Chirurgie最新文献

英文中文

Vagotomie tronculaire par vidéothoracoscopie sans drainage gastrique. Étude prospective de 250 cas opérés au Sénégal 不引流胃的胸腔镜分流术。对塞内加尔250例手术病例的前瞻性研究

IF 0.9 4区医学 Q4 SURGERY

Chirurgie

Pub Date : 1999-09-01 DOI: 10.1016/S0001-4001(00)80013-6

J.M. Andreu, E. Tardat, P. Balandraud, L. Cador

Aim of the study

The aim of this prospective study was to report early results of videothoracoscopic truncal vagotomy in non-complicated chronic duodenal ulcers.

Patients and methods

From 1995 to 1998, 250 patients suffering from chronic duodenal ulcer without pyloric stenosis were operated on in the main hospital of Dakar. They underwent videothoracoscopic truncal vagotomy without gastric drainage. The quality of gastric emptying and the incidence of secondary side-effects were assessed in the postoperative course and after one and three months.

Results

There were two intraoperative deaths, one due to aortic wound and the other one due to a poor surveillance after premature extubation. Postoperative complications included bronchopulmonary infection (n=9), one septic pleural effusion and one chylothorax. A postoperative gastroplegia occurred in 12 patients, which was always spontaneously regressive without endoscopic pyloric dilatation. After one month, 204 patients (82%) were classified Visik 1, and 44 (18%) classified Visik 2. An endoscopic control examination showed a healed peptic ulcer and open pylorus in all patients, and a gastric stasis present in 40 cases (16%). After three months and a new evaluation, 234 were classified Visik 1 (94%) and 14 Visik 2 (6%). Dumping syndrome was not observed in this series and the incidence of diarrhea, which was 40% after one month, decreased to 3% after three months.

Conclusion

The functional results of truncular vagotomy without gastric drainage were good or very good and improved with time. The quality of digestive comfort and the low frequency of side-effects are good arguments in favor of this procedure as an elective treatment of duodenal ulcers in developing countries.

这项前瞻性研究的目的是报告胸腔镜下迷走神经截切术治疗非并发症慢性十二指肠溃疡的早期结果。患者与方法1995 ~ 1998年在达喀尔主要医院对250例无幽门狭窄的慢性十二指肠溃疡患者进行了手术治疗。他们行胸腔镜下迷走神经截切术，无胃引流。观察两组患者术后1个月、3个月的胃排空质量及副反应发生情况。结果术中死亡2例，1例因主动脉损伤死亡，1例因过早拔管后监护不良死亡。术后并发症包括支气管肺部感染(n=9)，脓毒性胸腔积液1例，乳糜胸1例。12例患者术后发生胃麻痹，均为自行消退，未行幽门镜扩张。1个月后，204例(82%)患者进入Visik 1级，44例(18%)患者进入Visik 2级。内镜对照检查显示所有患者消化性溃疡和幽门打开愈合，40例(16%)出现胃淤积。3个月后重新评估，234例为Visik 1级(94%)，14例为Visik 2级(6%)。本研究未见倾倒综合征，腹泻发生率由1个月后的40%降至3个月后的3%。结论不加胃引流的迷走神经小管切开术功能较好或很好，并随时间延长而改善。在发展中国家，消化舒适的质量和低频率的副作用是支持这种手术作为十二指肠溃疡的选择性治疗的良好理由。

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引用次数: 4

Cholécystectomie cœlioscopique après 75 ans 75年后腹腔镜胆囊切除术

IF 0.9 4区医学 Q4 SURGERY

Chirurgie

Pub Date : 1999-09-01 DOI: 10.1016/S0001-4001(00)80015-X

P. Pessaux, J.J. Tuech, R. Duplessis, R. Seicean, J.P. Arnaud

Aim of the study

The aim of this prospective study was to determine the feasibility, complications and benefits of laparoscopic cholecystectomy in the patients over 75 years of age.

Methods

From January 1992 to July 1998, among the 863 patients who underwent laparoscopic cholecystectomy, 102 patients over 75 years (group I) were compared to 761 younger patients (group II).

Results

The conversion rate was 22% in group I versus 13% in group II (P = 0.017). Mortality and morbidity rates were respectively 1% and 13.7% in elderly patients versus 0 and 6.6% in younger patients (P = 0.009). Mean length of hospital stay was higher in group I: 6.9 versus 4.5 d in group II (P < 10⁻⁶).

Conclusions

Laparoscopic cholecystectomy is feasible in patients above 75 for the treatment of symptomatic gallstones and acute cholecystitis with a low morbidity rate.

本前瞻性研究的目的是确定75岁以上患者行腹腔镜胆囊切除术的可行性、并发症和益处。方法1992年1月~ 1998年7月，863例行腹腔镜胆囊切除术的患者中，75岁以上的102例(I组)与75岁以下的761例(II组)比较。结果I组的转换率为22%，II组为13% (P = 0.017)。老年患者死亡率和发病率分别为1%和13.7%，而年轻患者的死亡率和发病率分别为0和6.6% (P = 0.009)。I组患者的平均住院时间为6.9 d，而II组为4.5 d (P <10−6)。结论75岁以上患者行腹腔镜胆囊切除术治疗有症状的胆结石和急性胆囊炎是可行的，且发病率低。

引用次数: 4

Hommage à Jacques Oudot pour le 50e anniversaire de la première greffe de bifurcation aortique 在第一次主动脉分叉移植50周年之际向雅克·奥多致敬

IF 0.9 4区医学 Q4 SURGERY

Chirurgie

Pub Date : 1999-09-01 DOI: 10.1016/S0001-4001(00)80020-3

J. Natali

引用次数: 3

Société française d'anesthésie et de réanimation 法国麻醉和复苏学会

IF 0.9 4区医学 Q4 SURGERY

Chirurgie

Pub Date : 1999-09-01 DOI: 10.1016/S0001-4001(00)80019-7

引用次数: 0

Chimiothérapie et chirurgie comparées à la chirurgie seule dans les cancers localisés de l'œsophage 局部食道癌的化疗和手术与单独手术的比较

IF 0.9 4区医学 Q4 SURGERY

Chirurgie

Pub Date : 1999-09-01 DOI: 10.1016/S0001-4001(00)80021-5

M. Huguier

引用次数: 1

Endobrachyœsophage et chirurgie antireflux: étude d'une série de 26 patients 短管内食道与抗反流手术:26例患者的研究

IF 0.9 4区医学 Q4 SURGERY

Chirurgie

Pub Date : 1999-09-01 DOI: 10.1016/S0001-4001(00)80012-4

J. Baulieux , J.Y. Mabrut , C. Ducerf , M. Adham , E. De La Roche , N. Berthoux , O. Bourdeix , J.L. Gaudin , J.C. Souquet

Study aim

The aim of this study was to report the results of a retrospective series of 26 patients with Barrett's esophagus treated by antireflux surgery.

Patients and methods

From 1979 to 1998, 21 men and five women (mean age: 53 years) with histologically proven Barrett's esophagus underwent an antireflux procedure. The mean length of Barrett's epithelium was 5.9 cm for 19 patients (73.1%).Six patients (23.1%) had tongue lesions of Barrett's epithelium, and one (3.8%) had ectopic gastric mucosa. None of the patients had a preoperative esophageal biopsy that revealed high-grade dysplasia or carcinoma. Laparotomy was performed in 17 cases and laparoscopy in nine cases. Preoperative endoscopic local treatment with argon coagulation was performed in one patient.

Results

Clinical mean follow-up was 78 months and endoscopic mean follow-up was 59.3 months. No increase in the length of the Barrett's epithelium was observed. Seven patients (27%) had complete or partial regression (among them three patients with tongue lesions and one patient preoperatively treated by argon). No patients developed high-grade dysplasia or carcinoma.

Conclusion

Regression of Barrett's esophagus is possible but not frequent and unpredictable after antireflux procedure. However, endoscopic and histological surveillance should be continued postoperatively.

研究目的本研究的目的是报告26例巴雷特食管患者接受抗反流手术治疗的回顾性研究结果。患者和方法:从1979年到1998年，21名男性和5名女性(平均年龄:53岁)接受了组织学证实为Barrett食管的抗反流手术。19例(73.1%)患者Barrett上皮平均长度为5.9 cm。舌Barrett上皮病变6例(23.1%)，胃粘膜异位1例(3.8%)。所有患者术前食管活检均未发现高级别不典型增生或癌。其中开腹17例，腹腔镜9例。术前内镜局部氩凝治疗1例。结果临床平均随访78个月，内镜下平均随访59.3个月。未观察到巴雷特上皮长度增加。7例患者(27%)完全或部分消退(其中3例为舌部病变，1例术前行氩气治疗)。没有患者发生高度不典型增生或癌。结论抗反流手术后巴雷特食管有可能出现退行，但并不常见和不可预测。然而，术后应继续进行内镜和组织学检查。

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引用次数: 9

Résultats des hernioplasties cœlioscopiques. Étude de 401 cas chez 318 patients 腹腔镜疝成形术的结果。318例患者401例研究

IF 0.9 4区医学 Q4 SURGERY

Chirurgie

Pub Date : 1999-09-01 DOI: 10.1016/S0001-4001(00)80014-8

P. Blanc , J. Porcheron , C. Breton , P. Bonnot , S. Baccot , O. Tiffet , J. Cuilleret , J.G. Balique

Study aim

The aim of this retrospective study was to report a series of laparoscopic hernioplasty performed in two surgical centers, and to evaluate the results with a mean follow-up of 31 months.

Patients and methods

From January 1992 to January 1997, 318 patients with 401 inguinal hernias were operated on through laparoscopy by six senior surgeons and six junior surgeons. There were 302 men and 16 women (mean age: 53 years). The operation was performed through an extra-peritoneal approach (TEP) in 298 hernias, a trans-abdomino-preperitoneal approach (TAPP) in 62 hernias, and an intra-abdominal approach (IPOM) in 41 hernias.

Result

Conversion into open surgery was necessary in 7% of the patients. There was no postoperative death. The postoperative morbidity rate was 10%. The average hospital stay was three days. With a 1 to 5 year follow-up, 4% of the 94% of the patients who answered the questionnaire showed a recurrence (3% in the extra-peritoneal group; 4% in the trans abdomino-preperitoneal group; 10% in the intra-abdominal group).

Conclusion

Laparoscopic hernioplasty seems as efficient as traditional hernoplasty with the advantages of miniinvasive surgery. The extra-peritoneal approach was preferred and performed in most cases of this series. The intra-peritoneal approach was abandoned.

研究目的本回顾性研究的目的是报道在两个外科中心进行的一系列腹腔镜疝成形术，并通过平均31个月的随访来评估结果。患者与方法1992年1月~ 1997年1月，对318例401例腹股沟疝患者进行腹腔镜手术，由6名高级外科医生和6名初级外科医生分别进行手术。其中男性302人，女性16人(平均年龄53岁)。298例经腹膜外入路(TEP)， 62例经腹膜前入路(TAPP)， 41例经腹膜内入路(IPOM)。结果7%的患者需要转开手术。无术后死亡。术后发病率为10%。平均住院时间为3天。经过1 - 5年的随访，94%回答问卷的患者中有4%出现复发(腹膜外组为3%;经腹-腹膜前组4%;腹腔内组10%)。结论腹腔镜疝修补术与传统疝修补术疗效相当，具有微创手术的优点。在本系列的大多数病例中，首选腹膜外入路。放弃腹膜内入路。

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引用次数: 3

Stratégie chirurgicale dans le traitement des métastases hépatiques synchrones des cancers colorectaux. Analyse d'une série de 59 malades opérés 结直肠癌同步肝转移治疗的手术策略。对59例手术患者的分析

IF 0.9 4区医学 Q4 SURGERY

Chirurgie

Pub Date : 1999-06-01 DOI: 10.1016/S0001-4001(99)80091-9

D. Jaeck, P. Bachellier, J.C. Weber, K. Boudjema, A. Mustun, F. Pâris, J.C. Schaal, P. Wolf

Aim of the study

The surgical strategy for the treatment of resectable synchronous hepatic metastases of colorectal cancer remains controversial. The retrospective analysis of our series of resectable synchronous hepatic metastases is focused on the percentage of simultaneous resections, the circumstances, the indications, and the results of the one-step procedure compared to the two-step strategy.

Methods

From January 1 st 1982 to December 31 st 1996, 146 patients were operated on for resection of hepatic metastases of colorectal cancer. Fifty-nine (40%) presented with synchronous metastases, 28 (47.5%) of whom under-went simultaneous resection of the primary tumor and of the hepatic metastases (simultaneous resection group: SR). For the other 31 patients (52.5%), the hepatic resection was delayed for a mean interval of 6 ± 4 months (delayed resection group: DR).

Results

The mean age in the two groups was not significantly different (56 years vs. 60 years). The need for blood transfusion and the volume required were not significantly different between the two groups. The duration of each surgical operation was comparable between the two groups (320 ± 76 min vs. 308 ± 88 min). Postoperative complications were observed in 18% of patients in the SR group and in 16% of patients in the DR group (no significant difference). There was no postoperative mortality in either group. Survival was 86, 63 and 43% at 1, 2, 3 years respectively in the SR group, and 81, 51 and 36% in the DR group, with no significant difference between the groups.

Conclusion

Simultaneous resection of the primary tumor and the hepatic métastases does not increase neither mortality nor morbidity in our series. The best candidate for a one-step procedure is a patient with a right colonic tumor, in a good status, with liver synchronous metastases resectable by mean of a minor hepatectomy.

研究目的可切除的结直肠癌同步肝转移的手术治疗策略仍存在争议。回顾性分析我们的一系列可切除的同步肝转移集中在同时切除的百分比，情况，适应症，以及一步手术与两步策略的结果。方法1982年1月1日至1996年12月31日对146例结直肠癌肝转移患者行肝转移切除术。59例(40%)出现同步转移，其中28例(47.5%)行原发肿瘤和肝转移同时切除(同时切除组:SR)。其余31例(52.5%)患者肝切除术平均延迟6±4个月(延迟切除术组:DR)。结果两组患者的平均年龄56岁vs 60岁，差异无统计学意义。输血需要量和输血需要量在两组间无显著差异。两组的每次手术时间相当(320±76分钟vs 308±88分钟)。术后并发症发生率SR组为18%，DR组为16%(差异无统计学意义)。两组均无术后死亡率。SR组1年、2年、3年生存率分别为86,63和43%，DR组81,51和36%，组间无显著差异。结论本组病例中，同时切除原发肿瘤和肝脏肿瘤并不会增加死亡率和发病率。一次手术的最佳候选者是右结肠肿瘤，状态良好，肝脏同步转移可通过小肝切除术切除的患者。

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引用次数: 48

Nouvelles perspectives dans l'étiologie des hernies de l'aine 腹股沟疝病因学的新视角

IF 0.9 4区医学 Q4 SURGERY

Chirurgie

Pub Date : 1999-06-01 DOI: 10.1016/S0001-4001(99)80095-6

A. Pans

Aim of the study

To explore new etiological hypotheses of groin hernias, using a biomechanical and histochemical study of the transversalis fascia and of the rectus sheath.

Patients and methods

The samples were collected from 63 patients with uni- or bilateral hernias and from 30 control subjects without hernia. The biomechanical properties were assessed using a computerized-suction device (Cutometer ^®). Sections were stained with hematoxylin and eosin, Masson-trichrome and double-stained with sirius red and orcein.

Results

There was no major biomechanical and histological difference between the control and patient aponeuroses. The patient fascias from the non-herniated sides presented an increased extensibility and elasticity, as compared with the control fascias. Those fascias also showed a collagen framework with disorganized areas and an increased number of isolated fibers.

Conclusion

The transversalis fascia from the non-herniated side appears to be a pathological fascia. Therefore, a connective tissue pathology seems to be involved in the genesis of groin hernias, with a preferential manifestation in the inguinal region which affects mainly the collagen fibers.

目的通过对腹横筋膜和直肌鞘的生物力学和组织化学研究，探讨腹股沟疝的新的病因假说。患者和方法样本来自63例单侧或双侧疝患者和30例无疝的对照组。生物力学性能评估采用计算机抽吸装置(Cutometer®)。切片采用苏木精和伊红染色，马松三色染色，天狼星红和奥蓝双染。结果对照组和患者腱膜膜在生物力学和组织学上无明显差异。与对照筋膜相比，患者非突出侧的筋膜表现出增加的延伸性和弹性。这些筋膜也显示出胶原蛋白框架，有混乱的区域和孤立纤维的数量增加。结论非疝侧筋膜横肌为病理性筋膜。因此，结缔组织病理似乎参与了腹股沟疝的发生，并优先表现在腹股沟区，主要影响胶原纤维。

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引用次数: 11

Drain tuteur transanastomotique ou non dans les pancréatico-jejunostomies après duodénopancréatectomie ? Étude prospective 十二指肠胰腺切除术后胰腺空肠造口术中是否需要经吻合引导引流?前瞻性研究

IF 0.9 4区医学 Q4 SURGERY

Chirurgie

Pub Date : 1999-06-01 DOI: 10.1016/S0001-4001(99)80106-8

M. Huguier

引用次数: 0

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