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Application of 3-Step Laparoscopic Cholecystectomy in Acute Difficult Cholecystitis. 三步腹腔镜胆囊切除术在急性困难性胆囊炎中的应用
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1097/sle.0000000000001272
Chun Zhang, Dengfang Guo, Guifang Lv, Feng Lin, Qinglin Wang, Jianyuan Lin, Dexian Xiao, Ruotao Wang, Qingquan Gong
With the aging of the global population, the incidence rate of acute cholecystitis is increasing. Laparoscopic cholecystectomy is considered as the first choice to treat acute cholecystitis. How to effectively avoid serious intraoperative complications such as bile duct and blood vessel injury is still a difficult problem that puzzles surgeons. This paper introduces the application of laparoscopic cholecystectomy, a new surgical concept, in acute difficult cholecystitis.
随着全球人口老龄化的加剧,急性胆囊炎的发病率也在不断上升。腹腔镜胆囊切除术被认为是治疗急性胆囊炎的首选方法。如何有效避免胆管和血管损伤等严重术中并发症仍是困扰外科医生的难题。本文介绍了腹腔镜胆囊切除术这一全新手术理念在急性疑难胆囊炎中的应用。
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引用次数: 0
How I Do It: Robotic Choledochoscopy. 我是怎么做的机器人胆道镜检查
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1097/SLE.0000000000001258
Robert Acho, Maysen Calzon, Salvatore Docimo

Background: As the use of the robotic platform increases among general surgeons, the amount of robotic cholecystectomies is expected to increase as well. The use of intraoperative cholangiography is valuable in assessing for choledocholithiasis. We describe our technique of performing robotic intraoperative cholangiograms with choledochoscopy. Out technique aids in efficiency since no undocking is required.

Methods: Preoperatively, the decision to perform a cholangiogram is made based on physical exam, labs, and imaging findings. The procedure begins with obtaining a critical view of safety. The robotic arms are positioned in a manner that allows all 4 robotic arms to remain docked. A ductotomy is made and the cholangiocatheter is introduced. The cholangiogram images are then interpreted and if a stone is seen in the common bile duct we will then perform a transcystic common bile duct exploration using the SpyGlass Discover digital. A complete cholangiogram is then performed. The cystic duct is secured and the gallbladder is removed from the liver bed. The patients are watched overnight and discharged on postoperative day 1.

Conclusions: A robotic approach to performing a transcystic common bile duct exploration is a safe and reproducible treatment method for choledocholithiasis. Our approach offers an advantage since no undocking is required.

背景:随着普通外科医生越来越多地使用机器人平台,机器人胆囊切除术的数量预计也会增加。术中胆管造影在评估胆总管结石方面很有价值。我们介绍了利用胆道镜进行机器人术中胆管造影的技术。该技术无需解锁,因此有助于提高效率:术前,根据体格检查、实验室检查和成像结果决定是否进行胆管造影。手术首先要获得安全的关键视图。机械臂的定位方式是让所有 4 个机械臂保持对接。进行导管切开并导入胆管导管。然后解读胆管造影图像,如果发现胆总管内有结石,我们将使用 SpyGlass Discover 数字胆管造影仪进行经胆囊胆总管探查。然后进行完整的胆管造影。固定胆囊管,并从肝床移除胆囊。患者经过一夜观察,在术后第1天出院:经胆囊总胆管探查机器人方法是一种安全、可重复的胆总管结石治疗方法。我们的方法具有无需脱锁的优势。
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引用次数: 0
Feasibility of Robot-Assisted Cytoreductive Surgery With Upper-Abdominal Peritonectomy for Pseudomyxoma Peritonei With Low Peritoneal Carcinomatosis Index: A Pilot Study. 腹膜癌变指数低的腹膜假肌瘤腹膜上腹膜切除机器人辅助细胞剥脱手术的可行性:一项试点研究。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1097/SLE.0000000000001267
Daisuke Fujimoto, Yutaka Yonemura, Keizo Taniguchi, Hirotoshi Kobayashi

Introduction: Our study's objective was to provide the method for, and preliminary findings from, robot-assisted cytoreductive surgery (r-CRS) combined with upper-abdominal peritonectomy in pseudomyxoma peritonei (PMP) with limited peritoneal surface malignancy (PSM).

Materials and methods: We conducted a retrospective pilot study on consecutive patients with PSM secondary to pseudomyxoma peritonei with a peritoneal cancer index (PCI) of under 10 who were indicated for r-CRS combined with upper-abdominal peritectomy. Perioperative and 30-day major morbidity and mortality characteristics were analyzed and compared with cases in which laparoscopic CRS (l-CRS) was performed under the same conditions.

Results: Six patients underwent r-CRS combined with an upper-abdominal partial peritonectomy. Their mean PCI was 4.83. Complete cytoreduction was achieved in all patients. The mean duration of the operation was 156.8 minutes. There was no major complication and no mortality. The mean length of hospital stay after surgery was 6.33 days. r-CRS resulted in less blood loss, a lower C-reactive protein level, and a shorter length of hospital stay that were significantly different compared with those of l-CRS.

Conclusions: This is the initial technical report of a robotic approach for CRS combined with upper-abdominal peritonectomy. r-CRS with a combined upper-abdominal peritonectomy was shown to be safe and feasible for PMP with limited PSM.

简介我们的研究旨在提供机器人辅助细胞减灭术(r-CRS)联合上腹部腹膜切除术治疗腹膜假性肌瘤(PMP)伴局限性腹膜表面恶性肿瘤(PSM)的方法和初步结果:我们对腹膜癌指数(PCI)在10以下、继发于腹膜假性肌瘤的腹膜表面恶性肿瘤连续患者进行了一项回顾性试验研究,这些患者适用于r-CRS联合上腹部腹膜切除术。分析了围手术期和30天内的主要发病率和死亡率特征,并与在相同条件下进行腹腔镜CRS(l-CRS)的病例进行了比较:结果:六名患者接受了腹腔镜CRS联合上腹部部分腹膜切除术。他们的平均PCI为4.83。所有患者均实现了完全细胞减灭术。手术平均持续时间为 156.8 分钟。无重大并发症,无死亡病例。手术后的平均住院时间为 6.33 天。与 l-CRS 相比,r-CRS 的失血量更少、C 反应蛋白水平更低、住院时间更短,这些都有显著差异:r-CRS联合上腹部腹膜切除术被证明对于PMP伴有限PSM是安全可行的。
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引用次数: 0
Efficacy of ScopeGuide-Assisted Training in Enhancing Colonoscopy Competence and Reducing Patient Discomfort. ScopeGuide 辅助培训在提高结肠镜检查能力和减少患者不适感方面的功效。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1097/SLE.0000000000001236
Hui-Min Ma, Li-Ping Gao, Peng-Fei Wang, Fang Wang, Yan-Hu Feng, Li-Hong Yang, Yi Yu, Xiang Wang

Objective: In this study, we aimed to evaluate the efficacy of the Magnetic Scope Guide Assist (ScopeGuide) in enhancing the procedural competence of endoscopists and reducing patient discomfort during colonoscopy.

Methods: This was a retrospective study with 88 trainee participants. The study participants were trained on patients who underwent colonoscopy without anesthesia. Both ScopeGuide-assisted training and conventional training (without ScopeGuide) were utilized for colonoscopy instruction. The outcomes of training were compared, with a particular emphasis on the competency of looping resolution.

Results: ScopeGuide-assisted training was superior to conventional training in multiple aspects, including looping resolution ( Z =-3.681, P <0.001), pain scores ( Z =-4.211, P <0.001), time to reach the cecum ( Z =-4.06, P <0.001), willingness to undergo repeat colonoscopy ( Z =-4.748, P <0.001), competence of positional changes ( Z =-4.079, P <0.001), and the effectiveness of assisted compression ( Z =-3.001, P =0.003). Further stratified analysis revealed that the ScopeGuide-assisted training mode was more beneficial for junior endoscopists ( P <0.05 in all parameters) but not for intermediate endoscopists ( P >0.05) and partially beneficial for senior endoscopists ( P <0.05 for all parameters except looping resolution).

Conclusion: ScopeGuide-assisted training can significantly facilitate endoscopists in resolving loops and reducing patient pain, thereby enhancing their colonoscopy abilities.

目的在这项研究中,我们旨在评估磁性范围引导辅助装置(ScopeGuide)在提高内镜医师的手术能力和减少结肠镜检查过程中患者不适感方面的功效:这是一项回顾性研究,共有 88 名学员参加。方法:这是一项回顾性研究,共有 88 名受训者参加,受训者在无麻醉的情况下对患者进行结肠镜检查。在结肠镜检查指导过程中,使用了 ScopeGuide 辅助培训和传统培训(不使用 ScopeGuide)。对培训结果进行了比较,其中特别强调了循环解析的能力:结果:ScopeGuide 辅助培训在多个方面都优于传统培训,包括环路解析能力(Z=-3.681,P0.05),并且对高级内镜医师有部分益处(PC结论:ScopeGuide 辅助培训在多个方面都优于传统培训,包括环路解析能力(Z=-3.681,P0.05):ScopeGuide辅助培训能极大地帮助内镜医师解决循环问题,减少患者痛苦,从而提高他们的结肠镜检查能力。
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引用次数: 0
Laparoscopic Large Hiatal Hernia Repair With RefluxStop: Outcomes of Six Months Follow-up in Thirty Patients. 使用 RefluxStop 进行腹腔镜大疝修补术:30 名患者六个月的随访结果。
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1097/SLE.0000000000001256
Yannick Fringeli, Ioannis Linas, Ulf Kessler, Joerg Zehetner

Objective: The antireflux surgical technique with the RefluxStop device is one of the latest approaches to treating patients with gastroesophageal reflux disease (GERD). The aim of this study was to assess the safety and feasibility of laparoscopic hiatal hernia (HH) repair with the RefluxStop device in patients with GERD and concurrent large HH (≥4 cm).

Patients and methods: A retrospective chart review was performed for the first 30 patients with a large HH who consented and underwent HH surgery with the RefluxStop device. The operative technique and outcomes were evaluated to assess safety and feasibility, HH recurrence, dysphagia, and patient satisfaction.

Results: Between May 2020 and April 2022, 30 patients underwent laparoscopic HH repair with the RefluxStop device. All patients had typical symptoms of GERD, such as heartburn and regurgitation, and 15 patients (50%) had preoperative dysphagia. Median HH size was 5 cm (interquartile range, 4 to 5). Median operating time was 56 minutes (interquartile range, 52 to 63), with no intra and postoperative complications related to the device. One patient required laparotomy due to adhesions and associated bleeding when accessing the abdomen. All patients had postoperative imaging (video fluoroscopy) on postoperative day 1 and at 3 months, confirming the correct location of the RefluxStop device. One patient (3.3%) needed postoperative balloon dilatation due to severe dysphagia. Reflux symptoms (heartburn and acid regurgitation) resolved significantly in all patients ( P < 0.001) at 6 months. One episode of recurrence of HH (3.3%) occurred during the follow-up period of 6 months.

Conclusion: This study demonstrates the short-term safety and feasibility of laparoscopic HH repair with the RefluxStop device in patients with large HH, with a low rate of postoperative dysphagia and subsequent improvement or resolution of reflux symptoms in all patients.

目的:使用 RefluxStop 装置的抗反流手术技术是治疗胃食管反流病(GERD)患者的最新方法之一。本研究的目的是评估使用 RefluxStop 设备对胃食管反流病患者进行腹腔镜食管裂孔疝(HH)修补术的安全性和可行性:对首批 30 名同意并使用 RefluxStop 装置进行 HH 手术的大型 HH 患者进行回顾性病历审查。对手术技术和结果进行评估,以评估安全性和可行性、HH 复发率、吞咽困难和患者满意度:2020年5月至2022年4月期间,30名患者接受了使用RefluxStop装置的腹腔镜HH修复手术。所有患者都有胃食管反流病的典型症状,如烧心和反胃,15 名患者(50%)术前有吞咽困难。HH 大小中位数为 5 厘米(四分位间范围为 4 至 5)。手术时间中位数为 56 分钟(四分位间范围为 52 到 63 分钟),术中和术后均未出现与该装置有关的并发症。一名患者因粘连和进入腹部时伴有出血而需要开腹手术。所有患者都在术后第 1 天和 3 个月进行了术后成像(视频透视),确认了 RefluxStop 装置的正确位置。一名患者(3.3%)因严重吞咽困难而需要进行术后球囊扩张。所有患者的反流症状(烧心和胃酸倒流)在 6 个月时都明显缓解(P < 0.001)。随访 6 个月期间,有一次 HH 复发(3.3%):本研究表明,使用 RefluxStop 装置对大型 HH 患者进行腹腔镜 HH 修复术具有短期安全性和可行性,术后吞咽困难发生率低,所有患者的反流症状均得到改善或缓解。
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引用次数: 0
Foreign Glass Bodies in Pleura and Pancreas: Systematic Review for Entry Hypotheses and Treatment Options in an Unresolved Case. 胸膜和胰腺中的玻璃异物:系统综述:未解决病例的入口假设和治疗方案
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-04-01 DOI: 10.1097/SLE.0000000000001275
Jonas P Ehrsam, Olga Meier Adamenko, Rolf B Schlumpf, Othmar M Schöb

Background: Foreign bodies within the pleura and pancreas are infrequent, and the approaches to their treatment still a subject of debate. There is limited knowledge particularly regarding glass foreign bodies.

Methods: We present a case involving large glass splinters in the pleura and pancreas, with an unknown entry point. In addition, a systematic review was conducted to explore entry hypotheses and management options.

Results: In addition to our case, our review uncovered eight incidents of intrapleural glass, and another eight cases of glass in other intrathoracic areas. The fragments entered the body through impalement (81%), migrated through the diaphragm after impalement (6%), or caused transesophageal perforation (19%) following ingestion. Eight instances of glass inside the abdominal cavity were documented, with seven resulting from impalement injuries and one from transintestinal migration. There were no recorded instances of glass being discovered within the pancreas. Among the 41 nonglass intrapancreatic foreign bodies found, sewing needles (34%) and fish bones (46%) were the most common; following ingestion, they had migrated through either a transgastric or transduodenal perforation. In all these cases, how the foreign bodies were introduced was often poorly recalled by the patient. Many nonglass foreign bodies tend to become encapsulated by fibrous tissue, rendering them inert, though this is less common with glass. Glass has been reported to migrate through various tissues and cavities, sometimes with a significant delay spanning even decades. There are cases of intrapleural migration of glass causing hemothorax, pneumothorax, and heart and major blood vessels injury. For intrapleural glass fragment management, thoracoscopy proved to be effective in 5 reported cases, in addition to our patient. Most intrapancreatic nonglass foreign bodies tend to trigger pancreatitis and abscess formation, necessitating management ranging from laparoscopic procedures to subtotal pancreatectomy. There have been only four documented cases of intrapancreatic needles that remained asymptomatic with conservative management. There is no direct guidance from the existing literature regarding management of intrapancreatic glass foreign bodies. Consequently, our patient is under observation with regular follow-ups and has remained asymptomatic for the past 2 years.

Conclusions: Glass foreign bodies in the pleura are rare, and our report of an intrapancreatic glass fragment is the first of its kind. Impalement is the most likely method of introduction. As glass has significant migration and an ensuing complication potential, preventive removal of intrapleural loose glass should be considered. However, intrapancreatic glass fragment management remains uncertain.

背景:胸膜和胰腺内的异物并不常见,其治疗方法仍存在争议。人们对玻璃异物的了解尤其有限:我们介绍了一例胸膜和胰腺内的大块玻璃碎片,其进入点不明。此外,我们还进行了一项系统性回顾,以探讨入口假说和处理方案:结果:除了我们的病例,我们的综述还发现了八例胸膜内玻璃碎片事件,以及另外八例胸腔内其他部位的玻璃碎片事件。玻璃碎片通过撞击进入体内(81%),撞击后通过膈肌移动(6%),或摄入后造成经食道穿孔(19%)。据记录,有 8 例玻璃进入腹腔的情况,其中 7 例是由于刺入损伤,1 例是由于经肠道移位。没有在胰腺内发现玻璃的记录。在发现的 41 例胰腺内非玻璃异物中,缝衣针(34%)和鱼骨(46%)最为常见;在摄入后,它们通过经胃或经十二指肠穿孔转移。在所有这些病例中,患者对异物是如何进入的往往回忆不清。许多非玻璃异物往往会被纤维组织包裹,使其失去惰性,但这种情况在玻璃异物中并不常见。据报道,玻璃异物会通过各种组织和腔隙迁移,有时甚至会拖延数十年之久。曾有玻璃在胸腔内迁移导致血胸、气胸、心脏和大血管损伤的病例。对于胸腔内玻璃碎片的处理,除我们的患者外,胸腔镜检查在 5 个报道的病例中被证明是有效的。大多数胰腺内非玻璃异物往往会引发胰腺炎和脓肿形成,因此需要进行腹腔镜手术或次全胰切除术。目前仅有四例胰腺内针状物在保守治疗后仍无症状的病例记录在案。现有文献对胰腺内玻璃异物的处理没有直接指导。因此,我们的患者一直在接受观察和定期随访,过去两年来一直没有症状:胸膜内的玻璃异物非常罕见,我们报告的胰腺内玻璃碎片是首例此类异物。玻璃碎片最有可能的进入方式是撞击。由于玻璃具有明显的迁移性和随之而来的并发症可能性,因此应考虑对胸膜内松散玻璃进行预防性取出。不过,胰腺内玻璃碎片的处理仍不确定。
{"title":"Foreign Glass Bodies in Pleura and Pancreas: Systematic Review for Entry Hypotheses and Treatment Options in an Unresolved Case.","authors":"Jonas P Ehrsam, Olga Meier Adamenko, Rolf B Schlumpf, Othmar M Schöb","doi":"10.1097/SLE.0000000000001275","DOIUrl":"10.1097/SLE.0000000000001275","url":null,"abstract":"<p><strong>Background: </strong>Foreign bodies within the pleura and pancreas are infrequent, and the approaches to their treatment still a subject of debate. There is limited knowledge particularly regarding glass foreign bodies.</p><p><strong>Methods: </strong>We present a case involving large glass splinters in the pleura and pancreas, with an unknown entry point. In addition, a systematic review was conducted to explore entry hypotheses and management options.</p><p><strong>Results: </strong>In addition to our case, our review uncovered eight incidents of intrapleural glass, and another eight cases of glass in other intrathoracic areas. The fragments entered the body through impalement (81%), migrated through the diaphragm after impalement (6%), or caused transesophageal perforation (19%) following ingestion. Eight instances of glass inside the abdominal cavity were documented, with seven resulting from impalement injuries and one from transintestinal migration. There were no recorded instances of glass being discovered within the pancreas. Among the 41 nonglass intrapancreatic foreign bodies found, sewing needles (34%) and fish bones (46%) were the most common; following ingestion, they had migrated through either a transgastric or transduodenal perforation. In all these cases, how the foreign bodies were introduced was often poorly recalled by the patient. Many nonglass foreign bodies tend to become encapsulated by fibrous tissue, rendering them inert, though this is less common with glass. Glass has been reported to migrate through various tissues and cavities, sometimes with a significant delay spanning even decades. There are cases of intrapleural migration of glass causing hemothorax, pneumothorax, and heart and major blood vessels injury. For intrapleural glass fragment management, thoracoscopy proved to be effective in 5 reported cases, in addition to our patient. Most intrapancreatic nonglass foreign bodies tend to trigger pancreatitis and abscess formation, necessitating management ranging from laparoscopic procedures to subtotal pancreatectomy. There have been only four documented cases of intrapancreatic needles that remained asymptomatic with conservative management. There is no direct guidance from the existing literature regarding management of intrapancreatic glass foreign bodies. Consequently, our patient is under observation with regular follow-ups and has remained asymptomatic for the past 2 years.</p><p><strong>Conclusions: </strong>Glass foreign bodies in the pleura are rare, and our report of an intrapancreatic glass fragment is the first of its kind. Impalement is the most likely method of introduction. As glass has significant migration and an ensuing complication potential, preventive removal of intrapleural loose glass should be considered. However, intrapancreatic glass fragment management remains uncertain.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10986785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ambulatory Robotic Colectomy: Factors Affecting and Affected by Postoperative Opioid Use. 门诊机器人结肠切除术:影响术后阿片类药物使用的因素及受其影响的因素
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1097/SLE.0000000000001263
Michael M Vu, Jace J Franko, Anna Buzadzhi, Beau Prey, Maksim Rusev, Marta Lavery, Laila Rashidi

Background: The ongoing opioid crisis demands an investigation into the factors driving postoperative opioid use. Ambulatory robotic colectomies are an emerging concept in colorectal surgery, but concerns persist surrounding adequate pain control for these patients who are discharged very early. We sought to identify key factors affecting recovery room opioid use (ROU) and additional outpatient opioid prescriptions (AOP) after ambulatory robotic colectomies.

Methods: This was a single-institution retrospective review of ambulatory robotic colon resections performed between 2019 and 2022. Patients were included if they discharged on the same day (SDD) or postoperative day 1 (POD1). Outcomes of interest included ROU [measured in parenteral morphine milligram equivalents (MMEs)], AOP (written between PODs 2 to 7), postoperative emergency department presentations, and readmissions.

Results: Two hundred nineteen cases were examined, 48 of which underwent SDD. The mean ROU was 29.4 MME, and 8.7% of patients required AOP. Between SDD and POD1 patients, there were no differences in postoperative emergency department presentations, readmissions, recovery opioid use, or additional outpatient opioid scripts. Older age was associated with a lower ROU (-0.54 MME for each additional year). Older age, a higher body mass index, and right-sided colectomies were also more likely to use zero ROU. Readmissions were strongly associated with lower ROU. Among SDD patients, lower ROU was also associated with higher rates of AOP.

Conclusion: Ambulatory robotic colectomies and SDD can be performed with low opioid use and readmission rates. Notably, we found an association between low ROU and more readmission, and, in some cases, higher AOP. This suggests that adequate pain control during the postoperative recovery phase is a crucial component of reducing these negative outcomes.

背景:当前的阿片类药物危机要求对术后阿片类药物使用的驱动因素进行调查。非卧床机器人结肠切除术是结直肠手术中的一个新兴概念,但对于这些很早就出院的患者来说,充分的疼痛控制仍然令人担忧。我们试图找出影响非卧床机器人结肠切除术后恢复室阿片类药物使用(ROU)和门诊阿片类药物额外处方(AOP)的关键因素:这是对2019年至2022年期间进行的门诊机器人结肠切除术的单机构回顾性研究。当天(SDD)或术后第 1 天(POD1)出院的患者均被纳入。相关结果包括ROU[以肠外吗啡毫克当量(MMEs)计算]、AOP(写在POD2至7之间)、术后急诊就诊和再入院:共检查了 219 例患者,其中 48 例接受了 SDD。平均 ROU 为 29.4 MME,8.7% 的患者需要 AOP。SDD患者与POD1患者在术后急诊就诊、再入院、恢复期阿片类药物使用或门诊阿片类药物额外用量方面没有差异。年龄越大,ROU 越低(每多一年-0.54 MME)。年龄越大、体重指数越高、右侧结肠切除术的患者使用零 ROU 的可能性也越大。再入院与较低的 ROU 密切相关。在 SDD 患者中,较低的 ROU 也与较高的 AOP 率相关:结论:使用非卧床机器人结肠切除术和 SDD 可以降低阿片类药物的使用率和再入院率。值得注意的是,我们发现低 ROU 与更高的再入院率之间存在关联,在某些情况下还与更高的 AOP 有关。这表明,术后恢复阶段充分的疼痛控制是减少这些不良后果的关键因素。
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引用次数: 0
Effect of Intraperitoneal Instillation of Dexmedetomidine With Local Anesthetics in Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis of Randomized Trials. 腹腔镜胆囊切除术中右美托咪定与局部麻醉剂腹腔内灌注的效果:随机试验的系统回顾和元分析》。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2024-04-01 DOI: 10.1097/SLE.0000000000001262
Chenxu Sun, Zhengguang He, Biao Feng, Yaping Huang, Dawei Liu, Zhihua Sun

Objective: Dexmedetomidine (DEX) can strengthen the analgesic effects of local anesthetics (LAs) when used as an adjuvant through intrathecal, perineural, and intraperitoneal routes. Many studies have used intraperitoneal instillation of DEX with LAs in laparoscopic cholecystectomy (LC) to relieve postoperative pain. We performed a systematic review and meta-analysis to synthesize evidence of the efficacy and safety of intraperitoneal instillation of DEX as an adjuvant of LAs in patients undergoing LC.

Methods: A comprehensive literature search of the MEDLINE, PubMed, EMBASE, and Cochrane Library databases was performed to identify randomized controlled trials in which patients received intraperitoneal instillation of DEX combined with LAs during LC. A meta-analysis and sensitivity analysis of the results were conducted. We also performed a subgroup analysis to investigate the source of heterogeneity. The Egger test was used to check for publication bias.

Results: Eleven randomized controlled trials involving 890 patients were analyzed. We found that the addition of DEX to LAs significantly decreased pain scores at six postoperative time points (0.5, 1, 2, 4, 12, and 24 h) and significantly prolonged the time to the first analgesic request by patients. In addition, 24-hour postoperative analgesic consumption was decreased in the experimental group, and no significant difference in the incidence of nausea and vomiting was observed.

Conclusion: Our findings indicate that intraperitoneal instillation of DEX with LAs can reduce postoperative pain and prolong the time to first request analgesia after LC.

目的:右美托咪定(DEX右美托咪定(DEX)作为局麻药(LAs)的辅助药物,通过鞘内、硬膜外和腹膜内途径使用时,可加强局麻药的镇痛效果。许多研究在腹腔镜胆囊切除术(LC)中使用腹腔灌注 DEX 和 LAs 来缓解术后疼痛。我们进行了一项系统性回顾和荟萃分析,以综合腹腔内灌注DEX作为LAs在LC患者中辅助治疗的有效性和安全性的证据:方法:对 MEDLINE、PubMed、EMBASE 和 Cochrane Library 数据库进行了全面的文献检索,以确定在 LC 期间患者接受腹腔灌注 DEX 和 LAs 的随机对照试验。我们对结果进行了荟萃分析和敏感性分析。我们还进行了亚组分析,以研究异质性的来源。采用Egger检验检查发表偏倚:结果:我们对涉及 890 名患者的 11 项随机对照试验进行了分析。我们发现,在 LAs 中添加 DEX 可显著降低术后六个时间点(0.5、1、2、4、12 和 24 h)的疼痛评分,并显著延长患者首次要求镇痛药的时间。此外,实验组术后 24 小时的镇痛药用量减少,恶心和呕吐的发生率无明显差异:我们的研究结果表明,腹腔注射DEX和LAs可以减轻术后疼痛,延长LC术后首次要求镇痛的时间。
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引用次数: 0
Application of the Left Lateral Decubitus Position in Laparoscopic Right Posterior Lobectomy. 左侧卧位在腹腔镜右后叶切除术中的应用
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1097/SLE.0000000000001264
Dong-Fang Huang, Jian-Bo Xu, Ye-Mu Du, Ye-Bo Wang, Ding-Hua Zhou

Objective: To investigate the value of the left lateral decubitus position in laparoscopic right posterior lobe tumor resection.

Patients and methods: The clinical data of patients who underwent laparoscopic right posterior lobectomy from January 2020 to March 2023 were retrospectively collected and divided into group A (left lateral decubitus position group, n=30) and group B (conventional position group, n=35) according to different body positions. Intraoperative and postoperative data were collected and compared between the 2 groups.

Results: The operation time (210.43±57.56 vs. 281.97±65.89, t =5.887, P <0.05), hilar occlusion time (23.97±14.25 vs. 35.79±12.62, t =4.791, P <0.05), intraoperative blood loss (162.14±72.61 vs. 239.65±113.56, t =5.713, P <0.05), postoperative feeding time (1.13±0.36 vs. 1.57±0.67, t =3.681, P <0.05), postoperative visual analog scale score (5.16±0.89 vs. 7.42±1.31, t =3.721, P <0.05), postoperative abdominal drainage tube indwelling time (4.58±1.34 vs. 5.42±1.52, t =4.553, P <0.05), incidence rate of complications (43.33% vs. 82.86%, χ 2 =11.075, P <0.05) in group A were lower than those in group B ( P <0.05). Symptoms/side effects (32.42±3.42 vs. 27.44±3.31, t =4.331, P <0.05), and there were significant differences in social function (33.55±2.56 vs. 29.31±3.32, t =4.863, P <0.05).

Conclusion: For right posterior lobe tumors of the liver, the left lateral decubitus position has many advantages in laparoscopic right posterior lobectomy, such as a wide field of view, simple steps, a short operation time, less bleeding, and a high postoperative quality of life. It is an effective treatment for right posterior lobe tumors of the liver and is worthy of being widely popularized.

目的:探讨左侧卧位在腹腔镜右后叶肿瘤切除术中的价值:探讨左侧卧位在腹腔镜右后叶肿瘤切除术中的应用价值:回顾性收集2020年1月至2023年3月期间接受腹腔镜右后叶肿瘤切除术患者的临床资料,根据不同体位分为A组(左侧卧位组,30人)和B组(常规体位组,35人)。收集两组的术中和术后数据并进行比较:手术时间(210.43±57.56 vs. 281.97±65.89,t=5.887,PConclusion:对于肝右后叶肿瘤,左侧卧位在腹腔镜右后叶切除术中具有视野开阔、步骤简单、手术时间短、出血少、术后生活质量高等诸多优点。它是治疗肝右后叶肿瘤的有效方法,值得广泛推广。
{"title":"Application of the Left Lateral Decubitus Position in Laparoscopic Right Posterior Lobectomy.","authors":"Dong-Fang Huang, Jian-Bo Xu, Ye-Mu Du, Ye-Bo Wang, Ding-Hua Zhou","doi":"10.1097/SLE.0000000000001264","DOIUrl":"10.1097/SLE.0000000000001264","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the value of the left lateral decubitus position in laparoscopic right posterior lobe tumor resection.</p><p><strong>Patients and methods: </strong>The clinical data of patients who underwent laparoscopic right posterior lobectomy from January 2020 to March 2023 were retrospectively collected and divided into group A (left lateral decubitus position group, n=30) and group B (conventional position group, n=35) according to different body positions. Intraoperative and postoperative data were collected and compared between the 2 groups.</p><p><strong>Results: </strong>The operation time (210.43±57.56 vs. 281.97±65.89, t =5.887, P <0.05), hilar occlusion time (23.97±14.25 vs. 35.79±12.62, t =4.791, P <0.05), intraoperative blood loss (162.14±72.61 vs. 239.65±113.56, t =5.713, P <0.05), postoperative feeding time (1.13±0.36 vs. 1.57±0.67, t =3.681, P <0.05), postoperative visual analog scale score (5.16±0.89 vs. 7.42±1.31, t =3.721, P <0.05), postoperative abdominal drainage tube indwelling time (4.58±1.34 vs. 5.42±1.52, t =4.553, P <0.05), incidence rate of complications (43.33% vs. 82.86%, χ 2 =11.075, P <0.05) in group A were lower than those in group B ( P <0.05). Symptoms/side effects (32.42±3.42 vs. 27.44±3.31, t =4.331, P <0.05), and there were significant differences in social function (33.55±2.56 vs. 29.31±3.32, t =4.863, P <0.05).</p><p><strong>Conclusion: </strong>For right posterior lobe tumors of the liver, the left lateral decubitus position has many advantages in laparoscopic right posterior lobectomy, such as a wide field of view, simple steps, a short operation time, less bleeding, and a high postoperative quality of life. It is an effective treatment for right posterior lobe tumors of the liver and is worthy of being widely popularized.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis Risk Factors: Is Postsphincterotomy Bleeding Another Risk Factor? 内镜逆行胰胆管造影术后胰腺炎的风险因素:括约肌切开术后出血是另一个风险因素吗?
IF 1 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1097/SLE.0000000000001274
Tolga Düzenli, İbrahim Durak, Muhammed Kaya, Hüseyin Köseoğlu
{"title":"Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis Risk Factors: Is Postsphincterotomy Bleeding Another Risk Factor?","authors":"Tolga Düzenli, İbrahim Durak, Muhammed Kaya, Hüseyin Köseoğlu","doi":"10.1097/SLE.0000000000001274","DOIUrl":"10.1097/SLE.0000000000001274","url":null,"abstract":"","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
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