal placement of the fundic wrap while maintaining the benefits
of a minimally invasive approach.
Received: 8 September 1997/Accepted: 17 December 1997 相似文献
6.
Esophageal function after injection sclerotherapy: pathogenesis of esophageal stricture 总被引:3,自引:0,他引:3
Injection sclerotherapy effectively controls hemorrhage from esophageal varices. Treatment must be repeated at intervals to obliterate varices. Long-term sequelae of such treatment are unknown but may include stricture formation. To assess the impact of repeated sclerotherapy on esophageal function, this prospective study measured lower esophageal sphincter pressure, reflux, and motility in patients before and after treatment. Injection sclerotherapy had no effect on lower esophageal sphincter pressure. Reflux was common before treatment and became even more prevalent after treatment, with reflux occurring in 60 percent of postsclerotherapy patients. Striking disturbances in esophageal motility were observed after treatment. Injection sclerotherapy induces a chemical esophagitis that impairs esophageal motility. Delayed acid clearance in the presence of reflux results in superimposed acid esophagitis. Esophageal strictures may thus be produced. We advise a standard antireflux medical regimen in our sclerotherapy patients. 相似文献
7.
Background: Persistent postoperative dysphagia occurs in up to 24% of patients who undergo a laparoscopic Nissen fundoplication for reflux
disease [7]. We hypothesized that patient history, pH testing, and esophageal manometry could be used to preoperatively identify
patients at risk for this complication.
Methods: Of 156 laparoscopic Nissen fundoplications performed over a 27-month period, we identified 19 patients (12%) who suffered
from postoperative dysphagia longer than 3 months. The presenting complaint of preoperative swallowing difficulty was noted
as was the presence of a known esophageal stricture. Preoperative pH testing and esophageal manometry were performed for all
subjects. We compared the following parameters to an age and gender-matched control group: history of esophageal stricture,
presence of preoperative dysphagia, DeMeester reflux score, upper esophageal sphincter pressure and relaxation, esophageal
body motility, location of respiratory inversion point, and lower esophageal sphincter length, resting pressure, and relaxation.
Data were compared via t-test and Fisher's exact test.
Results: Patients who presented before surgery with complaints of difficulty swallowing were more likely to suffer from postoperative
dysphagia (p= 0.029). Incidence of stricture, DeMeester score, and manometric measurements did not differ between the dysphagia and control
groups (p > 0.05 for all parameters).
Conclusions: Although preoperative studies are not helpful in identifying patients at risk for persistent dysphagia after laparoscopic
Nissen fundoplication, patients presenting with the preoperative complaint of difficulty swallowing are at increased risk
for this complication.
Received: 1 April 1999/Accepted: 22 July 1999 相似文献
8.
Background: It has been suggested that antireflux surgery may cause an improvement in esophageal motor function (EMF) and lead to reduced
postoperative dysphagia.
Methods: We evaluated the changes in dysphagia symptom scores and esophageal and lower esophageal sphincter (LES) pressures in patients
before (n= 381), at 6 months (n= 260), and at 24 months (n= 97) after laparoscopic fundoplication.
Results: There was a significant increase in LES basal and nadir pressure following surgery in all patients and an improvement in
EMF only in patients with poor preoperative esophageal motor function. A total of 76% of the patients reported no dysphagia
or an improved dysphagia score 6 and 24 months after surgery. This improvement was more marked in patients with poor EMF.
An improvement in EMF did not correlate with the improvement in dysphagia score reported by other patients. Patients with
increased dysphagia scores 2 years after surgery had significantly higher LES basal and nadir pressures as compared to other
patients.
Conclusions: Laparoscopic Nissen fundoplication is associated with an overall reduction in dysphagia scores and leads to an improvement
in esophageal motor function in patients with poor preoperative esophageal motility. Tightness and inadequate relaxation of
the wrap during swallowing may be a determinant of long-term dysphagia.
Received: 5 May 1997/Accepted: 19 August 1997 相似文献
9.
C. A. Jacobi J. Ordemann B. Böhm H. U. Zieren H. D. Volk W. Lorenz E. Halle J. M. Müller 《Surgical endoscopy》1997,11(3):235-238
Background: Laparoscopy is increasingly used in patients with intraabdominal bacterial infection although pneumoperitoneum may increase
bacteremia by elevated intraabdominal pressure.
Methods: The influence of laparotomy and laparoscopy on bacteremia, endotoxemia, and postoperative abscess formation was investigated
in a rat model. Rats received intraperitoneally a standardized fecal inoculum and underwent laparotomy (n= 20), or laparoscopy (n= 20), or no further manipulation in the control group (n= 20).
Results: Bacteremia and endotoxemia were higher after laparotomy and laparoscopy compared to the control group (p= 0.01) 1 h after intervention. One hour after intervention, aerobic and anaerobic bacterial species were detected in the
laparotomy group while only anaerobic bacteria were found in the other two groups. Although bacteremia and endotoxemia did
not differ among the three groups after 1 week, the mean number of intraperitoneal abscesses was significantly higher (p < 0.05) after laparotomy (n= 10) compared with laparoscopy (n= 6) and control group (n= 5).
Conclusion: Laparoscopy does not increase bacteremia and intraperitoneal abscess formation compared to laparotomy in an animal model
of peritonitis.
Received: 28 May 1996/Accepted: 25 July 1996 相似文献
10.
Laparoscopic esophagomyotomy with posterior partial fundoplication for primary esophageal motility disorders 总被引:2,自引:0,他引:2
Background: The outcomes of a laparoscopic esophagomyotomy with posterior partial fundoplication were compared between groups of patients
with primary motility disorders.
Methods: In this study, 47 patients (26 women and 21 men, ages 24 to 77 years; mean, 47 years) with significant dysphagia or chest
pain who failed conservative treatment underwent a laparoscopic esophagomyotomy and posterior partial fundoplication. Preoperative
evaluation revealed four groups of primary motility disorders: achalasia (n= 12), nutcracker esophagus (n= 12), hypertensive lower esophageal sphincter (LES) (n= 16), and diffuse esophageal spasm (n= 7). Statistical analysis was performed by Cramer's V test.
Results: Average follow-up period was 30.3 months. There was no mortality or early morbidity. Late morbidity included dysphagia or
chest pain over 6 weeks in 10 patients (21%), recurrent gastroesophageal reflux disease (GERD) in 3 patients (6%), and recurrent
motility disorder in 2 patients (4%). Overall, 94% of the patients ultimately had complete resolution of dysphagia or chest
pain. There was no significant difference in outcomes between groups.
Conclusion: Early results suggest that laparoscopic esophagomyotomy with posterior partial fundoplication provides safe and effective
relief from dysphagia and chest pain in patients with each of the primary motility disorders.
Received: 18 February 1999/Accepted: 16 December 1999/Online publication: 13 June 2000 相似文献
11.
Endoscopic photodynamic therapy for obstructing esophageal cancer: 77 cases over a 2-year period 总被引:14,自引:0,他引:14
Luketich JD Christie NA Buenaventura PO Weigel TL Keenan RJ Nguyen NT 《Surgical endoscopy》2000,14(7):653-657
rid="id="<e5>Correspondence to:</e5> J. D. Luketich, 200 Lothrop Street, C-800, Presbyterian Hospital, Pittsburgh, PA 15213,
USA
Background: Photodynamic therapy (PDT) is an alternative treatment option for the palliation of obstructive esophageal cancer. We report
our experience with PDT for patients presenting with inoperable, obstructing, or bleeding esophageal cancer.
Methods: Seventy-seven patients with inoperable, obstructing esophageal cancer were treated with PDT from November 1996 to July 1998.
Photofrin (1.5–2.0 mg/kg) was administered, followed by endoscopic light treatment (630 nm red dye laser) at 48 h. Dysphagia
score (1 for no dysphagia to 5 for complete obstruction), dysphagia-free interval, and patient survival were assessed.
Results: Seventy-seven patients underwent 125 PDT courses. The mean dysphagia score at 4 weeks after PDT in 90.8% of the patients
improved from 3.2 ± 0.7 to 1.9 ± 0.8 (p < 0.05). PDT adequately controlled bleeding in all six patients who had bleeding. The most common complications after the
125 PDT courses were esophageal stricture (4.8%), Candida esophagitis (3.2%), symptomatic pleural effusion (3.2%), and sunburn (10.0%). Twenty-nine patients (38%) required more than
one PDT course, and seven patients required placement of an expandable metal stent for recurrent dysphagia. The mean dysphagia-free
interval was 80.3 ± 58.2 days. The median survival was 5.9 months.
Conclusions: Photodynamic therapy is a safe and effective treatment for the palliation of obstructing and bleeding esophagus cancer.
Received: 8 May 1999/Accepted: 24 September 1999/Online publication: 15 May 2000 相似文献
12.
D. D. Coster W. H. Bower V. T. Wilson R. T. Brebrick G. L. Richardson 《Surgical endoscopy》1997,11(6):625-631
Background: Since 1992, all patients at our institution who have met standard accepted criteria for surgical intervention for complicated
gastroesophageal reflux disease have been entered into a prospective sequential clinical study to evaluate outcomes of the
laparoscopic approach to the Nissen-Rosetti procedure and a modified Toupet procedure.
Methods: A standardized workup with upper GI series, esophagography, and endoscopy was used in all patients. Manometry, pH testing,
and other special tests were used selectively. A measuring technique was used to determine wrap size without the use of dilators.
The short gastric vessels were left intact in all patients. A cosurgeon approach was used, with technical factors described
herein.
Results: Some 226 of 231 cases were completed laparoscopically (98%)—125 patients in the Nissen-Rosetti group and 101 in the partial
fundoplication group. There were no clinical failures in either group. The partial fundoplication group performed better than
the Nissen-Rosetti group in all categories of comparison. Return to normal eating habits was much earlier in the partial wrap
group (p < 0.0001). Postop distal esophageal sphincter pressures in the two groups were equal at 15 mmHg. Eight patients suffered
significant dysphagia requiring endoscopy and dilatation, all in the Nissen-Rosetti group (p < 0.01). Minor complications occurred in 12% of the total group. There was a total surgical revision rate of 3%. There were
no gastric or esophageal perforations. Average operative time was 30 min. Average hospital stay was 1.4 days. Hospital charges
for the laparoscopic approach averaged $6,000 dollars compared to $12,000 for the open approach.
Conclusion: Laparoscopic partial fundoplication is as effective as laparoscopic Nissen-Rosetti fundoplication, with a higher satisfaction
rate and fewer side effects. Measuring for wrap and hiatus size eliminates the need for and risk of using stiff dilators.
By utilizing cosurgeons and currently available technology, cost, operative time, hospital time, and complications can be
reduced to a finite minimum.
Received: 12 December 1995/Accepted: 12 August 1996 相似文献
13.
Laparoscopic vs conventional Nissen fundoplication 总被引:18,自引:6,他引:12
Background: Laparoscopic Nissen fundoplication has gained wide acceptance among surgeons, but the results of the laparoscopic procedure
have not been compared to the results of an open fundoplication in a randomized study.
Methods: Some 110 consecutive patients with prolonged symptoms of grade II–IV esophagitis were randomized, 55 to laparoscopic (LAP)
and 55 to an open (OPEN) Nissen fundoplication. Postoperative recovery, complications, and outcome at 3- and 12-month follow-up
were compared in the two groups.
Results: Five LAP operations were converted to open laparotomy due to esophageal perforation (two), technical difficulties (two),
and bleeding (one). In the OPEN group (two) patients underwent splenectomy. There was no mortality. The mean hospital stay
was 3.2 days in the LAP group and 6.4 in the OPEN group. Dysphagia and gas bloating were the most common complaints 3 months
after the operation in both groups. These symptoms had disappeared at the 12-month follow-up examination. All patients in
the LAP group and 86% in the OPEN group were satisfied with the result.
Conclusions: Laparoscopic Nissen fundoplication is a safe and feasible procedure. Complications are few and functional results are good
if not better than those of conventional open surgery.
Received: 15 May 1996/Accepted: 10 September 1996 相似文献
14.
The purpose of this project was to evaluate the acute and chronic effects of sclerotherapy on esophageal motility and function. We studied motility in eight patients before and after injection sclerotherapy of esophageal varices. We injected the varices with 5% sodium morrhuate twice during the first week and then at 1, 2, 3, and 6 months. Lower esophageal sphincter pressure, contraction wave amplitude, and duration were not altered by sclerotherapy. However, the length of the high-pressure zone increased significantly from 3.6 +/- 0.3 cm to 4.2 +/- 0.2 cm during the first 3 days after initial treatment, and sclerotherapy caused considerable distortion of peristaltic wave form. Also, esophageal peristaltic velocity decreased in three patients who complained of dysphagia and subsequently developed esophageal stricture. The strictures have responded well to dilatation, and in two patients velocity has even returned toward the baseline value. Reflux esophagitis has not been a problem. Esophageal motility is altered by sclerotherapy of esophageal varices. Stricture formation seems to be reversible after sclerotherapy is stopped or discontinued. 相似文献
15.
Laparoscopic cholecystectomy and time-course changes in renal function 总被引:13,自引:3,他引:10
Y. Miki K. Iwase W. Kamiike E. Taniguchi K. Sakaguchi J. Sumimura H. Matsuda I. Nagai 《Surgical endoscopy》1997,11(8):838-841
Background: Recently, the retraction method has been used to reduce intraabdominal pressure (IAP) during laparoscopic surgery. The purpose
of this study was to determine the serial changes in renal function during laparoscopic cholecystectomy (LC) using the retraction
method.
Methods: Urine output, effective renal plasma flow (ERPF), and glomerular filtration rate (GFR) were measured serially in seven patients
who underwent LC with 12 mmHg pneumoperitoneum (High-IAP group) and five who underwent LC using the retraction method with
4 mmHg pneumoperitoneum (Low-IAP group).
Results: Urine output, ERPF, and GFR were decreased during pneumoperitoneum in the High-IAP group, whereas no significant changes
in any of these parameters were observed in the Low-IAP group.
Conclusions: Our findings demonstrate that reduction of IAP to 4 mmHg using the retraction method prevents the transient renal dysfunction
caused by prolonged 12 mmHg pneumoperitoneum during LC, suggesting that the retraction method reduces the risk of perioperative
renal dysfunction during laparoscopic surgery.
Received: 26 March 1996/Accepted: 27 July 1996 相似文献
16.
G. R. Soybir F. Köksoy C. Polat A. Özşeker O. Yalçln Y. Aker C. Topuzlu 《Surgical endoscopy》1997,11(7):711-713
Background: The effects of gallstones and sterile or infected bile on postoperative adhesions and abscess formation were investigated
in Sprague Dawley rats.
Methods: The first three groups were injected intraperitoneally with serum saline, sterile bile, or infected bile, respectively. Laparotomy
was adjusted to the next seven groups. Serum saline, sterile bile, and infected bile were injected in the fourth through sixth
groups intraperitoneally, respectively. Gallstones were placed intraabdominally to the seventh through ninth groups. The injections
of sterile bile in group 7 and of infected bile in group 8 were added to laparotomies. Only laparotomy was carried out in
group 10.
Results: Abscess formations were seen only in infected-bile-injected groups. Significant adhesion formations were seen in infected-bile
groups. Sterile bile and/or gallstones had no significant effect in abscess or adhesion formation.
Conclusions: Results suggest that noninfected gallstones and sterile bile, even in combination, do not increase postoperative intraabdominal
complications in rats.
Received: 29 March 1996/Accepted: 26 August 1996 相似文献
17.
Background: In laparoscopic surgery, fogging of the lens tip instantly degrades the quality of image and interrupts the flow of surgical
maneuvers. External warming devices prevent fogging for a certain length of time, but use of them is troublesome at best.
These problems prompted us to develop a fogless mechanism built into the scope so that the fogless image would be continuous
and trouble-free. We then conducted several experiments that demonstrate the precise effect it has on the lens tip.
Methods: The infrared radiation pyrometer was used to compare the temperature distribution as well as the temperature change against
time of each lens tip of the fogless and ordinary laparoscopes.
Results: The temperature of the lens tip of the ordinary scope did not change, but that of the fogless scope rose to 41°C in 184–208
s.
Conclusions: The fogless mechanism effectively warms the lens tip to a safe temperature that prevents fogging in the intraabdominal environment.
Received: 11 September 1996/Accepted: 14 December 1996 相似文献
18.
This report describes four patients with NSAID-induced esophageal ulcers documented by endoscopy. The cause of injury was
ibuprofen alone in two patients, aspirin in one patient, and a combination of aspirin and ibuprofen in one patient. The most
common findings were anemia, retrosternal pain, and dysphagia. Three patients had bleeding esophageal ulcers requiring blood
transfusions. One patient had massive bleeding which was controlled by endoscopic hemostasis. Three patients were followed
up by endoscopy, which showed healing in 3–4 weeks. These NSAID-induced ulcers had characteristic endoscopic features, namely,
a large, shallow, discrete ulcer in the midesophagus near the aortic arch with normal surrounding mucosa. These findings suggest
that the injury resulted from mucosal contact with NSAIDs. A precise history and immediate endoscopic examination were most
important in establishing the diagnosis of esophageal ulcer. Healing occurs if drug-induced injury is recognized early and
treatment is appropriately started with antacids and H2 blockade. Offending medication should be discontinued and patients should be counseled to take pills in an upright posture
with liberal amounts of fluids well before retiring for the night.
Received: 5 April 1996/Accepted: 28 May 1996 相似文献
19.
D. Collet 《Surgical endoscopy》1997,11(1):56-63
Background: In 1996, laparoscopic cholecystectomy is the gold standard for symptomatic cholelithiasis. The results of this operation
as published so far include data on the learning curve of the method. The aim of this study is to evaluate the results of
laparoscopic cholecystectomy when performed by a large number of surgeons during the year 1994, not taking into account the
beginning years in which the technique was being used.
Methods: This study has been carried out prospectively and anonymously among members of SFCERO. All the patients who underwent a cholecystectomy
started laparoscopically during 1994 have been included.
Results: Some 4,624 cholecystectomies were performed by 150 surgeons. There were 3,310 females (42.5 ± 19.8 years old) and 1,314 males
(56.3 ± 1.61 years old). The conversion rate was 6.9%: 320 operations had to be converted into laparotomy (group II) while
4,261 were performed entirely by laparoscopy (group I). Morbidity was 5% (N= 230)—4.7% in group I (N= 203) and 8.4% in group II (N= 27). Mortality was 0.2% (N= 9)—namely four intraabdominal complications (three cases of peritonitis and one biliary reoperation), two cardiac failures,
and one brain infarction. The causes of death were not specified in two patients.
Conclusions: These results show that morbidity and mortality have not changed dramatically since the beginnings of this technique, whereas
the frequency of common bile duct (CBD) injuries has decreased. However, the conversion rate has increased slightly. These
results make it possible to calculate the risk of conversion and postoperative complication according to the age of the patient
and the biliary symptoms.
Received: 25 January 1996/Accepted: 10 April 1996 相似文献
20.
Laparoscopic Heller myotomy relieves dysphagia in achalasia when the esophagus is dilated 总被引:4,自引:1,他引:3
M. G. Patti C. V. Feo U. Diener A. Tamburini M. Arcerito B. Safadi L. W. Way 《Surgical endoscopy》1999,13(9):843-847
Background: It has been said that a Heller myotomy cannot improve dysphagia in achalasia when the esophagus is markedly dilated or sigmoid
shaped. Those who hold this belief recommend esophagectomy as the primary treatment in such cases. This study aimed to compare
the results of laparoscopic Heller myotomy combined with Dor fundoplication in 66 patients with and without esophageal dilatation,
all of whom had achalasia.
Methods: On the basis of the maximal diameter of the esophageal lumen and the shape of the esophagus, the patients were placed into
four groups: group A (esophageal diameter <4.0 cm; 26 patients), group B (diameter 4.0–6.0 cm; 21 patients), group C1 (diameter
>6.0 cm and straight esophageal axis; 12 patients), and group C2 (diameter >6.0 cm and sigmoid-shaped esophagus; 7 patients).
All patients underwent a laparoscopic Heller myotomy and Dor fundoplication.
Results: The duration of the operation and the length of hospital stay were similar among the four groups. Excellent or good results
were obtained in 88% of group A, 100% of group B, 83% of group C1, and 100% of group C2. No patient in this consecutive series
ultimately required an esophagectomy.
Conclusions: In patients with achalasia who have esophageal dilation, a laparoscopic Heller myotomy and Dor fundoplication (a) took no
longer and was no more difficult, (b) was associated with no more postoperative complications, and (c) gave just as good relief
of dysphagia. We conclude that esophageal dilation by itself should rarely serve as an indication for esophagectomy rather
than myotomy as the initial surgical treatment.
Received: 1 March 1999/Accepted: 21 June 1999 相似文献