Pub Date : 2018-09-11DOI: 10.1002/9781119556978.ch12
C. Wilcox, D. Bosanquet, A. Rasheed, A. Cheang, T. Ahmed, K. Menon
s / International Journal of Surgery 36 (2016) S31eS132 S116 achieved bony union eventually with good alignment. Oxford Shoulder Scores indicated good shoulder function with a mean score of 41.5. Conclusion: Our data would support the use of hook plates in the treatment of lateral clavicular fractures. http://dx.doi.org/10.1016/j.ijsu.2016.08.420 Upper-gastrointestinal surgery 0045: BILATERAL THORACOSCOPIC SPLANCHNOTOMY: A SIMPLE TOOL TO ALLEVIATE PAIN IN CHRONIC PANCREATIC DISEASE C. Wilcox , D. Bosanquet , A. Rasheed . 1 Postgraduate Centre, Southampton General Hospital, Southampton, UK; Department of Surgery, Royal Gwent Hospital & University of South Wales, Newport, UK. Aim: Chronic intractable pain is a common problem in severe pancreatic disease. Bilateral thoracoscopic splanchnotomy (BTS), a thoracoscopic neurotomy of the splanchnic nerves, is very rarely performed, yet may provide significant pain relief in these patients. We describe our experience of a highly simple and effective technique of BTS, with reference to original intra-operative photographs and anatomical images. Method: Five patients underwent thoracoscopic splanchnotomy (four bilateral) in our institution over 10 years (mean age: 51 years). All were dependent on opioid analgesia. Our minimally invasive strategy involves prone positioning and two thoracoscopic ports for each hemithorax, permitting easy exposure and simple dissection of the greater and lesser splanchnic nerves. Result: All four patients undergoing BTS reported marked improvement in pain control, with a reduction in opioid requirements that lasted until death in the two patients with pancreatic cancer, and for approximately 12 months in those with chronic pancreatitis (median follow-up: 18 months). There were no postoperative complications. Conclusion: BTS is an effective intervention in carefully selected patients with a life expectancy of at least six months. We present a safe, simple and minimally invasive approach, with the potential to reduce opioid dependency and improve quality of life. http://dx.doi.org/10.1016/j.ijsu.2016.08.422 0054: DEFINITIVE TREATMENT OF COMMON BILE DUCT STONES WITH ENDOSCOPIC SPHINCTEROTOMY ALONE IN PATIENTS 70 YEARS AND ABOVE: IS IT JUSTIFIED? S. Daniel , A. Cheang , T. Ahmed , K. Menon . Airedlae General Hospital, Keighley, UK; Royal London Hospital, London, UK. Context: Prophylactic Cholecystectomy after ERCP and Sphincterotomy (ES) for CBD stones is recommended. However, in the elderly and unfit, cholecystectomy may be avoided. This is significant with a rising elderly population. Aim: To evaluate the likelihood of developing recurrent biliary complications in those who did not have cholecystectomy after ERCP. Methods: Retrospective cohort consisted of 80 patients 70 years and over with gall bladder stones and concomitant CBD stones who had an index ERCP. The cohort was followed to find how many had cholecystectomy subsequently and how many did not. The incidence of recurrent
s /国际外科杂志36 (2016)S31eS132 S116最终实现骨愈合，对齐良好。牛津肩部评分显示肩部功能良好，平均得分为41.5分。结论:我们的数据支持钩钢板治疗锁骨外侧骨折。http://dx.doi.org/10.1016/j.ijsu.2016.08.420上消化道外科0045:双侧胸腔镜下的内脏切开术:减轻慢性胰腺疾病疼痛的简单工具。1南安普敦总医院研究生中心，英国南安普敦;英国纽波特皇家格温特医院及南威尔士大学外科目的:慢性难治性疼痛是严重胰腺疾病的常见问题。双侧胸腔镜内脏神经切开术(BTS)是一种胸腔镜下的内脏神经切开术，很少进行，但可以显著缓解这些患者的疼痛。我们描述了我们的经验，一个高度简单和有效的技术BTS，参考原始的术中照片和解剖图像。方法:我院10多年来行胸腔镜下开腹手术患者5例(4例双侧)，平均年龄51岁。所有患者均依赖阿片类镇痛。我们的微创策略包括俯卧位和每个半胸的两个胸腔镜口，允许容易的暴露和简单的解剖大、小内脏神经。结果:所有四名接受BTS治疗的患者都报告了疼痛控制的显著改善，两名胰腺癌患者的阿片类药物需求减少，持续到死亡，慢性胰腺炎患者持续约12个月(中位随访:18个月)。无术后并发症。结论:BTS对于精心挑选的预期寿命至少为6个月的患者是一种有效的干预措施。我们提出了一种安全、简单、微创的方法，具有减少阿片类药物依赖和提高生活质量的潜力。http://dx.doi.org/10.1016/j.ijsu.2016.08.422 0054:在70岁及以上的患者中，单纯内窥镜括约肌切开术治疗胆总管结石是否合理?S. Daniel, A. Cheang, T. Ahmed, K. Menon。Airedlae总医院，英国基斯利;伦敦皇家医院，英国伦敦。背景:建议在ERCP和括约肌切开术(ES)后预防性胆囊切除术治疗CBD结石。然而，在老年人和不健康的情况下，可以避免胆囊切除术。随着老年人口的增加，这一点非常重要。目的:评价ERCP术后未行胆囊切除术患者发生复发性胆道并发症的可能性。方法:回顾性队列包括80例70岁及以上胆囊结石合并CBD结石且ERCP指数较高的患者。对队列进行随访，以确定有多少人随后进行了胆囊切除术，有多少人没有。比较两组术后2年胆道并发症复发情况。结果:80%未行胆囊切除术的患者无症状。另一方面，只有66%的胆囊切除术患者无症状。主要复发并发症为胆管炎(40%)、胆囊炎(25%)和胆绞痛(20%)。未行胆囊切除术组复发并发症的相对危险度为RR1 / 40.638, 95% CI (0.3093-1.3159)， p 0.2237。虽然没有显著性差异，但在接受预期治疗的患者中，并发症没有增加。结论:没有令人信服的证据表明采取观望政策是不安全的。http://dx.doi.org/10.1016/j.ijsu.2016.08.423 0153:系统综述:急性食物丸梗阻的处理。英国斯旺西莫里斯顿医院简介:食物丸是一个常见的遇到在急症室。尽管如此，只有8%的受访医院对此类演示的管理有指导。这些患者中的大多数在转诊前未能在急症室进行药物干预。这促使我们改进对食物丸阻塞的管理，并制定当地指南。方法:2015年6月通过OvidSp Medline®和美国国家医学图书馆检索相关文献35篇。结果:没有证据表明药物干预比保守管理更有效。56%的患者报告在保守治疗24小时内症状自行消退。关于使用气体形成剂的有效性的证据不足，并且有3%的粘膜撕裂风险和吸入风险增加。胰高血糖素对通过食道的时间有不利影响，因此应避免使用。使用丁基溴海莨菪碱的误解来自于一篇被错误引用的论文，该论文的作者随后反驳了这篇论文。 结论:初期(24小时)应保守处理，避免使用药物治疗。如果失败，则应采用柔性食道镜检查中远端梗阻，采用刚性食道镜检查较高位置的梗阻。http://dx.doi.org/10.1016/j.ijsu.2016.08.424 0193:腹腔镜辅助经皮内镜胃造口术，安全技术J. Whitaker, E. Leith, A. Rolls, P. Maxwell, D. Stoker。北米德尔塞克斯大学医院NHS信托，英国伦敦。目的:当需要肠内管喂养超过4周时，考虑胃造口喂养。经皮内镜胃造口术(PEG)和放射插入式胃造口术(RIG)是成熟、安全、微创的技术。通常在镇静和局部麻醉下进行。PEG和RIG有时在技术上是不可能的，通常在不利的患者解剖结构阻止安全的直接经皮胃穿刺。腹腔镜辅助PEG管放置在我们的机构已经实践作为一种替代开放式胃造口术。我们的目的是检讨我们的做法。方法:对2013年1月1日至2015年8月21日行Lap-assisted PEG的患者进行回顾性分析。结果:9例患者行lap-assisted PEG。平均年龄61岁，范围18-97岁。适应症包括;咽喉癌(2例)和神经系统疾病导致的吞咽不安全(7例);包括中风(2例)、脑瘫(2例)、学习困难(1例)、弗里德里希共济失调(1例)和精神分裂症合并帕金森病(1例)。所有患者均接受了安全的PEG植入，无术后并发症。恶性疾病患者通过引入技术进行胃造口术，而神经系统疾病患者则采用拉穿技术。结论:Lap-assisted PEG是一种安全可靠的建立肠内管喂养的技术。当传统的PEG或RIG插入不可能时，患者需要护理路径才能进入该手术。http://dx.doi.org/10.1016/j.ijsu.2016.08.425 0251:壶腹周围憩室与CBD插管失败和ercp前肝生化有关吗?
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